[MCOH-EH] Searching for rational method to determine which employees had significant exposure to inpatients discovered to have active tuberculosis

[Grubbs, Scott]

We are a low risk institution for tuberculosis.  However, when there is a possible exposure, our infection prevention staff use a protocol  which essentially deems anyone who walked in the room as "exposed," and thus included in immediate and delayed testing for TB.  As we are using IGRA testing, that runs into a good deal of money, as well as the unnecessary anxiety suffered by employees who really should have been reassured that they had trivial exposure.  

However, I have yet to find a evidence-based discussion as to how to make those determinations in the hospital environment.  I have seen articles about community contact investigations (1) and passing comments from health departments (2), and one regarding a NICU exposure reflecting unique characteristics of such infants (3) but no one who has discussed a rational evidence-based approach for such contact investigations among HCW in the hospital or health facility environment.  

It seems that it would ideally include several weighted factors:
A: The infectivity of the source:  cavitary disease; smear positivity or negativity, etc.
B:  The susceptibility of the HCW: such as HIV or other immunosuppressed status, etc.
C: The circumstances of exposure:	Involvement with such procedures such as bronchoscopy, sputum induction, autopsy
					How long the HCW (employee without a mask) was with the individual 
					The ventilation status of the space where the HCW was with the individual 

Do any of your institutions have such protocols in place for contact evaluation in the health care setting?  If so, I would greatly appreciate being able to review them for possible implementation locally.

Thanks for any help you can provide!

D. Scott Grubbs, MD
WorkWell Occupational Health
Bon Secours St. Francis Hospital
Greenville, SC 
Tel.  864-675-4632
Fax. 864-675-4604


1:  Contact investigation for tuberculosis: a systematic review and meta-analysis  Eur Respir J 2013; 41:140-156
     A Decision Tree for Tuberculosis Contact Investigation  Am J Respir Crit Care Med 2002; 166:1122

2: GUIDANCE AND CLARIFICATION ON HEALTHCARE WORKER TB SCREENING REQUIREMENTS IN OREGON  04/25/2016

3: Exposure to Pulmonary Tuberculosis in a Neonatal Intensive Care Unit: Unique Aspects of Contact Investigation and Management of Hospitalized Neonates
     Infection Control and Hospital Epidemiology, 2007; 28:661

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