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Volume 12, Number 9—September 2006
Perspective

Nosocomial Tuberculosis in India

Madhukar Pai*†Comments to Author , Shriprakash Kalantri†, Ashutosh Nath Aggarwal‡, Dick Menzies§, and Henry M. Blumberg¶
Author affiliations: *McGill University, Montreal, Quebec, Canada; †Mahatma Gandhi Institute of Medical Sciences, Sevagram, India; ‡Postgraduate Institute of Medical Education and Research, Chandigarh, India; §McGill University Montreal Chest Institute, Montreal, Quebec, Canada; ¶Emory University School of Medicine, Atlanta, Georgia, USA

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Table 2

Factors that may facilitate nosocomial transmission of tuberculosis (TB) in hospitals in India

Area Factor
Factors that increase risk for nosocomial exposure Overwhelming numbers of TB patients and repeated exposure to smear-positive TB patients
Unnecessary or prolonged hospitalization of smear-positive TB patients
Delays in initiating anti-TB treatment for those with TB
Poor adherence to treatment, use of suboptimal treatment regimens, and lack of adequate patient support to improve adherence
Interruptions in supply of TB medications in healthcare facilities
Lack of effective infection-control procedures Failure to recognize and isolate patients with active pulmonary TB
Laboratory delays in identification of TB, and poor use of tests such as sputum microscopy to identify infectious TB cases
Clustering patients with TB with susceptible and vulnerable patients (e.g., HIV-positive patients)
Lack of HIV testing services and delayed recognition of TB in HIV-infected patients because of atypical presentation and low level of clinical suspicion
Inadequate respiratory isolation facilities and engineering controls
Overcrowded hospital wards and outpatient departments
Poorly ventilated wards and rooms
Lack of adequate sunlight in hospital wards and departments
Lack of airborne infection isolation rooms
Lack of personal protection equipment (e.g., respirators)
Lack of screening programs to detect and treat TB among healthcare workers
Lack of commitment on the part of hospitals to invest in infection control programs
Lack of national guidelines on nosocomial TB tailored to the Indian healthcare environment
Gaps in knowledge and awareness Lack of awareness about nosocomial TB transmission in healthcare settings in India
Healthcare workers' belief that nosocomial infection is an occupational hazard that cannot be avoided
Lack of educational programs on occupational safety and hygiene
Poor patient education regarding cough etiquette and sputum disposal

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Page created: November 17, 2011
Page updated: November 17, 2011
Page reviewed: November 17, 2011
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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