Malik M Parmar1, K S Sachdeva2, Kiran Rade3, Mayank Ghedia3, Avi Bansal4, Sharath Burugina Nagaraja5, Matthew D Willis6, Dyson P Misquitta7, Sreenivas A Nair3, Patrick K Moonan6, Puneet K Dewan8. 1. National Professional Officer - Drug Resistant TB, World Health Organization - Country Office for India, New Delhi, India. Electronic address: parmarm@who.int. 2. Central TB Division, Ministry of Health and Family Welfare, New Delhi, India. 3. World Health Organization - Country Office for India, New Delhi, India. 4. National JALMA Institute for Leprosy & Other Mycobacterial Diseases, Agra, India. 5. Department of Community Medicine, ESIC Medical College & PGIMSR, Bangalore, India. 6. U.S Centers for Disease Control, Atlanta, USA. 7. Doctoral Scholar, Tata Institute of Social Sciences, Mumbai, India. 8. Bill & Milanda Gates Foundation, India Country Office, India.
Abstract
BACKGROUND: Tuberculosis transmission in health care settings represents a major public health problem. In 2010, national airborne infection control (AIC) guidelines were adopted in India. These guidelines included specific policies for TB prevention and control in health care settings. However, the feasibility and effectiveness of these guidelines have not been assessed in routine practice. This study aimed to conduct baseline assessments of AIC policies and practices within a convenience sample of 35 health care settings across 3 states in India and to assess the level of implementation at each facility after one year. METHOD: A multi-agency, multidisciplinary panel of experts performed site visits using a standardized risk assessment tool to document current practices and review resource capacity. At the conclusion of each assessment, facility-specific recommendations were provided to improve AIC performance to align with national guidelines. RESULT: Upon initial assessment, AIC systems were found to be poorly developed and implemented. Administrative controls were not commonly practiced and many departments needed renovation to achieve minimum environmental standards. One year after the baseline assessments, there were substantial improvements in both policy and practice. CONCLUSION: A package of capacity building and systems development that followed national guidelines substantially improved implementation of AIC policies and practice.
BACKGROUND: Tuberculosis transmission in health care settings represents a major public health problem. In 2010, national airborne infection control (AIC) guidelines were adopted in India. These guidelines included specific policies for TB prevention and control in health care settings. However, the feasibility and effectiveness of these guidelines have not been assessed in routine practice. This study aimed to conduct baseline assessments of AIC policies and practices within a convenience sample of 35 health care settings across 3 states in India and to assess the level of implementation at each facility after one year. METHOD: A multi-agency, multidisciplinary panel of experts performed site visits using a standardized risk assessment tool to document current practices and review resource capacity. At the conclusion of each assessment, facility-specific recommendations were provided to improve AIC performance to align with national guidelines. RESULT: Upon initial assessment, AIC systems were found to be poorly developed and implemented. Administrative controls were not commonly practiced and many departments needed renovation to achieve minimum environmental standards. One year after the baseline assessments, there were substantial improvements in both policy and practice. CONCLUSION: A package of capacity building and systems development that followed national guidelines substantially improved implementation of AIC policies and practice.
Keywords:
Airborne Infection Control (AIC); Health Care Facilities (HCF); India; Revised National Tuberculosis Control Program (RNTCP); Tuberculosis (TB)
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