# Difficulty of isolating recalcitrant patients with infectious TB

## TL;DR

This study explores challenges in isolating difficult-to-manage TB patients in Japanese hospitals and identifies factors contributing to their non-compliance.

## Contribution

The study characterizes recalcitrant TB patients and highlights the need for specialized facilities to enforce isolation.

## Key findings

- 12 recalcitrant TB patients were identified, with 66.7% self-discharging and 33.3% discharged by the hospital.
- Psychiatric issues, including possible dementia, were the main reason for recalcitrance in 41.7% of cases.
- 25% of patients verbally or physically assaulted staff or other patients.

## Abstract

Hospitals in Japan with more than five TB isolation beds.

Approximately 4,000 cases of sputum smear-positive TB were reported in 2022, who were isolated in a TB ward at least until they became sputum smear-negative. However, some recalcitrant patients are difficult to isolate because of their behaviour. This study aims to characterise recalcitrant patients with TB and determine why they left the hospitals.

This was a descriptive study. We sent a self-administered questionnaire to the hospitals asking about recalcitrant inpatients with TB from April 2022 through March 2023.

A total of 12 recalcitrant patients were identified, of whom 8 (66.7%) self-discharged, and the other 4 (33.3%) were discharged by the hospital. All were male with an average age of 58.9 years. The main reason why the patients were considered recalcitrant was related to psychiatric problems (41.7%), including 2 with possible dementia (16.7%). However, 3 (25.0%) patients verbally insulted or physically assaulted staff members and other patients.

Although the number of recalcitrant patients was small, we recommend that there should be one or two TB facilities readily available for law enforcement officials to enforce isolation.