429. Use of Administrative Data to Investigate Possible TB Transmission in an Outpatient Setting
Session: Poster Abstract Session: Novel Devices and Technologies
Thursday, October 18, 2012
Room: SDCC Poster Hall F-H
Background:

As health care delivery moves from inpatient to outpatient (OP) settings, best infection control practices will require refinement. One advantage of OP care is that administrative databases track patient movement closely, including check-in and check-out times. This data may be useful for calculating exposure times and stratifying patient risk. We utilized this approach after a case of pulmonary TB was diagnosed at an OP facility.  

Methods:

Memorial Sloan-Kettering Cancer Center (MSKCC) Sleepy Hollow (SH) is a suburban OP unit of MSKCC. In 2011, 3293 unique patients had more than 10,000 visits to the facility. In February 2012, a pt at SH developed pulmonary TB. We used administrative data to determine possible exposure duration for other pts managed at the facility. “Possible exposure time” (PET) was defined as duration in minutes that a pt was present in the OP facility with the index case. We could not determine physical proximity of the index to the other pts; however, PET after the patient developed cough was distinguished from earlier visits before onset of cough.  

Results:

The index case had 8 visits during the 3 months before diagnosis, including 2 after cough onset. 135 other pts received care at SH on those 8 days; 30 were excluded because their in-clinic time did not overlap with the index case. The remaining 105 had 1-3 visits (129 total visits) which were converted to minutes of PET. A simple sum of minutes was used for individuals with >1 visit. Median cumulative PET was 71 minutes; 21 of 105 possibly exposed pts were considered at risk: 9 pts had PET >= 3h and another 12 pts had PET >= 90m after index case developed cough. On PPD testing none had evidence of new infection. 

Conclusion:

Infection control has focused on inpatient surveillance and investigation, yet much care is provided in clinics. We used administrative databases designed to determine clinic efficiency to direct TB investigation. Use of check-in and check-out times allowed us to define a small group at risk and focus our resources. Administrative data may be useful for future OP infection control investigations.

Maryam Shafaee, MD1, Gretchen Copeland, DrEd, RN2, Janet Eagan, RN, MPH3, Catherine Hydzik, RN2, Donna Schick, RN2, Crystal Son, MPH4 and Kent A. Sepkowitz, MD, FIDSA, FSHEA5, (1)New York Presbyterian-Weill Cornell Medical Center, New York, NY, (2)Memorial Sloan-Kettering Cancer Center, New York, NY, (3)Memorial Sloan-Kettering Cancer Ctr., New York, NY, (4)Infection Control, Memorial Sloan-Kettering Cancer Center, New York, NY, (5)Memorial Sloan Kettering Cancer Center, New York, NY

Disclosures:

M. Shafaee, None

G. Copeland, None

J. Eagan, None

C. Hydzik, None

D. Schick, None

C. Son, None

K. A. Sepkowitz, None

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