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Devaleenal Daniel B, Baskaran A, D B, Mercy H, C P. Addressing the challenges in implementing airborne infection control guidelines and embracing the policies. Indian J Tuberc 2023; 70:460-467. [PMID: 37968052 DOI: 10.1016/j.ijtb.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 03/29/2023] [Indexed: 11/17/2023]
Abstract
Airborne pathogens not only lead to epidemics and pandemics, but are associated with morbidity and mortality. Administrative or managerial control, environmental control and use of personal protective equipments are the three components in airborne infection control. National and international guidelines for ideal airborne infection control (AIC) practices are available for more than a decade; however the implementation of these need to be looked into, challenges identified and addressed for effective prevention of airborne disease transmission. Commitment of multiple stakeholders from policy makers to patients, budget allocation and adequate fund flow, functioning AIC committees at multiple levels with an inbuilt reporting and monitoring mechanism, adaptation of the AIC practices at various health care levels, supportive supervision, training and ongoing education for health care providers, behaviour change communication to patients to adapt the practices at health care facility level, by health care personnel and patients will facilitate health system preparedness for handling any emergencies, but will also help in reducing the burden of persisting airborne diseases such as tuberculosis. Operational research in this least focused area will also help to identify and address the challenges.
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Affiliation(s)
- Bella Devaleenal Daniel
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis, 1, Mayor Satyamoorthy Road, Chetpet, Chennai, 600031, Tamil Nadu, India
| | - Abinaya Baskaran
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis, 1, Mayor Satyamoorthy Road, Chetpet, Chennai, 600031, Tamil Nadu, India
| | - Baskaran D
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis, 1, Mayor Satyamoorthy Road, Chetpet, Chennai, 600031, Tamil Nadu, India
| | - Hephzibah Mercy
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis, 1, Mayor Satyamoorthy Road, Chetpet, Chennai, 600031, Tamil Nadu, India
| | - Padmapriyadarsini C
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis, 1, Mayor Satyamoorthy Road, Chetpet, Chennai, 600031, Tamil Nadu, India.
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Talukdar R, Sahu SK, Rajaram M. Implementation Status of Airborne Infection Control Measures in Primary and Secondary Public Health Facilities, Puducherry: A Mixed-Methods Study. Indian J Community Med 2023; 48:483-491. [PMID: 37469915 PMCID: PMC10353669 DOI: 10.4103/ijcm.ijcm_196_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 04/19/2023] [Indexed: 07/21/2023] Open
Abstract
Background Poor ventilation in healthcare settings is a concern for airborne infections, particularly in light of the potential for coronavirus disease 2019 (COVID-19) transmission. This study aimed to assess the implementation status of airborne infection control (AIC) measures in primary and secondary public healthcare facilities (HCFs) and to explore the facilitating factors and barriers in the implementation of AIC measures. Methods A mixed-methods approach was adopted, which includes a cross-sectional descriptive study using a checklist to collect data on the implementation of AIC measures in 22 primary and two secondary public HCFs in Puducherry, South India, between October 2020 and February 2021. Further, key informant interviews (KIIs) were conducted among medical officers (MOs). The qualitative data were manually analyzed, and transcripts created from handwritten notes and audio recordings were deductively evaluated. Results Of the twenty-four health facilities visited, 54.2% had infection control (IC) committees. Annual IC training was held for housekeeping staff, MOs, nurses, and laboratory technicians in 23 (95.8%), 21 (87.5%), 20 (83.4%), and 14 (58.4%) facilities, respectively. Respiratory symptomatic patients were counseled on cough etiquettes in 22 (91.6%) facilities. Adequate cross-ventilation was present in outpatient departments in 16 (66.6%) institutions. N95 masks and face shields were provided in 21 (87.5%) facilities. Training through the KAYAKALP program and the presence of a separate sputum collection area were facilitators of IC, while lack of patient adherence and delays in fund release were found as barriers. Conclusion Overall, the AIC measures were well-implemented, but improvements are needed in infrastructure development for patient segregation in outpatient departments and dedicated AIC training for all healthcare personnel.
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Affiliation(s)
- Rounik Talukdar
- Department of Preventive and Social Medicine, JIPMER, Puducherry, India
| | | | - Manju Rajaram
- Department of Pulmonary Medicine, JIPMER, Puducherry, India
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Shah R, Khakhkhar T, Modi B. Efficacy and Safety of Different Drug Regimens for Tuberculosis Preventive Treatment: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e38182. [PMID: 37252497 PMCID: PMC10224701 DOI: 10.7759/cureus.38182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2023] [Indexed: 05/31/2023] Open
Abstract
Tuberculosis prevention treatment (TPT) is crucial to the eradication of tuberculosis (TB). Through a comprehensive review and meta-analysis, we compared the efficacy and safety of different TPT regimens. We searched PubMed, Google Scholar, and medrxiv.org with search terms Tuberculosis Preventive Treatment, TPT, efficacy, safety, and drug regimens for TPT and all RCT, irrespective of age, setting, or co-morbidities, comparing at least one TPT regimen to placebo, no therapy, or other TPT regimens were screened and those reporting either efficacy or safety or both were included. The meta-analysis data were synthesized with Review Manager and the risk ratio (RR) was calculated. Out of 4465 search items, 15 RCTs (randomized-controlled trials) were included. The TB infection rate was 82/6308 patients in the rifamycin plus isoniazid group (HR) as compared to 90/6049 in the isoniazid monotherapy (H) group (RR: 0.89 (95% CI: 0.66, 1.19; p=0.43). A total of 965/6478 vs 1065/6219 adverse drug reactions (ADRs) occurred in HR and H groups respectively (RR: 0.86 (95%CI: 0.80 0.93); P<0.0001). Efficacy analysis of the rifampicin plus pyrazinamide (RZ) vs H showed that the risk ratio of infection rate was not considerably varied (RR: 0.97 (95% CI: 0.47, 2.03); P=0.94). Safety analysis showed in 229/572 patients developed ADRs in rifampicin plus pyrazinamide as compared to 129/600 ADRs in the isoniazid group. (RR: 1.87 (95% CI: 1.44, 2.43)). Safety analysis of only rifamycin (R) vs H group showed 23/718 ADRs in R vs 57/718 ADRs in H group (RR: 0.40 (95% CI: 0.25 0.65); P=0.0002). Rifamycin plus isoniazid (3HP/R) has no edge over other regimens in terms of efficacy but this regimen was found significantly safer as compared to any other regimens used for TPT. Rifampicin plus pyrazinamide (RZ) was found equally efficacious but less safe as compared to other regimens.
