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. 2019 Mar 1;8(1):bmjoq-2018-000347.
doi: 10.1136/bmjoq-2018-000347. eCollection 2019.

Improving TB infection control in a regional hospital in the Eastern Cape, South Africa

Ilsa Louisa Haeusler  1 , Felicity Knights  1 , Vishaal George  2 , Andy Parrish  1   3   4
Affiliations

Improving TB infection control in a regional hospital in the Eastern Cape, South Africa

Ilsa Louisa Haeusler et al. BMJ Open Qual. .

Abstract

This quality improvement (QI) work was carried out in Cecilia Makiwane Hospital (CMH), a regional public hospital in the Eastern Cape, South Africa (SA). SA has among the highest incidence of tuberculosis (TB) in the world and this is a leading cause of death in SA. Nosocomial infection is an important source of TB transmission. Adherence to TB infection prevention control (IPC) measures in the medical inpatient department was suboptimal at CMH. The overall aim of this QI project was to make sustainable improvements in TB IPC. A multidisciplinary team was formed to undertake a root cause analysis and develop a strategy for change. The main barriers to adherence to IPC measures were limited knowledge of IPC methods and stigma associated with TB. Specifically, the project aimed to increase the number of: 'airborne precaution' signs placed above patients' beds, patients correctly isolated and patients wearing surgical face masks. Four Plan-Do-Study-Act cycles were used. The strategy for change involved education and awareness-raising in different formats, including formal in-service training delivered to nurses and doctors, a hospital-wide TB awareness week with engaging activities and competitions, and a World TB Day provincial solidarity march. Data on adherence to the three IPC measures were collected over an 8-month period. Pre-intervention (October 2016), a mean of 2% of patients wore face masks, 22% were correctly isolated and 12% had an airborne precaution sign. Post-intervention (May 2017), the compliance improved to 17%, 50% and 25%, respectively. There was a large variation in compliance to each measure. Improvement was greatest in the number of patients correctly isolated. We learnt it is important to work with, not in parallel to, existing teams or structures during QI work. On-the-ground training of nurses and clinicians should be undertaken alongside engagement of senior staff members and managers. This improves the chance of change being adopted into hospital policy.

Keywords: PDSA; healthcare quality improvement; infection control; nosocomial infections.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Run chart showing adherence to infection control measures over 32 weeks. TB, tuberculosis.
See this image and copyright information in PMC

References

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    1. National Department of Health South Africa. National Department of Health Annual performance plan 2014/15 - 2016/17. 2014.
    1. Company UR. Tuberculosis in Healthcare Workers : Findings from South Africa. Infection Control 2008.
    1. World Health Organization. The End TB Strategy. World Health Organization; 2015.

MeSH terms