Document 0300
 DOCN  M9590300
 TI    Nosocomial tuberculosis--strategies for prevention.
 DT    9509
 AU    Gilbert GL; Centre for Infectious Disease and Microbiology, Westmead;
       Hospital, NSW.
 SO    Annu Conf Australas Soc HIV Med. 1994 Nov 3-6;6:207 (unnumbered
       abstract). Unique Identifier : AIDSLINE ASHM6/95291799
 AB    Nosocomial transmission from patients with open pulmonary tuberculosis
       (TB) is a recognized risk for health care workers (HCW) and other
       patients. It is uncommon with effective antituberculous therapy and
       limited periods of hospitalization. Recent outbreaks of nosocomial TB in
       the USA have been associated with: delayed diagnosis of TB or of
       multidrug resistance (MDR); delayed or inadequate treatment; inadequate
       isolation facilities; premature release from isolation; patients with
       unrecognized TB in contact with highly susceptible patients e.g.
       HIV/AIDS or transplant units; poor ventilation in rooms where aerosols
       are generated e.g. by collection induced sputum or treatment with
       aerosolized pentamidine. The risk of transmission depends on the
       bacterial concentrations in sputum, the extent to which respiratory
       secretions are expelled into the air, ventilation and the susceptibility
       of contact. It can be reduced by rapid diagnosis and treatment of TB and
       early recognition of MDR; education of patients to cover their mouths
       when coughing; nursing patients (if admission to hospital is necessary)
       in well-ventilated single isolation rooms (with or without negative
       pressure or ultraviolet light) until the sputum is smear negative;
       appropriate use of masks. Acid fast staining of sputum is the best rapid
       method for diagnosis of infectious pulmonary TB; results should be
       available within 24 hours. Rapid identification by DNA probe and use of
       the BACTEC radiometric system for susceptibility testing of
       M.tuberculosis (Mtb) has reduced the time to specific diagnosis.
       Susceptibility testing using the luciferase reporter phage technique
       could provide results within 24 hours. Selective PCR to distinguish Mtb
       from M. avium in smear-positive AIDS patients could reduce unnecessary
       isolation. Molecular methods for detection of MDR e.g. by PCR and
       probing for changes in resistance genes (such as katG, inhA, rpoB) may
       be available for the diagnostic laboratory in future.
 DE    AIDS-Related Opportunistic Infections/*PREVENTION & CONTROL  Cross
       Infection/*PREVENTION & CONTROL  *Disease Transmission,
       Patient-to-Professional  Disinfection  Human  Occupational
       Diseases/*PREVENTION & CONTROL  *Patient Care Team  Risk Factors
       Tuberculosis, Pulmonary/*PREVENTION & CONTROL  Ventilation  MEETING
       ABSTRACT

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).