Delayed Tuberculosis Detection in Healthcare Workers: Lessons from a Tuberculosis Outbreak in a Tertiary Care Hospital

In March 2024, a healthcare worker (HCW) at a tertiary care hospital was confirmed with pre-extensively drug-resistant tuberculosis (pre-XDR-TB) after a delay of over 30 days following an abnormal chest X-ray (CXR). We investigated to verify the outbreak and diagnosis, describe its characteristics, review the HCW TB screening program, and identify factors associated with adequate CXR follow-up. We reviewed TB cases among HCWs in the hospital and conducted contact investigations via TB symptoms, CXR screening, and sputum GeneXpert tests. Confirmed cases were defined by positive bacteriological test, while probable cases were defined otherwise. We interviewed stakeholders to identify possible causes of delayed TB detection. We confirmed three HCWs with pulmonary TB (one pre-XDR-TB) and identified one probable case. There were three females and one male, all aged 30–39, and three had delayed detection. The attack rate among 90 contacts was 3.3%. In 2023, 32 out of 310 HCWs with abnormal CXRs (10%) completed CXR follow-up and 19 (6%) underwent sputum testing. The TB screening program faced challenges due to deviations from national guidelines, reliance on clinician judgment, and limited resources, contributing to delayed detection. A history of TB treatment and receiving sputum test for TB were significantly associated with adequate CXR follow-up, while good tuberculosis knowledge was probably associated with adequate CXR follow-up. This outbreak highlights the need to improve TB screening processes and education to reduce delayed detection in HCWs.