IMPLEMENTATION AND EVALUATION OF AN ALGORITHM FOR ISOLATION OF PATIENTS WITH SUSPECTED PULMONARY TUBERCULOSIS

OBJECTIVE: To implement and evaluate an algorithm designed to assist i n the consistent placement of patients with suspected pulmonary tuberc ulosis into negative-pressure isolation rooms (NPIRs). DESIGN: A stand ard algorithm was designed for the appropriate room placement of patie nts with suspected pulmonary tuberculosis using clinical, radiographic , and laboratory criteria and reported risk factors. A case-patient wa s defined as an inpatient who had at least one Mycobacterium tuberculo sis culture-positive respiratory specimen from January 1, 1993, throug h December 31, 1994. Demographic, clinical, laboratory, case contact, and isolation and room placement data were collected prospectively on all case-patients. SETTING: A 900-bed university teaching and referral center. RESULTS: During 1993 and 1994, 69 patients were evaluated for possible pulmonary tuberculosis, and 31 case-patients were identified . Of the 31 case-patients, 26 (84%) were placed on respiratory isolati on in NPIRs, including 19 (61%) who were isolated within 24 hours of a dmission (1993, 14 of 20 [70%]; 1994, 5 of 11 [45%]). Seven case-patie nts (23%) were isolated in NPIRs following delays that ranged from 2 t o 31 days (median, 9 days), and five case-patients (16%) never were is olated during admissions of from 3 to 28 days (median, 4 days). These 12 case-patients contributed a total of 136 patient-exposure days duri ng their hospitalizations. Misclassification of patient risk status by user error delayed isolation of five (42%) of the 12 improperly isola ted case-patients. CONCLUSIONS: The use of an algorithm incorporating radiographic, laboratory, and clinical criteria and reported risk fact ors may assist in the rapid isolation of patients with suspected pulmo nary tuberculosis (Infect Control Hosp Epidemiol 1996;17:412-418).