PENINGKATAN PENGETAHUAN DAN KEAHLIAN DIAGNOSIS MIKROSKOPIS BTA PETUGAS LABORATORIUM DI SORONG PADA ERA PANDEMI COVID-19

ABSTRAKPenyakit Tuberkulosis (TB) Paru merupakan salah satu penyebab morbiditas dan mortalitas penting di dunia. Indonesia masih merupakan salah satu negara yang mempunyai beban TB yang terbesar diantara 5 negara yaitu: India, China, Nigeria dan Pakistan. Kota dan Kabupaten Sorong merupakan salah satu daerah di Propinsi Papua Barat dimana TB masih menjadi salah satu permasalahan kesehatan. Pemeriksaan mikroskopis TB dengan metode Ziehl Neelsen, menurut WHO, masih merupakan sarana diagnostik yang sensitif, spesifik, praktis, dan juga murah. Belum terstandardisasinya kinerja petugas laboratorium TB juga menjadi kendala tersendiri dalam diagnosis TB dengan metode Ziehl Neelsen. Munculnya pandemi Covid-19 yang melanda dunia termasuk Indonesia, membuat berbagai kegiatan menjadi tertunda. Kegiatan Pengabdian Kepada Masyarakat di tengah pandemi Covid-19 ini terpaksa dilakukan dalam bentuk “workshop online”. Dalam meningkatkan pengetahuan digunakan aplikasi zoom untuk kuliah penyegaran, memberikan informasi terbaru terkait TB di Indonesia dan pengetahuan tambahan lainnya. Sedangkan dalam meningkatkan keahlian dilakukan praktek pembuatan sediaan mikroskopis TB dan latihan pembacaan sediaan mikroskopis TB yang dilaksanakan secara offline di laboratorium Mikrobiologi Rumah Sakit JP Wanane, yang dimonitor dan dibimbing oleh Dokter Spesialis Mikrobiologi Klinik yang bertugas di sana. Melalui kegiatan Pengabdian Kepada Masyarakat yang dilakukan oleh Universitas Airlangga ini, diharapkan dapat membangkitkan lagi semangat, melakukan penyegaran serta menambah pengetahuan dan ketrampilan bagi tenaga kesehatan di daerah untuk dapat melakukan tugasnya dengan baik sehingga Program Pengendalian Infeksi Tuberkulosis dapat kembali berjalan sebagaimana seharusnya. Kata kunci : tuberkulosis, pemeriksaan mikroskopis, sorong, pandemi Covid-19 ABSTRACTPulmonary Tuberculosis (TB) is one of the most important causes of morbidity and mortality in the world. Indonesia is still one of the countries with the largest burden of TB among 5 countries, namely: India, China, Nigeria and Pakistan. Sorong City is one of the areas in Western Papua, Indonesia, where TB is still a health problem. According to WHO, microscopic examination of TB by the Ziehl Neelsen method is still a sensitive, specific, practical, and inexpensive diagnostic tool. The unstandardized performance of TB laboratory personnel has also become an obstacle in itself in diagnosing TB with the Ziehl Neelsen method. The emergence of the Covid-19 pandemic has delayed various activities. Community Service Activities in the midst of the Covid-19 pandemic had to be carried out in the form of an "online workshop". In increasing knowledge, the zoom application is used for refresher lectures, providing the latest information related to TB in Indonesia and other additional knowledge. Meanwhile, in increasing expertise, the practice of making TB microscopic preparations and reading exercises for TB microscopic preparations was carried out offline in the Microbiology laboratory of the JP Wanane Hospital, which was monitored and guided by the Clinical Microbiology Specialist who served there. Through this Community Service activity carried out by Airlangga University, it is hoped that it can revive enthusiasm, refresh and increase knowledge and skills for health workers in the regions to be able to carry out their duties properly so that the Tuberculosis Infection Control Program can resume running as it should.Keyword : tuberculosis, microscopic examination, Sorong, Covid-19 pandemic

Knowledge, attitudes and practices regarding tuberculosis amongst healthcare workers in Moyen-Ogooué Province, Gabon

Background In countries with a high tuberculosis incidence such as Gabon, healthcare workers are at enhanced risk to become infected with tuberculosis due to their occupational exposure. In addition, transmission can occur between patients and visitors, if a tuberculosis infection is not suspected in time. Knowledge about tuberculosis and correct infection control measures are therefore highly relevant in healthcare settings. Methods We conducted an interviewer-administered knowledge, attitude and practice survey amongst healthcare workers in 20 healthcare facilities at all levels in the Moyen-Ogooué province, Gabon. Correctly answered knowledge questions were scored and then categorised into four knowledge levels. Additionally, factors associated with high knowledge levels were identified. Fisher’s Exact test was used to identify factors associated with high knowledge levels. Results A total of 103 questionnaires were completed by various healthcare personnel. The most-frequently scored category was ‘intermediate knowledge’, which was scored by 40.8% (42/103), followed by ‘good knowledge’ with 28.2% (29/103) and ‘poor knowledge’ with 21.4% (22/103) of participating healthcare workers, respectively. ‘Excellent knowledge’ was achieved by 9.7% (10/103) of the interviewees. Apart from the profession, education level, type of employing healthcare facility, as well as former training on tuberculosis were significantly associated with high knowledge scores. Attitudes were generally positive towards tuberculosis infection control efforts. Of note, healthcare workers reported that infection control measures were not consistently practiced; 72.8% (75/103) of the participants were scared of becoming infected with tuberculosis, and 98.1% saw a need for improvement of local tuberculosis control. Conclusions The survey results lead to the assumption that healthcare workers in the Moyen-Ogooué province are at high risk to become infected with tuberculosis. There is an urgent need for improvement of tuberculosis infection control training for local healthcare personnel, particularly for less trained staff such as assistant nurses. Furthermore, the lack of adequate infection control measures reported by staff could possibly be correlated with a lack of adequate facility structures and protective equipment and requires further investigation.

Implementation status of national tuberculosis infection control guidelines in Bangladeshi hospitals

In response to the World Health Organization (WHO) recommendation to reduce healthcare workers’ (HCWs’) exposure to tuberculosis (TB) in health settings, congregate settings, and households, the national TB control program of Bangladesh developed guidelines for TB infection prevention and control (IPC) in 2011. This study aimed to assess the implementation of the TB IPC healthcare measures in health settings in Bangladesh. Between February and June 2018, we conducted a mixed-method study at 11 health settings. The team conducted 59 key-informant interviews with HCWs to understand the status of and barriers impeding the implementation of the TB IPC guidelines. The team also performed a facility assessment survey and examined TB IPC practices. Most HCWs were unaware of the national TB IPC guidelines. There were no TB IPC plans or committees at the health settings. Further, a presumptive pulmonary TB patient triage checklist was absent in all health settings. However, during facility assessment, we observed patient triaging and separation in the TB specialty hospitals. Routine cough-etiquette advice was provided to the TB patients mentioned during the key-informant interviews, which was consistent with findings from the survey. This study identified poor implementation of TB IPC measures in health settings. Limited knowledge of the guidelines resulted in poor implementation of the recommendations. Interventions focusing on the dissemination of the TB IPC guidelines to HCWs along with regular training may improve compliance. Such initiatives should be taken by hospital senior leadership as well as national policy makers.