Email this article 
Hide
Show all
Original Research
Tuberculosis infection control practices in a high-burden metro in South Africa: A perpetual bane for efficient primary health care service delivery
Submitted: 15 September 2017 | Published: 30 May 2018
About the author(s)
Michelle C. Engelbrecht, Centre for Health Systems Research and Development, University of the Free State, South AfricaGladys Kigozi, Centre for Health Systems Research and Development, University of the Free State, South Africa
Andre P. Janse van Rensburg, Centre for Health Systems Research and Development, University of the Free State, South Africa; Health and Demographic Research Unit, Department of Sociology, Ghent University, Belguim; Department of Political Science, Stellenbosch University, South Africa
Dingie H.C.J van Rensburg, Centre for Health Systems Research and Development, University of the Free State, South Africa
Abstract
Background: Tuberculosis (TB) prevention, including infection control, is a key element in the strategy to end the global TB epidemic. While effective infection control requires all health system components to function well, this is an area that has not received sufficient attention in
South Africa despite the availability of policy and guidelines.
Aim: To describe the state of implementation of TB infection control measures in a high-burden metro in South Africa.
Setting: The research was undertaken in a high TB- and HIV-burdened metropolitan area of South Africa. More specifically, the study sites were primary health care facilities (PHC), thatamong other services also diagnosed TB.
Methods: A cross-sectional survey, focusing on the World Health Organization levels of infection control, which included structured interviews with nurses providing TB diagnosis and treatment services as well as observations, at all 41 PHC facilities in a high TB-burdened and HIV-burdened metro of South Africa.
Results: Tuberculosis infection control was poorly implemented, with few facilities scoring 80% and above on compliance with infection control measures. Facility controls: 26 facilities (63.4%) had an infection control committee and 12 (29.3%) had a written infection control plan. Administrative controls: 26 facilities (63.4%) reported separating coughing and noncoughing patients, while observations revealed that only 11 facilities (26.8%) had separate waiting areas for (presumptive) TB patients. Environmental controls: most facilities used open windows for ventilation (n = 30; 73.2%); however, on the day of the visit, only 12 facilities (30.3%) had open windows in consulting rooms. Personal protective equipment: 9 facilities (22%) did not have any disposable respirators in stock and only 9 respondents (22%) had undergone fit testing. The most frequently reported barrier to implementing good TB
infection control practices was lack of equipment (n = 22; 40%) such as masks and disposable respirators, as well as the structure or layout of the PHC facilities. The main recommendation to improve TB infection control was education for patients and health care workers (n = 18; 33.3%).
Conclusion: All levels of the health care system should be engaged to address TB prevention and infection control in PHC facilities. Improved infection control will address the nosocomial spread of TB in health facilities and keep health care workers and patients safe from infection.
Keywords
Metrics
Total abstract views: 5579Total article views: 8470
Crossref Citations
1. Airborne infection prevention and control implementation: A positive deviant organisational case study of tuberculosis and COVID-19 at a South African rural district hospital
Helene-Mari van der Westhuizen, Sarah Tonkin-Crine, Rodney Ehrlich, Chris C. Butler, Trisha Greenhalgh
Global Public Health vol: 19 issue: 1 year: 2024
doi: 10.1080/17441692.2024.2382343
2. Implementation status of national tuberculosis infection control guidelines in Bangladeshi hospitals
Arifa Nazneen, Sayeeda Tarannum, Kamal Ibne Amin Chowdhury, Mohammad Tauhidul Islam, S. M. Hasibul Islam, Shahriar Ahmed, Sayera Banu, Md Saiful Islam, Michelle Engelbrecht
PLOS ONE vol: 16 issue: 2 first page: e0246923 year: 2021
doi: 10.1371/journal.pone.0246923
3. The burden of tuberculosis and drug resistance in 22 Sub-Saharan African countries, 1990–2021: a GBD 2021 analysis and progress towards WHO 2035 targets with projections to 2050
Shirong Li, Emmanuel Mensah, Min Liu, Lingling Pan, Wei Lu, Susheng Zhou, Liqin Zhang, Yusheng Cheng, Hui Zhao, Shuoshuo Wei, Lei Zha
Frontiers in Microbiology vol: 16 year: 2025
doi: 10.3389/fmicb.2025.1695592
