Infection control in hospitals managing drug-resistant tuberculosis in Pakistan: how are we doing?

Assesses the implementation of TB infection control practices and reasons for non-adherence to guidelines

From:: Department for International Development
Published: 21 March 2017

Country:: Pakistan
Document Type:: Journal Article
Theme:: Health
Authors:: Waheed, Y, Khan, M.A., Fatima, R, Yaqoob, A, Mirza, A, Qadeer, E, Shakeel, M, Heldal. E, Kumar, A.M.V.

Abstract

Setting

10 hospitals managing drug-resistant tuberculosis (TB) in Pakistan.

Objective

To assess the implementation of TB infection control (IC) practices and reasons for non-adherence to guidelines.

Design

This was a descriptive study conducted between April and October 2016 with three components: 1) non-participant observation of service delivery areas (SDAs) (n = 82) in hospitals (n = 10) using structured checklists; 2) exit interviews with 100 patients (10 per hospital); and 3) interviews with 100 health-care workers (HCWs, 10/hospital).

Results

Of the 82 SDAs, posters were displayed in 34 (41%), mechanical ventilation was implemented in 79% and functional ultraviolet germicidal irradiation (UVGI) was available in only 26%. Patient interviews showed 50–65% adherence to triage and use of personal protective measures. Key reasons for non-adherence were lack of adequate supplies, discomfort using N-95 masks, a lack of knowledge or training, perceived non-cooperation by patients, poor maintenance of mechanical ventilators and UVGI due to unstable electricity supply, a lack of clarity in roles (no-one designated in charge) and staff shortages and subsequent workloads. Adherence to natural ventilation usage was poor for reasons related to climate and privacy.

Conclusion

Implementation of TBIC measures in hospitals was suboptimal. Urgent measures need to be put in place, including retraining of HCWs, addressing weaknesses in mask and poster supplies and constant supervision and monitoring.

This research was supported by the UK Department for International Development’s Operational Research Capacity Building Programme led by the International Union Against TB and Lung Disease (The Union)

Citation

Waheed Y, Khan MA, Fatima R, Yaqoob A, Mirza A, Qadeer E, Shakeel M, Heldal E, Kumar AMV. Infection control in hospitals managing drug-resistant tuberculosis in Pakistan: how are we doing? Public Health Action. 2017; 7(1):26–31.