Utilization of Electronic Health Record Events to Conduct a Tuberculosis Contact Investigation in a High-Risk Oncology Unit

Abstract

OBJECTIVE To describe the utilization of electronic medical data resources, including health records and nursing scheduling resources, to conduct a tuberculosis (TB) exposure investigation in a high-risk oncology unit. SETTING A 42-bed inpatient unit with a mix of surgical and medical patients at a large tertiary-care cancer center in New York City. PARTICIPANTS High-risk subjects and coworkers exposed to a healthcare worker (HCW) with cavitary smear positive lung TB. RESULTS During the 3-month exposure period, 270 patients were admitted to the unit; 137 of these (50.7%) received direct care from the index case HCW. Host immune status and intensity of exposure were used to establish criteria for postexposure testing, and 63 patients (45%) met these criteria for first-tier postexposure testing. No cases of active TB occurred. Among coworkers, 146 had significant exposure (ie, >8 hours cumulative). In the 22-month follow-up period after the exposure, no purified protein derivative or interferon gamma release assay conversions or active cases of TB occurred among exposed HCWs or patients. CONCLUSIONS Electronic medical records and employee scheduling systems are useful resources to conduct otherwise labor-intensive contact investigations. Despite the high-risk features of our index case, a highly vulnerable immunocompromised patient population, and extended proximity to coworkers, we did not find any evidence of transmission of active or latent tuberculosis infection among exposed individuals. Infect Control Hosp Epidemiol 2017;38:1235-1239.