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Affiliation(s)
- Rima Shah
- Department of Pharmacology, All India Institute of Medical Sciences, Rajkot, Rajkot, IND
| | - Tejas Khakhkhar
- Department of Pharmacology, Gujarat Medical and Education Research Society (GMERS) Medical College, Porbandar, IND
| | - Bhavesh Modi
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rajkot, Rajkot, IND
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Devaleenal DB, Jeyapal L, Thiruvengadam K, Giridharan P, Velayudham B, Krishnan R, Baskaran A, Mercy H, Dhanaraj B, Chandrasekaran P. Holistic Approach to Enhance Airborne Infection Control Practices in Health Care Facilities Involved in the Management of Tuberculosis in a Metropolitan City in India - An Implementation Research. WHO South East Asia J Public Health 2023; 12:38-44. [PMID: 37843179 DOI: 10.4103/who-seajph.who-seajph_128_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Background Airborne infection control (AIC) is a less focused aspect of tuberculosis (TB) prevention. We describe AIC practices in primary health care centres, awareness and practices of AIC among health care providers (HCPs) and TB patients. We implemented a package of interventions to improve awareness and practices among them and assessed its impact. Methodology The study used a quasi-experimental study design. A semi-structured checklist was used for health facility assessment and a self-administered questionnaire of HCPs. Pre- and postintervention assessments were made in urban primary health centers (UPHCs), HCPs, and patients. Interventions included sharing facility-specific recommendations, AIC plans and guidelines, HCP training, and patient education. Statistical difference between the two time periods was assessed using the Chi-square test. Results A total of 23 and 25 UPHCs were included for pre- and postintervention assessments. All 25 centers participated in interventions. Open areas were >20% of ground area in all facilities. No AIC committee was present in any of the facilities at both pre- and postintervention. Of all HCPs, 7% (23/337) versus 65% (202/310) had undergone AIC training. Good awareness improved from 24% (81/337) to 71% (220/310) after intervention (P < 0.001). Appropriate cough hygiene was known to 20% (51/262) versus 58% (152/263) patients at two assessments (P < 0.001). Conclusion Comprehensive intervention, including supportive supervision of health centers, training of HCPs, and patient education, can improve AIC practices.
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Affiliation(s)
- Daniel Bella Devaleenal
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Lavanya Jeyapal
- Programme Officer, NTEP, Greater Chennai Corporation, Chennai, Tamil Nadu, India
| | - Kannan Thiruvengadam
- Department of Epid. Statistics, ICMR-National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Prathiksha Giridharan
- Department of Epidemiology, ICMR-National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Banurekha Velayudham
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Rajendran Krishnan
- Department of Epid. Statistics, ICMR-National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Abinaya Baskaran
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Hephzibah Mercy
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Baskaran Dhanaraj
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
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RP3MES: A Key to Minimize Infection Spreading. TRANSACTIONS OF THE INDIAN NATIONAL ACADEMY OF ENGINEERING 2022; 7:809-821. [PMID: 35836616 PMCID: PMC9001167 DOI: 10.1007/s41403-022-00328-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 03/16/2022] [Indexed: 11/17/2022]
Abstract
Healthcare facilities, especially in highly populated countries like India where patient to doctor ratio is very high, are under a huge burden. Thus, Remote Patient Physiological Parameter Monitoring using Embedded System (RP3MES) becomes essential to monitor a large number of people admitted in hospitals and also patients afflicted with infectious diseases. The design for RP3MES addresses the key issues of portability, cost-effectiveness, low power consumption, user-friendliness, high accuracy and remote communication to facilitate vital parameter(s), like heart rate and body temperature, measurements and emergency notification, keeping in mind, the health of the caregiver(s). ARM Cortex M3 embedded processor and low-cost sensors are used to achieve the cost-effectiveness and low power consumption. Alarming unit intimidates a remote caregiver regarding their patient’s health condition. The accuracy of the system measured data is 99.4% compared with the gold standard, which has been verified using Lin’s Concordance Correlation Coefficient and Bland–Altman analysis. A comparison of our system with other commercially available ones is also presented here. The proposed system has wireless connectivity which minimizes infection transmission among family members and caregivers of the patients. It may also reduce the burden on healthcare staffs in hospitals.
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Nimavat N, Hasan MM, Charmode S, Mandala G, Parmar GR, Bhangu R, Khan I, Singh S, Agrawal A, Shah A, Sachdeva V. COVID-19 pandemic effects on the distribution of healthcare services in India: A systematic review. World J Virol 2022; 11:186-197. [PMID: 36159611 PMCID: PMC9372784 DOI: 10.5501/wjv.v11.i4.186] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/19/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has brought fundamental changes to our problems and priorities, especially those related to the healthcare sector. India was one of the countries severely affected by the harsh consequences of the COVID-19 pandemic.
AIM To understand the challenges faced by the healthcare system during a pandemic.
