An Investigation of Pulmonary Tuberculosis among Health Care Workers in Maechan Hospital, Chiang Rai Province, Thailand, 17 July – 17 October 2014

Abstract

Background: On 17 July 2014 Epidemiology Unit Maechan Hospital was notified a pulmonary tuberculosis in a health care worker. The acid fast bacilli stain on sputum (AFB) was positive. Surveillance and Rapid Response Team (SRRT) and Occupational Health and Safety of Maechan Hospital conducted a case investigation to confirm the diagnosis and treatment, to describe the magnitude of problems and to implement control and prevent measures.
Methods: We reviewed medical records of index case and interviewed the cases. Active case finding was done. A suspected case was a health care worker in Maecha Hospital and had major criteria at least 1 symptom; 1) cough more than 2 weeks and 2) hemoptysis or a minor criteria at least 2 symptoms; 1) low grade fever at least 2 weeks 2) night sweating 3) weight reduction over 5 percent in 1 month or 10 percent in 3 months 4) anorexia 5) fatigue 6) breathless and 7) angina pain between 17 July and 17 October 2014. Confirmed case was a suspected case and AFB smear-positive or had a CXR consistent with pulmonary tuberculosis between 17 July and 17 October 2014. Environment surveys at hospital and house of the case was done for assess risk of disease.
Results: Total 420 health care workers were working in the hospital. There were 7 cases met definition of pulmonary tuberculosis. There was one confirmed and 6 suspected cases. The incidence rate was 1.67% (7/420). Five cases were female and two were male. Two cases worked at outpatient department and others were working in the different areas. The most clinical presentation was cough for more than 2 weeks (100 %), fatigue (86%), dyspnea (71%), fatigue (57%), night sweats (29%), weight loss (29%), chest pain (29%), fever more than 2 weeks (14%) and anorexia (14%). The index case was confirmed with positive AFB and abnormal chest-X ray. She received treatment with category 2 (CAT 2: 2SHRZE/HRZE/5HRE). She had experienced with lymph node tuberculosis in 2001 and completed treatment. She working at department of charged. Another 6 suspected cases were normal chest x-ray and negative AFB for 3 days. The environmental surveys revealed at confirmed case's home was clean, well ventilated. Air-conditioned rooms are well ventilated. The confirmed case’s office was a closed room with air condition. After 3 months follow up, there was no new case.
Conclusion: We confirmed one case of pulmonary tuberculosis in health care worker at Maechan Hospital. The source of the infection was uncertain. The closed contacts both at home and at office were negative AFB and CXR. But there is still in closed follow up. The confirmed case must meet the TB patient in the hospital and worked in air-conditioned without ventilated fan. This might be a factor for TB infection in the workplace. For disease control, increasing awareness, use appropriate protective equipment and modify the environment of workplace was done. The clinical and mental assessment after treatment should be done before restart working. Counseling health care workers for prevent denial of stigma, discrimination to patients.