Australia: HCW with TB in Queensland

[Gert van der Hoek]

Alert after health worker found with TB

April 20, 2007 01:28pm

A QUEENSLAND hospital is trying to find staff and patients who came into contact with a health worker with tuberculosis at the Gold Coast Hospital.

The hospital's director of internal medicine Dr John Gerrard said staff were working to identify and advise about 500 staff and patients that may have come in contact with a person who had been diagnosed with TB.

"It is important to emphasise that TB has a low infection rate and is extremely difficult to contract unless contact is prolonged and continuous," Dr Gerrard said.

"There is generally a minimal risk of transmission in most situations."

Those people identified as being at risk will be offered screening as a precaution.

Initial testing involves a chest X-ray and a skin test.

Dr Gerrard said there were about 100 cases of TB diagnosed in Queensland each year.

Warning signals are a cough that persists for more than two to three weeks, spitting of blood or blood-streaked sputum, persistent or recurring pains in the chest, afternoon rises in temperature, and night sweats.

"It is important that further information sharing is done between a possible contact and a trained health professional who can provide appropriate counselling and prevent misinformation," Dr Gerrard said.

http://www.news.com.au/heraldsun/story/0,21985,21591759-662,00.html

[cartski]

Re: Australia: HCW with TB in Queensland

A hospital acquire case that ended up in the Canadian courts:

http://www.flutrackers.com/forum/showpost.php?p=76765&postcount=4

[Gert van der Hoek]

Re: Australia: HCW with TB in Queensland

Probe deepens over TB doctor

24Apr07

NEW questions are being asked about how a Gold Coast Hospital doctor, believed to be foreign-trained, managed to enter Australia and begin work at a major hospital while infected with tuberculosis.

The questions and criticisms don't stop there.

Queensland Health yesterday was forced to defend its 13 HEALTH hotline number, its decision to promote another hotline closed to inquiries over the weekend, and its refusal to reveal information on the doctor.

The decision to use letters to contact the people in need of screening for the infectious disease also came under scrutiny.

Reiterating the very minimal risk of infection, Queensland Health and the state Health Minister Stephen Robertson yesterday said national protocols for the management of tuberculosis (TB) were in place and being followed.

"It is important that former patients and visitors to Gold Coast Hospital be reassured that there is minimal risk of them contracting tuberculosis," said Mr Robertson.

"I am advised doctors at the hospital and the Queensland Tuberculosis Control Centre have followed (the established national procedures) to the letter."

However, a national immigration protocol designed to ensure people infected with TB are either denied entry or given immediate treatment, and another check by the Queensland Medical Board, failed to identify the threat and risk of further infection.

Sources have told The Gold Coast Bulletin the infected employee is a male doctor.

Australia has one of the lowest instances of TB in the world and cases are usually limited to those born overseas, prompting speculation the patient is overseas trained and brought in to prop up Queensland's troubled health system.

Up to 500 former patients and visitors to the Gold Coast Hospital will be contacted by letter this week, asking them to be screened for the possible illness.

Screening is expected to start on Friday, with Queensland Health refusing to give out any further identifying information on the doctor.

"There would be no public benefit in releasing any information on the health worker confirmed with TB. It is in the best interests of the public to conduct the process in this manner."

Opposition health spokesman John-Paul Langbroek yesterday backflipped on his support for Queensland Health and its handling of the process.

Mr Langbroek said it was becoming obvious that the issue had been poorly managed.

He was critical of Queensland Health's decision to promote a hotline number that was closed for inquiries over the weekend, and leave off its 24-hour 13 HEALTH hotline from media releases when breaking the news of the tuberculosis diagnosis.

Though the Health Minister says the number was raised in the media conference and used by other media, the 13 HEALTH number cannot be found in the White Pages phone directory, and an incomplete but working number is provided on the White Pages website.

None of this is the fault of Queensland Health or the Health Minister, according to his spokesman who said Telstra should be answerable for the latest oversight.

Yesterday, Mr Langbroek also criticised the delay in contacting the 500 people, with the first letters not expected to arrive at their addresses until tomorrow.

"In the meantime, the hotline the Health Minister directed them to over the weekend told them to call back on Monday morning," said Mr Langbroek.

"It demonstrates that either the Beattie Government isn't on hand to handle its own crisis outside Monday to Friday 9-5, or once again their commitment to patients is nothing more than mere rhetoric."

Just last month, a Queensland Health spokesman and the head of the Gold Coast dental school, Newell Johnson, said letters had failed to reach new dental patients and that a new system was being employed.

http://www.gcbulletin.com.au/article/2007/04/24/4689_news.html

[Gert van der Hoek]

Re: Australia: HCW with TB in Queensland

TB tests for 450 after X-rays fail

25Apr07

TWO chest X-rays, one before entering Australia and another after, and further checks for a persistent cough failed to detect the tuberculosis in a Gold Coast Hospital health worker.

