Tuberculosis infection prevention and control in rural Papua New Guinea: an evaluation using the infection prevention and control assessment framework

Background Tuberculosis (TB) infection prevention and control (TB-IPC) is recommended as an essential public health intervention to control TB transmission worldwide. Nonetheless, merely applying evidence-based prevention and control measures is often inadequate for effective TB prevention and treatment goals. This study examined healthcare workers’ (HCWs’) perceptions of strategies important for TB-IPC in primary healthcare (PHC) settings in Papua New Guinea. Methods Using a nominal group technique, this study sought the views of a diverse range of HCWs (ranging from clinical, IPC personnel to policymakers) from national and subnational levels, and various provinces to prioritise TB-IPC guidelines implementation needs in practice. Group discussions were conducted with 51 HCWs, and encompassed quantitative and qualitative data collection techniques. Nine key strategies drawn from a preceding study and literature review were presented to participating HCWs, and from these, three significant strategies related to TB-IPC policy were identified as key priorities. Results The participants recommended HCWs’ capacity building on TB-IPC policy and strategy, improving PHC infrastructure, and increasing community awareness of TB as the most important strategies to improve TB-IPC practices. Conclusions This study investigated the perceptions of diverse key HCWs of the implementation of TB-IPC guidelines in PHC settings in rural Papua New Guinea. The HCWs identified key strategies needed for effective TB-IPC practice in PHC to prevent TB transmission. This study supports previous recommendations that call for adopting multi-pronged strategies to improve the high TB burden. Key stakeholders’ insights have been shared to inform public health policy and program implementation both locally and as part of the global goals of the TB eradication program.

Background:Tuberculosis (TB) infection prevention and control (IPC) in healthcare facilities is key to reducing transmission risk. A framework for systematically improving TB IPC through training and mentorship was implemented in 9 healthcare facilities in China from 2017 to 2019.Methods:Facilities conducted standardized TB IPC assessments at baseline and quarterly thereafter for 18 months. Facility-based performance was assessed using quantifiable indicators for IPC core components and administrative, environmental, and respiratory protection controls, and as a composite of all control types We calculated the percentage changes in scores over time and differences by IPC control type and facility characteristics.Results:Scores for IPC core components increased by 72% during follow-up when averaged across facilities. The percentage changes for administrative, environmental, and respiratory protection controls were 39%, 46%, and 30%, respectively. Composite scores were 45% higher after the intervention. Overall, scores increased most during the first 6 months. There was no association between IPC implementation and provincial economic development or volume of TB services.Conclusions:TB IPC policies and practices showed most improvement early during implementation and did not differ consistently by facility characteristics. The training component of the project helped increase the capacity of healthcare professionals to manage TB transmission risks. Lessons learned here will inform national TB IPC guidance.

<h3>Introduction</h3> Effective tuberculosis (TB) infection prevention and control (IPC) measures including education and training are crucial in limiting the spread of TB in healthcare settings. We aimed to explore how well HCWs adhere to TB IPC practices, the nature and extent of training related to TB IPC across demographic and occupational factors. <h3>Method</h3> An interviewer-driven structured survey was conducted among HCWs in a provincial tertiary hospital in Gauteng Province, South Africa. Data were analysed using SPSS version 24. Pearson's Chi Square test or Fisher's exact tests checked differences between categorical variables; logistic regression assessed associations between covariates. <h3>Results</h3> Of the 285 HCWs surveyed, only 43% reported having received training on TB transmission, signs and symptoms; 29.8% of nurses had been trained on the proper use of N95 respirators; only 5% of support workers were trained on mode of transmission; and only 37.2% of all HCWs were aware of a protocol for managing TB patients. Only 56.3% of nurses and 66.7% of doctors reported they always or sometimes wore respirators when managing suspected or confirmed TB cases, although 70.5% of the nurses and 86.7% of the doctors reported that these personal protective equipments were not readily available. Importantly, non-clinical (support) HCWs were more than 7 times more likely to use respirators if trained on their proper use. <h3>Discussion</h3> Major gaps persist in both availability of respirators and training of HCWs on TB transmission, both factors highly associated with lack of adherence to TB IPC. To protect HCWs, hospital management should ensure availability of respirators as well as effective trainings for all job categories, with particular attention to support staff, who seem to be particularly poorly trained and at high risk of TB.

