Tuberculosis infection control measures and knowledge in primary health centres in Bandung, Indonesia

Background Health care workers (HCWs) in low- and middle-income countries (LMICs) continue to have an unacceptably high prevalence and incidence of Mycobacterium tuberculosis infection due to high exposure to tuberculosis (TB) cases at health care facilities and often inadequate infection control measures. This can contribute to an increased risk of transmission not only to HCWs themselves but also to patients and the general population. Aim We assessed implementation of TB infection control measures in primary health centres (PHCs) in Bandung, Indonesia, and TB knowledge among HCWs. Methods A cross-sectional study was conducted between May and November 2017 amongst a stratified sample of the PHCs, and their HCWs, that manage TB patients in Bandung. Questionnaires were used to assess TB infection control measures plus HCW knowledge. Summary statistics, linear regression and the Kruskal–Wallis test were used for analysis. Results The median number of TB infection control measures implemented in 24 PHCs was 21 of 41 assessed. Only one of five management controls was implemented, 15 of 24 administrative controls, three of nine environmental controls and one of three personal respiratory protection controls. PHCs with TB laboratory facilities and high TB case numbers were more likely to implement TB infection control measures than other PHCs ( p=0.003). In 398 HCWs, the median number of correct responses for knowledge was 10 (IQR 9–11) out of 11. Discussion HCWs had good TB knowledge. TB infection control measures were generally not implemented and need to be strengthened in PHCs to reduce M. tuberculosis transmission to HCWs, patients and visitors.

Tuberculosis infection control measures in healthcare facilities in Moyen-Ogooué Province, Gabon

Background Healthcare workers (HCW) are at higher risk of tuberculosis (TB) than the general population. We assessed healthcare facilities for their TB infection control standards and priorities. Methods A standardised tool was applied. The assessment was conducted by direct observation, documents review and interviews with the facility heads. Results Twenty healthcare facilities were assessed; 17 dispensaries, an HIV-clinic, a private not-for-profit hospital and a public regional hospital. In both hospitals, outpatient departments, internal medicine wards, paediatric wards, emergency departments; and the MDR-TB unit of the public regional hospital were assessed. In Gabon, there are currently no national guidelines for TB infection control (TBIC) in healthcare settings. Consequently, none of the facilities had an infection control plan or TBIC focal point. In three departments of two facilities (2/20 facilities), TB patients and presumed TB cases were observed to be consistently provided with surgical masks. One structure reported to regularly test some of its personnel for TB. Consultation rooms were adequately ventilated in six primary care level facilities (6/17 dispensaries) and in none of the hospitals, due to the use of air conditioning. Adequate personal protective equipment was not provided regularly by the facilities and was only found to be supplied in the MDR-TB unit and one of the paediatric wards. Conclusions In Moyen-Ogooué province, implementation of TBIC in healthcare settings is generally low. Consequently, HCW are not sufficiently protected and therefore at risk for M. tuberculosis infection. There is an urgent need for national TBIC guidelines and training of health workers to safeguard implementation.

Combined assessment of tuberculosis case notification rate and infection control at health facilities of Dale districts, Sidama Zone, Southern Ethiopia

Background Mycobacterium tuberculosis (TB) is the deadliest disease that claims millions of deaths globally. Ethiopia is among the countries heavily hit by the disaster. Despite the effective directly observed treatment and TB infection control (TBIC) measures provided by the world health organization (WHO), the rate of new cases increased daily throughout the country. Healthcare workers (HCWs) are at highest risk serving without having the necessary facility in place while overcrowding of patients exacerbated TB transmission. The study aimed to assess TBIC implementation and analyze case notification rate (CNR) of smear-positive pulmonary TB in the selected health facilities at Dale district, Sidama Zone, Southern Ethiopia. Methods Seven health care facilities have been visited in the study area and smear-positive pulmonary TB notification rate was determined retrospectively during the years 2012 to 2014. Data on smear positive test results and demographic characteristics were collected from the TB unit registries. A structured questionnaire, facility survey, and observation checklists were used to assess the presence of TBIC plans at the health care facilities. Results The overall case notification rate of smear-positive pulmonary tuberculosis was 5.3% among all 7696 TB suspected patients. The odds of being diagnosed with smear-positive TB were 24% more in males than in females (adj OR = 1.24, 95% CI: (1.22, 1.55). Moreover, in the study area, only 28% of the facilities have been practiced TB infection control and 71% of the facilities assigned a focal person for the TBIC plan. The implementation of environmental control measures in the facilities was ranged between 16–83%. N95 particulate respirators were found only in 14% of the facilities. Conclusion TB CNR in Dale district was low. Moreover, implementations of TBIC in Dale district health facilities were poor when the survey was done. Hence, urgent measures should be taken to reverse the burden of TB.

