An occupational health service intervention to improve TB infection prevention and control among South African health workers

Abstract

BACKGROUND : South Africa has adopted strategies to prevent workplace transmission of diseases, including tuberculosis (TB). Occupational health and safety (OHS), and infection prevention and control (IPC), are essential in combatting human immunodeficiency virus (HIV) and TB in the workplace. We evaluated the effect of a multi-faceted policy, practice and education intervention on OHS and TB IPC at a provincial teaching hospital in South Africa. METHODS : A quasi-experimental study was conducted in 2014-2017 in an 800-bed hospital in Tshwane, South Africa, as part of a larger research collaboration. A multi-faceted intervention (including elements focused on primary, secondary and tertiary prevention) to improve OHS and TB IPC in the hospital was implemented. Observational walkthrough surveys were conducted and an infection control practices assessment tool was completed pre- and post-intervention to evaluate the impact of the intervention. Total TB IPC scores were calculated and differences in scores between pre- and post-intervention were compared, using t-tests. RESULTS : While there was substantial strengthening in the hospital’s OHS systems, including HIV and TB services, resources and infrastructure, little improvement in IPC occurred and administrative controls did not improve at all, despite the interventions and support provided. The total TB IC score decreased from 12.5/37 to 11.0/37 (p = 0.0363). CONCLUSION : Strengthened workplace programmes for health workers in low- and middle-income countries, including those targeting HIV and TB, are possible with political will and involvement of management and workers. However, a monitoring and evaluation system, supported by top management, is essential to ensure implementation by frontline health workers, and to guard against complacency.