Evaluation of tuberculosis infection control measures implemented at primary health care facilities in Kwazulu-Natal province of South Africa

Abstract

BackgroundTuberculosis (TB) is a global public health concern. It is even more so as its incidence seems to be increasing in South Africa. The aim of this study was to describe and compare the tuberculosis infection control measures implemented by facilities in Ugu and Uthungulu health districts of Kwazulu-Natal province.MethodsThis was a cross-sectional survey based on a self-administered questionnaire and site visit observations. Data were collected from healthcare workers at 52 health facilities from the beginning of February to mid-March 2012. The facilities that completed the questionnaires were visited for site observations.ResultsThe mean age of participants was 44.7 ± 11.7 years of age, ranging from 22 to 66 years old; 89.1% of them were females and nurses. Overall, some 48.6% (18 out of 37) of aspects of tuberculosis infection control encompassing administrative, environmental, clinical and occupational health measures were complied with by at least 80% of facilities surveyed. The unfortunate outcome of this inadequate compliance was that 23 and 12 cases of nosocomial tuberculosis had been diagnosed among staff members respectively in Ugu and Uthungulu districts.ConclusionsOverall, it appears that at the facilities surveyed, less than 50% of tuberculosis infection control measures were complied with. This finding calls for appropriate interventions to be designed and implemented. These include the purchase and installation of environmental control systems; the implementation of administrative tuberculosis infection control measures at each facility together with the training of staff members on the strict adherence to preventive measures including the use of personal protective equipment.

Factors associated with good TB infection control practices among primary healthcare workers in the Free State Province, South Africa

“…International and national policies [10, 11] recommend several simple and effective infection control measures aimed at reducing the nosocomial spread of TB in healthcare settings, particularly in resource poor settings. However, as in most endemic settings, healthcare workers in South Africa fail to implement appropriate infection control measures to protect both themselves and their patients from TB infection [19–27, 30]. Our study aligns with these findings, and identified that almost three in ten healthcare workers failed to implement good TB infection control practices in their facilities.…”

“…Notwithstanding the availability of guidelines on the implementation of TB infection control practices in healthcare facilities [17, 18], research conducted in South African health facilities found that infection control is often not well implemented [19–27] despite healthcare workers displaying good levels of knowledge about infection control practices [19, 20, 25]. While knowledge may not always be associated with good practices, research has found that motivation and support are priorities for the implementation of interventions to increase healthcare workers’ appropriate execution of TB infection control practices [20].…”

Agents of change: The role of healthcare workers in the prevention of nosocomial and occupational tuberculosis

“…The lack of implementation and scale up of these preventative measures, with an emphasis on rapidly diagnosing and treating unsuspected TB, are primarily responsible for nosocomial TB transmission 10,34,35 . In HBCs such as South Africa, poor building design, overcrowding, lack of knowledge and training regarding facility-based IC plans and guidelines, and poor managerial involvement in the design and implementation of local TB-IC policy have been noted as barriers to the implementation of such measures 36,37 . It should be mentioned that TB-IC is also often neglected in low and medium incidence countries.…”

Safety and Disease Evolution of Fixed-Dose Combination of Antitubercular Treatment Compared to Separate-Drugs Preparation in Extra-Pulmonary Tuberculosis

“…Despite the availability of effective anti-TB drugs, achieving a high cure rate is challenging and critical, for several reasons: poor drug adherence [2], inadequate doses or dosing frequency [3,4], and drugs given in unsupervised manner [5] may lead to treatment failure and then promote drug resistance. Development of multi-drug resistance is a further threat to TB control, especially in TBendemic countries.…”