Knowledge, Attitude, and Practices on Drug-Resistant Tuberculosis Infection Control in Nepal: A Cross-Sectional Study

Drug-resistant tuberculosis (DR-TB) transmission is an important problem, particularly in low-income settings. This study is aimed at assessing the knowledge, attitude, and practices of DR-TB infection control among the healthcare workers under the National Tuberculosis Control Program in Nepal. In this cross-sectional study, we studied the healthcare workers from all the 11 functioning DR-TB treatment centers across Nepal in March 2018. Through face-to-face interviews, trained data collectors collected data on the characteristics of healthcare workers, their self-reported knowledge, attitude, and practice on DR-TB infection control. We entered the data in Microsoft Excel and analyzed in the R statistical software. We assigned a score of one to the correct response and zero to the incorrect or no response and calculated a composite score in each of the knowledge, attitude, and practice domains. We ascertained the healthcare workers as having good knowledge, appropriate attitude, and optimal practices when the composite score was ≥50%. We summarized the numerical variables with median (interquartile range (IQR)) and the categorical variables with proportions. We ran appropriate correlation tests to identify relationships between knowledge, attitude, and practice scores. We regarded a p value of <0.05 as significant. A total of 95 out of 102 healthcare workers responded. There were 46 male respondents. The median age was 33 years (IQR 26-42). Most of them (53, 55.79%) were midlevel paramedics. We found 91 (95.79%) respondents had good knowledge, 49 (51.58%) had an appropriate attitude, and 35 (36.84%) had optimal practices on DR-TB infection control. We found a statistically significant positive correlation between attitude and practice scores ( ρ = 0.37 , p ≤ 0.001 ). The healthcare workers at the DR-TB treatment centers in Nepal have good knowledge of DR-TB infection control, but it did not translate into an appropriate attitude or optimal practices.

Improving “Fast” Indicators of TB Infection Control through Targeted Health Workers Training; Findings from Facility Based Studies in Abia State, Nigeria

Aim: The aim of this study was to assess the effect of health workers training and implementation of the FAST strategy on the “FAST” indicators at Abia State University Teaching Hospital (ABSUTH); a tertiary referral facility. ”FAST” strategy; a focused approach to stopping TB spread in congregate settings developed by TB Care1 stands for Finding TB cases Actively, Separating safely, and Treating effectively. Study Design: This was a facility based interventional study using control group design methods with ABSUTH as the intervention facility while Federal Medical Centre Umuahia (FMCU) was the control. Methodology: Health workers (74 across cadres; doctors, nurses, laboratory scientist and medical record staff) selected through stratified random sampling were trained to ensure daily cough surveillance and screening for TB among patients at the General outpatient, medical wards and HIV clinic of ABSUTH under supervision of a “FAST” focal person.Baseline “Fast Indicators” in the facility TB records of newly diagnosed TB patients 3 months before and 3 months after the training intervention were obtained. Results: At baseline the “FAST” strategy indicators recorded in the study facility include time to diagnosis > 1 week, time to treatment 3.5 days, presumptive TB cases 92, number of cases commenced on treatment were 22 while presumptive DRTB cases was 0.33. This study observed a significant positive difference in all the “FAST” indicators following the intervention. Time to diagnosis decreased by 52%, time to treatment decreased by 17% while the number of presumptive TB cases increased by over 100%. Number of TB cases diagnosed also increased by 100% as well as the cases commenced on treatment by 91%, while number of diagnosed DRTB cases increased by over 100%.These were all statistically significant ( P=.013,.03, .032, and .049 except time to treatment P= 0.053). Conclusion: The training intervention on ‘FAST” strategy of TB infection Control significantly improved FAST Indicators in the intervention facility with attendant reduction in diagnostic delays and increased case notification.

