Examining pulmonary TB patient management and healthcare workers exposures in two public tertiary care hospitals, Bangladesh

Abstract

Implementation of tuberculosis (TB) infection prevention and control (IPC) guidelines in public tertiary care general hospitals remain challenging due to limited evidence of pulmonary TB (PTB) patients’ duration of hospital stay and management. To fill this evidence gap, this study examined adult PTB patient management, healthcare workers’ (HCWs) exposures and IPC practices in two public tertiary care hospitals in Bangladesh.Between December 2017 and September 2019, a multidisciplinary team conducted structured observations, a hospital record review, and in-depth interviews with hospital staff from four adult medicine wards.Over 20 months, we identified 1,200 presumptive TB patients through the hospital record review, of whom 263 were confirmed PTB patients who stayed in the hospital, a median of 4.7 days without TB treatment and possibly contaminated the inpatients wards. Over 141 observation hours, we found a median of 3.35 occupants present per 10 m2 of floor space and recorded a total of 17,085 coughs and 316 sneezes: a median of 3.9 coughs or sneezes per 10 m2 per hour per ward. Only 8.4% of coughs and 21% of sneezes were covered by cloths, paper, tissues, or by hand. The HCWs reportedly could not isolate the TB patients due to limited resources and space and could not provide them with a mask. Further, patients and HCWs did not wear any respirators.The study identified that most TB patients stayed in the hospitals untreated for some duration of time. These PTB patients frequently coughed and sneezed without any facial protection that potentially contaminated the ward environment and put everyone, including the HCWs, at risk of TB infection. Interventions that target TB patients screening on admission, isolation of presumptive TB patients, respiratory hygiene, and HCWs’ use of personal protective equipment need to be enhanced and evaluated for acceptability, practicality and scale-up.

Improving Nurses’ Knowledge, Practice, and Self-Efficacy Regarding Caring Patients with Tuberculosis: A Quasi-Experimental Design

“…The data collection tools included tool 1, composed of Part (1): Demographic variables of nurses – nurses’, age, gender, level of education, years of experience, and training courses about care. Part 2: Knowledge assessment of nurses – a self-administered knowledge questionnaire developed based on relevant literature[ 20 , 20 , 21 , 22 , 23 ] and by adapting content from related studies[ 7 , 10 ] to assess nurses’ knowledge. The knowledge section contained 39 questions subdivided into six items: risk factors and causative factors questions (4 questions), symptom and TB diagnosis (12 questions), multidrug-resistant TB (6 questions), appropriate nutrition (4 questions), treatment and side effects (3 questions), and infection control (9 questions).…”

“…Patient self-efficacy can significantly contribute to improved outcomes and disease management, such as through improved medication compliance, seeking care,[ 7 ] preventive risk behaviors,[ 8 ] and gaining improved health consequences through these specific actions. [ 9 , 10 ] Thus, self-efficacy has been a main factor in designing interventions to progress patients’ illness management. [ 11 ] Even though TB is treatable, it has proved difficult to eradicate, and the number of drug-resistant cases has risen.…”