Occupational Risk of Airborne Mycobacterium tuberculosis Exposure: A Situational Analysis in a Three-Tier Public Healthcare System in South Africa

Abstract

This study aimed to detect airborne Mycobacterium tuberculosis (MTB) at nine public health facilities in three provinces of South Africa and determine possible risk factors that may contribute to airborne transmission. Personal samples (n = 264) and stationary samples (n = 327) were collected from perceived high-risk areas in district, primary health clinics (PHCs) and TB facilities. Quantitative real-time (RT) polymerase chain reaction (PCR) was used for TB analysis. Walkabout observations and work practices through the infection prevention and control (IPC) questionnaire were documented. Statistical analysis was carried out using Stata version 15.2 software. Airborne MTB was detected in 2.2% of samples (13/572), and 97.8% were negative. District hospitals and Western Cape province had the most TB-positive samples and identified risk areas included medical wards, casualty, and TB wards. MTB-positive samples were not detected in PHCs and during the summer season. All facilities reported training healthcare workers (HCWs) on TB IPC. The risk factors for airborne MTB included province, type of facility, area or section, season, lack of UVGI, and ineffective ventilation. Environmental monitoring, PCR, IPC questionnaire, and walkabout observations can estimate the risk of TB transmission in various settings. These findings can be used to inform management and staff to improve the TB IPC programmes.

Assessing Medical Students’ Preferences for Rural Internships Using a Discrete Choice Experiment: A Case Study of Medical Students in a Public University in the Western Cape

“…The importance of personal protective equipment availability among medical students could be interpreted as being due to these students being trained in the Western Cape, which has the highest rates of airborne tuberculosis sampled at public health facilities in South Africa [37]. In a survey among South African medical and physiotherapy students, 49% reported no access to N95 respirators at the health facilities where they were training, which is concerning in the context of HCWs being three times more likely to be at risk of TB disease compared to the general population [37,38]. The ongoing COVID-19 pandemic has highlighted the need for the improved control of airborne pathogens in healthcare settings.…”