A tuberculin skin test survey among healthcare workers in two public tertiary care hospitals in Bangladesh

Chughtai, Abrar Ahmad; Nazneen, Arifa; Chowdhury, Kamal Ibne Amin; Islam, Muhammad Tauhidul; Islam, Saiful; Seale, Holly

doi:10.1371/journal.pone.0243951

Cited by 7 publications

(9 citation statements)

References 39 publications

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“…Second, this study was conducted in 11 hospitals that were not randomly selected and therefore, the findings may not be generalizable to all hospitals that provide care to TB patients. However, this study findings are consistent with prior reports and studies conducted in other government and non-government hospitals in Bangladesh [ 7 , 10 , 31 ].…”

Section: Discussionsupporting

confidence: 93%

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Implementation status of national tuberculosis infection control guidelines in Bangladeshi hospitals

et al. 2021

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In response to the World Health Organization (WHO) recommendation to reduce healthcare workers’ (HCWs’) exposure to tuberculosis (TB) in health settings, congregate settings, and households, the national TB control program of Bangladesh developed guidelines for TB infection prevention and control (IPC) in 2011. This study aimed to assess the implementation of the TB IPC healthcare measures in health settings in Bangladesh. Between February and June 2018, we conducted a mixed-method study at 11 health settings. The team conducted 59 key-informant interviews with HCWs to understand the status of and barriers impeding the implementation of the TB IPC guidelines. The team also performed a facility assessment survey and examined TB IPC practices. Most HCWs were unaware of the national TB IPC guidelines. There were no TB IPC plans or committees at the health settings. Further, a presumptive pulmonary TB patient triage checklist was absent in all health settings. However, during facility assessment, we observed patient triaging and separation in the TB specialty hospitals. Routine cough-etiquette advice was provided to the TB patients mentioned during the key-informant interviews, which was consistent with findings from the survey. This study identified poor implementation of TB IPC measures in health settings. Limited knowledge of the guidelines resulted in poor implementation of the recommendations. Interventions focusing on the dissemination of the TB IPC guidelines to HCWs along with regular training may improve compliance. Such initiatives should be taken by hospital senior leadership as well as national policy makers.

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Section: Discussionsupporting

confidence: 93%

“…In middle- and low-income high TB-burden countries, all healthcare workers (HCWs) are at risk of TB exposure due to the presence of presumptive and or confirmed TB patients in the hospital [ 5 – 7 ]. Public tertiary care hospitals often lack basic infection prevention and control (IPC) measures that make HCWs more vulnerable [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Implementation status of national tuberculosis infection control guidelines in Bangladeshi hospitals

et al. 2021

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“…Similarly, the reported TB disease among HCWs may be attributable to the exposure to untreated TB patients in the hospital wards. This theory is supported by the findings from a companion study conducted in the same hospitals, which found that 42% of the HCWs were positive with a tuberculin skin test and HCWs at the medicine wards were 3.65 (95% CCI: 2.01-6.79) times more likely to be positive with TST when compared with administrative workers in the hospital [28].…”

Section: Discussionmentioning

confidence: 71%

Examining pulmonary TB patient management and healthcare workers exposures in two public tertiary care hospitals, Bangladesh

Islam

Chowdhury

Nazneen

et al. 2022

PLOS Glob Public Health

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Implementation of tuberculosis (TB) infection prevention and control (IPC) guidelines in public tertiary care general hospitals remain challenging due to limited evidence of pulmonary TB (PTB) patients’ duration of hospital stay and management. To fill this evidence gap, this study examined adult PTB patient management, healthcare workers’ (HCWs) exposures and IPC practices in two public tertiary care hospitals in Bangladesh.Between December 2017 and September 2019, a multidisciplinary team conducted structured observations, a hospital record review, and in-depth interviews with hospital staff from four adult medicine wards.Over 20 months, we identified 1,200 presumptive TB patients through the hospital record review, of whom 263 were confirmed PTB patients who stayed in the hospital, a median of 4.7 days without TB treatment and possibly contaminated the inpatients wards. Over 141 observation hours, we found a median of 3.35 occupants present per 10 m2 of floor space and recorded a total of 17,085 coughs and 316 sneezes: a median of 3.9 coughs or sneezes per 10 m2 per hour per ward. Only 8.4% of coughs and 21% of sneezes were covered by cloths, paper, tissues, or by hand. The HCWs reportedly could not isolate the TB patients due to limited resources and space and could not provide them with a mask. Further, patients and HCWs did not wear any respirators.The study identified that most TB patients stayed in the hospitals untreated for some duration of time. These PTB patients frequently coughed and sneezed without any facial protection that potentially contaminated the ward environment and put everyone, including the HCWs, at risk of TB infection. Interventions that target TB patients screening on admission, isolation of presumptive TB patients, respiratory hygiene, and HCWs’ use of personal protective equipment need to be enhanced and evaluated for acceptability, practicality and scale-up.

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“…There was the minimal implementation of TB IPC measures in public tertiary care general hospitals [ 3 ]. In addition, pulmonary TB patients in inpatients wards with limited or no IPC measures have been shown to increase HCW exposure to TB, resulting in 42% of latent TB infections among HCW [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Preparedness of tertiary care hospitals to implement the national TB infection prevention and control guidelines in Bangladesh: A qualitative exploration

et al. 2022

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In high tuberculosis (TB) burden countries, health settings, including non-designated TB hospitals, host many patients with pulmonary TB. Bangladesh’s National TB Control Program aims to strengthen TB infection prevention and control (IPC) in health settings. However, there has been no published literature to date that assessed the preparedness of hospitals to comply with the recommendations. To address this gap, our study examined healthcare workers knowledge and attitudes towards TB IPC guidelines and their perceptions regarding the hospitals’ preparedness in Bangladesh. Between January to December 2019, we conducted 16 key-informant interviews and four focus group discussions with healthcare workers from two public tertiary care hospitals. In addition, we undertook a review of 13 documents [i.e., hospital policy, annual report, staff list, published manuscript]. Our findings showed that healthcare workers acknowledged the TB risk and were willing to implement the TB IPC measures but identified key barriers impacting implementation. Gaps were identified in: policy (no TB policy or guidelines in the hospital), health systems (healthcare workers were unaware of the guidelines, lack of TB IPC program, training and education, absence of healthcare-associated TB infection surveillance, low priority of TB IPC, no TB IPC monitoring and feedback, high patient load and bed occupancy, and limited supply of IPC resources) and behavioural factors (risk perception, compliance, and self and social stigma). The additional service-level gap was the lack of electronic medical record systems. These findings highlighted that while there is a demand amongst healthcare workers to implement TB IPC measures, the public tertiary care hospitals have got key issues to address. Therefore, the National TB Control Program may consider these gaps, provide TB IPC guidelines to these hospitals, assist them in developing hospital-level IPC manual, provide training, and coordinate with the ministry of health to allocate separate budget, staffing, and IPC resources to implement the control measures successfully.

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A tuberculin skin test survey among healthcare workers in two public tertiary care hospitals in Bangladesh

Cited by 7 publications

References 39 publications

Implementation status of national tuberculosis infection control guidelines in Bangladeshi hospitals

Implementation status of national tuberculosis infection control guidelines in Bangladeshi hospitals

Examining pulmonary TB patient management and healthcare workers exposures in two public tertiary care hospitals, Bangladesh

Preparedness of tertiary care hospitals to implement the national TB infection prevention and control guidelines in Bangladesh: A qualitative exploration

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