BACKGROUND: The importance of infection control (IC) in health care settings with tuberculosis (TB) patients has been highlighted by recent health care-associated outbreaks in South Africa. OBJECTIVE: To conduct operational evaluations of IC in drug-resistant TB settings at a national level. METHODS: A cross-sectional descriptive study was conducted from June to September 2009 in all multidrug-resistant (MDR-TB) and extensively drug-resistant TB (XDR-TB) facilities in South Africa. Structured interviews with key informants were completed, along with observation of IC practices. Health care workers (HCWs) were asked to complete an anonymous knowledge, attitudes and practices (KAP) questionnaire. Multilevel modeling was used to take into consideration the relationship between center and HCW level variables. RESULTS: Twenty-four M(X)DR-TB facilities (100%) were enrolled. Facility infrastructure and staff adherence to IC recommendations were highly varied between facilities. Key informant interviews were incongruent with direct observation of practices in all settings. A total of 499 HCWs were enrolled in the KAP evaluation. Higher level of clinical training was associated with greater IC knowledge (P < 0.001), more appropriate attitudes (P < 0.001) and less time spent with coughing patients (P < 0.001). IC practices were poor across all disciplines. CONCLUSION: These findings demonstrate a clear need to improve and standardize IC infrastructure in drug-resistant TB settings in South Africa.
BACKGROUND: The importance of infection control (IC) in health care settings with tuberculosis (TB) patients has been highlighted by recent health care-associated outbreaks in South Africa. OBJECTIVE: To conduct operational evaluations of IC in drug-resistant TB settings at a national level. METHODS: A cross-sectional descriptive study was conducted from June to September 2009 in all multidrug-resistant (MDR-TB) and extensively drug-resistant TB (XDR-TB) facilities in South Africa. Structured interviews with key informants were completed, along with observation of IC practices. Health care workers (HCWs) were asked to complete an anonymous knowledge, attitudes and practices (KAP) questionnaire. Multilevel modeling was used to take into consideration the relationship between center and HCW level variables. RESULTS: Twenty-four M(X)DR-TB facilities (100%) were enrolled. Facility infrastructure and staff adherence to IC recommendations were highly varied between facilities. Key informant interviews were incongruent with direct observation of practices in all settings. A total of 499 HCWs were enrolled in the KAP evaluation. Higher level of clinical training was associated with greater IC knowledge (P < 0.001), more appropriate attitudes (P < 0.001) and less time spent with coughing patients (P < 0.001). IC practices were poor across all disciplines. CONCLUSION: These findings demonstrate a clear need to improve and standardize IC infrastructure in drug-resistant TB settings in South Africa.
Authors: M L Moro; I Errante; A Infuso; L Sodano; A Gori; C A Orcese; G Salamina; C D'Amico; G Besozzi; L Caggese Journal: Int J Tuberc Lung Dis Date: 2000-01 Impact factor: 2.373
Authors: Michael K Leonard; Kathleen B Egan; Ekaterina Kourbatova; Nancy White; Patricia Parrott; Carlos Del Rio; Henry M Blumberg Journal: Am J Infect Control Date: 2006-03 Impact factor: 2.918
Authors: Julie Jarand; Karen Shean; Max O'Donnell; Marian Loveday; Charlotte Kvasnovsky; Martie Van der Walt; Shahieda Adams; Paul Willcox; Justin O'Grady; Alimuddin Zumla; Keertan Dheda Journal: Trop Med Int Health Date: 2010-10 Impact factor: 2.622
Authors: Neel R Gandhi; Anthony Moll; A Willem Sturm; Robert Pawinski; Thiloshini Govender; Umesh Lalloo; Kimberly Zeller; Jason Andrews; Gerald Friedland Journal: Lancet Date: 2006-11-04 Impact factor: 79.321
Authors: Max R O'Donnell; Julie Jarand; Marian Loveday; Nesri Padayatchi; Jennifer Zelnick; Lise Werner; Kasavan Naidoo; Iqbal Master; Garth Osburn; Charlotte Kvasnovsky; Karen Shean; Madhukar Pai; Martie Van der Walt; Charles R Horsburgh; Keertan Dheda Journal: Ann Intern Med Date: 2010-10-19 Impact factor: 25.391
Authors: Sanjay Basu; Jason R Andrews; Eric M Poolman; Neel R Gandhi; N Sarita Shah; Anthony Moll; Prashini Moodley; Alison P Galvani; Gerald H Friedland Journal: Lancet Date: 2007-10-27 Impact factor: 79.321
Authors: Jason R Andrews; Neel R Gandhi; Prashini Moodley; N Sarita Shah; Louise Bohlken; Anthony P Moll; Manormoney Pillay; Gerald Friedland; A Willem Sturm Journal: J Infect Dis Date: 2008-12-01 Impact factor: 5.226
Authors: N Sarita Shah; Sara C Auld; James C M Brust; Barun Mathema; Nazir Ismail; Pravi Moodley; Koleka Mlisana; Salim Allana; Angela Campbell; Thuli Mthiyane; Natashia Morris; Primrose Mpangase; Hermina van der Meulen; Shaheed V Omar; Tyler S Brown; Apurva Narechania; Elena Shaskina; Thandi Kapwata; Barry Kreiswirth; Neel R Gandhi Journal: N Engl J Med Date: 2017-01-19 Impact factor: 91.245
Authors: Palwasha Y Khan; Tom A Yates; Muhammad Osman; Robin M Warren; Yuri van der Heijden; Nesri Padayatchi; Edward A Nardell; David Moore; Barun Mathema; Neel Gandhi; Vegard Eldholm; Keertan Dheda; Anneke C Hesseling; Valerie Mizrahi; Roxana Rustomjee; Alexander Pym Journal: Lancet Infect Dis Date: 2018-12-13 Impact factor: 25.071
Authors: Jason E Farley; Timothy F Landers; Catherine Godfrey; Virginia Lipke; Jeremy Sugarman Journal: J Acquir Immune Defic Syndr Date: 2014-01-01 Impact factor: 3.731
Authors: Jennifer R Zelnick; Andrew Gibbs; Marian Loveday; Nesri Padayatchi; Max R O'Donnell Journal: J Public Health Policy Date: 2013-05-30 Impact factor: 2.222
Authors: C Emerson; V Lipke; N Kapata; N Mwananyambe; A Mwinga; M Garekwe; S Lanje; Y Moshe; S L Pals; A K Nakashima; B Miller Journal: Int J Tuberc Lung Dis Date: 2016-07 Impact factor: 2.373