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

Abstract

BackgroundDespite the availability of TB infection control guidelines, and good levels of healthcare worker knowledge about infection control, often these measures are not well implemented. This study sought to determine the factors associated with healthcare workers’ good TB infection control practices in primary health care facilities in the Free State Province, South Africa.MethodsA cross-sectional self-administered survey among nurses (n = 202) and facility-based community healthcare workers (n = 34) as well as facility observations were undertaken at all 41 primary health care facilities in a selected district of the Free State Province.ResultsThe majority of respondents were female (n = 200; 87.7 %) and the average age was 44.19 years (standard deviation ±10.82). Good levels of knowledge were recorded, with 42.8 % (n = 101) having an average score (i.e. 65–79 %) and 31.8 % (n = 75) a good score (i.e. ≥ 80 %). Most respondents (n = 189; 80.4 %) had positive attitudes towards TB infection control practices (i.e. ≥ 80 %). While good TB infection control practices were reported by 72.9 % (n = 161) of the respondents (i.e. ≥75 %), observations revealed this to not necessarily be the case. For every unit increase in attitudes, good practices increased 1.090 times (CI:1.016–1.169). Respondents with high levels of knowledge (≥80 %) were 4.029 (CI: 1.550–10.469) times more likely to have good practices when compared to respondents with poor levels of knowledge (<65 %). The study did not find TB/HIV-related training to be a predictor of good practices.ConclusionsPositive attitudes and good levels of knowledge regarding TB infection control were the main factors associated with good infection control practices. Although many respondents reported good infection control practices - which was somewhat countered by the observations - there are areas that require attention, particularly those related to administrative controls and the use of personal protective equipment.

Tuberculosis prevention knowledge, attitudes, and practices of primary health care nurses

“…Based on our previous findings (Engelbrecht et al, ), knowledge is strongly associated with practice when it comes to TB prevention by health care workers in PHC facilities. We were therefore interested to explore whether this was true for nurses as well and also whether certain factors might prove to influence this relationship between knowledge and practice.…”

“…In 2013, the TB incidence rate was 686 per 100 000 (compared with the national average of 593 per 100 000); the successful TB treatment rate was 72.1% (compared with the national average of 77.9%); the proportion of total PHC facilities that were visited at least once a month in the 2014/2015 year was 61.1%, lower than the 73.5% national average (Massyn, Peer, Padarath, et al, ). In terms of the prevention of TB in health facilities, previous studies have highlighted several deficiencies on PHC level (Engelbrecht et al, ; Engelbrecht & Janse van Rensburg, ; Engelbrecht, Janse van Rensburg, Kigozi, et al, ).…”

“…A survey questionnaire was developed following a literature review and was composed of sections focusing on (1) demographic information and (2) knowledge, attitudes, and practices related to TB prevention. Scales were developed based on previous studies (Engelbrecht et al, ; Engelbrecht et al, ; Engelbrecht & Janse van Rensburg, ; Janse van Rensburg et al, ). The scale enquiring about TB prevention knowledge was composed of 22 statements with response options “True,” “False,” or “I don't know” and included statements on TB symptoms, TB transmission, personal protective equipment, cough etiquette, ventilation, separation of coughing patients, and TB/HIV.…”

“…Due in large part to their caring role, nurses are in close and prolonged contact with patients infected with TB and have been suggested to be occupationally exposed in South African health facilities (Janse van Rensburg, Engelbrecht, Spiegel, Nophale, & Bryce, ). Further, there is a growing cognisance of the importance of focusing on nurses' plight in primary health care (PHC) settings in countries such as South Africa, where a lack of TB infection prevention and control training and equipment is chronic (Engelbrecht, van Rensburg, Kigozi, & van Rensburg, ; Malangu & Mngomezulu, ).…”

Towards understanding the drivers of policy change: a case study of infection control policies for multi-drug resistant tuberculosis in South Africa

“…Various studies revealed that the treatment of MDR-TB in South Africa was not sufficient unless backed up by IPC measures [13, 40, 41]. A study by Ghandi et al [17] indicated that MDR-TB treatment required a longer course, is more toxic and is more costly than first-line treatment of TB, and is not readily available in resource-limited settings.…”