The Role of Powerlessness Among Health Care Workers in Tuberculosis Infection Control

Abstract

Due to their occupational exposure in health care settings, health care workers (HCW) have increased risk of Mycobacterium tuberculosis infection. They face challenges to remain up-to-date with evidence-based clinical practices and translate educational information into actions in infection control practices. Our purpose was to examine this "knowledge-action" gap about how HCWs understand their occupational M. tuberculosis risk and use recommended infection control measures in clinical practices in the Dominican Republic (DR). We conducted 10 focus groups with 40 physicians and nurses at two tertiary-level DR institutions. Using grounded theory methods, we developed a theoretical model to describe the decision-making process related to adherence to M. tuberculosis infection control measures in clinical practice. Findings highlight intrinsic and extrinsic factors that influenced the observed knowledge-action gap related to M. tuberculosis infection control practices in two DR health institutions.

Caracterización del proceso de implementación de la Política Nacional para el Control de la Tuberculosis en Costa Rica, 2012-2015

“…Con respecto al personal de salud, otros autores han mencionado el riesgo de infección de TB que tienen estos trabajadores durante la atención de los pacientes con la enfermedad activa, por lo que es necesario implementar medidas administrativas y protección personal; además mencionan la importancia de mejorar la competencia y conocimiento en este personal (Ahmed, Aro, y Sodemann, 2009;Chapman et al, 2017). Los hallazgos de esta investigación indican que se tiene poco recurso en los centros de salud y muchas veces el personal de salud debe trabajar en lugares hacinados, sin poder separar a quienes padecen de diferentes patologías en otros salones, a pesar de que la política establezca condiciones para el aislamiento de estas personas.…”

“…Los hallazgos de esta investigación indican que se tiene poco recurso en los centros de salud y muchas veces el personal de salud debe trabajar en lugares hacinados, sin poder separar a quienes padecen de diferentes patologías en otros salones, a pesar de que la política establezca condiciones para el aislamiento de estas personas. Aunado a esto, el personal no percibe la importancia de su trabajo para el diagnóstico y manejo de la TB, lo mismo se encontró en otro estudio (Chapman et al, 2017).…”

Barriers and facilitators of tuberculosis infection prevention and control in low- and middle-income countries from the perspective of healthcare workers: A systematic review

“…There were no studies that were of sufficiently poor quality to warrant exclusion from this review. [8,27]. The nationwide study from Romania reported an underdeveloped system for reporting TB amongst healthcare workers [13].…”

“…Poor funding and insufficient resources were the theme by far most frequently mentioned across all studies. Healthcare workers cited poor infrastructure, such as a lack of isolation space [17,24], poor clinic layout [28], windows opening in the wrong direction [29], and being unable to maintain equipment such as extractor fans as barriers to implementing isolation or environmental measures [17,19,26,27,30]. Because of insufficient funding to hire more staff, overstretched healthcare workers viewed cough screening, isolation and patient education as additional, non-essential tasks [14,17,19,22,30,31].…”

“…Staff training. Healthcare workers in the Dominican Republic supported the use of health education programmes to improve adherence to TBIPC measures [27]. Various barriers were brought up regarding training.…”