Health-care workers’ perspectives on workplace safety, infection control, and drug-resistant tuberculosis in a high-burden HIV setting

Abstract Background BPaL, a 6 month oral regimen composed of bedaquiline, pretomanid, and linezolid for treating extensively drug-resistant tuberculosis (XDR-TB) is a potential alternative for at least 20 months of individualized treatment regimens (ITR). The ITR has low tolerability, treatment adherence, and success rates, and hence to limit patient burden, loss to follow-up and the emergence of resistance it is essential to implement new DR-TB regimens. The objective of this study was to assess the acceptability, feasibility, and likelihood of implementing BPaL in Indonesia, Kyrgyzstan, and Nigeria. Methods We conducted a concurrent mixed-methods study among a cross-section of health care workers, programmatic and laboratory stakeholders between May 2018 and May 2019. We conducted semi-structured interviews and focus group discussions to assess perceptions on acceptability and feasibility of implementing BPaL. We determined the proportions of a recoded 3-point Likert scale (acceptable; neutral; unacceptable), as well as the overall likelihood of implementing BPaL (likely; neutral; unlikely) that participants graded per regimen, pre-defined aspect and country. We analysed the qualitative results using a deductive framework analysis. Results In total 188 stakeholders participated in this study: 63 from Kyrgyzstan, 51 from Indonesia, and 74 from Nigeria The majority were health care workers (110). Overall, 88% (146/166) of the stakeholders would likely implement BPaL once available. Overall acceptability for BPaL was high, especially patient friendliness was often rated as acceptable (93%, 124/133). In contrast, patient friendliness of the ITR was rated as acceptable by 45%. Stakeholders appreciated that BPaL would reduce workload and financial burden on the health care system. However, several stakeholders expressed concerns regarding BPaL safety (monitoring), long-term efficacy, and national regulatory requirements regarding introduction of the regimen. Stakeholders stressed the importance of addressing current health systems constraints as well, especially in treatment and safety monitoring systems. Conclusions Acceptability and feasibility of the BPaL regimen is high among TB stakeholders in Indonesia, Kyrgyzstan, and Nigeria. The majority is willing to start using BPaL as the standard of care for eligible patients despite country-specific health system constraints.

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Extensively Drug-Resistant Tuberculosis – A Threat to Health Care Workers.

10.1164/ajrccm-conference.2009.179.1_meetingabstracts.a2206 ◽

2009 ◽

Author(s):

JM Jarand ◽

M Loveday ◽

K Shean ◽

P Willcox ◽

K Dheda

Keyword(s):

Health Care ◽

Health Care Workers ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Resistant Tuberculosis ◽

Extensively Drug Resistant ◽

Care Workers

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Gender Impacts on Occupational Risks for Extensively Drug Resistant Tuberculosis (XDR-TB) among Health Care Workers (HCW) in South Africa.

10.1164/ajrccm-conference.2009.179.1_meetingabstracts.a4785 ◽

2009 ◽

Author(s):

JR Zelnick ◽

MR O'Donnell ◽

A Gibbs ◽

S Willan

Keyword(s):

South Africa ◽

Health Care ◽

Health Care Workers ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Occupational Risks ◽

Resistant Tuberculosis ◽

Extensively Drug Resistant ◽

Care Workers ◽

Gender Impacts

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Extensively drug-resistant tuberculosis (XDR-TB) among health care workers in South Africa

Tropical Medicine & International Health ◽

10.1111/j.1365-3156.2010.02590.x ◽

2010 ◽

Vol 15 (10) ◽

pp. 1179-1184 ◽

Cited By ~ 24

Author(s):

Julie Jarand ◽

Karen Shean ◽

Max O’Donnell ◽

Marian Loveday ◽

Charlotte Kvasnovsky ◽

...

Keyword(s):

South Africa ◽

Health Care ◽

Health Care Workers ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Resistant Tuberculosis ◽

Extensively Drug Resistant ◽

Care Workers

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Multidrug Resistant and Extensively Drug Resistant Tuberculosis among South African Health Care Workers.

10.1164/ajrccm-conference.2009.179.1_meetingabstracts.a2205 ◽

2009 ◽

Author(s):

MR O'Donnell ◽

N Padayatchi ◽

J Zelnick ◽

I Master ◽

G Osborn ◽

...

