TB Infection Control Practices Among Healthcare Workers
Added on 2020-10-22
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CHAPTER 4: RESULTS 4.1Profile of study participantsInformation on the socio-demographic profiles of the study participants is presented in Table 4.1below. The majority of the participants were female (57%, N=87). About three quarters (76%) of therespondents were in the 20-39 years range while just below a quarter (23%) were aged 40-59years. Half of the study participants were nurses and the remainder were more-or-less an equallyspread between doctors (10%), laboratory technicians (11%), TB field promoters (10%), cleaners(10%) and others (9%). Table 4.1 – Socio-demographic information of study participants (N=152)Variables Frequency and percentage Gender Male 65 (43)Female 87 (57)Age Groups Less than 202 (1)20-2956 (37)30-3960 (39)40-4919 (13)50-5915 (10)Profession Doctor15 (10)Nurse76 (50)Laboratory technician17 (11)TB field promoter15 (10)Cleaner15 (10)Other14 (9)1
4.2TB trends among Healthcare WorkersFigure 4.1 shows the trends of TB among Namibian health care workers for the period of five years(2013-2017). The data was obtained from health records and it reveals that the highest number ofHCW who were diagnosed with TB was obtained in 2015 (n = 55) with the least recorded in 2016 (n= 41). An average (mean) number of TB cases diagnosed over those 5 years is about 49 per year.Despite an upward spike in the number of cases to 55 in 2015, the trend has been of a generaldecline, as shown by a 19% overall decline from 53 in 2013 to 43 in 2017.Figure 4.1 – Number of HCW diagnosed with TB (Clinical) – 2013 to 2017 (Note: I have just removed the colour and am not sure what else the supervisor would prefer) 4.3Evaluation of Pulmonary Tuberculosis Risk FactorsTable 4.2 shows how the five items pertaining to Work Practices were evaluated in the survey. Theattribute with the lowest percentage of positive affirmations (67%) was on the assignment ofpersons responsible for staff screening on TB at the health facilities, with a third (33%) of the studyparticipants saying this was not in place. On the other hand, close to all (97%) of the respondentsagreed they had been made aware of the occupational risk of contracting TB. On average, the listedwork practice related factors were positively evaluated about 4 out of 5 times (83%). Table 4.2 - Evaluation of Work Practices (n=152)FactorsFrequency and percentageFacility assigned a person responsible for staff screening on TB102 (67)Encouraged to go for HIV testing, considering vulnerability to TB120 (79)Confidentiality is protected when screened for TB127 (84)Adequate steps taken to encourage self-reporting on coughs134 (88)Made aware of occupational risk to contracting TB148 (97)2
Table 4.3 shows that only 18% of the participants agreed that they always put on a mask beforeseeing TB patients, making this the highest perceived risk factor in relation to personal protectiveequipment. The participants also rated ‘fit testing” of N95 respirators largely negatively, with onlyabout 1 in 3 (35%) of the respondents confirming this was done properly. Table 4.3 - Evaluation of Personal Protective Equipment (N=152)FactorsFrequency and percentageThere are no instances where TB patients are seen without a mask28 (18)Have been 'fit tested' to ensure selection of right N95 respirator53 (35)Are available respirators of the right and fit for you all the time84 (55)Have access to disposable particulate N95 respirators127 (84)The weakest aspect of the administrative control measures was on access to rapid diagnostic tests,with almost 6 in 10 of the participants saying they did not have access to such. Almost all (93%) ofthe respondents affirmed the importance of giving surgical masks to suspected TB patients. Table 4.4 - Evaluation of Administrative Control Measures (N=152)FactorsFrequency and percentageHave access to rapid diagnostic tests62 (41)Know procedures on how to screen potential TB patients144 (75)Out-patients provided with health education on cough etiquette119 (78)Surgical masks provided to all presumptive and confirmed TB patients119 (78)Facility adheres with respiratory hygiene guidelines or policies124 (82)It is important that a surgical mask is given to suspected TB patients141 (93)In relation to environmental control, the highest risk was on lack of UVGI units in rooms dealing withMDR-TB patients. Up to 59% of the respondents stated that the units were not installed. There werehowever relatively more positive evaluations on room ventilation and instructions on directing TBpatients. Table 4.5 - Evaluation of Environmental Control (N=152)FactorsFrequency and percentageRooms, especially those dealing with MDR-TB patients, fitted with UVGIunits62 (41)TB patients’ rooms adequately ventilated and doors and windows alwaysopen99 (65)Have clearly labelled instructions and directions on where suspected TBpatients should go100 (66)3
Note: I have removed the tables on the overall scores by the 4 risk groups because the supervisor does notseem to follow what they mean. However, just for clarity, note that when it comes to the totals for the 4 riskgroups, the percentages are interpreted differently. For the individual statements above, the frequencies andpercentages shown are less complicated because they are straight forward numbers and percentages of the152 respondents who answered “yes” to the statement in question. But to calculate the average scores foreach of the factors groups I had to compute that as shown below. Factors(a)Number ofstatements (b)Number ofrespondents(c)Total number ofresponses (a) x (b) (d)Number of “yes”responses (e)“Yes” responsesas % of totalnumber ofresponses Personal Protective Equipment515276036548%Environmental Control415260834657%Administrative Control Measures615291267574%Work Practices315245637883%The percentage shown in column (e) does not represent the percentage of participants who said “yes”.Instead it is the percentage of the number of times a “yes” response was given when one looks across all thestatements belonging to that risk group. For example, for personal protective equipment, there were 5statements each answered by 152 respondents and thus giving a total of 760 responses. Out of those 760responses, 365 were “yes” answers (i.e. the other 295 were “no”). Therefore, the rate of “yes” responses was365/760 (i.e. 0.48 or 48%). Because 0.48 is a rate, I then did the comparisons using ANOVA rather than Chi-square. Like I said in my earlier email, this was the best way of computing total evaluation scores by thebroader risk groups (which I imagined was also required over and above reporting just the categorial yes/noresults for the individual statements). The only other way to get overall scores would have been if therespondents had been asked directly during the survey to answer yes/no to the overall situation pertaining toeach of the 4 risks groups (e.g. “Taking everything into account, all issues pertaining to personal protectiveequipment are provided for sufficiently at the heath facility” – yes/no). In that case the answers would havebeen categorical, and the comparisons done using Chi-square. I have since deleted all the ANOVA tables tokeep things simple and am just providing the explanation below in case you would still want to use it.4
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