Tuberculosis infection prevention and control: why we need a whole systems approach
Tuberculosis infection prevention and control: why we need a whole systems approach
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DOI：
10.1186/s40249-020-00667-6
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发表时间：
2020-05-25
影响因子：
8.1
通讯作者：
Grant, Alison D.
中科院分区：
文献类型：
--
作者：
Kielmann, Karina;Karat, Aaron S.;Grant, Alison D.
为减少耐药结核病和药物敏感结核病在卫生设施中的传播而采取的感染预防和控制措施得到了很好的描述，但执行不力。TB IPC的实施主要通过定量和结构化方法进行评估，这些方法将行政、环境和个人防护措施视为独立的实体。我们提出了一个正在进行的项目，名为Umoya omuhle（“好空气”），在南非的两个省进行，采用跨学科的，“整体系统”的方法来分析问题和干预措施的发展，以减少结核分枝杆菌（Mtb）的医院传播，通过改进IPC。我们认为，结核病IPC是一个复杂的干预措施，是在一个动态的背景下提供的政策指导方针，卫生设施的空间，基础设施，护理组织和管理文化。从流行病学，人类学，卫生政策和系统研究得出的方法，使丰富的背景分析如何院内结核病传播发生，以及从整体上解决问题的机会。一个“整体系统”的方法可以确定杠杆点内的卫生设施的基础设施和组织的护理，可以告知干预措施的设计，以减少院内结核病传播的风险。
Infection prevention and control (IPC) measures to reduce transmission of drug-resistant and drug-sensitive tuberculosis (TB) in health facilities are well described but poorly implemented. The implementation of TB IPC has been assessed primarily through quantitative and structured approaches that treat administrative, environmental, and personal protective measures as discrete entities. We present an on-going project entitled Umoya omuhle ("good air"), conducted in two provinces of South Africa, that adopts an interdisciplinary, 'whole systems' approach to problem analysis and intervention development for reducing nosocomial transmission of Mycobacterium tuberculosis (Mtb) through improved IPC. We suggest that TB IPC represents a complex intervention that is delivered within a dynamic context shaped by policy guidelines, health facility space, infrastructure, organisation of care, and management culture. Methods drawn from epidemiology, anthropology, and health policy and systems research enable rich contextual analysis of how nosocomial Mtb transmission occurs, as well as opportunities to address the problem holistically. A 'whole systems' approach can identify leverage points within the health facility infrastructure and organisation of care that can inform the design of interventions to reduce the risk of nosocomial Mtb transmission.