According to authorities, it was only due to the vigilance and ongoing health concerns of the infected employee that an investigation was held and TB confirmed, which now means a further 450 staff, visitors and patients of the hospital will be tested for the disease, starting on Friday.

The employee's status as a foreign health worker has been confirmed but his role as a doctor denied by Queensland Tuberculosis Control Centre director Tom Konstantinos who said yesterday that was the only information that would be released.

"It was (the centre's) decision not to release further identifying information ... it's enough that we have the right information to carry out the relevant checks and screenings ... and that the public are aware of the issue and symptoms to watch out for," he said.

Dr Konstantinos defended the health worker yesterday and the national health and immigration protocols in place to deal with possible TB outbreaks.

"Tuberculosis is a slow developing disease that in most cases can take three to six months to develop symptoms, but in other cases people can have it for a lifetime and not develop the disease symptoms," he said.

"My understanding of this particular case is that the health worker had chest X-rays before and after entering Australia and both came up clear.

"It was only due to the concerns of this health worker that further TB checks were carried out."

The Federal Immigration Department agreed.

"We know that an X-ray was carried out before entry and again post-arrival in January. Both were clear. It wasn't until an X-ray in April that the early stages of TB were found," said a department spokeswoman.

"We're happy that all the right checks were made."

Dr Konstantinos said TB could cause infections outside the lung, which would not show up in chest X-rays, but these cases were not infectious and not common.

"Another rare case, not detectable in chest X-rays, is when the TB germ gets into the lining of the lung and not the lung tissue. This is an early stage of infection and can lead to misdiagnosis, particularly in areas with low TB cases," he said.

"I believe our health checks and systems are adequate. It's just too difficult to maintain a system of awareness for every possible symptom and disease."

But he said there were lessons to be learned from the case.

"I think this does highlight the need to always look at the 'prior risks' of a case, particularly if there are some symptoms of rare illnesses, such as TB," he said.

The Queensland Medical Board would not confirm yesterday whether it was investigating concerns that information given at the time of the health worker registering was incorrect.

Board chairwoman Mary Cohn said having a health condition did not preclude a practitioner from being registered.

"All doctors seeking to work in Queensland must declare their fitness to practise ... stating if they suffer from any ongoing medical or mental condition," she said.

http://www.gcbulletin.com.au/article/2007/04/25/4696_news.html

[Gert van der Hoek]

Re: Australia: HCW with TB in Queensland

Hospital TB scare after 28 fail tests

23 May07

TWENTY-eight people screened for tuberculosis after a TB scare at the Gold Coast Hospital have been recalled for further tests after an initial skin test failed to clear them.

The 28 were among 515 who were potentially exposed to the disease through a hospital health worker.

Another 210 hospital staff members and 18 former patients have yet to show up for their tests, even though the Queensland Tuberculosis Control Centre sent them letters warning of their potential exposure and need for screening almost a month ago.

It is not known how many more of the 210 staff still working at the hospital or former patients may need follow-up tests.

Initially, Queensland Health estimated the exposure at 450 people but the latest figure has been revised up to 515, comprising 353 hospital staff and 127 patients.

The TB scare was sparked after an overseas-trained healthcare worker fell sick and was diagnosed with tuberculosis in April.

It is believed the healthcare worker arrived in Australia at the start of the year. Three chest X-rays, before and after his entry in Australia, failed to pick up the onset of the disease before he started work at the hospital.

TB control centre director Tom Konstantinos said the 515 people sent letters were identified as having been in close proximity with the worker.

Screening is not compulsory and Dr Konstantinos said TB developed very slowly and had a low infection rate.

"Initial testing is done via a Mantoux skin test, which determines exposure to infection," said Dr Konstantinos.

"Of the 276 screened ... 28 will require further clinical reviews by centre staff, either because of a significant tuberculin skin test (which indicates there is a probability of infection) or because of an abnormal chest X-rays in subjects with non-significant skin test reaction but with symptoms requiring further evaluation."

Dr Konstantinos said there was no evidence there had been transmission of TB. "It must be noted that this does not mean that all or any of the 28 people have TB," he said.

"There was a significant proportion with underlying health issues that would render the skin test unreliable."

Some of those in need of further checks will be screened at their homes. Others will have chest X-rays.

All of those who are tested will also be asked to have a further check-up in three months, as the TB bacterium can take between two to 12 weeks before a physical immune response occurs.

The control centre held another screening of staff and patients yesterday, but it was not known how many turned up.

Queensland Health and the control centre defended its method of contacting patients with letters last month, when initial concerns were raised over the effectiveness of letters.

Fewer than half of those people sent letters have replied, with the control centre resorting to phoning those in need of tests.

A Queensland Health spokeswoman said: "We would prefer every person contacted via letter be screened and depending on how many come today, another screening date may be offered for those who haven't been tested."

http://www.gcbulletin.com.au/article/2007/05/23/5298_news.html