Examining pulmonary TB patient management and healthcare workers exposures in two public tertiary care hospitals, Bangladesh

Md Saiful Islam; Sayera Banu; Sayeeda Tarannum; Kamal Ibne Amin Chowdhury; Arifa Nazneen; Mohammad Tauhidul Islam; S M Zafor Shafique; S M Hasibul Islam; Abrar Ahmad Chughtai; Holly Seale

doi:10.1371/journal.pgph.0000064

Examining pulmonary TB patient management and healthcare workers exposures in two public tertiary care hospitals, Bangladesh

PLOS Glob Public Health. 2022 Jan 5;2(1):e0000064. doi: 10.1371/journal.pgph.0000064. eCollection 2022.

Affiliations

¹ Emerging Infections Program, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh.
² School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia.

Abstract

Implementation of tuberculosis (TB) infection prevention and control (IPC) guidelines in public tertiary care general hospitals remain challenging due to limited evidence of pulmonary TB (PTB) patients' duration of hospital stay and management. To fill this evidence gap, this study examined adult PTB patient management, healthcare workers' (HCWs) exposures and IPC practices in two public tertiary care hospitals in Bangladesh.Between December 2017 and September 2019, a multidisciplinary team conducted structured observations, a hospital record review, and in-depth interviews with hospital staff from four adult medicine wards.Over 20 months, we identified 1,200 presumptive TB patients through the hospital record review, of whom 263 were confirmed PTB patients who stayed in the hospital, a median of 4.7 days without TB treatment and possibly contaminated the inpatients wards. Over 141 observation hours, we found a median of 3.35 occupants present per 10 m2 of floor space and recorded a total of 17,085 coughs and 316 sneezes: a median of 3.9 coughs or sneezes per 10 m2 per hour per ward. Only 8.4% of coughs and 21% of sneezes were covered by cloths, paper, tissues, or by hand. The HCWs reportedly could not isolate the TB patients due to limited resources and space and could not provide them with a mask. Further, patients and HCWs did not wear any respirators.The study identified that most TB patients stayed in the hospitals untreated for some duration of time. These PTB patients frequently coughed and sneezed without any facial protection that potentially contaminated the ward environment and put everyone, including the HCWs, at risk of TB infection. Interventions that target TB patients screening on admission, isolation of presumptive TB patients, respiratory hygiene, and HCWs' use of personal protective equipment need to be enhanced and evaluated for acceptability, practicality and scale-up.

Copyright: © 2022 Islam et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

This research protocol was funded by the United States Centre for Disease Control and Prevention (CDC), through the cooperative agreement grant number 5U01GH1207. MSI and SB received this award. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.