Context matters: Examining the factors impacting the implementation of tuberculosis infection prevention and control guidelines in health settings in seven high tuberculosis burden countries
Context matters: Examining the factors impacting the implementation of tuberculosis infection prevention and control guidelines in health settings in seven high tuberculosis burden countries
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DOI：
10.1016/j.jiph.2021.01.014
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发表时间：
2021-04-10
影响因子：
6.7
通讯作者：
Seale, Holly
中科院分区：
文献类型：
--
作者：
Islam, M. Saiful;Chughtai, Abrar Ahmad;Seale, Holly
背景：结核病（TB）高负担国家的医护人员（HCW）由于接触结核病患者的增加以及卫生机构结核感染预防和控制（TB IPC）措施实施不力，结核病感染的风险增加。虽然存在各种关于结核病感染预防和控制的指南，但人们对这些指南的内容知之甚少，也不清楚它们是否与具体情况相关，以及是否在低收入和中等收入结核病高负担国家得到适当实施。本研究旨在严格审查结核病IPC指南的实施情况，以及影响七个结核病高负担国家卫生机构结核病IPC实施的因素。方法：回顾了世界卫生组织2009年和国家级结核病IPC指南以及七个结核病高负担国家已发表的文献并提取了相关信息。来自案例研究国家的 11 个关键利益相关者接受了采访，以进一步阐明影响结核病 IPC 指南实施的促进因素和障碍。 结果：我们的研究发现，所有研究国家都采用了 WHO 2009 年指南，没有针对当地情况进行任何修改或进行最小程度的修改。因此，结核病 IPC 建议的后续转化在某些情况下受到限制和损害。基础设施薄弱、隔离空间不足、缺乏结核病 IPC 培训、个人防护设备供应有限、N95 呼吸器使用时的不适以及结核病患者数量众多是影响结核病 IPC 指南实施的一些因素。结论：结核病 IPC 指南在所有七个国家的实施都受到限制。它受到不同背景的影响，每个国家和每个设施都有不同的卫生基础设施和结核病负担。研究结果需要重新评估这些结核病高负担国家当前的情况，并根据当地情况和证据对国家指南进行后续修订。 (c) 2021 年由爱思唯尔有限公司代表沙特本阿卜杜勒阿齐兹国王健康科学大学出版。这是一篇遵循 CC BY-NC-ND 许可证 (http://creativecommons.org/licenses/bync-nd/4.0/) 的开放获取文章。
Background: Healthcare workers (HCWs) in high tuberculosis (TB) burden countries are at increased risk of TB infection due to increased exposures to TB patients and inadequate implementation of TB infection prevention and control (TB IPC) measures in health settings. While various guidelines on TB IPC exist, there is little understanding of the content of these guidelines, whether they are relevant to the context and are being appropriately implemented in low-and middle-income high TB burden countries. This study aimed to critically examine the implementation of TB IPC guidelines, along with factors impacting TB IPC implementation in health settings in seven high TB burden countries.Methods: The WHO 2009 and national level TB IPC guidelines and the published literature from seven TB high burden countries were reviewed and relevant information extracted. Eleven key-stakeholders from the case study countries were interviewed to elucidate further facilitators and barriers impacting TB IPC guidelines implementation.Results: Our study identified that all the study countries adopted the WHO 2009 guidelines with no or minimal modifications for the local context. Therefore, the subsequent translation of the TB IPC recommendations into practice has been limited and impaired in some settings. Poor infrastructure, inadequate space for isolation, lack of TB IPC training, limited supply of personal protective equipment, the discomfort of using N95 respirators, and a high number of TB patients were some of the factors impacting the implementation of TB IPC guidelines.Conclusion: The implementation of TB IPC guidelines in all seven countries was limited. It was affected by the diverse context where each of the countries and each of the facilities had a different health infrastructure and TB disease burdens. The findings warrant re-assessment of the current context prevailing in these high TB burden countries and subsequent revisions of national guidelines based to account for local context and evidence. (c) 2021 Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/bync-nd/4.0/).