Isolation practice of active pulmonary tuberculosis patients in an acute care setting at a teaching hospital in Ethiopia: a challenge for TB control

Abstract

BACKGROUND: Prompt detection and isolation of active Pulmonary Tuberculosis(PTB) are critical to prevent hospital transmission. In Ethiopia, evidence on PTB isolation practices in high-risk settings is limited. This study assessed the median time to isolation and factors associated with delays in a teaching hospital emergency department. METHODS: All adult GenXpert-confirmed active PTB patients diagnosed in the emergency outpatient (acute care) department of a Yekatit 12 Hospital Medical College in Addis Ababa, Ethiopia, between November 2021 and March 2024, were included. Data were extracted from the electronic medical records database. Delay in isolation was defined as failure to isolate a patient suspected or confirmed to have infectious tuberculosis (TB) at the first point of contact in the study hospital (triage). The Multivariable analysis using the Cox proportional hazards model was used to determine the statistically significant predictors of delayed isolation of active PTB with P-values < 0.05. RESULTS: Seventy-five patients with a mean age of 32 years were included. The median time to isolation for active PTB was two days (interquartile range: 1-4 days). More than half (58.7%) of patients were isolated within two days. In the Multivariable Cox regression analysis, several factors were associated with a longer time to isolation: acute cough (Hazard Ratio, HR: 0.43; 95% CI: 0.23-0.80), requirement for supplemental oxygen (HR: 0.46; 95% CI: 0.23-0.89), non-cavitary lesion on chest radiograph (HR: 0.46; 95% CI: 0.25-0.85), intravenous antibiotic use (HR: 0.46; 95% CI: 0.33-0.97), abnormal white blood cell count (HR: 0.27; 95% CI: 0.13-0.56), and weekend emergency department visits (HR: 0.46; 95% CI: 0.25-0.84). CONCLUSIONS: This study found that clinical and laboratory factors, as well as the timing of hospital visits, were associated with delayed isolation of active PTB patients in the emergency department. These findings highlight key areas for improving timely isolation in the acute care setting. CLINICAL TRIAL REGISTRATION NUMBER: The study is purely observational. Thus, the clinical trial registration number is not applicable.