METHODS The literature search for this review was conducted using PubMed, EMBASE, Scopus, Web of Science, and Google Scholar. We also used Reference Citation Analysis (RCA) to search and improve the results. We focused on the published scientific articles concerned with two major vital areas: (1) The Indian healthcare system; and (2) COVID-19 pandemic effects on the Indian healthcare system.
RESULTS The Indian healthcare system was suffering even before the pandemic. The pandemic has further stretched the healthcare services in India. The main obstacle in the healthcare system was to combat the rising number of communicable as well as noncommunicable diseases. Besides the pandemic measures, there was a diversion of focus of the already established healthcare services away from the chronic conditions and vaccinations. The disruption of the vaccination services may have more severe short and long-term consequences than the pandemic’s adverse effects.
CONCLUSION Severely restricted resources limited the interaction of the Indian healthcare system with the COVID-19 pandemic. Re-establishment of primary healthcare services, maternal and child health services, noncommunicable diseases programs, National Tuberculosis Elimination Program, etc. are important to prevent serious long-term consequences of this pandemic.
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Affiliation(s)
- Nirav Nimavat
- Department of Community Medicine, Dr. Kiran C Patel Medical College and Research Institute, Bharuch 392001, India
| | - Mohammad Mehedi Hasan
- Department of Biochemistry and Molecular Biology, Mawlana Bhashani Science and Technology University, Tangail 1902, Bangladesh
| | - Sundip Charmode
- Department of Anatomy, All India Institute of Medical Sciences, Rajkot 360006, Gujarat, India
| | - Gowthamm Mandala
- Independent Researcher, Centre Groove High School, Greenwood, IN 46143, United States
| | | | - Ranvir Bhangu
- Department of Medical, Caribbean Medical University, Des Plaines, IL 60018, United States
| | - Israr Khan
- Shifa International Hospital, Islamabad 999010, Pakistan
| | - Shruti Singh
- Department of Pharmacology, All India Institute of Medical Sciences, Patna 801507, India
| | - Amit Agrawal
- Department of Paediatrics, Gandhi Medical College, Bhopal 462001, India
| | - Ashish Shah
- Department of Pharmacy, Sumandeep Vidyapeeth, Vadodara 391760, India
| | - Vishi Sachdeva
- Department of Medical, Adesh Institute of Medical Sciences and Research, Bathinda 151009, India
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Singh R. Public Health Issue of Indoor Dilution Ventilation for Disease Prevention Versus PM2.5 in Intake Air in Auditoriums of Premier Engineering Institutes in India. Cureus 2022; 14:e25258. [PMID: 35755566 PMCID: PMC9217168 DOI: 10.7759/cureus.25258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Dilution ventilation by enhancing fresh air intake has been prescribed to reduce airborne infection spread during the COVID-19 pandemic. This is all the more important in assembly spaces like auditoriums. Premier technology institutes have large campuses with large auditoriums for academic and cultural events in India. These institutes serve as role models for society, where gatherings are essential, but there is also the possibility of transmission of all airborne respiratory infections, including tuberculosis, into the community. The fresh air taken in should also be filtered for pollution to prevent other lung issues. Aims: Fresh air intake and filtration have been studied in order to understand whether the outside air supplied indoors is filtered for PM2.5, which is a major ambient polluter in India. Settings and design/methods: In this study, the Right to Information Act of 2005 has been used to obtain first-hand information from the institutes with respect to the heating, ventilation, and air conditioning (HVAC) systems in their auditoriums. Twelve of the 19 institutes fall in cities with non-attainment of ambient air quality standards. Results: Eleven out of all those had recently integrated fresh air supply, and six replied in the negative. Only one out of all of them had appropriate filters. Conclusion: This study highlights the need for a possible trade-off between the use of air conditioners for thermal comfort + assumed protection against PM2.5, which is the switching off of air conditioners and manually opening up windows and using fans for ventilation. Indian HVAC design for gathering spaces, especially educational institutes, needs to factor in fresh air for dilution ventilation as well as PM2.5 filtration.
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Singh R. The Risk Status of Waiting Areas for Airborne Infection Control in Delhi Hospitals. Cureus 2022; 14:e23211. [PMID: 35444905 PMCID: PMC9012110 DOI: 10.7759/cureus.23211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 11/08/2022] Open
Abstract
Background Hospital waiting areas are overlooked from the airborne infection control viewpoint as they are not classified as critical for infection control. This is the area where undiagnosed and potentially infected patients gather with susceptible and vulnerable patients, and there is no mechanism to segregate the two, especially when the potentially infected visitors/patients themselves are unaware of the infection or may be asymptomatic. It is important to know whether hospitals in Delhi, a populated, low-resource setting having community transmission/occurrence of airborne diseases such as tuberculosis, consider waiting areas as critical. Hence, this study aims to determine whether hospitals in Delhi consider waiting areas as critical areas from the airborne infection control viewpoint. Methodology The Right to Information Act, 2005, was used to request information from 11 hospitals included in this study. Results After compiling the results, it was found that five out of the 11 hospitals did not consider waiting areas as critical from the infection spread point of view. Two of the 11 hospitals acknowledged the criticality of waiting areas but did not include the same in the list of critical areas. Only three out of the 11 considered waiting areas as critical and included these in the list of critical areas in a hospital. Conclusions This study provided evidence that most hospitals in Delhi do not include waiting areas in the list of critical areas in a hospital.
