Tuberculosis and blood-borne infectious diseases: workplace conditions and practices of healthcare workers at three public hospitals in the Free State

Engelbrecht, Michelle; Rensburg, André van; Rau, Asta; Yassi, Annalee; Spiegel, Jerry; O’Hara, Lyndsay M.; Bryce, Elizabeth; Nophale, Lucky

doi:10.1080/23120053.2015.1103958

Cited by 19 publications

(30 citation statements)

References 18 publications

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“…The HIV prevalence was also higher in the Free State at 19.6 % (15–49 years old) than the national prevalence of 17.9 % [7]. Previous indications are that TB infection control is sub-optimal in some public health facilities in this region [26, 30], underlining the need to determine what influences good infection control practices.…”

Section: Methodsmentioning

confidence: 99%

Factors associated with good TB infection control practices among primary healthcare workers in the Free State Province, South Africa

et al. 2016

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BackgroundDespite the availability of TB infection control guidelines, and good levels of healthcare worker knowledge about infection control, often these measures are not well implemented. This study sought to determine the factors associated with healthcare workers’ good TB infection control practices in primary health care facilities in the Free State Province, South Africa.MethodsA cross-sectional self-administered survey among nurses (n = 202) and facility-based community healthcare workers (n = 34) as well as facility observations were undertaken at all 41 primary health care facilities in a selected district of the Free State Province.ResultsThe majority of respondents were female (n = 200; 87.7 %) and the average age was 44.19 years (standard deviation ±10.82). Good levels of knowledge were recorded, with 42.8 % (n = 101) having an average score (i.e. 65–79 %) and 31.8 % (n = 75) a good score (i.e. ≥ 80 %). Most respondents (n = 189; 80.4 %) had positive attitudes towards TB infection control practices (i.e. ≥ 80 %). While good TB infection control practices were reported by 72.9 % (n = 161) of the respondents (i.e. ≥75 %), observations revealed this to not necessarily be the case. For every unit increase in attitudes, good practices increased 1.090 times (CI:1.016–1.169). Respondents with high levels of knowledge (≥80 %) were 4.029 (CI: 1.550–10.469) times more likely to have good practices when compared to respondents with poor levels of knowledge (<65 %). The study did not find TB/HIV-related training to be a predictor of good practices.ConclusionsPositive attitudes and good levels of knowledge regarding TB infection control were the main factors associated with good infection control practices. Although many respondents reported good infection control practices - which was somewhat countered by the observations - there are areas that require attention, particularly those related to administrative controls and the use of personal protective equipment.

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Section: Methodsmentioning

confidence: 99%

Factors associated with good TB infection control practices among primary healthcare workers in the Free State Province, South Africa

et al. 2016

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“…A workplace audit in the Free State, South Africa, found infection control measures in all three public hospitals evaluated to be unsatisfactory, specifically the unavailability of, or overflowing sharps containers. In addition, over a quarter (28.5%) of staff washed their gloves after use and a fifth did not always wash their hands with soap and water between patients, likely due to the absence of gloves and soap in the wards [33]. At minimum, safety equipment and gloves should be universally available and sharps containers positioned and maintained to allow for easy and safe disposal of sharps.…”

