Volume 12, Number 9—September 2006
Perspective
Nosocomial Tuberculosis in India
Madhukar Pai*†
, Shriprakash Kalantri†, Ashutosh Nath Aggarwal‡, Dick Menzies§, and Henry M. Blumberg¶
, Shriprakash Kalantri†, Ashutosh Nath Aggarwal‡, Dick Menzies§, and Henry M. Blumberg¶
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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