To ascertain tuberculosis (TB) infection control measures and incidence of TB in nursing homes for elder. The questionnaire on TB infection control was distributed to all nursing homes in Osaka City in 2005. The questionnaire was returned from 197 (90%) out of 219 facilities. In more than half of facilities, infection control committee was organized (57%) and automated ventilation system was installed (59%). In almost all facilities, residents had annual chest X-ray screening (94%). Respiratory symptoms were checked for residents and "day service" users in majority of facilities. 100% of employees had annual chest X-ray screening. However TB education session for employees was held annually in only 40% of facilities. Education materials on TB were distributed in 19%. Tuberculin skin test (TST) was conducted for new employees in 31%. TB patients were diagnosed in 22% of facilities in the past 3 years from 2002 to 2004. Incidence rate of TB is 75.2 per 100,000 for residents and 24.1 per 100,000 for employees. Analysis showed that TB incidence rate is higher in facilities with larger number of residents and in facilities where infection control committee is organized, and facilities where TST is conducted for new employees. In Osaka City, TB infection control was more often implemented in facilities where TB patient was diagnosed. When age structure is taken into consideration, TB incidence rate of employees or residents was lower than general population. Nosocomial TB infection does not seem to be occurring in nursing homes. However, as TB patients were diagnosed occasionally, TB infection control measures should be strengthened in Osaka City.

World TB Day, March 24, 2000 – Forging new partnerships to stop TB

BackgroundTuberculosis (TB) is a major global health challenge, and South Africa is one of the high-burden countries. A national TB infection control (TBIC) guideline has stipulated three areas of infection control at health facilities: work practice and administrative control, environmental control, and personal protection for health workers.AimThe aim of this study was to identify the gaps and address the challenges in institutional TBIC.SettingThe district hospital and a primary health care clinic within the Mossel Bay sub-district in the Western Cape.MethodsAccording to the national TBIC draft guideline, a quality improvement cycle was used to evaluate and improve TBIC. Each facility had an existing infection and prevention control and occupational health and safety team, which were used as the audit teams.ResultsA baseline assessment was followed by a set of interventions, which did not show a significant improvement in TBIC. The difference between the pre- and post-intervention TB screening rate was not statistically significant. An assessment of time interval between 101 patients presenting with TB symptoms and diagnosed with TB was 4 days at baseline and post-intervention. Most of the anticipated improvements were dependent on the health workers’ adherence to the local TBIC policies, which emerged as an unexpected finding.ConclusionWe found good managerial commitment reflected by the presence of various policies, guidelines, specific personnel and committees to deal with infection control in general. This study has created awareness about TBIC among staff and pointed out the complexity of health workers’ behaviour towards adhering to policies.

Tuberculosis (TB) has been and is still an important public health issue in China. According to the most recent report from the World Health Organization, China had an estimation of 1.4 million existing TB and 1 million incident TB in 2011 [1]. Among the new cases, approximately 1.2% combined the existing HIV infection [1]. Since TB is directly related to people’s health status and work capability, therefore, the control of TB prevalence has been of priority both in the public health and in the economic development of China. The progress in controlling TB in China is, however, currently influenced by the following two major factors. First, the migration and health system compounds the prevention from TB. It is known that eighty percent of TB exists in rural areas, particularly in north and northwestern regions with low socioeconomic status in China. In the past three decades, there has been an increasing number of people from these areas that immigrated to the large urban cities; and they could potentially result in the spread of the disease in cities if they were TB-carriers. The urban living style and working conditions promote the transmission of TB in the big cities via crowded conditions and airborne pollution. However, the subsidized management of TB is only available through facilities in the birth place of immigrants and it is sometimes difficult for them to get screened, diagnosed and treated in the big cities. Also, multidrug resistant (MDR) TB has been another pressing public health issue in China. MDR TBs are spread from individual to individual in the same manner as regular TB, but are usually resistant to at least isoniazid and rifampicin, the two most powerful first-line anti-TB medications. Since most TB therapy consists of short-course chemotherapy, the treatment could only cure a small proportion of MDR TBs and the treatment using second-line TB medications is usually very expensive. Therefore, MDR TBs have brought about difficulty in the treatment, especially in developing countries such as China. With an increasing number of patients not being treated, TB would be problematic, and the epidemic of TB would be revived. In 2013, the prevalence of MDR TB in mainland China was 5.3% to 27.4% [2]. Despite these challenges, Chinese government has successfully addressed TB problem in the past few decades, and has great contribution to global TB prevention. Also, Centers for Disease Control in China together with other institutes conducts many preventive interventions of TB funded by The Global Fund to Fight AIDS, Tuberculosis, and Malaria program initiated by the World Health Organization. Chinese health professionals believe that they could fulfill the world-wide goal towards elimination of tuberculosis by 2050 [3].

