Respiratory Isolation for Tuberculosis

摘要

The resurgence of tuberculosis (TB) in the 1980's has posed an increased risk of nosocomial exposure to mycobacterium tuberculosis. The current guidelines for the control of nosocomial transmission of TB recommend respiratory isolation for all patients with suspected TB. As the rate of TB has recently decreased, the application of these guidelines has resulted in a large number of patients unnecessarily placed in isolation. The objective of this proposal was to validate a previously derived clinical rule to predict the need for isolation of inpatients with suspected TB. A sample of 516 individuals who were isolated on admission for clinically suspected TB was evaluated for the presence of clinical variables associated with TB. Variables analyzed included TB risk factors, clinical symptoms, as well as findings from physical examination and chest radiograph. Of the 516 patients, 19 (3.7%) had positive sputum culture for TB. The prediction rule had a sensitivity of 95% (95% CI, 74%-100%) and a specificity of 36% (95% CI, 31%-40%). Approximately one third of the unnecessary episodes of isolation could have been avoided had the rule been applied.