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Kaushal P, Sangwan G, Rana K, Biswal M, Kaur M, Lakshmi P. Implementation status of national airborne infection control guidelines in the health care facilities of a North Indian State: A mixed method study. PUBLIC HEALTH IN PRACTICE 2021; 2:100149. [PMID: 36101590 PMCID: PMC9461529 DOI: 10.1016/j.puhip.2021.100149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/19/2021] [Accepted: 05/25/2021] [Indexed: 11/30/2022] Open
Abstract
Objective Healthcare-acquired infection (HCAIs), have become a significant cause of morbidity as well as mortality among the hospitalized patients and health care workers. The implementation of air-borne infection control measures play an important role in prevention of health care acquired infections (HCAIs). Hence, this study was planned to assess the implementation status of National Airborne Infection Control Guidelines in the health care settings of a North Indian State. Study design A mixed method study was planned in all the 13 health facilities of Himachal Pradesh having both the Anti-Retroviral Therapy (ART) Centre and Directly observed Treatment Short course (DOTS) for TB center in the same facility. Methods The implementation of airborne infection control measures was evaluated using a Standardized Health Care Facility Airborne Infection Risk Assessment Tool and an observational checklist. In-depth interviews are conducted with hospital staff. At all health facilities, risk assessment and implementation of airborne infection control was evaluated by using a pretested semi-structured questionnaire. The qualitative data was analyzed manually and transcripts prepared from hand written notes and audio tape records were analyzed thematically. Results Only 5 out of 13 health facilities were having specially designated airborne infection control committee. The incidence of tuberculosis among hospital staff was 2.32% at secondary level health care facilities and 0.35% at tertiary care level health facilities. Among the tuberculosis cases, maximum were nursing staff (59.5%) as compared to other categories of health care workers. Improper functioning of health care system and individual factors were main reasons for deficiencies in the implementation of air-borne infection control measures. Conclusion The health care facilities were not implementing the infection control measure to the fullest both at secondary and tertiary care health facilities. There is a need to set up the surveillance of airborne infections in the hospital and especially the passive surveillance of tuberculosis among health care workers. The implementation of airborne infection control measures was evaluated by using standardized tools and checklist. In-depth interviews were conducted with the hospital staff. There were gaps in implementation at all the three levels i.e. administrative, environmental and individual levels. There is a need to set up the surveillance of air borne infections in the hospitals. Passive surveillance of tuberculosis among health care workers should be implemented.
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Paleckyte A, Dissanayake O, Mpagama S, Lipman MC, McHugh TD. Reducing the risk of tuberculosis transmission for HCWs in high incidence settings. Antimicrob Resist Infect Control 2021; 10:106. [PMID: 34281623 PMCID: PMC8287104 DOI: 10.1186/s13756-021-00975-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 07/06/2021] [Indexed: 11/10/2022] Open
Abstract
Globally, tuberculosis (TB) is a leading cause of death from a single infectious agent. Healthcare workers (HCWs) are at increased risk of hospital-acquired TB infection due to persistent exposure to Mycobacterium tuberculosis (Mtb) in healthcare settings. The World Health Organization (WHO) has developed an international system of infection prevention and control (IPC) interventions to interrupt the cycle of nosocomial TB transmission. The guidelines on TB IPC have proposed a comprehensive hierarchy of three core practices, comprising: administrative controls, environmental controls, and personal respiratory protection. However, the implementation of most recommendations goes beyond minimal physical and organisational requirements and thus cannot be appropriately introduced in resource-constrained settings and areas of high TB incidence. In many low- and middle-income countries (LMICs) the lack of knowledge, expertise and practice on TB IPC is a major barrier to the implementation of essential interventions. HCWs often underestimate the risk of airborne Mtb dissemination during tidal breathing. The lack of required expertise and funding to design, install and maintain the environmental control systems can lead to inadequate dilution of infectious particles in the air, and in turn, increase the risk of TB dissemination. Insufficient supply of particulate respirators and lack of direction on the re-use of respiratory protection is associated with unsafe working practices and increased risk of TB transmission between patients and HCWs. Delayed diagnosis and initiation of treatment are commonly influenced by the effectiveness of healthcare systems to identify TB patients, and the availability of rapid molecular diagnostic tools. Failure to recognise resistance to first-line drugs contributes to the emergence of drug-resistant Mtb strains, including multidrug-resistant and extensively drug-resistant Mtb. Future guideline development must consider the social, economic, cultural and climatic conditions to ensure that recommended control measures can be implemented in not only high-income countries, but more importantly low-income, high TB burden settings. Urgent action and more ambitious investments are needed at both regional and national levels to get back on track to reach the global TB targets, especially in the context of the COVID-19 pandemic.
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Affiliation(s)
- Ana Paleckyte
- UCL Centre for Clinical Microbiology, Division of Infection & Immunity, UCL, London, UK
| | | | - Stella Mpagama
- Kibong'oto Infectious Diseases Hospital, Kilimanjaro, Tanzania
| | - Marc C Lipman
- UCL Respiratory, Division of Medicine, UCL, London, UK
| | - Timothy D McHugh
- UCL Centre for Clinical Microbiology, Division of Infection & Immunity, UCL, London, UK.