Section: Discussionmentioning

confidence: 99%

Exposure incidents among medical students in a high-prevalence HIV setting

Rossouw¹,

Rooyen²,

Richter³

2017

J Infect Dev Ctries

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Introduction: Occupational injuries in medical students are concerning, especially in countries with a high prevalence of bloodborne infections. With more HIV-infected patients on antiretroviral treatment, appropriate post-exposure prophylaxis (PEP) depends on knowledge of source patients' infection status and treatment response. This study determined the number and type of exposure incidents, reporting practices, and PEP use among medical students at the University of Pretoria, South Africa. Methodology: Data were collected from an anonymous voluntary questionnaire completed by medical students from years 1 to 6 of study as well as from incident records archived at the Department of Family Medicine. Data were described and tests of association performed in Stata 11. Results: Thirteen percent of students overall and 21% of senior students reported an incident in the preceding year. The majority of incidents occurred during phlebotomy, with fatigue and work pressure found to be major contributing factors. Underreporting was common and many students displayed a lack of risk awareness and a preference for managing the incident privately. Although 59% knew the HIV-status of the source patient, less than a third knew the viral load and only 16.9% the regimen. Side-effects on antiretroviral treatment used for PEP were common and only about three-quarters of the students completed the course. Conclusions: We recommend targeted training, especially in the senior years, together with improving the work environment through attention to working hours, sharps disposal and ready availability of safety devices, improved reporting systems, individualised PEP, and possibly the implementation of an occupational injury support line.

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“…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].…”

Section: Data Collection and Analysismentioning

confidence: 99%

“…Pelonomi Hospital in the Free State province was chosen, as it met the criteria of a) having an existing occupational health unit active in infection control and eager to take on a new challenge (including implementing a surveillance system); b) supportive management; c) a functional joint health and safety committee comprising management and worker representatives; d) strong support from the provincial Department of Health's Provincial Occupational Health Unit; and e) a local university that could serve as a research partner [43,65]. This hospital became the main site for re-engineering of the Occupational Health and Safety Information System (OHASIS) based on the experience of the Canadian web-based system [20,[45][46][47].…”

Section: Contextualizing Why and How The Canadian-south African Partnmentioning

confidence: 99%

“…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].…”

Section: Contextualizing Why and How The Canadian-south African Partnmentioning

confidence: 99%

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

et al. 2016

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BackgroundHealth workers are at high risk of acquiring infectious diseases at work, especially in low and middle-income countries (LMIC) with critical health human resource deficiencies and limited implementation of occupational health and infection control measures. Amidst increasing interest in international partnerships to address such issues, how best to develop such collaborations is being actively debated. In 2006, a partnership developed between occupational health and infection control experts in Canada and institutions in South Africa (including an institute with a national mandate to conduct research and provide guidance to protect health workers from infectious diseases and promote improved working conditions). This article describes the collaboration, analyzes the determinants of success and shares lessons learned.MethodsSynthesizing participant-observer experience from over 9 years of collaboration and 10 studies already published from this work, we applied a realist review analysis to describe the various achievements at global, national, provincial and hospital levels. Expectations of the various parties on developing new insights, providing training, and addressing service needs were examined through a micro-meso-macro lens, focusing on how each main partner organization contributed to and benefitted from working together.ResultsA state-of-the-art occupational health and safety surveillance program was established in South Africa following successful technology transfer from a similar undertaking in Canada and training was conducted that synergistically benefitted Northern as well as Southern trainees. Integrated policies combining infection control and occupational health to prevent and control infectious disease transmission among health workers were also launched. Having a national (South-South) network reinforced by the international (North–south) partnership was pivotal in mitigating the challenges that emerged.ConclusionsHigh-income country partnerships with experience in health system strengthening – particularly in much needed areas such as occupational health and infection control – can effectively work through strong collaborators in the Global South to build capacity. Partnerships are particularly well positioned to sustainably reinforce efforts at national and sub-national LMIC levels when they adopt a “communities of practice” model, characterized by multi-directional learning. The principles of effective collaboration learned in this “partnership of partnerships” to improve working conditions for health workers can be applied to other areas where health system strengthening is needed.

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Tuberculosis and blood-borne infectious diseases: workplace conditions and practices of healthcare workers at three public hospitals in the Free State

Cited by 19 publications

References 18 publications

Factors associated with good TB infection control practices among primary healthcare workers in the Free State Province, South Africa

Factors associated with good TB infection control practices among primary healthcare workers in the Free State Province, South Africa

Exposure incidents among medical students in a high-prevalence HIV setting

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

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