Implementation of infection prevention and control measures against nosocomial tuberculosis among healthcare workers in Muhoroni Sub-County, Kisumu County, Kenya

Abstract

Background: Transmission of tuberculosis in healthcare settings to both patients and healthcare workers (HCWs) has been reported from virtually every country of the world, regardless of local TB incidence (Baussano et al., 2011). TB is mainly caused by Mycobacterium tuberculosis. The rate of nosocomial transmission of TB has increased commensurate with the evolving HIV epidemic. There are three levels of TB infection prevention and control (TB-IPC) measures at the health facility setting. The three levels are administrative control measures, environmental control measures, and personal protective measures in order of priority. Objectives: The broad objective was to assess implementation of TB-IPC measures among HCWs at health facilities in Muhoroni sub-county. The specific objectives were to evaluate the implementation of administrative, environmental and personal protective TB-IPC measures, to determine the factors associated with implementation of TB-IPC measures and to determine if the HCWs had any training on TB-IPC. Methods: The study was carried out in Muhoroni sub-county in Kisumu County, Kenya. A descriptive cross-sectional study design was used. Sample size was calculated using the Fisher’s formula. Subsequently, Mugenda and Mugenda’s correction formula was applied. Multistage sampling was used which involved application of purposive, proportionate and simple random sampling. Data was collected using two interviewer administered questionnaires and an observation checklist. Data analysis was done using standard statistical software, R. Categorical variables were summarized as frequencies and corresponding percentages. Continuous variables were summarized as mean, corresponding standard deviation, median and inter quartile range (IQR). Association between categorical variables was assessed using Fisher’s exact test and Wilcoxon rank-sum test. Findings: Slightly more than half, 82 (58.6%) of the HCWs routinely asked patients about cough upon entering the facility. Out of the 15 facilities, 10 (66.7%) had a TB-IPC plan present. Close to half, 63 (45.0%), of the respondents kept the windows open sometimes when examining patients with 5 (3.6%) reporting that they never kept them open. A significant proportion of HCWs reported not to wear an N-95 respirator while only 65 (46.4%) wore a lab coat while working at the facility. Slightly over two-thirds, 95 (67.9%), reported to have ever received training on TB-IPC. Statistical analysis revealed that the support staff were less likely to implement TB-IPC measures compared to other cadres. HCWs at the FBOs/Mission hospitals were more likely to implement TB-IPC measures compared to those serving at the dispensaries. Conclusion: Implementation of administrative, environmental and personal protective IPC measures by HCWs in Muhoroni sub-county was found to fall short of the recommended standards in the National TB-IPC guidelines. The proportion of HCWs who had received training on TB-IPC was inadequate. HCWs serving at the larger facilities were more likely to implement TB-IPC measures compared to their counterparts at the lower level facilities. Recommendations: At individual level, there is need for HCWs to be provided with more education on TB-IPC. Each health facility should have a TB-IPC plan and a functional TB-IPC committee. At policy level, implementation of the National TB-IPC guidelines across the country should be enforced and evaluation done on a regular basis.