TB outbreak at hospital sparks alert

CELIA HALL

Medical Editor

A London hospital has changed its procedures following an outbreak of multi-drug-resistant tuberculosis in which one patient may have infected four others on an Aids ward.

More than 52 contacts of the patients involved have been identified and public health doctors in 12 local authorities across the United Kingdom and now offering them a TB test. It is believed to be the first UK outbreak of the serious strain of TB and public health officials are taking it "extremely seriously".

The first patient, who had HIV and has since died, was isolated as soon as the diagnosis was made but he produced sputum samples on an open six- bed ward which he shared with five other patients over two days. The four who became infected - all of them HIV-positive - are responding to treatment. Since the outbreak he Chelsea and Westminster Hospital, which treats 21 per cent of the country's HIV patients, has stopped collecting sputum samples on the open ward.

Tuberculosis is passed from one person to another through airborne droplets expelled in coughing or sneezing. This type of TB, known as MDRTB, has caused serious problems in New York among the HIV and drug-injecting populations. It is identified as TB which is resistant to at least two of the "first- line" TB drugs, isoniazid and rifamicin. In the UK in 1994, 42 cases of MDRTB were reported compared with 5,694 cases of the common forms of TB.

Dr Brian Gazzard, clinical director of HIV and genito-urinary medicine at the hospital, said: "We very much wish this had not happened. We now do induced sputum investigations in isolation. At the time we had no reason to believe that the patient might have TB since he had had it previously and had been successfully treated. We have every reason to believe that this outbreak has been contained."

In fact, doctors suspected he might have had PCP, pneumocystis carinii, a type of pneumonia which is common in Aids patients. Dr Sally Hargreaves, director of public health for Kensington, Chelsea and Westminster Health Authority, has the responsibility of ensuring that all measures are taken to control the outbreak.

"We have taken this extremely seriously. We have now identified all the people who need to be contacted all over the country. This risk of infection in people who are not HIV-positive is minimal, but greater in those who are HIV-positive," she said.

She said that patients diagnosed with MDRTB have to be nursed in isolation in special rooms with negative pressure which enables safe and continuous exchanges of air. "The Chelsea and Westminster Hospital has six rooms. If this spreads you could need 50 rooms. We are, however, confident that all the appropriate measures are being taken," Dr Hargreaves said.

Paul Mayho, one of the patients who became infected at the Chelsea and Westminster, is sharply critical of the infection control measures on his ward. He told the Nursing Times that "no special precautions were taken". He said: "I realised I might have been infected with TB in the hospital possibly from the induced sputum tests."

He is now being treated at St Mary's Hospital in Paddington. His colleagues at Positive Nation, a new magazine to be published next month, have all been tested and found to be clear. Dominic Gough, speaking for Mr Mayho, said: "He is very angry that he was exposed in a hospital where you are supposed to get better, not to get something else."