Challenging Tuberculosis Cases Encountered at Outpatient Departments in Medical Facilities across Japan : 67 Cases Reported as Open－ended Responses in a Questionnaire Survey

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  • 全国の医療機関の外来部門における結核困難事例 : アンケート調査の自由回答に挙げられた67例
  • ゼンコク ノ イリョウ キカン ノ ガイライ ブモン ニ オケル ケッカク コンナン ジレイ アンケート チョウサ ノ ジユウ カイトウ ニ アゲラレタ 67レイ

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Objective: The aim of this study was to clarify current conditions and issues that complicate tuberculosis (TB) infection control measures in outpatient departments at medical facilities. Method: Questionnaires were mailed to 1,369 medical facilities across Japan that were found to employ either Certified Nurses in Infection Control or　Certified Nurse Specialists in Infection Control Nursing. The questionnaire included a question asking whether there were "any particularly challenging cases related to infection control measures in their outpatient　department". For those who responded "yes", they were asked to describe the time period, name of infection (suspected infection), status of condition, control measures and outcome　(open-ended section). Questionnaires that mentioned TB as the infection (including suspected infections) were collected and the data were analyzed. The survey was conducted between November 1, 2015 and February 29, 2016. Results: Of the 569 medical facilities that returned the questionnaires, 246 facilities (43.2%) reported that they had experienced particularly challenging cases with infection control measures and 67 of them (27.2%) noted TB as the infection that they found especially trouble. Based on the analysis of the responses from the open-ended section, the following five categories emerged which reflected the current challenging conditions related to infection control measures of TB patients and suspects: "securing is olation areas"; "delay in identifying TB"; "insufficient exposure measures"; "dealings with patients" and "problems with management". Conclusion: The current state and issues of TB infection control at outpatient departments difficult were lack of isolation areas of TB patients, delay in identifying TB, and lack of appropriate implementation of exposure control measures. There seems to be room for improvement by introducing infection control activities that address early detection of TB patients, performance of triage on-site and implementation of exposure measures.

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