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Zwama G, Diaconu K, Voce AS, O'May F, Grant AD, Kielmann K. Health system influences on the implementation of tuberculosis infection prevention and control at health facilities in low-income and middle-income countries: a scoping review. BMJ Glob Health 2021; 6:bmjgh-2020-004735. [PMID: 33975887 PMCID: PMC8118012 DOI: 10.1136/bmjgh-2020-004735] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/20/2021] [Accepted: 04/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background Tuberculosis infection prevention and control (TB-IPC) measures are consistently reported to be poorly implemented globally. TB-IPC guidelines provide limited recognition of the complexities of implementing TB-IPC within routine health systems, particularly those facing substantive resource constraints. This scoping review maps documented system influences on TB-IPC implementation in health facilities of low/middle-income countries (LMICs). Methods We conducted a systematic search of empirical research published before July 2018 and included studies reporting TB-IPC implementation at health facility level in LMICs. Bibliometric data and narratives describing health system influences on TB-IPC implementation were extracted following established methodological frameworks for conducting scoping reviews. A best-fit framework synthesis was applied in which extracted data were deductively coded against an existing health policy and systems research framework, distinguishing between social and political context, policy decisions, and system hardware (eg, information systems, human resources, service infrastructure) and software (ideas and interests, relationships and power, values and norms). Results Of 1156 unique search results, we retained 77 studies; two-thirds were conducted in sub-Saharan Africa, with more than half located in South Africa. Notable sociopolitical and policy influences impacting on TB-IPC implementation include stigma against TB and the availability of facility-specific TB-IPC policies, respectively. Hardware influences on TB-IPC implementation referred to availability, knowledge and educational development of staff, timeliness of service delivery, availability of equipment, such as respirators and masks, space for patient separation, funding, and TB-IPC information, education and communication materials and tools. Commonly reported health system software influences were workplace values and established practices, staff agency, TB risk perceptions and fears as well as staff attitudes towards TB-IPC. Conclusion TB-IPC is critically dependent on health system factors. This review identified the health system factors and health system research gaps that can be considered in a whole system approach to strengthen TB-IPC practices at facility levels in LMICs.
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Affiliation(s)
- Gimenne Zwama
- Institute for Global Health and Development, School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | - Karin Diaconu
- Institute for Global Health and Development, School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | - Anna S Voce
- Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Fiona O'May
- Institute for Global Health and Development, School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | - Alison D Grant
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK.,Africa Health Research Institute, School of Laboratory Medicine & Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Karina Kielmann
- Institute for Global Health and Development, School of Health Sciences, Queen Margaret University, Edinburgh, UK
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Islam MS, Chughtai AA, Banu S, Seale H. Context matters: Examining the factors impacting the implementation of tuberculosis infection prevention and control guidelines in health settings in seven high tuberculosis burden countries. J Infect Public Health 2021; 14:588-597. [PMID: 33848888 DOI: 10.1016/j.jiph.2021.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 01/12/2021] [Accepted: 01/31/2021] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Healthcare workers (HCWs) in high tuberculosis (TB) burden countries are at increased risk of TB infection due to increased exposures to TB patients and inadequate implementation of TB infection prevention and control (TB IPC) measures in health settings. While various guidelines on TB IPC exist, there is little understanding of the content of these guidelines, whether they are relevant to the context and are being appropriately implemented in low-and middle-income high TB burden countries. This study aimed to critically examine the implementation of TB IPC guidelines, along with factors impacting TB IPC implementation in health settings in seven high TB burden countries. METHODS The WHO 2009 and national level TB IPC guidelines and the published literature from seven TB high burden countries were reviewed and relevant information extracted. Eleven key-stakeholders from the case study countries were interviewed to elucidate further facilitators and barriers impacting TB IPC guidelines implementation. RESULTS Our study identified that all the study countries adopted the WHO 2009 guidelines with no or minimal modifications for the local context. Therefore, the subsequent translation of the TB IPC recommendations into practice has been limited and impaired in some settings. Poor infrastructure, inadequate space for isolation, lack of TB IPC training, limited supply of personal protective equipment, the discomfort of using N95 respirators, and a high number of TB patients were some of the factors impacting the implementation of TB IPC guidelines. CONCLUSION The implementation of TB IPC guidelines in all seven countries was limited. It was affected by the diverse context where each of the countries and each of the facilities had a different health infrastructure and TB disease burdens. The findings warrant re-assessment of the current context prevailing in these high TB burden countries and subsequent revisions of national guidelines based to account for local context and evidence.
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Affiliation(s)
- M Saiful Islam
- School of Public Health and Community Medicine, University of New South Wales, Room 212, Samuels Building, Sydney, Australia; Program on Emerging Infections, Infectious Diseases Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b).
| | - Abrar Ahmad Chughtai
- School of Public Health and Community Medicine, University of New South Wales, Room 212, Samuels Building, Sydney, Australia
| | - Sayera Banu
- Program on Emerging Infections, Infectious Diseases Division, Infectious Diseases Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b)
| | - Holly Seale
- School of Public Health and Community Medicine, University of New South Wales, Room 212, Samuels Building, Sydney, Australia
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Behera D, Praveen D, Behera MR. Protecting Indian health workforce during the COVID-19 pandemic. J Family Med Prim Care 2020; 9:4541-4546. [PMID: 33209760 PMCID: PMC7652162 DOI: 10.4103/jfmpc.jfmpc_925_20] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/19/2020] [Accepted: 08/03/2020] [Indexed: 12/14/2022] Open
Abstract
Rapidly growing rate of infection among health workers during the current COVID-19 pandemic, is posing a serious challenge to global health systems. Lately, India is also witnessing an intensifying COVID-19 disease burden and its impact on health workers. This paper aims to discuss the challenges to health worker protection in India and the possible ways forward. Given the inadequate and unequally distributed healthcare workforce, it is highly essential for the country to strategize prompt measures for ensuring occupational health and safety of its health workers. Information for this paper were gathered by searching PubMed and Google Scholar databases using “COVID-19”, “Infection Control”, “Health worker”, “India” as search keywords in different combinations. In addition, websites of Government of India, relevant UN agencies and leading news agencies were also searched manually for related reports and publications. India must take timely measures in rapid manufacturing and procurement of essential personal protective equipment (PPE) to ensure adequate stockpiling to meet the rising demands. Comprehensive and repeated training with sharply focussed content including usage of PPE kits as well as active surveillance of adherence to recommended protocol are critical in protecting health workers especially the primary care physicians and frontline health staff from the deadly COVID-19 infection. The provision of psychological and financial support for health workers and their families is absolutely critical in building trust and dedicated work efforts by the health workforce for a continuous fight against the deadly disease.