Keyword(s):

South African ◽

Health Care Workers ◽

Multidrug Resistant ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Resistant Tuberculosis ◽

Extensively Drug Resistant ◽

African Health ◽

Care Workers ◽

South African Health

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Tuberculosis infection control practices in a high-burden metro in South Africa: A perpetual bane for efficient primary health care service delivery

African Journal of Primary Health Care & Family Medicine ◽

10.4102/phcfm.v10i1.1628 ◽

2018 ◽

Vol 10 (1) ◽

Cited By ~ 2

Author(s):

Michelle C. Engelbrecht ◽

Gladys Kigozi ◽

Andre P. Janse van Rensburg ◽

Dingie H.C.J Van Rensburg

Keyword(s):

Health Care ◽

Infection Control ◽

Health Care Workers ◽

Control Measures ◽

High Burden ◽

Infection Control Measures ◽

Primary Health ◽

Care Workers ◽

Tuberculosis Infection Control ◽

Tb Infection Control

Background: Tuberculosis (TB) prevention, including infection control, is a key element in the strategy to end the global TB epidemic. While effective infection control requires all health system components to function well, this is an area that has not received sufficient attention inSouth Africa despite the availability of policy and guidelines.Aim: To describe the state of implementation of TB infection control measures in a high-burden metro in South Africa.Setting: The research was undertaken in a high TB- and HIV-burdened metropolitan area of South Africa. More specifically, the study sites were primary health care facilities (PHC), thatamong other services also diagnosed TB.Methods: A cross-sectional survey, focusing on the World Health Organization levels of infection control, which included structured interviews with nurses providing TB diagnosis and treatment services as well as observations, at all 41 PHC facilities in a high TB-burdened and HIV-burdened metro of South Africa.Results: Tuberculosis infection control was poorly implemented, with few facilities scoring 80% and above on compliance with infection control measures. Facility controls: 26 facilities (63.4%) had an infection control committee and 12 (29.3%) had a written infection control plan. Administrative controls: 26 facilities (63.4%) reported separating coughing and noncoughing patients, while observations revealed that only 11 facilities (26.8%) had separate waiting areas for (presumptive) TB patients. Environmental controls: most facilities used open windows for ventilation (n = 30; 73.2%); however, on the day of the visit, only 12 facilities (30.3%) had open windows in consulting rooms. Personal protective equipment: 9 facilities (22%) did not have any disposable respirators in stock and only 9 respondents (22%) had undergone fit testing. The most frequently reported barrier to implementing good TBinfection control practices was lack of equipment (n = 22; 40%) such as masks and disposable respirators, as well as the structure or layout of the PHC facilities. The main recommendation to improve TB infection control was education for patients and health care workers (n = 18; 33.3%).Conclusion: All levels of the health care system should be engaged to address TB prevention and infection control in PHC facilities. Improved infection control will address the nosocomial spread of TB in health facilities and keep health care workers and patients safe from infection.

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The fundamental role of educational intervention on improving health care workers’ knowledge, attitude and practice towards infection control precautions

International Journal of Infection Control ◽

10.3396/ijic.v12i3.020.16 ◽

2016 ◽

Vol 12 (3) ◽

Author(s):

Rasha H. Bassyouni ◽

Ahmed-Ashraf Wegdan ◽

Naglaa A El-Sherbiny

Keyword(s):

Health Care ◽

Infection Control ◽

Educational Intervention ◽

Health Care Workers ◽

Standard Precautions ◽

Attitude And Practice ◽

Care Workers ◽

Atp Bioluminescence ◽

Knowledge Attitude And Practice

To evaluate the role of educational intervention on health care workers' (HCWs) compliance to standard precautions and cleaning of frequently touched surfaces at critical care units, forty-nine HCWs at 2 intensive care units (ICUs) and one neonatology unit at Fayoum University hospital were evaluated for knowledge, attitude and practice (KAP) towards standard precautions as well as obstacles affecting their compliance to standard precautions before and after a 32-hour purposed-designed infection control education program. A structured self-administrated questionnaire as well as observational checklists were used. Assessment of Environmental cleaning was investigated by observational checklist, ATP bioluminescence and aerobic bacteriological culture for 118 frequently touched surfaces. Pre-intervention assessment revealed that 78.6% of HCWs were with good knowledge, 82.8% with good attitude and 80.8% had good practice. Obstacles identified by HCWs were as follow: making patient-care very technical (65.3%), deficiency of hand washing facilities (59.2%), skin irritation resulting from hand hygiene products (51%), and unavailability of PPE (38.8%). High significant improvements of knowledge, attitude and practice were detected after one month of educational intervention (P= 0.000). During the pre-interventional period only 30.5% of surfaces were considered clean versus 97.45% post intervention (P< 0.05). The highest Median ATP bioluminescence values were obtained from telephone handset, light switches and Blood pressure cuffs. S. aureus was the most common isolated organism followed by Enterococcus spp and E.coli (52, 38 and 19 surfaces respectively). In conclusion, contentious training of HCWs on standard precautions should be considered a mandatory element in infection control programs

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