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Exposure to Pulmonary Tuberculosis in a Neonatal Intensive Care Unit: Unique Aspects of Contact Investigation and Management of Hospitalized Neonates

Published online by Cambridge University Press:  02 January 2015

Joseph Jacob Nania ,
Jena Skinner ,
Kathie Wilkerson ,
Jon V. Warkentin ,
Valerie Thayer ,
Melanie Swift ,
William Schaffner  and
Thomas R. Talbot
Joseph Jacob Nania*
Affiliation:
Division of Pediatric Infectious Diseases and Department of Pediatrics, Nashville, Tennessee
Jena Skinner
Affiliation:
Vanderbilt University School of Medicine, the Department of Infection Control and Prevention, Nashville, Tennessee
Kathie Wilkerson
Affiliation:
Vanderbilt University School of Medicine, the Department of Infection Control and Prevention, Nashville, Tennessee
Jon V. Warkentin
Affiliation:
Vanderbilt University Medical Center, and the Tennessee Department of Health, Nashville, Tennessee
Valerie Thayer
Affiliation:
Occupational Health Clinic, Nashville, Tennessee
Melanie Swift
Affiliation:
Department of Medicine, Nashville, Tennessee Occupational Health Clinic, Nashville, Tennessee
William Schaffner
Affiliation:
Department of Medicine, Nashville, Tennessee Department of Preventive Medicine, Nashville, Tennessee
Thomas R. Talbot
Affiliation:
Department of Medicine, Nashville, Tennessee Department of Preventive Medicine, Nashville, Tennessee
*
1161 21st Avenue South, D-7235 Medical Center North, Nashville, Tennessee 37232 ([email protected])
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Abstract

Objective.

We describe the investigation of a tuberculosis (TB) exposure in which a neonatal intensive care unit (NICU) respiratory therapist was the index patient, as well as the rationale by which exposed infants were managed and possible explanations for the lack of transmission to these patients.

Design.

Description of an exposure investigation.

Setting.

Academic, level IV NICU of a tertiary care children's hospital.

Participants.

Contacts of a respiratory therapist with pulmonary TB disease, including household members, healthcare coworkers, and infant patients.

Results.

In addition to 5 household contacts, 248 healthcare coworkers and 180 infant patients were identified as possibly exposed during the 24 days that the index patient worked between December 3, 2004, and January 30, 2005. Tuberculin skin tests (TSTs) were performed for 233 of the 235 contacts with the greatest degree of exposure (household and coworker contacts) who had a previously documented negative TST result or whose TST status was unknown prior to the investigation. No cases of latent tuberculosis infection or TB disease were identified. Because of characteristics of the index case, the exposure duration and setting, the infants' small lung volumes, and lack of evidence of transmission to higher-risk contacts, infants were not clinically evaluated or empirically treated for TB disease. Surveillance for subsequent illness was carried out by primary healthcare providers and parents. No TB disease or unexplained illness in these infants was reported in the 20 months following the exposure.

Conclusion.

After limited hospital exposure to a healthcare worker with pulmonary TB disease who is not highly contagious, neonates can be safely managed without specific evaluation for TB disease or empirical treatment.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 6 , June 2007 , pp. 661 - 665
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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