Pilot study to detect airborne Mycobacterium tuberculosis exposure in a South African public healthcare facility outpatient clinic

Abstract

SummaryBackground: Airborne transmission of Mycobacterium tuberculosis (TB) remains an

Occupational tuberculosis in South Africa: are health care workers adequately protected?

“…This study was part of an international collaborative project that included measuring TB in the air throughout a provincial tertiary hospital in Gauteng province, South Africa, which indicated a widespread presence of Mycobacterium tuberculosis in the facility, with five (50%) air samples tested for TB in the breathing zone of medical doctors and three (23%) in the breathing zone of nurses yielding positive results. 15 The 762-bed hospital employs 2000 HCWs, conducts about 192 000 consultations annually in its out-patient and emergency departments, and had 276 960 admissions, with approximately 905 TB patients, in 2015 and an unknown number of undiagnosed patients with TB. This study was originally designed to provide a baseline workplace assessment for TB IPC upon which to design future appropriate interventions.…”

Capture and visualization of liveMycobacterium tuberculosisbacilli from tuberculosis bioaerosols

“…Studying aerosolized Mtb is complicated by the low numbers of bacilli produced and the presence of environmental and patient-derived "contaminating" microorganisms and particulate matter (29). While molecular methods have enabled consistent and reliable detection of Mtb DNA in bioaerosols (30)(31)(32), these approaches cannot distinguish live from dead organisms nor do they allow investigations of the physiological state(s) of the aerosolized bacilli. The method of bacillary capture is also key: approaches based on forced or induced cough might not reflect natural transmission events (33,34), whereas face-mask and related aerosol sampling methodologies either make live-cell analyses impossible (35) or require downstream in vitro propagation (via microbiological culture) (36), unavoidably altering the physiological and metabolic state of the captured samples.…”

Protecting health workers from infectious disease transmission: an exploration of a Canadian-South African partnership of partnerships

“…As we were the ones most directly involved with all the components of the research -from the formation of the collaboration, to planning the research agenda and designing the projects, to collecting and analyzing the data and synthesizing results for decision-makers and scholarly venuesour own perceptions, synthesized through the process of writing this article, provided the main source of data. The description was aided by reference to the over 10 publications already published from our collaboration [20,[43][44][45][46][47][48][49][50][51][52].…”

“…Many of the program's "graduates" continued to play an active role in the larger research program that subsequently developed [47]. A South African graduate student assisted in implementation in Free State; several Canadian graduate students worked with each of the various projects [48][49][50][51] helping to implement this program, with one Canadian graduate student writing his Master's thesis about this program overall [48]. One of the South African trainee projects ( Table 2 row 6), led by a nurse from a rural hospital in Free State, was subsequently published in a peer-reviewed journal [50].…”

“…c) Implementing occupational health infection control programs in a high TB-burden hospital in Gauteng and in Free State NIOH took on responsibility for implementing a workplace health programme to protect heath workers at a hospital in Gauteng province, with the North-South partnership collaboratively designing and implementing a TB infection control programme (ICP) in this hospital. The TB ICP has three major components: 1) training of hospital personnel and implementation of a TB workplace assessment (audit) to identify hazards for airborne diseases, as well as identify best practice where applicable (recommendations are being implemented and will be reassessed); 2) a survey of healthcare workers' experience and perceptions about TB infection control at the hospital which revealed high TB exposure risk, lack of TB infection control training and a threefold greater risk of TB compared to the general population [45]); and 3) methodology for quantifying TB bacilli in the air [51] with the findings then used to sensitise management to the need to implement control measures. The partnership succeeded in elevating attention to TB infection control and occupational health and [48].…”