Abstract
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.
Highlights
Qualitative studies, which have a greater capacity to probe health workers’ experience, reveal a perception among health workers of a disproportionate focus on individual-level personal protections, N95 respirators [24]; an experience of powerlessness [29]; habituation to TB risk or a sense of fatalism [26]; and difficulty in understanding patients and securing patient cooperation with infection prevention and control (IPC) [21,28,31]. The objectives of this piece are to argue for a comprehensive occupational health approach to the problem of TB in health workers, and to reflect on what such an approach adds to the prospects for improved prevention and practice
Extent to which opportunities are provided for the views and experiences of and advocacy health workers to be raised to influence the organisation of healthcare
A little more downstream, we recently used the WHO health systems framework from an occupational health perspective to explore the perceptions of key informants within the South African health system of barriers to protection of health workers from TB [38]
Summary
High rates of tuberculosis (TB) in the populations of low- and middle-income countries (LMICs) are associated with high rates of latent TB infection (LTBI) and TB disease in health workers [1,2,3]. Recent guidelines, have employed the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) rating framework for public health and clinical recommendations which includes other sources of information and judgements—a balance of benefits and disadvantages, values and preferences, and resource requirements [13,20]. This enables “low quality” evidence on effect size to contribute to a “moderate”. Qualitative studies, which have a greater capacity to probe health workers’ experience, reveal a perception among health workers of a disproportionate focus on individual-level personal protections, N95 respirators [24]; an experience of powerlessness [29]; habituation to TB risk or a sense of fatalism [26]; and difficulty in understanding patients and securing patient cooperation with IPC [21,28,31]
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