Utilization of paediatric isolation facilities in a TB-endemic setting
Date
2015-09
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
Abstract
Introduction: In hospital settings, patient isolation is used to limit transmission of certain pathogens (e.g. M. tuberculosis
[TB], antibiotic-resistant bacteria and viruses causing respiratory and enteric infection). Data is lacking on utilization of
paediatric isolation facilities in low-resource, TB-endemic settings.
Methods: Prospective weekday observation of 18 paediatric isolation rooms at Tygerberg Children’s Hospital, Cape Town,
South Africa, was conducted between 1 May 2014 and 31 October 2014 documenting: occupancy rate; indication for
isolation; duration of isolation; application of transmission-based precautions and infection prevention (IPC) behaviour of
personnel. Potential under-utilization of isolation rooms was determined by cross-referencing isolation room occupancy
with laboratory isolates of antibiotic-resistant bacteria, M. tuberculosis and selected viral pathogens.
Results: Six percent (335/5906) of hospitalized children were isolated: 78 % (260/335) for IPC purposes. Most IPC-isolated
patients had community-acquired infections (213/260; 82 %), including tuberculosis (130/260; 50 %) and suspected viral
infections (75/260; 29 %). Children (median age 17 months [IQR 6–50]) spent 4 days (IQR 2–8) in isolation.
Isolation occupancy was 66 % (2172/3294 occupied bed days), but varied significantly by month. Laboratory
data identified an additional 135 patients warranting isolation with 2054 extra bed-days required. Forty patients with
171 patient days of inappropriate isolation were identified. During 1223 weekday visits to IPC-isolated patient rooms:
alcohol-based handrub was available (89 %); transmission-based precautions were appropriately implemented (71 %);
and personal protective equipment was provided (74 %). Of 358 observed interactions between paediatric staff and
isolated patients, hand hygiene compliance was 65 % and adherence to transmission-based precautions was 58 %.
Conclusion: Patients isolated for TB (under airborne precautions) accounted for more than half of all isolation episodes.
Missed opportunities for patient isolation were common but could be reduced by implementation of syndromic isolation.
Demand for isolation facilities was seasonal, with projected demand exceeding available isolation beds over
winter months.
Description
CITATION: Dramowski, A., Cotton, M.F., & Whitelaw, A. 2015. Utilization of paediatric isolation facilities in a TB-endemic setting. Antimicrobial Resistance and Infection Control, 4(36), doi:10.1186/s13756-015-0078-z.
The original publication is available at https://aricjournal.biomedcentral.com
Publication of this article was funded by the Stellenbosch University Open Access Fund.
The original publication is available at https://aricjournal.biomedcentral.com
Publication of this article was funded by the Stellenbosch University Open Access Fund.
Keywords
Isolation (Hospital care) -- South Africa -- Cape Town, Tygerberg Children’s Hospital, Tuberculosis -- Treatment, Children -- Hospital care -- South Africa -- Cape Town
Citation
Dramowski, A., Cotton, M. F., & Whitelaw, A. 2015. Utilization of paediatric isolation facilities in a TB-endemic setting. Antimicrobial Resistance and Infection Control, 4(36), doi:10.1186/s13756-015-0078-z.