Tuberculosis in Healthcare Workers and Infection Control Measures at Primary Healthcare Facilities in South Africa

Claassens, Mareli; Schalkwyk, Cari van; Toit, E. Du; Roest, Eline; Lombard, Carl; Enarson, Donald A.; Beyers, Nulda; Borgdorff, Martien W.

doi:10.1371/journal.pone.0076272

Cited by 78 publications

(107 citation statements)

References 19 publications

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“…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 .…”

Section: Challengesmentioning

confidence: 99%

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

Nathavitharana

Bond²,

Dramowski

et al. 2017

La Presse Médicale

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Healthcare workers (HCWs) play a central role in global tuberculosis (TB) elimination efforts but their contributions are undermined by occupational TB. HCWs have higher rates of latent and active TB than the general population due to persistent occupational TB exposure, particularly in settings where there is a high prevalence of undiagnosed TB in healthcare facilities and TB infection control (TB-IC) programmes are absent or poorly implemented. Occupational health programmes in high TB burden settings are often weak or non-existent and thus data that record the extent of the increased risk of occupational TB globally are scarce. HCWs represent a limited resource in high TB burden settings and occupational TB can lead to workforce attrition. Stigma plays a role in delayed diagnosis, poor treatment outcomes and impaired wellbeing in HCWs who develop TB. Ensuring the prioritization and implementation of TB-IC interventions and occupational health programmes, which include robust monitoring and evaluation, is critical to reduce nosocomial TB transmission to patients and HCWs. The provision of preventive therapy for HCWs with latent TB infection can also prevent progression to active TB. Unlike other patient groups, HCWs are in a unique position to serve as agents of change to raise awareness, advocate for necessary resource allocation and implement TB-IC interventions, with appropriate support from dedicated TB-IC officers at the facility and national TB programme level. Students and community health workers (CHWs) must be engaged and involved in these efforts. Nosocomial TB transmission is an urgent public health problem and adopting rights-based approaches can be helpful. However, these efforts cannot succeed without increased political will, supportive legal frameworks and financial investments to support HCWs in efforts to decrease TB transmission.

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Section: Challengesmentioning

confidence: 99%

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

Nathavitharana

Bond²,

Dramowski

et al. 2017

La Presse Médicale

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“…29,30 In some studies smear positivity was defined as at least 1 25,27,28,30,35,41,42 or at least 2 [22][23][24]34 positive smears, whereas others did not provide any definition. 10,21,26,[31][32][33][36][37][38][39][40] A study from South Africa stratified rates of reported pre-treatment loss to followup by smear status (smear-positive or smear-negative but culture-positive), 23 whereas another study, also from South Africa, reported on pre-treatment loss to follow-up in tuberculosis patients whose diagnosis was established clinically and/ or bacteriologically. 29 …”

Section: Study Characteristicsmentioning

confidence: 99%

“…41 The recruitment periods ranged from 3 months 24,34,36 to 90 months. 30 Only 9 studies [22][23][24][25]27,29,31,36,37 applied a cut-off for time since diagnosis -ranging from 1 month to 3 months -to define pretreatment loss to follow-up.…”

Section: Quality Of Included Studiesmentioning

confidence: 99%

“…Studies that reported on data from a single clinical site 21,22,26,29,31,33,35,40 had higher rates of pre-treatment loss to follow-up (range: 14-38%) than studies reporting on national or regional data (range: 4-25%). 10,[23][24][25]27,28,30,32,34,[36][37][38][39]41,42 In total, 10 studies 10,24,25,[30][31][32][33][34]38,40 attempted to trace tuberculosis patients with pre-treatment loss to follow-up (Table 4). One of them did not detail the tracing method used.…”

Section: Pre-treatment Loss To Follow-upmentioning

confidence: 99%

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Pre-treatment loss to follow-up in tuberculosis patients in low- and lower-middle-income countries and high-burden countries: a systematic review and meta-analysis

MacPherson

Houben

Glynn

et al. 2013

Bull. World Health Organ.

187

179

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“…1,3,11 Personal testimonials of HCW who contracted occupational TB were shared to counter the misconception that only immune-compromised people develop TB. Students could relate to their fellow HCW experiences of the devastating effects of occupational TB.…”

Section: Application In Interventionmentioning

confidence: 99%

Knowledge, attitudes and practices regarding TB infection control among health science students in a TB-endemic setting

Westhuizen

Kotze

Narotam

et al. 2015

Int. j. infect. control

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Medical and physiotherapy students in tuberculosis (TB)-endemic settings are at high risk of developing occupational TB. Didactic lectures are the traditional method for delivering education on the topic of TB infection control (TB-IC) to undergraduate health science students. The aim of this study was to evaluate the impact of a novel educational package for teaching TB-IC to undergraduate health science students in a TBendemic setting.Undergraduate medical and physiotherapy students at Stellenbosch University, South Africa (n = 326) participated in a cross-sectional survey documenting TB-IC knowledge, attitudes and practices at the training institution. A self-administered questionnaire was completed before and after a novel educational intervention which utilized the health belief model (and included personal testimonials from healthcare workers and an IC expert who had survived occupational TB).Students perceived themselves to be at high risk of occupational TB, but underestimated drug-resistant TB mortality. Pre-intervention knowledge of TB-IC measures was poor, but improved post-intervention (58% vs . Senior students had better pre-intervention knowledge of N95 respirator use. Negative attitudes and TB-IC practices of senior staff at the training institution reportedly influenced those of students. TB-IC measures (natural and mechanical ventilation; airborne precaution signage; patient isolation) were reportedly poorly implemented. Access to personal protective equipment was problematic with 49% (87/177) of senior students stating that N95 respirators were never available.IntIn conclusion, students lack knowledge of TB-IC measures and report poor implementation of TB-IC measures at their training institution. A novel structured educational intervention increased students' knowledge of TB-IC measures and heightened awareness of occupational TB risk.

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Tuberculosis in Healthcare Workers and Infection Control Measures at Primary Healthcare Facilities in South Africa

Cited by 78 publications

References 19 publications

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

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

Pre-treatment loss to follow-up in tuberculosis patients in low- and lower-middle-income countries and high-burden countries: a systematic review and meta-analysis

Knowledge, attitudes and practices regarding TB infection control among health science students in a TB-endemic setting

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