Tuberculosis Transmission from Healthcare Workers to Patients and Co-workers: A Systematic Literature Review and Meta-Analysis

<div><p>Healthcare workers (HCWs) are at risk of becoming infected with tuberculosis (TB), and potentially of being infectious themselves when they are ill. To assess the magnitude of healthcare-associated TB (HCA-TB) transmission from HCWs to patients and colleagues, we searched three electronic databases up to February 2014 to select primary studies on HCA-TB incidents in which a HCW was the index case and possibly exposed patients and co-workers were screened.We identified 34 studies out of 2,714 citations. In 29 individual investigations, active TB was diagnosed in 3/6,080 (0.05%) infants, 18/3,167 (0.57%) children, 1/3,600 (0.03%) adult patients and 0/2,407 HCWs. The quantitative analysis of 28 individual reports showed that combined proportions of active TB among exposed individuals were: 0.11% (95% CI 0.04–0.21) for infants, 0.38% (95% CI 0.01–1.60) for children, 0.09% (95% CI 0.02–0.22) for adults and 0.00% (95% CI 0.00–0.38) for HCWs. Combined proportions of individuals who acquired TB infection were: 0.57% (95% CI 7.28E-03 – 2.02) for infants, 0.9% (95% CI 0.40–1.60) for children, 4.32% (95% CI 1.43–8.67) for adults and 2.62% (95% CI 1.05–4.88) for HCWs. The risk of TB transmission from HCWs appears to be lower than that recorded in other settings or in the healthcare setting when the index case is not a HCW. To provide a firm evidence base for the screening strategies, more and better information is needed on the infectivity of the source cases, the actual exposure level of screened contacts, and the environmental characteristics of the healthcare setting.</p></div

Characteristics of 117 Health Care Workers index cases of pulmonary Tuberculosis in 34 included studies.

<p>Characteristics of 117 Health Care Workers index cases of pulmonary Tuberculosis in 34 included studies.</p

Proportion meta-analysis (random effects).

<p>Forest plots for: A. Proportion of active TB cases among infants; B. Proportion of active TB cases among children; C. Proportion of active TB cases among adult patients; D. Proportion of active TB cases among HCWs. (A B C D elements are ordered from top to bottom and left to right).</p

Additional file 2: of Awareness, discussion and non-prescribed use of HIV pre-exposure prophylaxis among persons living with HIV/AIDS in Italy: a Nationwide, cross-sectional study among patients on antiretrovirals and their treating HIV physicians

a: PrEPventHIV_patients_1405. Original database (Patients). b: PrEPventHIV_physicians_87. Original database (HIV specialists). (ZIP 177 kb

Hematology unit.

<p>(A) Map of the unit. Areas for outpatients and inpatients are in yellow and blue, respectively. Crosses indicate the location of patients with at least one <i>P. aeruginosa</i> isolate according to the case definitions (red, incident case; green, prevalent case; see text for details). L1 to L4 indicate the sites from which <i>Pseudomonas</i> spp. were isolated: L1, soap dispenser; L2 soap dispenser; L3 and L4 water outlets. (B) Drugs deposit and preparation room where the contaminated soap dispenser (L2) was placed.</p

Epidemic curve.

<p>The diagram shows the 10 incident cases (with respective codes) identified throughout the 16 time fractions (T1–T16) of the retrospective cohort study. Red and blue squares denote died and survived patients, respectively. The incidence rate per 1000 person-days with 95% CI and the total time at risk is reported for each time fraction.</p

Time-line of the tasks.

<p>For each of the task the time and type of activity have been specified.</p

Association between <i>Pseudomonas aeruginosa</i> infection and selected characteristics.

<p>IRR =  incidence rate ratio; 95% CI = 95% confidence interval; HSCT =  hematopoietic stem cell transplant.</p>a<p>IRR is reported for 10 years increment of age.</p>b<p>IRR is reported for 10 days increment of exposure.</p

Clinical and epidemiological features of 18 cases of <i>P. aeruinosa</i> infections identified throughout the investigation.

<p>UTI =  urinary tract infection; CVC =  central venous catheter; URT =  upper respiratory tract; S =  sensitive; I =  intermediate; R =  resistant; NA not applicable because the activity of the unit was moved to another hospital building.</p><p>^<b>a</b> Cases were coded by assigning to each patient a progressive number (i.e.: 1–14); subsequent cases in the same patient were identified by adding a letter (i.e.: a, b and c) to the patient's number.</p><p>^<b>b</b>Prevalent cases.</p><p>^<b>c</b>This patient was admitted to the new located unit at the time of the look-back therefore he is previously identified as an asymptomatic case in the look-back and eventually, as a prevalent case, in the prospective surveillance.</p><p>^<b>d</b>Case identified during look back; for them time-fraction and room number is referred to their last admission.</p><p>^<b>e</b>These samples were used for bacterial typing as shown in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0017064#pone-0017064-g003" target="_blank">fig. 3</a>.</p><p>^<b>f</b>This represent 2 specimens taken the same day and yielding an identical molecular type to that found in the blood culture (data not shown).</p

Characteristics of patients included in the study.

a<p>IQR, interquartile range.</p