Preventing Occupational Tuberculosis in Health Workers: An Analysis of State Responsibilities and Worker Rights in Mozambique

Exploring the Role of Healthcare Personnel in Designing Tuberculosis Infection Prevention and Control Measures in Healthcare Settings: A Scoping Review

Background: Healthcare personnel (HCP) in high TB-burdened countries continue to be at high risk of occupational TB due to inadequate implementation of Tuberculosis Infection Prevention and Control (TB-IPC) measures and a lack of understanding of the context and relevance to local settings. Such transmission in the healthcare workplace has prompted the development and dissemination of numerous guidelines for strengthening TB-IPC for use in settings globally. However, a lack of involvement of healthcare personnel in the conceptualisation and development of guidelines and programmes seeking to improve TB-IPC in high-burden countries generally has been observed. Objectives: The aim of this review was to explore the inclusion of HCP in decision-making when designing the TB-IPC guidelines, in healthcare settings. Methods: A scoping review methodology was selected for this study to gain insight into the relevant research evidence, identifying and mapping key elements in the TB-IPC measures in relation to HCP as implementors. Results: Studies in this review refer to factors related to HCP's knowledge of TB-IPC, perception regarding occupational risks and behaviours, their role against a background of structural resource constraints, and guidelines' adherence. They report several challenges in TB-IPC implementation and adherence, particularly eliciting recommendations from HCP for improved TB-IPC practices. Conclusions: This review highlights a lack of participation in decision-making by the implementers of the policies and guidelines, yet adherence to TB-IPC measures is anticipated. Future research needs to focus more on consultations with users to understand the preferences from both within individual healthcare facilities and the communities. There is an urgent need for research on the participation of the implementers in the decision-making when developing TB-IPC policies and guidelines.

Systematizing Information Use to Address Determinants of Health Worker Health in South Africa: A Cross-sectional Mixed Method Study

Background

Recognizing that access to safe and healthy working conditions is a human right, the World Health Organization (WHO) calls for specific occupational safety and health (OSH) programs for health workers (HWs). The WHO health systems' building blocks, and the International Labour Organization (ILO), highlight the importance of information as part of effective systems. This study examined how OSH stakeholders access, use, and value an occupational health information system (OHIS).

Methods

A cross-sectional survey of OSH stakeholders was conducted as part of a larger quasi experimental study in four teaching hospitals. The study hospitals and participants were purposefully selected and data collected using a modified questionnaire with both closed and open-ended questions. Quantitative analysis was conducted and themes identified for qualitative analysis. Ethics approval was provided by the University of Pretoria and University of British Columbia.

Results

There were 71 participants comprised of hospital managers, health and safety representatives, trade unions representatives and OSH professionals. At least 42% reported poor accessibility and poor timeliness of OHIS for decision-making. Only 50% had access to computers and 27% reported poor computer skills. When existing, OHIS was poorly organized and needed upgrades, with 85% reporting the need for significant reforms. Only 45% reported use of OHIS for decision-making in their OSH role.

Conclusion

Given the gap in access and utilization of information needed to protect worker's rights to a safe and healthy workplace, more attention is warranted to OHIS development and use as well as education and training in South Africa and beyond.

Assessing Medical Students' Preferences for Rural Internships Using a Discrete Choice Experiment: A Case Study of Medical Students in a Public University in the Western Cape

As new graduates are crucial in providing healthcare services in rural areas, this study aimed to identify and describe the rural facility attributes that attract medical students to apply for rural internships. A literature review and focus groups informed a discrete choice experiment conducted amongst graduating medical students at one public university in South Africa. One main effect using a mixed logit model and another main effect plus interaction model was estimated. Females (130/66.33%) of urban origin (176/89.80%) with undergraduate exposure to rural facilities (110/56.12%) were the majority. The main effects only model showed advanced practical experience, hospital safety, correctly fitting personal protective equipment, and the availability of basic resources were the strongest predictors of rural internship uptake. Respondents were willing to forgo 66% of rural allowance (ZAR 2645.92, 95% CI: 1345.90; 3945.94) for a facility offering advanced practical experience. In contrast, increased rural allowance and housing provision were weak predictors of rural work uptake. Based on the interaction model, females and those not intending to specialise preferred hospital safety compared to advanced practical experience. To improve internship recruitment, rural facility managers should provide staff with supervision, safety, and protection from occupational exposure to contractible illnesses.

