Aggressive Contact Investigation of In-Hospital Exposure to Active Pulmonary Tuberculosis

BACKGROUND: In-hospital detection of newly diagnosed active pulmonary tuberculosis (TB) is important for prevention of potential outbreaks. Here, we report our experience of the aggressive contact investigation strategy in a university hospital in the Republic of Korea after healthcare workers (HCWs), patients, and visitors experience an in-hospital exposure to active pulmonary TB. METHODS: A contact investigation after the unexpected detection of newly diagnosed active pulmonary TB (index patients) was performed in a university hospital from August 2016 to April 2017. Initial and 3-month-post-exposure chest radiographs were advised for all patients, visitors, and HCWs in close contact with the index patients. An additional tuberculous skin test or interferon gamma releasing assay was performed at the time of exposure and 3 months post-exposure in HCWs in close contact with the index patients. RESULTS: Twenty-four index patients were unexpectedly diagnosed with active pulmonary TB after admission to the hospital with unassociated diseases. The median time from admission to TB diagnosis was 5 days (range, 1–22 days). In total, 1,057 people were investigated because of contact with the index patients, 528 of which had close contact (206 events in 157 HCWs, 322 patients or visitors). Three months post exposure, 9 (9.2%) among 98 TB-naïve close contact HCWs developed latent tuberculosis infections (LTBIs). Among the 65 close contact patients or visitors, there was no radiological or clinical evidence of active pulmonary TB. CONCLUSION: An aggressive contact investigation after an unexpected in-hospital diagnosis of active pulmonary TB revealed a high incidence of LTBI among TB-naïve HCWs who had contact with the index patients.

The Efficacy of the Moisturizer APDDR-1001 for Post-laser Wound Care / 대한피부과학회지

BACKGROUND: Because cosmetic laser treatments are getting popular, post-laser wound care becomes more important. Currently, topical moisturizers are reported to be sufficient to accelerate re-epithelialization and reduce downtime in post-laser wound care. OBJECTIVE: This study was performed to evaluate the effects of the moisturizer APDDR-1001 for post-laser wound care, after ablative fractional laser on the face. METHODS: In this double-blind, split-face study, 41 patients with photo-aged face received ablative fractional laser. They were divided into two groups, APDDR-1001 and vehicle (group 1) or control moisturizer (group 2), which were applied to the opposite sides of the face for 1 week after the laser treatment. The treatment efficacy was evaluated by the transepidermal water loss (TEWL), erythema index, investigator's assessment for recovery in erythema and overall improvement of the wound. Subjects ranked irritating symptoms and overall satisfaction ratings in the overall improvement. RESULTS: APDDR-1001 was well-tolerated and showed improvement in the erythema index and TEWL during the 7 days of treatment. In group 2, improvement in erythema graded by investigators was significantly higher for APDDR-1001 on day 3 (p<0.05). The overall improvement of wound ranked by investigators was significantly higher for APDDR-1001, compared with the controls in both groups. Subjective assessment demonstrated significantly less erythema (p=0.043), edema (p=0.041) and overall satisfaction ratings in the overall improvement (p<0.048) with APDDR-1001; however, no differences were detected in pain and edema between APDDR-1001 and vehicle (group 1). In group 2, subjects ranked 'much or very much improved' in 75 % of APDDR-1001 side and 55% of control moisturizer side. No significant differences in erythema, edema, pain and itching were reported between APDDR-1001 and control moisturizer in group 2. CONCLUSION: The moisturizer APDDR-1001 demonstrated effective improvements in wound healing and subjective symptoms after ablative fractional laser therapy.

An Experience in Successful Infection Control against Norwegian Scabies in Hospital and a Proposal for Hospital Infection Control / 병원감염관리

BACKGROUND: Norwegian scabies is a highly infectious disease characterized by crust formation, different from ordinary scabies, and is caused by Sarcoptes scabiei. After the patient in our case was diagnosed with Norwegian scabies, active measures were taken to prevent its transmission within the hospital. Methods: A 66-year-old female patient was admitted to the general ward of a university hospital on January 23rd, 2008 and 6 days later, she was found to have been infected with Norwegian scabies all over the body. For epidemiological investigation, those who had been in contact with the patient were identified and interviewed. The patient was advised to follow the contact precaution, and linen the patient used was cleaned thoroughly. The surrounding environment was decontaminated by applying surface disinfectant. Preventive cream against the Norwegian scabies was distributed to staff members and patients who had been exposed to the patient, and appointed a dermatologist to educate them on how to use of medicine, what the mechanism of the disease is, what cautions must be taken, and how to write an ex post facto report. RESULTS: After the confirmation of the 1st case, no additional cases have been reported in the hospital during the ensuing 2 months. Therefore, prompt prevention and infection control activities against Norwegian scabies can be thought to have been successful. CONCLUSION: Whena patient with an uncertain skin disease is admitted, pertinent measures must be taken from the moment the patient is admitted and contact precaution should be applied both to the patients and the staff members. When a scabies patient is detected in an institution, the medical staff must enforce as much active preventive measures as possible, and by doing so, there will be a better chance to prevent the outbreak of scabies in the hospital.