Prevalence and Predictors of Compliance with Discontinuation of Airborne Isolation in Patients with Suspected Pulmonary Tuberculosis

Abstract

Objective.Examine the use of airborne isolation by identifying reasons for nontimely discontinuation and predictors of compliance with Centers for Disease Control and Prevention (CDC) guidelines. Compliance with guidelines should result in timely (within 48 hours) discontinuation of isolation in patients without infectious pulmonary tuberculosis (TB).Design.Retrospective, observational study.Setting.A private, university-affiliated, tertiary-care medical center.Patients.All patients in airborne isolation for suspected pulmonary TB from June through December 2011.Method.Chart reviews were performed to identify airborne isolation practices and delayed (greater than 48 hours) or very delayed (greater than 72 hours) discontinuation. We used descriptive statistics and logistic regression to determine independent predictors of nontimely discontinuation of isolation.Results.We identified 113 patients (mean age ± standard deviation, 59.8 ± 17.7 years; male sex, 75.2%; white race, 15.9%; mean collection interval ± standard deviation, 21.4 ± 12.9 hours). Delayed and very delayed isolation discontinuation was noted in 81% and 49% of patients, respectively. No significant differences in demographic characteristics and clinical characteristics were identified between groups. Predictors of timely (within 48 hours) airborne isolation discontinuation included use of alternate diagnosis for discontinuation of isolation (P = .02), early infectious diseases (ID) consultation (P = .03), pulmonary consultation (P = .02), average sputum collection interval less than 24 hours (P = .03), and need for more than 1 induced sputum specimen (P = .05). Adjusting for potential confounders, pulmonary consultation (odds ratio [OR] [95% confidence interval (CI)], 0.14 [0.03-0.58]), alternate diagnosis for discontinuation of isolation (OR [95% CI], 4.5 [1.3-15.8]), and early ID consultation (OR [95% CI], 4.0 [1.1-14.8]) were independently associated with timely discontinuation.Conclusions.Timely airborne isolation discontinuation occurs in only 18.6% of cases and is an opportunity for cost savings, improved efficiency, and potentially patient safety and satisfaction.