南非耐药结核病医院的国家感染控制评估。
A national infection control evaluation of drug-resistant tuberculosis hospitals in South Africa.
机构信息
School of Nursing, Johns Hopkins University, Baltimore, Maryland 21205, USA.
出版信息
Int J Tuberc Lung Dis. 2012 Jan;16(1):82-9. doi: 10.5588/ijtld.10.0791.
BACKGROUND
The importance of infection control (IC) in health care settings with tuberculosis (TB) patients has been highlighted by recent health care-associated outbreaks in South Africa.
OBJECTIVE
To conduct operational evaluations of IC in drug-resistant TB settings at a national level.
METHODS
A cross-sectional descriptive study was conducted from June to September 2009 in all multidrug-resistant (MDR-TB) and extensively drug-resistant TB (XDR-TB) facilities in South Africa. Structured interviews with key informants were completed, along with observation of IC practices. Health care workers (HCWs) were asked to complete an anonymous knowledge, attitudes and practices (KAP) questionnaire. Multilevel modeling was used to take into consideration the relationship between center and HCW level variables.
RESULTS
Twenty-four M(X)DR-TB facilities (100%) were enrolled. Facility infrastructure and staff adherence to IC recommendations were highly varied between facilities. Key informant interviews were incongruent with direct observation of practices in all settings. A total of 499 HCWs were enrolled in the KAP evaluation. Higher level of clinical training was associated with greater IC knowledge (P < 0.001), more appropriate attitudes (P < 0.001) and less time spent with coughing patients (P < 0.001). IC practices were poor across all disciplines.
CONCLUSION
These findings demonstrate a clear need to improve and standardize IC infrastructure in drug-resistant TB settings in South Africa.
背景
最近南非发生了几起与医疗保健相关的结核病（TB）暴发事件，突显了医疗保健环境中感染控制（IC）的重要性。
目的
在国家层面上对耐多药结核病（MDR-TB）环境中的感染控制进行操作评估。
方法
2009 年 6 月至 9 月期间，在南非所有耐多药（MDR-TB）和广泛耐药（XDR-TB）的设施中进行了一项横断面描述性研究。对关键信息员进行了结构化访谈，并观察了感染控制实践。要求医护人员（HCWs）填写一份匿名的知识、态度和实践（KAP）调查问卷。采用多水平建模来考虑中心和 HCW 水平变量之间的关系。
结果
共纳入了 24 家 M（X）DR-TB 机构（100%）。各机构之间的设施基础设施和工作人员对感染控制建议的遵守情况存在很大差异。关键信息员访谈与所有设置中的实践直接观察不一致。共纳入了 499 名 HCWs 进行 KAP 评估。更高水平的临床培训与更高的 IC 知识（P<0.001）、更恰当的态度（P<0.001）和与咳嗽患者相处的时间更少（P<0.001）相关。所有学科的 IC 实践都很差。
结论
这些发现表明，南非需要改善和规范耐药结核病环境中的感染控制基础设施。
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