Pulmonary tuberculosis in a South African regional emergency centre: Can infection control be improved to lower the risk of nosocomial transmission?

Background. George Regional Hospital (GRH) is a 272-bed regional referral hospital for the Eden and Central Karoo districts, Western Cape Province, South Africa. The perception among emergency centre (EC) staff is that a high burden of tuberculosis (TB) is being diagnosed and that infection control procedures are currently lacking, leading to a high risk of nosocomial transmission.Objectives. To establish the burden of pulmonary TB (PTB) presenting to GRH via the EC and audit current infection prevention and control practices, to quantify the risk of transmission of PTB in the EC and to establish whether infection control measures are inadequate.Methods. An audit of infection control based on the Centers for Disease Control audit tool for TB, analysis of results, and implementation of new infection control measures including a new standard operating procedure based on a set of triage criteria.Results. Implementation of new triage criteria and a standard operating procedure led to the longest length of stay of a patient with suspected TB in the EC being reduced by 40% (from 142 hours to 84 hours). The average time between seeing a doctor and leaving the EC for patients with suspected TB was reduced by 20% (from 20 hours 40 minutes to 16 hours 45 minutes).Conclusion. Simple measures implemented in the EC led to a significant reduction in the time patients with suspected or confirmed TB spent in the EC. This should lead to a reduced risk of nosocomial transmission of TB to both staff and patients