4. Beyond checklists: Using clinic ethnography to assess the enabling environment for tuberculosis infection prevention control in South Africa
Stella Arakelyan, Hayley MacGregor, Anna S. Voce, Janet Seeley, Alison D. Grant, Karina Kielmann, Melanie Boeckmann
PLOS Global Public Health vol: 2 issue: 11 first page: e0000964 year: 2022
doi: 10.1371/journal.pgph.0000964
5. Health system determinants of tuberculosis mortality in South Africa: a causal loop model
Muhammad Osman, Aaron S Karat, Munira Khan, Sue-Ann Meehan, Arne von Delft, Zameer Brey, Salome Charalambous, Anneke C Hesseling, Pren Naidoo, Marian Loveday
BMC Health Services Research vol: 21 issue: 1 year: 2021
doi: 10.1186/s12913-021-06398-0
6. Estimating waiting times, patient flow, and waiting room occupancy density as part of tuberculosis infection prevention and control research in South African primary health care clinics
Aaron S. Karat, Nicky McCreesh, Kathy Baisley, Indira Govender, Idriss I. Kallon, Karina Kielmann, Hayley MacGregor, Anna Vassall, Tom A. Yates, Alison D. Grant, Reuben Kiggundu
PLOS Global Public Health vol: 2 issue: 7 first page: e0000684 year: 2022
doi: 10.1371/journal.pgph.0000684
7. Exploring options for reprocessing of N95 Filtering Facepiece Respirators (N95-FFRs) amidst COVID-19 pandemic: A systematic review
Diptanu Paul, Ayush Gupta, Anand Kumar Maurya, Amitava Mukherjee
PLOS ONE vol: 15 issue: 11 first page: e0242474 year: 2020
doi: 10.1371/journal.pone.0242474
8. Health system influences on the implementation of tuberculosis infection prevention and control at health facilities in low-income and middle-income countries: a scoping review
Gimenne Zwama, Karin Diaconu, Anna S Voce, Fiona O'May, Alison D Grant, Karina Kielmann
BMJ Global Health vol: 6 issue: 5 first page: e004735 year: 2021
doi: 10.1136/bmjgh-2020-004735
9. Compliance of Healthcare Worker’s toward Tuberculosis Preventive Measures in Workplace: A Systematic Literature Review
Halim Ismail, Naiemy Reffin, Sharifa Ezat Wan Puteh, Mohd Rohaizat Hassan
International Journal of Environmental Research and Public Health vol: 18 issue: 20 first page: 10864 year: 2021
doi: 10.3390/ijerph182010864
10. Occupational Risk of Airborne Mycobacterium tuberculosis Exposure: A Situational Analysis in a Three-Tier Public Healthcare System in South Africa
Dikeledi O. Matuka, Thabang Duba, Zethembiso Ngcobo, Felix Made, Lufuno Muleba, Tebogo Nthoke, Tanusha S. Singh
International Journal of Environmental Research and Public Health vol: 18 issue: 19 first page: 10130 year: 2021
doi: 10.3390/ijerph181910130
11. Exploring the Role of Healthcare Personnel in Designing Tuberculosis Infection Prevention and Control Measures in Healthcare Settings: A Scoping Review
Sikhethiwe Masuku, Ramadimetja Shirley Mooa, Mmapheko Doriccah Peu
International Journal of Environmental Research and Public Health vol: 21 issue: 5 first page: 524 year: 2024
doi: 10.3390/ijerph21050524
12. Context matters: Examining the factors impacting the implementation of tuberculosis infection prevention and control guidelines in health settings in seven high tuberculosis burden countries
M. Saiful Islam, Abrar Ahmad Chughtai, Sayera Banu, Holly Seale
Journal of Infection and Public Health vol: 14 issue: 5 first page: 588 year: 2021
doi: 10.1016/j.jiph.2021.01.014
13. Occupation-related airborne diseases: Management and prevention of tuberculosis among nurses working in Ekiti State University Teaching Hospital
Olaolorunpo Olorunfemi, Damilola Samuel, Joseph Adekunle Adebiyi, Adewole Peter Akindipe, Wakeel Adelani Tijani
Journal of Integrative Nursing vol: 5 issue: 4 first page: 280 year: 2023
doi: 10.4103/jin.jin_75_23
14. Reflecting on the updates to the World Health Organisation 2019 Tuberculosis Infection Control Guidelines through the lens of a low-income/high TB burden country
M. Saiful Islam, Abrar Ahmad Chughtai, Holly Seale
Journal of Infection and Public Health vol: 13 issue: 8 first page: 1057 year: 2020
doi: 10.1016/j.jiph.2020.02.039
15. ‘It has become everybody’s business and nobody’s business’: Policy actor perspectives on the implementation of TB infection prevention and control (IPC) policies in South African public sector primary care health facilities
Christopher J. Colvin, Idriss I. Kallon, Alison Swartz, Hayley MacGregor, Karina Kielmann, Alison D. Grant
Global Public Health vol: 16 issue: 10 first page: 1631 year: 2021
doi: 10.1080/17441692.2020.1839932
16. Diagnosing Tuberculosis: What Do New Technologies Allow Us to (Not) Do?
Shima M. Abdulgader, Anna O. Okunola, Gcobisa Ndlangalavu, Byron W.P. Reeve, Brian W. Allwood, Coenraad F.N. Koegelenberg, Rob M. Warren, Grant Theron
Respiration vol: 101 issue: 9 first page: 797 year: 2022
doi: 10.1159/000525142