Infection control in hospitals managing drug-resistant tuberculosis in Pakistan: how are we doing?

Abstract

Ten hospitals managing drug-resistant tuberculosis (TB) in Pakistan. To assess the implementation of TB infection control (IC) practices and reasons for non-adherence to guidelines. This was a descriptive study conducted between April and October 2016 with three components: 1) non-participant observation of service delivery areas (SDAs) ( = 82) in hospitals ( = 10) using structured checklists; 2) exit interviews with 100 patients (10 per hospital); and 3) interviews with 100 health-care workers (HCWs, 10/hospital). Of the 82 SDAs, posters were displayed in 34 (41%), mechanical ventilation was implemented in 79% and functional ultraviolet germicidal irradiation (UVGI) was available in only 26%. Patient interviews showed 50-65% adherence to triage and use of personal protective measures. Key reasons for non-adherence were lack of adequate supplies, discomfort using N-95 masks, a lack of knowledge or training, perceived non-cooperation by patients, poor maintenance of mechanical ventilators and UVGI due to unstable electricity supply, a lack of clarity in roles (no-one designated in charge) and staff shortages and subsequent workloads. Adherence to natural ventilation usage was poor for reasons related to climate and privacy. Implementation of TBIC measures in hospitals was suboptimal. Urgent measures need to be put in place, including retraining of HCWs, addressing weaknesses in mask and poster supplies and constant supervision and monitoring.

Use of personal protective equipment to protect against respiratory infections in Pakistan: A systematic review

“…After reviewing titles and abstracts, 46 studies were selected for full text review. Finally, 13 articles were included in this review (Table 1) [20][21][22][23][24][25][26][27][28][29][30][31][32]. We only found observational/cross-sectional studies on the use of PPE for infectious diseases in healthcare settings in Pakistan.…”

“…No clinical trials or laboratory-based studies on the use of PPE in such settings were found. Seven studies examined the use of PPE in hospital [20][21][22][23]25] and among those, two examined the PPE perceptions among medical students [24] or pharmacy students [32]. Two studies were conducted in the laboratory settings [26,27] while, four in dental settings [28][29][30][31] Two studies focused on the use of PPE for influenza [24,32], two were for tuberculosis [20,25] and nine studies were on multiple respiratory diseases, including influenza [21,22] or general infections [23,[26][27][28][29][30][31].…”

“…Seven studies examined the use of PPE in hospital [20][21][22][23]25] and among those, two examined the PPE perceptions among medical students [24] or pharmacy students [32]. Two studies were conducted in the laboratory settings [26,27] while, four in dental settings [28][29][30][31] Two studies focused on the use of PPE for influenza [24,32], two were for tuberculosis [20,25] and nine studies were on multiple respiratory diseases, including influenza [21,22] or general infections [23,[26][27][28][29][30][31]. Only two studies examined the use of PPE alone [21,22], while other studies examined other infection control practices as well [20,[23][24][25][26][27][28][29][30][31][32].…”

“…Another survey showed that 25% of participants used PPE for patients with suspected tuberculosis and 56% used PPE for patients with confirmed tuberculosis [25]. A study in a ward for patients with multidrug-resistant tuberculosis reported that 65% of the healthcare workers used N95 respirators and 58% were provided with a mask [20]. A study on 253 biosafety level (BSL) 2 laboratory workers showed that PPE was not used by about half of the staff (46.2%) [27].…”

A country-wide evaluation of infection control for tuberculosis in health-care facilities in Armenia

“…In Armenia, TB care is provided through outpatient and inpatient services spread throughout the country. TB management follows WHO guidelines and services are provided free of cost under the umbrella of the National TB control program (NTCC) [11]. Since 2015, the program has strived to establish a continuing quality improvement system to raise the quality of services being provided to patients in the country [12].…”