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Affiliation(s)
- Deepanjali Behera
- School of Public Health, Asian Institute of Public Health (AIPH) University, Bhubaneswar, Odisha, India
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Islam MS, Chughtai AA, Seale H. Reflecting on the updates to the World Health Organisation 2019 Tuberculosis Infection Control Guidelines through the lens of a low-income/high TB burden country. J Infect Public Health 2020; 13:1057-1060. [PMID: 32241724 DOI: 10.1016/j.jiph.2020.02.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/17/2019] [Accepted: 02/05/2020] [Indexed: 11/18/2022] Open
Abstract
Hospital-acquired tuberculosis infection among healthcare workers is a global concern due to the increased attributable risk of tuberculosis infection among this group. To reduce healthcare workers' exposure to airborne Mycobacterium tuberculosis, various policies and guidelines have been developed and updated by the World Health Organisation (WHO) since 1999. In March 2019, the WHO published the updated tuberculosis infection control guidelines. It had previously been suggested that the existence of multiple guidelines and the changes in the contents across versions may confuse end-users and challenge the implementation. With this issue in mind, we examined the updated WHO 2019 TB infection control guidelines. The WHO 2019 updated guideline is a shorter and more focused document that includes more of the evidence from published systematic reviews for TB infection prevention and control. The guidelines focus on implementing TB infection control as an integrated infection control and prevention 'package'. However, a few key elements have been omitted or integrated with other WHO policies that were previously included in the guidelines, many of which are also still present in other international and in many national level TB infection control guidelines. In this commentary, we highlighted the inconsistencies in the different versions of the guidelines, the challenges that the high TB burden and low-income countries may face while implementing the guidelines and some factors that may be considered in the future guidelines. The arguments we made have important implications for tuberculosis infection control strategy development and implementation in low-income and high TB burden countries.
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Affiliation(s)
- M Saiful Islam
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Kensington, Australia.
| | - Abrar Ahmad Chughtai
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Kensington, Australia
| | - Holly Seale
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Kensington, Australia
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15
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Raj A, Ramakrishnan D, Thomas CRMT, Mavila AD, Rajiv M, Suseela RPB. Assessment of Health Facilities for Airborne Infection Control Practices and Adherence to National Airborne Infection Control Guidelines: A Study from Kerala, Southern India. Indian J Community Med 2019; 44:S23-S26. [PMID: 31728084 PMCID: PMC6824168 DOI: 10.4103/ijcm.ijcm_25_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 09/03/2019] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Nosocomial transmission of airborne infections, such as H1N1, drug-resistant tuberculosis, and Nipah virus disease, has been reported recently and has been linked to the limited airborne infection control strategies. The objective of the current study was to assess the health facilities for airborne infection control (AIC) practices and adherence to the National AIC (NAIC) guidelines, 2010. MATERIALS AND METHODS A cross-sectional study was conducted in 25 public and 25 private hospitals selected from five randomly selected districts in the state of Kerala. A checklist with 62 components was developed based on the NAIC guidelines. Frequencies, percentages, and mean with standard deviation were used to summarize facility risk assessment and compliance to guidelines. RESULTS Most of the facilities had infection control committees 35 (70%). Annual infection control trainings were held for staff in 21 (42%) facilities. Twenty (40%) facilities were not familiar with NAIC guidelines. Counseling on cough etiquette at registration was practiced in 5 (10%) institutions. Cross ventilation was present in outpatient departments in 27 (54%) institutions. Sputum was disposed properly in 43 (86%) institutions. N95 masks were available in high-risk settings in 7 (14%) health facilities. CONCLUSION There exist deficiencies in adherence to all components of NAIC guidelines including administrative, environmental, and use of personal protective equipment in both government and private hospitals in the state.
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Affiliation(s)
- Arun Raj
- Department of Community Medicine and Public Health, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Devraj Ramakrishnan
- Department of Community Medicine and Public Health, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | | | - Amrita Das Mavila
- Department of Community Medicine and Public Health, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Midhun Rajiv
- Department of Community Medicine and Public Health, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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16
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Moonan PK, Nair SA, Agarwal R, Chadha VK, Dewan PK, Gupta UD, Ho CS, Holtz TH, Kumar AM, Kumar N, Kumar P, Maloney SA, Mase SR, Oeltmann JE, Paramasivan CN, Parmar MM, Rade KK, Ramachandran R, Rao R, Salhorta VS, Sarin R, Sarin S, Sachdeva KS, Selvaraju S, Singla R, Surie D, Tonsing J, Tripathy SP, Khaparde SD. Tuberculosis preventive treatment: the next chapter of tuberculosis elimination in India. BMJ Glob Health 2018; 3:e001135. [PMID: 30364389 PMCID: PMC6195150 DOI: 10.1136/bmjgh-2018-001135] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 01/07/2023] Open
Abstract
The End TB Strategy envisions a world free of tuberculosis—zero deaths, disease and suffering due to tuberculosis by 2035. This requires reducing the global tuberculosis incidence from >1250 cases per million people to <100 cases per million people within the next two decades. Expanding testing and treatment of tuberculosis infection is critical to achieving this goal. In high-burden countries, like India, the implementation of tuberculosis preventive treatment (TPT) remains a low priority. In this analysis article, we explore potential challenges and solutions of implementing TPT in India. The next chapter in tuberculosis elimination in India will require cost-effective and sustainable interventions aimed at tuberculosis infection. This will require constant innovation, locally driven solutions to address the diverse and dynamic tuberculosis epidemiology and persistent programme monitoring and evaluation. As new tools, regimens and approaches emerge, midcourse adjustments to policy and practice must be adopted. The development and implementation of new tools and strategies will call for close collaboration between local, national and international partners—both public and private—national health authorities, non-governmental organisations, research community and the diagnostic and pharmaceutical industry. Leading by example, India can contribute to global knowledge through operational research and programmatic implementation for combating tuberculosis infection.
