Why healthcare workers are sick of TB

Abstract

Dr Thato Mosidi never expected to be diagnosed with tuberculosis (TB), despite widely prevalent exposure and very limited infection control measures. The life-threatening diagnosis of primary extensively drug-resistant TB (XDR-TB) came as an even greater shock. The inconvenient truth is that, rather than being protected, Dr Mosidi and thousands of her healthcare colleagues are at an increased risk of TB and especially drug-resistant TB. In this viewpoint paper we debunk the widely held false belief that healthcare workers are somehow immune to TB disease (TB-proof) and explore some of the key factors contributing to the pervasive stigmatization and subsequent non-disclosure of occupational TB. Our front-line workers are some of the first to suffer the consequences of a progressively more resistant and fatal TB epidemic, and urgent interventions are needed to ensure the safety and continued availability of these precious healthcare resources. These include the rapid development and scale-up of improved diagnostic and treatment options, strengthened infection control measures, and focused interventions to tackle stigma and discrimination in all its forms. We call our colleagues to action to protect themselves and those they care for.

Agents of change: The role of healthcare workers in the prevention of nosocomial and occupational tuberculosis

“…Side effects such as peripheral neuropathy, ototoxicity and vision loss may be career-ending for HCWs 27,45,46 . Although HCWs may have better access to healthcare facilities than other patients, they may encounter greater stigma and be reluctant to engage in care 47 . This also has implications for their ability to return to work.…”

“…One of the symbols of the contagious nature of TB, and hence also the stigma associated with it, is the mask. Interestingly, although masks are worn routinely in some clinical environments like the operating theatre and in certain countries when using public transport, patients wearing masks to reduce TB transmission report feeling stigmatized and HCWs wearing respirators for protection find that this creates a barrier between them and their patients 47,55 .…”

“…Although students in endemic settings may report perceiving themselves to be at higher risk of TB and are more likely to have received TB-IC training than other HCWs 69 , they are not more likely to provide correct examples of TB-IC measures or to use PPE as recommended 70,71 . Additionally, it is concerning to note that healthcare students have indicated that they perceive their professional mentors to be similarly aware of the risks of occupational tuberculosis, but report that they do not take the necessary precautions 47,69 . Many professional behaviours are modeled on those of mentors 72 , and efforts need to be made to ensure that safe practices are emphasized in order to form a foundation for future practices.…”

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

“…As TB transmission frequently occurs before an accurate diagnosis is made, it is the responsibility of healthcare workers, particularly managers, to ensure the implementation of appropriate TB infection control measures in all high risk settings so as to ensure that “health care facilities become known as places of healing and safety, not death and contagion” [16]. Good TB infection control relies on the early identification, isolation and rapid initiation of effective treatment of TB suspects combined with good organisation in facilities to avoid overcrowding and ensure appropriate patient flow [10].…”

A prevalência e a incidência de tuberculose ocupacional em serviços de saúde: uma revisão sistemática da literatura

“…10,22 As evidências demonstram que a contaminação pode estar associada com o atraso da instituição em iniciar precauções específicas dos pacientes com suspeita ou confirmação de tuberculose pulmonar e também com práticas assistenciais realizadas de forma inadequada, ventilação imprópria do local, falha na manutenção do sistema de ventilação e falta de proteção respiratória para os profissionais. 20,21,22,23,24 O desconhecimento sobre a doença, sua repercussão e a sensação de estar protegido ou de que os profissionais são imunes à doença e uma baixa percepção do auto risco são fatores que levam os PAS a não valorizar e a não adotar ações de precaução para a transmissão da doença, apesar do risco aumentado de transmissão em áreas com alta prevalência. 22,24,25 Os estabelecimentos de saúde devem ser espaços seguros para o coletivo dos PAS e não apenas locais de cuidados diagnósticos e terapêuticos dirigidos a indivíduos doentes.…”