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Failure to Implement Respiratory Isolation: Why Does it Happen?

Published online by Cambridge University Press:  02 January 2015

Kentaro Iwata ,
Barbara A. Smith ,
Eloisa Santos ,
Bruce Polsky  and
Emilia M. Sordillo
Kentaro Iwata
Affiliation:
Department of Medicine, St. Luke's-Roosevelt Hospital Center, College of Physicians & Surgeons, Columbia University, New York, New York
Barbara A. Smith
Affiliation:
Division of Infectious Diseases and Epidemiology, St. Luke's-Roosevelt Hospital Center, College of Physicians & Surgeons, Columbia University, New York, New York
Eloisa Santos
Affiliation:
Division of Infectious Diseases and Epidemiology, St. Luke's-Roosevelt Hospital Center, College of Physicians & Surgeons, Columbia University, New York, New York
Bruce Polsky
Affiliation:
Department of Medicine, St. Luke's-Roosevelt Hospital Center, College of Physicians & Surgeons, Columbia University, New York, New York Division of Infectious Diseases and Epidemiology, St. Luke's-Roosevelt Hospital Center, College of Physicians & Surgeons, Columbia University, New York, New York
Emilia M. Sordillo*
Affiliation:
Department of Medicine, St. Luke's-Roosevelt Hospital Center, College of Physicians & Surgeons, Columbia University, New York, New York Division of Infectious Diseases and Epidemiology, St. Luke's-Roosevelt Hospital Center, College of Physicians & Surgeons, Columbia University, New York, New York Department of Pathology and Laboratory Medicine, St. Luke's-Roosevelt Hospital Center, College of Physicians & Surgeons, Columbia University, New York, New York
*
St. Luke's-Roosevelt Hospital Center, 1111 Amsterdam Avenue, New York, NY 10025
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Abstract

Background:

Respiratory isolation for 90% of individuals with acid-fast bacillus (AFB)-smear–positive tuberculosis (TB) is a recommended performance indicator in recent Infectious Diseases Society of America and Centers for Disease Control and Prevention guidelines. However, compliance with respiratory isolation reported from multiple centers in the United States and Europe falls short of that goal.

Objective:

To identify missed clues in TB patients who are not appropriately isolated.

Design:

Retrospective survey.

Setting:

A 900-bed voluntary hospital.

Patients:

All patients with AFB-smear–positive TB admitted between January 1995 and December 1999 who were not appropriately isolated.

Results:

There were 173 TB cases admitted, including 106 with pulmonary TB. AFB smears were positive in 82 cases; 24 (29%) of these were not appropriately isolated. During the study period, the number of TB cases declined, but the proportion of appropriately isolated patients did not change. Most isolation failure cases were men (median age, 45.5 years); 21 of these patients were black, 2 were Hispanic white, and 1 was Asian, but none was non-Hispanic white. All isolation failure cases had at least one characteristic predictive of TB that could have been elicited at admission (eg, abnormal chest radiograph findings consistent with TB, fever, weight loss, a history of TB, a positive result on tuberculin skin test, hemoptysis, and human immunodeficiency virus infection).

Conclusion:

Consistent with experiences at other hospitals, we found that the rate of isolation failure remained unchanged despite an overall decline in TB cases. In our experience, almost all isolation failures could be avoided by careful review of the history, physical examination, and chest radiograph for characteristics classically considered predictive of TB. (Infect Control Hosp Epidemiol 2002;23:595-599).

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 10 , October 2002 , pp. 595 - 599
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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