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Affiliation(s)
- Patrick K Moonan
- Global Tuberculosis Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Reshu Agarwal
- CDC India Country Office, U.S. Centers for Disease Control and Prevention, New Delhi, India
| | - Vineet K Chadha
- Department of Epidemiology and Research, National Tuberculosis Institute, Bangalore, India
| | - Puneet K Dewan
- Global Health, Bill and Melinda Gates Foundation, Seattle, USA
| | - Umesh D Gupta
- National JALMA Institute for Leprosy and other Mycobacterial Diseases, Agra, India
| | - Christine S Ho
- CDC India Country Office, U.S. Centers for Disease Control and Prevention, New Delhi, India
| | - Timothy H Holtz
- CDC India Country Office, U.S. Centers for Disease Control and Prevention, New Delhi, India
| | - Ajay M Kumar
- Department of Research, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Nishant Kumar
- Revised National Tuberculosis Control Programme, India Ministry of Health and Family Welfare, New Delhi, India
| | | | - Susan A Maloney
- Global Tuberculosis Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sundari R Mase
- WHO India Country Office, World Health Organization, New Delhi, India
| | - John E Oeltmann
- Global Tuberculosis Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - C N Paramasivan
- India Country Office, Foundation for Innovative New Diagnostics, New Delhi, India
| | - Malik M Parmar
- India Country Office, World Health Organization, New Delhi, India
| | - Kiran K Rade
- India Country Office, World Health Organization, New Delhi, India
| | | | - Raghuram Rao
- Revised National Tuberculosis Control Programme, India Ministry of Health and Family Welfare, New Delhi, India
| | - Virendra S Salhorta
- Revised National Tuberculosis Control Programme, India Ministry of Health and Family Welfare, New Delhi, India
| | - Rohit Sarin
- National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Sanjay Sarin
- India Country Office, Foundation for Innovative New Diagnostics, New Delhi, India
| | - Kuldeep S Sachdeva
- Revised National Tuberculosis Control Programme, India Ministry of Health and Family Welfare, New Delhi, India
| | - Sriram Selvaraju
- Department of Epidemiology, National Institute for Research in Tuberculosis, Chennai, India
| | - Rupak Singla
- Department of Tuberculosis and Respiratory Diseases, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Diya Surie
- Global Tuberculosis Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jamhoih Tonsing
- South-east Asia Office, International Union Against Tuberculosis and Lung Disease, New Delhi, India
| | | | - Sunil D Khaparde
- Revised National Tuberculosis Control Programme, India Ministry of Health and Family Welfare, New Delhi, India
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Chatterjee S, Poonawala H, Jain Y. Drug-resistant tuberculosis: is India ready for the challenge? BMJ Glob Health 2018; 3:e000971. [PMID: 30116597 PMCID: PMC6089296 DOI: 10.1136/bmjgh-2018-000971] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/01/2018] [Accepted: 07/02/2018] [Indexed: 12/13/2022] Open
Affiliation(s)
- Soumya Chatterjee
- Division of Infectious Diseases, Allergy and Immunology, Saint Louis University, St Louis, Missouri, USA
| | - Husain Poonawala
- Department of Immunology, National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Yogesh Jain
- Jan Swasthya Sahyog, Ganiyari, Chhattisgarh, India
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Akshaya KM, Shewade HD, Aslesh OP, Nagaraja SB, Nirgude AS, Singarajipura A, Jacob AG. " Who has to do it at the end of the day? Programme officials or hospital authorities?" Airborne infection control at drug resistant tuberculosis (DR-TB) centres of Karnataka, India: a mixed-methods study. Antimicrob Resist Infect Control 2017; 6:111. [PMID: 29142744 PMCID: PMC5674795 DOI: 10.1186/s13756-017-0270-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 10/26/2017] [Indexed: 12/18/2022] Open
Abstract
Background Drug resistant tuberculosis (DR-TB) centers admit patients with DR-TB for initiation of treatment and thereby concentrate the patients under one setting. It becomes imperative to assess the compliance of DR-TB centres to national airborne infection control (AIC) guidelines and explore the provider perspectives into reasons for unsatisfactory compliance. Methods This mixed methods study (triangulation design) was carried out across all the six DR-TB centers of Karnataka state, India, between November 2016 and April 2017. Non-participant observation using a structured format was carried out at the DR-TB wards (n = 6), outpatient departments (n = 6), patient waiting areas outside outpatient departments (n = 6) and culture and drug susceptibility testing laboratories (n = 3). Structured interviews of admitted patients (n = 30) were done to assess the knowledge on cough hygiene and sputum disposal. Key informant interviews (KIIs) of health care providers (n = 20) were done. Manual descriptive content analysis was done to analyse the transcripts of KIIs. Results The findings related to compliance in non-participant observation were corroborated by KIIs. All the laboratories were consistently implementing the AIC guidelines. Compliance to hand hygiene, wet mopping and ventilation measures were satisfactory in four or more DR-TB wards. The non-availability of N95 masks in wards as well as outpatient departments was staggering. Sputum disposal without prior disinfection and the lack of display materials on cough hygiene and patient education was common. Patient fast tracking in outpatient department waiting areas and visitor restrictions in wards were lacking. Trainings on AIC measures were uncommon. About half and one-third of patients admitted had satisfactory knowledge regarding sputum disposal and situations demanding mask respectively. The reasons for unsatisfactory compliance to AIC guidelines were poor coordination between programme and hospital authorities leading to lack of ownership; ineffective or non-existent infection control committees; vacant posts of medical officers; and attitudes of health care delivery staff. Conclusion Compliance with AIC guidelines in DR-TB centers of Karnataka was sub-optimal. The reasons identified require urgent attention of the programme managers and hospital authorities. Electronic supplementary material The online version of this article (10.1186/s13756-017-0270-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Hemant Deepak Shewade