Responding to COVID-19 pandemic: Why a strong health system is required.

SUMMARY The prison setting has been often cited as a possible reservoir of tuberculosis (TB) including multidrug-resistant (MDR)-TB. This is particularly true in low-income, high TB prevalence countries in Sub-Saharan Africa. A systemic literature review was done to assess the prevalence, drug resistance and risk factors for acquiring TB in the prison population. Our review indicated a high prevalence of TB in prisons which is reported to be 3- to 1000-fold higher than that found in the civilian population, indicating evidence and the need for public health policy formulation. In addition, high levels of MDR and extensively drug-resistant (XDR)-TB have been reported from prisons, which is a warning call to review prison TB control strategy. Multiple risk factors such as overcrowding, poor ventilation, malnutrition, human immunodeficiency virus (HIV), and others have fuelled the spread of TB in prisons. Furthermore, the impact extends beyond the prison walls; it affects the civilian population, because family visits, prison staff, and members of the judiciary system could be potential portals of exit for TB transmission. The health of prisoners is a neglected political and scientific issue. Within these background conditions, it is suggested that political leaders and scientific communities should work together and give special attention to the control of TB and MDR-TB in prisons. If not, TB in prisons will remain a neglected global problem and threatens national and international TB control programmes. Further researches are required on the prevalence and drug resistance of smear-negative TB in prisons. In addition, evidence of the circulating strains and transmission dynamics inside prisons is also warranted.

One of genetic loci involved in tuberculosis (TB) infection control in mice is located within the segment of Chr. 17 occupied by the H2 complex, the mouse MHC. As far as this region includes approximately 40 Mb and contains hundreds of genes affecting immune responses and host-parasite interactions, narrowing the interval by genetic recombination is pre-requisite for identification of particular gene(s). We have developed a panel of recombinant congenic strains bearing different parts of the H2 complex from TB-susceptible I/St mice on the genetic background of TB-resistant C57BL/6 mice. By superposing the phenotype "severe vs. mild infectious course" against the chart of alleles inherited by these new strains from the two parental strains, we have mapped a locus involved in TB control within the segment 33.305-34.479 Mb (-1.1 Mb) of the Chr. 17. Such a location indicates that allelic variants of the prominent pro-inflammatory factor TNF do not affect TB course in our experimental system. This result was confirmed by the assessment of the TNF level in the lung tissue of infected mice of different strains. The QTL (quantitative trait locus) mapped in our study influences several important parameters of TB infection: multiplication of mycobacteria in the lungs, severity of lung pathology and regulation of the early inflammatory response.

Reasons for healthcare workers becoming infected with novel coronavirus disease 2019 (COVID-19) in China

