Chapter 14, Problem 2CCS

TB in the Nursery

In the early fall, a neonatal nurse in a large metropolitan hospital became ill with a cough and fever. His physician believed he had seasonal allergies and so treated him with cough suppressant, antihistamines, and aerosol steroids. He returned to work in the hospital’s nursery.

Three weeks later, his condition had worsened; his symptoms were complicated by shortness of breath and bloody sputum. Upon further questioning, his physician noted that he was working in the United States on a work visa and was a native of South Africa. He had a positive skin test for tuberculosis (TB) but had always believed this was his body’s natural reaction to the TB vaccine he had received as a child. His chest X-ray films in the past had always been clear of infection.

This time, however, his sputum smear tested positive for acid-fast bacilli. He was diagnosed with active tuberculosis and began a standard drug regimen for TB. He was restricted from work and placed in respiratory isolation for six weeks, but during the three weeks that he had continued to work in the nursery, he had exposed over 900 obstetric patients, including 620 newborns, to TB, an airborne infectious disease.

1. 1. How can private physicians quickly assess their clients for the possibility of an infectious disease?
2. 2. What policies should be in place at hospitals to protect patients from exposure to infectious staff members?
3. 3. How could doctors’ offices improve public knowledge and protect the public from tuberculosis and other infectious diseases?

Reference: Adapted from MMWR 54:1280–1283, 2005.