Tuberculosis Exposure and Conversion Rates Can Guide Deimplementation of Annual Tuberculosis Screening

Background: The CDC recently updated recommendations on tuberculosis (TB) screening in healthcare facilities, suggesting the discontinuation of annual TB screening. However, hospitals may opt to continue based on their local TB epidemiology. We assessed TB infection control parameters in our facility to guide the implementation of the new CDC recommendations. Methods:We retrieved data for patients with an International Classification of Disease, Tenth Revision (ICD-10) code for TB treated at the University of Iowa Hospitals and Clinics during 2016–2019. We supplemented our search with microbiology data: culture or PCR for Mycobacterium tuberculosis. Based on manual chart review, we adjudicated each patient as active TB, latent TB, previously treated TB, unclear history, or no TB. We further labeled active TB cases based on their risk of transmission (pulmonary or extrapulmonary cases that underwent an aerosol generating procedure). We then calculated the number of exposure events associated with those patients and tuberculin skin test (TST) conversion rates among the exposed. Results: During 2016–2019, we identified 197 patients based on ICD-10 codes. In total, 10 additional patients were detected by microbiology data review. Of these 207 patients, 48 (23.2%) had active TB: lung, n = 24 (50%); lymph node, n = 9 (19%); bone or spine, n = 5 (10%); eye, n = 3 (6%); disseminated, n = 2 (4%); pleura, n = 2 (4%); skin abscess, n = 2 (4%); and meningitis, n = 1 (2%). Of the 24 pulmonary patients, 6 (25%) had either a positive smear or a cavity on imaging. In total, 159 patients were excluded: no TB, n = 22 (14%); latent TB, n = 27 (17%); old or treated TB, n = 93 (58%); and unclear history, n = 9 (6%). Of the 48 cases with active TB, 31 (65%) were deemed potentially infectious. Also, 10 cases (32%) led to the exposure of 204 healthcare workers (HCWs). Baseline and postexposure TST were available for 179 HCWs (88%); 72 (35%) followed up in the employee health clinic within the 8–12 weeks after exposure. Of 161 HCWs with a negative TST at baseline, no conversions occurred. Of 18 HCWs with positive TST at baseline, no HCW developed symptoms during the observation period. Conclusions: Nearly one-third of infectious TB cases led to HCW exposures in a low-incidence setting. However, no TST conversions or active TB infections were seen. Exposure and conversion rates are useful indicators of TB infection control in healthcare facilities and may help guide implementation of the new CDC TB control recommendations.Funding: NoneDisclosures: None

TB Infection Control in TB/HIV Settings in Cross River State, Nigeria: Policy Vs Practice

TB and HIV remain a dangerous duo of significant public health concern across the globe. Both diseases require significant community and health system activities to be successfully managed. TB infection control is an important disease prevention strategy among the general population and among people living with HIV, in cost and management. We undertook to assess the situation of TB infection control at three levels of health care in Cross River State of Nigeria. A qualitative method was used to assess TB infection control (TBIC) knowledge, attitudes, and practices of the health care workers at each of the purposefully selected facilities using a semi-structured questionnaire - University of Calabar Teaching hospital, Calabar; Infectious disease Hospital, Calabar and primary Health Centre, Calabar Municipal, between 15th to 31st November, 2019 in the first phase, and an extension to February, 2020 due to delayed ethical clearance from the University of Calabar Teaching hospital. Data was collected and entered on an excel template and cleaned by trained data entry clerks. Charts and color diagrams were developed to compare specific descriptive data. There is wide variation between the written policies of TB infection control and the practices among health workers. Even though there are strong administrative protocols to support TB infection control in the higher levels of care, it is better practiced in the lower level PHC where the protocols were not spelt out.

Airborne infection control for TB in healthcare settings: it’s time to act

Globally, an estimated 10.0 million people were affected by TB in 2018 with India leading with 27% incidence. Ending the TB epidemic by 2030 is among the health targets of the Sustainable Development Goals set by WHO. Unsuspected TB cases contribute to TB transmission because they may go unsuspected for weeks, and may visit multiple health-care facilities or be admitted indoors to non-isolation wards hence posing threat to Health care workers (HCW) who are at high risk for both latent TB and TB infection when compared to general community population. The TB infection control program should be followed by the hospitals which should include Administrative measures, Environmental measures and Personal protective measures. Health-care worker (HCW) education, training and capacity building on TB infection is an essential part of a TB infection control program. Standard precautions should be taken for maintaining TB laboratory, proper management of accidents/spillages and appropriate methods of waste handling and disposal. Effective infection control in health care workers integrated approach at National, State, Local health officials and Hospital administrative levels are required for effective tackling infection to health care workers along with political commitment and leadership at all the levels. Finally, TB infection control programs can have secondary benefits with infection control in general, which, if improved, could also prevent other infectious diseases that may be nosocomially transmitted.