Nigeria is one of the countries with a high burden of tuberculosis (TB) in the world. TB associated inflammation is reported to be central to progression from latent TB to active TB or drug sensitive TB (DSTB) to drug resistant TB (DRTB). Inflammatory cytokines, especially interferon-gamma (IFN-γ) and tumor necrosis factor-alpha (TNF-α), act synergistically in the control of TB infection. They activate macrophages to produce effector molecules such as inducible nitric oxide synthase (iNOS), nitric oxide, and ultimately 3-nitrotyrosines(3-NTs), which are involved in the control of TB. This study investigated the potential involvement of TNF-α, IFN-γ, iNOS, and 3-NT in differentiating DRTB and DSTB in Ibadan, Nigeria. One hundred participants above 18 years were recruited into this study and were grouped as follows: 32 DRTB, 34 DSTB, and 34 apparently healthy controls. Plasma from the patients was used for the analyses of inflammatory (TNF α and IFN-γ) and oxidative stress (iNOS and 3-NT) biomarkers using the ELISA. Mann-Whitney test was applied for the statistical test. Mean levels of plasma TNF-α, IFN-γ, iNOS, and 3-NT were higher in DRTB (19.74 ± 3.62 pg/mL, 4.41 ± 0.96 pg/mL, 1791.07 ± 419.42 pg/mL, and 20.27 ± 1.80 ng/mL, respectively) and DSTB (17.02 ± 1.84 pg/mL, 5.59 ± 1.40 pg/mL, 2823.42 ± 685.32 pg/mL, and 25.06 ± 2.15 ng/mL, respectively) compared with controls (12.18 ± 0.92 pg/mL, 1.58 ± 0.21 pg/mL, 1275.86 ± 166.12 pg/mL, and 19.98 ± 1.23 ng/mL, respectively). In addition, higher plasma levels of IFN-γ (P > 0.05), iNOS (P > 0.05), and 3-NT (P < 0.05) were observed in DSTB compared with DRTB patients. The 3-NT may be used as differentiating markers of DSTB from DRTB.

Tuberculosis (TB) kills ∼1.5 million people worldwide each year.1 Among children and adolescents infected with TB, those <5 years old and those with HIV coinfection have a higher risk of death.2–4 Not only have few researchers quantified the impact of antiretroviral therapy (ART) regarding those with coinfected with HIV,4–6 there are important gaps in our overall knowledge for adolescents treated for TB. Numerous observational studies conducted before the availability of anti-TB antibiotics revealed that TB disease and death peaked in the first 2 years of life and then decreased until adolescence, after which it rose steeply.7 Some reports revealed sex-based differences in incidence and mortality during adolescence.8–11 In recent decades, however, adolescents have received little attention in TB research, and their vulnerability to the disease has been largely forgotten, mostly because TB surveillance systems group individuals <15 years with children and those ≥15 years with adults.1,12 Disaggregated TB data have not been reported routinely for adolescents, although this practice will change in 2021 after the World Health Organization’s request for countries to disaggregate TB data by 5-year age bands for people <25 years old.In this issue of Pediatrics, Osman et al13 address these research gaps by analyzing the South African Electronic Treatment Register, a national surveillance database of individuals treated for drug-susceptible TB. The study includes ∼85 000 HIV coinfected children and adolescents, of whom nearly one-half were not receiving ART at TB diagnosis. The authors found that, compared with HIV-uninfected children and adolescents, those with HIV on ART were >5 times as likely to die within 6 months of TB diagnosis, whereas those with HIV not on ART were >8 times more likely to die. These findings highlight the importance of TB preventive therapy and timely ART initiation in HIV-infected children and adolescents.4,5Using finely age-disaggregated case fatality ratios (CFRs), Osman et al13 found that the risk of death was high in the first year of life for both sexes (4.1%), early adolescence for boys (4.3%), and late adolescence for girls (4.2%). Estimating standardized mortality ratios (SMRs), the authors found that, in 2016, observed TB deaths occurred at 4 to 5 times the rate of expected deaths in children <5 years of age. In contrast, in 2016, TB deaths occurred at 77 to 92 times the rate of expected deaths in adolescents 10 to 14 years old. Notably, SMRs were much higher for adolescent girls than for adolescent boys. As the authors hypothesize, lower SMRs in young children may reflect their susceptibility to other diseases, and the discrepancy between adolescent boys and girls may reflect the high risk of death from injury and violence among boys in South Africa. Nonetheless, SMRs reveal the impact of TB on specific groups and should be incorporated into future research to inform public health decisions.Another strength of this study is its examination of time trends between 2004 and 2016. The authors observed similar CFRs in all age groups in 2004. Thereafter, CFRs declined in children <10 years old (most steeply in those <5 years old) but remained stable in adolescents. This discrepancy is consistent with a global trend of sharp mortality declines in young children, compared with adolescents.14 Taken together, the study observations underscore the need to devote more resources to adolescents: identifying and addressing their risk factors for TB mortality, prioritizing them in TB-contact investigations and screening activities, and increasing the prescription of and adherence to TB preventive treatment in this age group.A key consideration is that the data available for this study do not include people who are diagnosed with TB but do not initiate treatment, are never diagnosed with TB at all, or have drug-resistant TB. Because an estimated 20% of children <15 years old with untreated TB disease die within 1 year and treatment outcomes for those with drug-resistant TB are likely worse,4 the findings represent the “best case scenario” for child and adolescent TB mortality in South Africa.In the study, Osman et al13 clarify the impact of HIV and ART on TB mortality in children and adolescents and expose adolescents’ overall high risk of poor TB outcomes. In future research efforts, researchers should incorporate the study’s granular age categories and innovative use of both CFRs and SMRs to examine TB deaths in children and adolescents in diverse settings. For example, in former Soviet republics, where >15% of adolescents have rifampin-resistant TB, characterizing the impact of drug-resistance on TB mortality is particularly important.15 The World Health Organization’s recent request for data disaggregation by 5-year age bands will facilitate more detailed evaluations of TB deaths among children and adolescents around the world. By analyzing these disaggregated data, researchers can help improve outcomes for the most vulnerable children and adolescents.

