A clinician's account of patients with active tuberculosis arriving in Anchorage operating rooms between 2010 and 2016 without the team being told opens the episode. It explains why an operating room is a particular place for an airborne disease, drawing on 2005 federal guidance and outbreaks from unsuspected cases elsewhere. It asks why disclosure fails without blaming patients, and sets Alaska's written policy beside what the clinician says he saw.
Who's who
- Paul A. JensenLead author of the CDC's 2005 TB transmission guidelines for health-care settings
- Anne Zink+2 more episodesAlaska chief medical officer at the 2023 public health summit
- Andrew CourtwrightCo-author of a 2010 systematic review of tuberculosis stigma
- Abigail Norris TurnerCo-author of a 2010 systematic review of tuberculosis stigma
- Lynn E. SosaLead author of 2019 recommendations on TB testing of health-care personnel
- Yuri SpringerResearcher comparing TB among Alaska Native and other American Indian people
Where it happens
- Anchorage, Alaska+6 more episodesCity where undisclosed TB patients reached operating rooms
- Alaska Regional Hospital, AnchoragePrivate hospital where the account is set
- Alaska Native Medical Center, AnchorageTribal health system's statewide referral hospital
- Ketchikan, AlaskaHome of Ketchikan General, where the clinician's Alaska work began
Timeline
- 1982Catanzaro reports ten of thirteen susceptible staff at a bronchoscopy converted their skin tests
- 1990Hutton reports nine secondary cases and fifty-nine skin-test conversions from one patient
- December 30, 2005CDC publishes guidelines for preventing TB transmission in health-care settings
- 2010 to 2016Period of the incidents in Anchorage by the clinician's account
- March 2021Alaska's revised manual calls observed therapy the standard of care for all TB patients
- 2024Alaska reports 91 cases, a rate of 12.3 per 100,000, the nation's highest
Still debated
Whether observed therapy was in use in Anchorage from 2010 to 2016 is unresolved: written state policy says yes, while the clinician says it was not. Who should have told the operating room team is open, and the reasons his patients did not disclose are unknown.
