Management of mycobacteriosis in general hospital without isolation ward for tuberculosis patients. 3. Current status of tuberculosis patient care in university hospitals and general hospitals in Japan

A recent epidemiological survey has revealed that the incidence of Mycobacterium tuberculosis (TB) patients in Japan has just increased again after four decades of decline. In fact, recently there have been numerous reports of TB outbreaks in health-care facilities. Although our medical school hospital does not have TB isolation rooms, we have to take care of more than a few TB patients, most of whom have been transferred from primary care clinics. Although, some of these TB patients have highly infectious (sputum smear positive), most of them have not been diagnosed as having highly infectious TB, and therefore, some of their patients ultimately have to be retransferred to a TB hospital. This indicates that most physicians in primary care clinics have little knowledge about TB. This may be partly because of lack of training regarding TB during their medical student days and residencies. To elucidate current TB patient care status in university hospitals in Japan, a survey of physicians working in such hospitals was conducted from September 1997 to January 1998. The survey (questionnaire) revealed that the majority (76%) of these hospitals do not have TB isolation rooms. However, these hospitals have to take care of TB patients in their outpatient clinics and sometimes on their wards because the patients have serious complications that can not be treated in ordinary TB hospitals. The survey also showed that for this reason and from an educational point of view, the majority of the physicians (90%) working in these hospitals thought that university hospitals should have isolation rooms for such patients. Another questionnaire revealed that few physicians and nurses in university hospitals have sufficient experiences in taking care of TB patients. This situation may have been responsible for producing physicians with little knowledge about TB. Recent scientific advances have made it possible to construct TB isolation rooms in ordinary wards by means of separate ventilation systems. Although combatting TB requires a variety of strategies, appropriate education for both medical students and residents using isolation rooms in university hospitals may be an effective means of preventing spread of TB, and this approach may also increase awareness concerning the prevention of TB outbreaks in hospitals and health-care facilities.