Abstract
BackgroundChallenges exist regarding TB infection control and TB in hospital-based healthcare workers in South Africa. However, few studies report on TB in non-hospital based healthcare workers such as primary or community healthcare workers. Our objectives were to investigate the implementation of TB infection control measures at primary healthcare facilities, the smear positive TB incidence rate amongst primary healthcare workers and the association between TB infection control measures and all types of TB in healthcare workers.MethodsOne hundred and thirty three primary healthcare facilities were visited in five provinces of South Africa in 2009. At each facility, a TB infection control audit and facility questionnaire were completed. The number of healthcare workers who had had TB during the past three years was obtained.ResultsThe standardised incidence ratio of smear positive TB in primary healthcare workers indicated an incidence rate of more than double that of the general population. In a univariable logistic regression, the infection control audit score was significantly associated with reported cases of TB in healthcare workers (OR=1.04, 95%CI 1.01-1.08, p=0.02) as was the number of staff (OR=3.78, 95%CI 1.77-8.08). In the multivariable analysis, the number of staff remained significantly associated with TB in healthcare workers (OR=3.33, 95%CI 1.37-8.08).ConclusionThe high rate of TB in healthcare workers suggests a substantial nosocomial transmission risk, but the infection control audit tool which was used did not perform adequately as a measure of this risk. Infection control measures should be monitored by validated tools developed and tested locally. Different strategies, such as routine surveillance systems, could be used to evaluate the burden of TB in healthcare workers in order to calculate TB incidence, monitor trends and implement interventions to decrease occupational TB.
Highlights
The World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) have proposed practical low cost interventions to reduce nosocomial transmission of Mycobacterium tuberculosis in resource limited settings [1,2]
A case series from KwaZulu-Natal in South Africa [9] reported the psychosocial impact of drug resistant TB on five human immunodeficiency virus (HIV) negative doctors who, after they recovered from their illness and because of their disease experience, had minimal or no involvement with TB patients
Our results indicate that (i) occupational TB is concerning amongst primary healthcare workers and (ii) the audit tool did not perform as expected as a measure of nosocomial transmission risk since we found inverse associations, in other words the presence of nosocomial transmission risk was associated with better infection control measures
Summary
The World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) have proposed practical low cost interventions to reduce nosocomial transmission of Mycobacterium tuberculosis in resource limited settings [1,2]. Evidence from systematic reviews reinforces the need to design and implement simple, effective and affordable TB infection control measures in healthcare facilities [3,4,5]. Such measures conserve resources in terms of direct and indirect costs and reduce the TB burden [1]. Other studies reported poor infection control measures at primary healthcare facilities [14] and TB hospitals admitting drug resistant cases [15]. Infection control measures should be monitored by validated tools developed and tested locally Different strategies, such as routine surveillance systems, could be used to evaluate the burden of TB in healthcare workers in order to calculate TB incidence, monitor trends and implement interventions to decrease occupational TB
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