- International Union against Tuberculosis and Lung Diseases, South East Asia Office, New Delhi, India
| | | | | | - Abhay Subashrao Nirgude
- Department of Community Medicine, Yenepoya Medical College, Yenepoya University, Mangaluru, 575018 India
| | - Anil Singarajipura
- Department of Health and Family Welfare, Government of Karnataka, Bengaluru, India
| | - Anil G Jacob
- International Union against Tuberculosis and Lung Diseases, South East Asia Office, New Delhi, India
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Barker AK, Brown K, Siraj D, Ahsan M, Sengupta S, Safdar N. Barriers and facilitators to infection control at a hospital in northern India: a qualitative study. Antimicrob Resist Infect Control 2017; 6:35. [PMID: 28405312 PMCID: PMC5385016 DOI: 10.1186/s13756-017-0189-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/17/2017] [Indexed: 01/29/2023] Open
Abstract
Background Hospital acquired infections occur at higher rates in low- and middle-income countries, like India, than in high-income countries. Effective implementation of infection control practices is crucial to reducing the transmission of hospital acquired infections at hospitals worldwide. Yet, no comprehensive assessments of the barriers to sustained, successful implementation of hospital interventions have been performed in Indian healthcare settings to date. The Systems Engineering Initiative for Patient Safety (SEIPS) model examines problems through the lens of interactions between people and systems. It is a natural fit for investigating the behavioral and systematic components of infection control practices. Methods We conducted a qualitative study to assess the facilitators and barriers to infection control practices at a 1250 bed tertiary care hospital in Haryana, northern India. Twenty semi-structured interviews of nurses and physicians, selected by convenience sampling, were conducted in English using an interview guide based on the SEIPS model. All interview data was subsequently transcribed and coded for themes. Results Person, task, and organizational level factors were the primary barriers and facilitators to infection control at this hospital. Major barriers included a high rate of nursing staff turnover, time spent training new staff, limitations in language competency, and heavy clinical workloads. A well developed infection control team and an institutional climate that prioritizes infection control were major facilitators. Conclusions Institutional support is critical to the effective implementation of infection control practices. Prioritizing resources to recruit and retain trained, experienced nursing staff is also essential. Electronic supplementary material The online version of this article (doi:10.1186/s13756-017-0189-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna K Barker
- Department of Population Health Sciences, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI USA
| | - Kelli Brown
- Department of Population Health Sciences, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI USA
| | - Dawd Siraj
- Department of Medicine, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI USA
| | - Muneeb Ahsan
- Medanta Institute of Eduation and Research, Medanta the Medicity Hospital, Gurgaon, Haryana India
| | - Sharmila Sengupta
- Department of Clinical Microbiology & Infection Control, Medanta the Medicity Hospital, Gurgaon, Haryana India
| | - Nasia Safdar
- Department of Medicine, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI USA.,William S. Middleton Memorial Veterans Affairs Hospital, Madison, WI USA
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Nathavitharana RR, Bond P, Dramowski A, Kotze K, Lederer P, Oxley I, Peters JA, Rossouw C, van der Westhuizen HM, Willems B, Ting TX, von Delft A, von Delft D, Duarte R, Nardell E, Zumla A. Agents of change: The role of healthcare workers in the prevention of nosocomial and occupational tuberculosis. Presse Med 2017; 46:e53-e62. [PMID: 28256382 DOI: 10.1016/j.lpm.2017.01.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/04/2017] [Accepted: 01/17/2017] [Indexed: 11/29/2022] Open
Abstract
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 well-being 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 (LTBI) 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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Affiliation(s)
- Ruvandhi R Nathavitharana
- TB Proof, Cape Town, South Africa; Beth Israel Deaconess Medical Center, Division of Infectious Diseases, Boston, MA 02215, USA.
| | | | - Angela Dramowski
- TB Proof, Cape Town, South Africa; Paediatric Infectious Diseases, Stellenbosch University, Department of Paediatrics and Child Health, Cape Town, South Africa
| | - Koot Kotze
- TB Proof, Cape Town, South Africa; East London Hospital Complex, East London, South Africa
| | - Philip Lederer
- TB Proof, Cape Town, South Africa; Massachusetts General Hospital, Division of Infectious Diseases, , Boston, MA 02215, USA
| | - Ingrid Oxley
- Nelson Mandela Metropolitan University, Dietetics Division, , Port Elizabeth, South Africa
| | - Jurgens A Peters
- TB Proof, Cape Town, South Africa; London School of Hygiene and Tropical Medicine, Faculty of Infectious and Tropical Diseases, Clinical Research Department, London, UK
| | | | | | - Bart Willems
- TB Proof, Cape Town, South Africa; Stellenbosch University, Division of Community Health, Faculty of Medicine and Health Sciences, , Cape Town, South Africa
| | - Tiong Xun Ting
- TB Proof, Cape Town, South Africa; Clinical Research Center, Sarawak General Hospital, Kuching, Sarawak, Malaysia
| | - Arne von Delft
- TB Proof, Cape Town, South Africa; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, 7925 Observatory, South Africa
| | | | - Raquel Duarte
- Institute of Public Health, Porto University, EpiUnit, Portugal; Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Edward Nardell
- Brigham and Women's Hospital, Division of Global Health and Social Medicine, 02115 Boston, MA, USA
| | - Alimuddin Zumla
- TB Proof, Cape Town, South Africa; University College London, and NIHR Biomedical Research Centre, University College London Hospital, Division of Infection and Immunity, London, UK
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