Creating a “living document” for tuberculosis infection prevention and control in health care settings in Kwazulu-Natal province, South Africa

Abstract

Introduction In settings that are poorly resourced with healthcare personnel working under high cognitive load, tuberculosis prevention and control measures (TB-IPCs) often lack adoption. Implementing these measures in healthcare settings reduces infectious disease transmission. The effective implementation of TB infection prevention and control measures is an integral role of nurses and a public health and safety priority in healthcare settings. The scoping review revealed a lack of literature exploring the inclusion of nurses and other healthcare personnel in decision making when policies and guidelines are designed. The lower levels of knowledge reported for some indicators in our study highlight a gap that could benefit from continuous professional development and perhaps the modification of the curriculum for nurse training programs to best equip nurses with infection prevention and control, with a specific focus on airborne infections. The overall aim of this study was to create a “living document” for TB infection prevention and control in healthcare facilities in South Africa. Methods: This quantitative multimethod study collected baseline data on knowledge, practices, perceptions, and documented practices and conducted discussions with experts in the creation of a “living document” for TB prevention and control. Data were collected in two phases to address the objectives of the study. For each of the variables, dimensions were formed, and data analysis was performed within these dimensions. In phase one, for the first objective, the study utilized a scoping review methodology based on the Joanna Briggs Institute framework, adapted from Arksey and O'Malley (2005). The framework includes five stages: identifying the research question, identifying relevant studies, selecting studies, charting data, and summarizing results. For the second objective, data were collected using a self-administered structured questionnaire comprising three sections: section 1), with seven subsections; section 3), with self-reported practices of TB-IPC measures; section C), with TB infection control; and section 4), with two dichotomous questions (yes/no) and two open-ended questions designed to 1) provide reasons for nonadherence to TB-IPC; and 2), to provide suggestions that may promote the implementation of TB-IPC. Phase two data were collected using a consensus method through a modified Delphi technique with TB-IPC experts and health care personnel (HCPs) using online discussion. Agreements were reached on the items to include in the “living document”. Findings: This study created components of the “living document” for TB-IPC for use in healthcare facilities”. The scoping review found all subject areas relevant to the research question but noted a significant gap in literature regarding the inclusion of implementers in decision-making. There was also a possibility of missing some relevant published and Gray literature. Both knowledge and self-reported practices were good, although responses on practice could be biased towards desirable responses. Issues such as lack of training were highlighted. The reviewed articles presented valuable insight into the relevant research question to be answered, although most of them focused on factors affecting and influencing the adoption of TB-IPC measures in health settings. Conclusion and recommendations: With the assistance of the experts who participated in this study, components for a “living document” for TB-IPC were documented. The suggested design could be arranged into 4 components: 1) managerial measures implemented at the facility, 2) administrative measures implemented at the facility, 3) environmental measures, such as the built environment, and 4) personal protection equipment, referring to staff using respirators when attending patients. Lower levels of knowledge were reported for three indicators, indicating a gap that could benefit from continuous professional development and perhaps modifying the curriculum for nurse training programs to best equip nurses with infection prevention and control, with a specific focus on airborne infections. We recommend that this study be repeated in a much wider geographic area for generalization. We recommend that implementation research evaluate this intervention in healthcare facilities to determine its appropriateness, acceptability, feasibility, fidelity, and coverage.