Evaluation of Utility of the Checklist against Nosocomial Tubercular Infection

Abstract

  A checklist of actions against tubercular infection intended for the early detection and treatment was internally compiled and came into use in our hospital in 2008. It has been used for new inpatients at all wards and for outpatients who require long-time treatment. The items to check focused on the medical history of tuberculosis for patients as well as their family, and on the chest x-ray diagnosis and the respiratory condition. Furthermore, early diagnosis with sputum examination was given to the patients with suspected tuberculosis according to the checklist. The utilization rate of the checklist escalated from 77.4% at the beginning of operation to 96.8% one year later. The number of contact investigations decreased from 6 to 0 for the same one year period before and after introduction of checklist, but increased again to 6 for the following one year. The checklist was used for all 6 cases, and 5 of 6 cases received sputum specimen collection test on admission, but results were all negative. However, tubercle bacilli were detected after admission in cases that showed different symptoms and progress from typical tuberculosis. The increase of checklist utilization was achieved by mainly two factors: enlightenment activity of infection control team, and sharing and visualization of the utilization rate of all medical departments. Early detection of atypical tuberculosis by utilizing the checklist was clearly difficult. However, the utilization of the checklist enabled medical staff to keep the possibility of tuberculosis in mind when seeing patients, so may be effective to prevent the spread of typical tuberculosis infection.