Repeat Auditing of Primary Health-care Facilities Against Standards for Occupational Health and Infection Control: A Study of Compliance and Reliability

Abstract

a b s t r a c tBackground: The elevated risk of occupational infection such as tuberculosis among health workers in many countries raises the question of whether the quality of occupational health and safety (OHS) and infection prevention and control (IPC) can be improved by auditing. The objectives of this study were to measure (1) audited compliance of primary health-care facilities in South Africa with national standards for OHS and IPC, (2) change in compliance at reaudit three years after baseline, and (3) the inter-rater reliability of the audit. Methods: The study analyzed audits of 60 primary health-care facilities in the Western Cape Province of South Africa. Baseline external audits in the time period 2011e2012 were compared with follow-up internal audits in 2014e2015. Audits at 25 facilities that had both internal and external audits conducted in 2014/2015 were used to measure reliability. Results: At baseline, 25% of 60 facilities were "noncompliant" (audit score<50%), 48% "conditionally compliant" (score >50 < 80%), and only 27% "compliant" (score >80%). Overall, there was no significant improvement in compliance three years after baseline. Percentage agreement on specific items between internal and external audits ranged from 28% to 92% and kappa from -0.8 to 0.41 (poor to moderate). Conclusion: Low baseline compliance with OHSeIPC measures and lack of improvement over three years reflect the difficulties of quality improvement in these domains. Low inter-rater reliability of the audit instrument undermines the audit process. Evidence-based investment of effort is required if repeat auditing is to contribute to occupational risk reduction for health workers.

Tuberculosis infection status and risk factors among health workers: an updated systematic review

“…In many of the countries, despite the increasing risk of TB infection in HWs, the quality of occupational health and safety, and infection prevention and control have not improved significantly. Evidence-based investment of effort is required for the effective risk reduction for HWs [ 48 49 ].…”

Current Guidelines for Protecting Health Workers from Occupational Tuberculosis Are Necessary, but Not Sufficient: Towards a Comprehensive Occupational Health Approach

“…A common approach to improving implementation is auditing, using operational checklists as a basis for expected quality improvement [41,73]. However, what we propose here is that the concept of a checklist be expanded to include the widest perspective possible.…”

“…The objectives of this piece are to argue for a comprehensive occupational health approach to the problem of TB in health workers, and to reflect on what such an approach adds to the prospects for improved prevention and practice. We draw on research carried out by our group as occupational health professionals and researchers in recent years [31][32][33][34][35][36][37][38][39][40][41][42], plus the experience of two of the authors (R.E. and A.Y.)…”