Roles and challenges of nurses in tuberculosis care in Africa: A narrative review

Nurses form the bulk of the health care workforce in Africa although their roles and challenges in tuberculosis (TB) care are not well documented. In this article we discuss roles and challenges of nurses in TB care in Africa. Nurses in Africa are key in TB prevention, diagnosis, treatment initiation, treatment monitoring, and evaluation and documentation of TB treatment outcomes. However, there is little involvement of nurses in TB-related research and policy. Challenges faced by nurses in TB care mostly relate to poor working conditions that compromise their occupational safety and mental health. There is need to expand nursing school curricula on TB to equip nurses with broad skills required for the wide repertoire of roles. Nurses should be equipped with research skills and funding opportunities for nurse-led TB research projects should be easily accessible. Occupational safety of nurses through infrastructural modification of TB units, provision of personal protective equipment and ensuring access to compensation in case a nurse develops active TB is important. Nurses also need psychosocial support given the complexity of caring for people with TB.

Clinical diagnosis, treatment, and medical identification of specific pulmonary infection in naval pilots: Four case reports

BACKGROUND

Specific pulmonary infection could seriously threaten the health of pilots and their companions. The consequences are serious. We investigated the clinical diagnosis, treatment, and medical identification of specific pulmonary infections in naval pilots.

CASE SUMMARY

We analyzed the medical waiver and clinical data of four pilots with specific pulmonary infections, who had accepted treatment at the Naval Medical Center of Chinese People’s Liberation Army between January 2020 and November 2021, including three cases of tuberculosis and one of cryptococcal pneumonia. All cases underwent a series of comprehensive treatment courses. Three cases successfully obtained medical waiver for flight after being cured, while one was grounded after reaching the maximum flight life after being cured.

CONCLUSION

Chest computed tomography scanning should be used instead of chest radiography in pilots’ physical examination. Most pilots with specific pulmonary infection can be cured and return to flight.

Health worker experiences of implementing TB infection prevention and control: A qualitative evidence synthesis to inform implementation recommendations

Implementation of TB infection prevention and control (IPC) measures in health facilities is frequently inadequate, despite nosocomial TB transmission to patients and health workers causing harm. We aimed to review qualitative evidence of the complexity associated with implementing TB IPC, to help guide the development of TB IPC implementation plans. We undertook a qualitative evidence synthesis of studies that used qualitative methods to explore the experiences of health workers implementing TB IPC in health facilities. We searched eight databases in November 2021, complemented by citation tracking. Two reviewers screened titles and abstracts and reviewed full texts of potentially eligible papers. We used the Critical Appraisals Skills Programme checklist for quality appraisal, thematic synthesis to identify key findings and the GRADE-CERQual method to appraise the certainty of review findings. The review protocol was pre-registered on PROSPERO, ID CRD42020165314. We screened 1062 titles and abstracts and reviewed 102 full texts, with 37 studies included in the synthesis. We developed 10 key findings, five of which we had high confidence in. We describe several components of TB IPC as a complex intervention. Health workers were influenced by their personal occupational TB risk perceptions when deciding whether to implement TB IPC and neglected the contribution of TB IPC to patient safety. Health workers and researchers expressed multiple uncertainties (for example the duration of infectiousness of people with TB), assumptions and misconceptions about what constitutes effective TB IPC, including focussing TB IPC on patients known with TB on treatment who pose a small risk of transmission. Instead, TB IPC resources should target high risk areas for transmission (crowded, poorly ventilated spaces). Furthermore, TB IPC implementation plans should support health workers to translate TB IPC guidelines to local contexts, including how to navigate unintended stigma caused by IPC, and using limited IPC resources effectively.

Current Guidelines for Protecting Health Workers from Occupational Tuberculosis Are Necessary, but Not Sufficient: Towards a Comprehensive Occupational Health Approach

Health workers globally are at elevated occupational risk of tuberculosis infection and disease. While a raft of guidelines have been published over the past 25 years on infection prevention and control (IPC) in healthcare, studies in different settings continue to show inadequate implementation and persistence of risk. The aim of this commentary is to argue, based on the literature and our own research, that a comprehensive occupational health approach is an essential complement to IPC guidelines. Such an approach includes a health system framework focusing on upstream or mediating components, such as a statutory regulation, leadership, an information system, and staff trained in protective disciplines. Within the classical prevention framework, primary prevention needs to be complemented by occupational health services (secondary prevention) and worker's compensation (tertiary prevention). A worker-centric approach recognises the ethical implications of screening health workers, as well as the stigma perceived by those diagnosed with tuberculosis. It also provides for the voiced experience of health workers and their participation in decision-making. We argue that such a comprehensive approach will contribute to both the prevention of occupational tuberculosis and to the ability of a health system to withstand other crises of infectious hazards to its workforce.