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

Abstract

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.

Assessment of Infection Prevention and Control (IPC) Implementation and Strategies Used for IPC Preparedness at Facility Level in Underdeveloped Areas of Pakistan

“…Tertiary care hospitals in many countries did not exercise proper IPC practices for tuberculosis, influenza-like illness, and other respiratory diseases. 20 A similar study conducted in Islamabad, Pakistan indicated inadequate scores for all five hospitals in Islamabad. 21 Ongoing COVID-19 response provided the opportunities for the healthcare institutions to initiate the IPC program and development of guidelines at the hospital level.…”

“…Tertiary care hospitals in many countries did not exercise proper IPC practices for tuberculosis, influenza-like illness, and other respiratory diseases. 20 A similar study conducted in Islamabad, Pakistan indicated inadequate scores for all five hospitals in Islamabad. 21 …”

Exploring the Role of Healthcare Personnel in Designing Tuberculosis Infection Prevention and Control Measures in Healthcare Settings: A Scoping Review

“…Six qualitative studies focused on the knowledge of TB-IPC among HCP and their perception regarding occupational risks when exposed to occupational hazards, such as TB infection. They explored factors influencing the behaviours toward adoption and compliance with TB-IPC measures in healthcare settings [12,13,15,27]. The other three crosssectional studies assessed the level of practice and the perceptions of HCP regarding the TB-IPC implementation and adherence at different levels of care in facilities [28][29][30], while the last three described the legal framework and the barriers to policy development and implementation [29,31,32].…”

Tuberculosis infection prevention and control in rural Papua New Guinea: An evaluation using the Infection Prevention and Control Assessment Framework

“…The inadequate capacity building for HCWs in PNG is consistent with a study in Pakistan and Bangladesh found that limited IPC training among HCWs has affected TB-IPC practice. Additionally, TB-IPC training was available for facility managers and senior HCWs but not all staff (13). Similarly, a study in seven high TB-burden countries found that over half of the HCWs receiving training on TB-IPC guidelines did not understand the content and were unaware of many IPC interventions (35).This point suggests that the quality of training is also important.…”

“…1). The WHO recommends IPC as one of the three measures for reducing the high burden of TB in TB/HIV-prevalent countries (13). These measures include isoniazid preventive treatment, intensi ed case nding, and IPC.…”