Structured assessment of healthcare facilities and knowledge, attitudes and practices of healthcare workers regarding tuberculosis infection control in Moyen-Ogooué, Gabon

Background: Due to their interaction with infectious TB patients, HCW are at greater risk to develop TB than the general population. TB transmission in healthcare settings does not only threaten HCW, but also other patients and visitors in the hospital. Although Gabon ranks among the top-ten high incidence countries in the world, there are currently no national guidelines available for TBIC and several TB cases have already been notified among HCW. In the Moyen-Ogooué province, where resources are limited and evidence of a high MDR-TB prevalence is accumulating, effective TB control remains a challenge. The aim of this study was to assess the current TBIC practices in different healthcare facilities in the Moyen-Ogooué province and to provide insight into the knowledge, attitude and practices of HCW regarding TB. Methods: Twenty healthcare facilities, including two hospitals, one ambulatory HIV-clinic and 17 dispensaries, were assessed using a standardized tool. The assessments were conducted by direct observation, reviewing documents and in-depth interviews with the head of the facility or department. Current TBIC practices in the Moyen-Ogooué province were evaluated in comparison to the WHO recommendations on TBIC in healthcare facilities in limited-resource settings. In addition, the knowledge, attitude and practices of HCW were investigated by means of an interviewer-administered questionnaire which was particularly designed for this study. Results: The study revealed a complete absence of managerial TBIC controls such as infection control guidelines or committees. The implementation of administrative and environmental control measures was generally low. The MDR-TB department of one of the assessed hospitals was the only department that provided regular TB screening for its personnel. A total of 103 KAP survey questionnaires were completed by HCW. According to predefined categories, 40.8% of the respondents had “rather poor” knowledge about TB. However, all doctors had “good” or “excellent” knowledge. The professional category, level of education and former training on TB were found to be significantly associated with good knowledge levels. Attitudes towards TB and TBIC were overall positive. With 72.8%, the majority of HCW was scared of getting TB and 97.1% would be willing to be screened for TB regularly. Reported TBIC practice rates were rather low, especially regarding triaging of presumed TB cases and environmental controls. Good knowledge about TB was not statistically associated with good TBIC practice. Conclusions: The study results provided evidence for the urgent need of national TBIC guidelines, as HCW in the Moyen-Ogooué province are not sufficiently protected from occupational TB transmission. The assessment results can serve as a reference point for elaborating feasible guidelines and monitoring their implementation. The KAP survey results suggest, that effective TBIC does not only depend on good knowledge about TB, but also requires adequate facility structures, manpower and financing. However, particularly HCW with a lower professional degree, who represent the peripheral healthcare system, must receive training on TB and TBIC, as basic knowledge about TB is crucial for the early identification of TB patients

Tuberculosis infection control measures in healthcare facilities in Moyen-Ogooué Province, Gabon

Background Healthcare workers (HCW) are at higher risk of tuberculosis (TB) than the general population. We assessed healthcare facilities for their TB infection control standards and priorities. Methods A standardised tool was applied. The assessment was conducted by direct observation, documents review and interviews with the facility heads. Results Twenty healthcare facilities were assessed; 17 dispensaries, an HIV-clinic, a private not-for-profit hospital and a public regional hospital. In both hospitals, outpatient departments, internal medicine wards, paediatric wards, emergency departments; and the MDR-TB unit of the public regional hospital were assessed. In Gabon, there are currently no national guidelines for TB infection control (TBIC) in healthcare settings. Consequently, none of the facilities had an infection control plan or TBIC focal point. In three departments of two facilities (2/20 facilities), TB patients and presumed TB cases were observed to be consistently provided with surgical masks. One structure reported to regularly test some of its personnel for TB. Consultation rooms were adequately ventilated in six primary care level facilities (6/17 dispensaries) and in none of the hospitals, due to the use of air conditioning. Adequate personal protective equipment was not provided regularly by the facilities and was only found to be supplied in the MDR-TB unit and one of the paediatric wards. Conclusions In Moyen-Ogooué province, implementation of TBIC in healthcare settings is generally low. Consequently, HCW are not sufficiently protected and therefore at risk for M. tuberculosis infection. There is an urgent need for national TBIC guidelines and training of health workers to safeguard implementation

Knowledge, attitudes and practices regarding tuberculosis amongst healthcare workers in Moyen-Ogooué Province, Gabon

Background: In countries with a high tuberculosis incidence such as Gabon, healthcare workers are at enhanced risk to become infected with tuberculosis due to their occupational exposure. In addition, transmission can occur between patients and visitors, if a tuberculosis infection is not suspected in time. Knowledge about tuberculosis and correct infection control measures are therefore highly relevant in healthcare settings. Methods: We conducted an interviewer-administered knowledge, attitude and practice survey amongst healthcare workers in 20 healthcare facilities at all levels in the Moyen-Ogooué province, Gabon. Correctly answered knowledge questions were scored and then categorised into four knowledge levels. Additionally, factors associated with high knowledge levels were identified. Fisher’s Exact test was used to identify factors associated with high knowledge levels. Results: A total of 103 questionnaires were completed by various healthcare personnel. The most-frequently scored category was ‘intermediate knowledge’, which was scored by 40.8% (42/103), followed by ‘good knowledge’ with 28.2% (29/103) and ‘poor knowledge’ with 21.4% (22/103) of participating healthcare workers, respectively. ‘Excellent knowledge’ was achieved by 9.7% (10/103) of the interviewees. Apart from the profession, education level, type of employing healthcare facility, as well as former training on tuberculosis were significantly associated with high knowledge scores. Attitudes were generally positive towards tuberculosis infection control efforts. Of note, healthcare workers reported that infection control measures were not consistently practiced; 72.8% (75/103) of the participants were scared of becoming infected with tuberculosis, and 98.1% saw a need for improvement of local tuberculosis control. Conclusions: The survey results lead to the assumption that healthcare workers in the Moyen-Ogooué province are at high risk to become infected with tuberculosis. There is an urgent need for improvement of tuberculosis infection control training for local healthcare personnel, particularly for less trained staff such as assistant nurses. Furthermore, the lack of adequate infection control measures reported by staff could possibly be correlated with a lack of adequate facility structures and protective equipment and requires further investigation