Background. Today, the topic of combating Healthcare-Associated Infections (HAIs) is becoming increasingly relevant. The World Health Organization has developed the concept of Infection Prevention and Control (IPC), which is a key component of quality control and patient safety in hospitals. Aim. To analyze modern methods of infection prevention and the role of healthcare workers in the effective implementation of infection control measures, according to the data of modern literature sources. Materials and Methods. We analyzed the literature on prevention of hospital-acquired infections, as well as the importance of infection control in improving patient safety, the role of medical staff in the provision of medical care. The search for scientific information was carried out using the scientific databases Scopus, PubMed, Web of Science, Google Scholar. Results &amp; Conclusions. Hospital-acquired infections are a serious public health problem associated with increased patient morbidity and mortality, as well as an economic burden on healthcare systems. Approximately 10% of hospitalized patients in high-income countries are affected by HAIs. Infection control is defined as a set of effective organizational, preventive and anti-epidemic measures aimed at preventing the occurrence and spread of healthcare-associated infections. Healthcare workers play an important role in the effective implementation of infection control measures. The use of Personal Protective Equipment (PPE), hand hygiene, environmental cleaning, screening and isolation, sterilization and disinfection, surveillance and reporting, vaccination and the introduction of innovative technologies in hospital infection control are important elements of the prevention and control of HAIs. Hospital infection control is essential to protect patients, healthcare workers and the wider community from HAIs. These measures are important to protect patients, healthcare workers and all society. Keywords: hand hygiene, healthcare-associated infections, infection prevention.

Background: Tuberculosis (TB), caused by Mycobacterium tuberculosis, remains a major global health concern, particularly for healthcare workers (HCWs) who are at increased risk due to occupational exposure. This study evaluates nurses’ knowledge, attitudes, and practices (KAP) in implementing TB infection control measures in hospital settings across Ethiopia, Zimbabwe, Nepal, Saudi Arabia, India, Gabon, and Malaysia. Despite the availability of preventive measures, their inconsistent application due to inadequate training, resource shortages, and systemic challenges continues to hinder effective TB control. Identifying these gaps is crucial for improving infection prevention strategies. Purpose: This study aims to assess nurses' KAP regarding TB infection control, identify critical gaps in their understanding and practices, and highlight the need for targeted interventions such as in-service training, resource allocation, and stigma-reduction efforts. Methods: A literature review was conducted on studies published between 2020 and 2024 using the PubMed, ProQuest, and Scopus databases. The inclusion criteria focused on studies involving nurses in hospital settings that discussed knowledge, attitudes, and practices related to TB prevention. The 340 articles identified, 29 articles met the eligibility criteria after applying strict exclusion criteria for duplicate and non-empirical publications and studies that did not specifically focus on nurses in hospitals. To ensure accuracy and credibility, the included studies were assessed using the critical appraisal tool from the Joanna Briggs Institute (JBI) to minimize the risk of bias. Results: Findings revealed substantial gaps in nurses' knowledge and infection control practices, despite generally positive attitudes. For instance, many incorrectly relied on surgical masks instead of N95 respirators. Inconsistencies in infection control were linked to inadequate training, resource limitations, and high workloads. Conclusion: Addressing these deficiencies through structured training, improved resource distribution, and stigma-reduction strategies is essential to enhance TB prevention efforts in hospital settings.