Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Parow, South Africa ; Department of Clinical Epidemiology, Biostatistics and Bio-informatics, University of Amsterdam, Amsterdam, The Netherlands.
PLoS One. 2013 Oct 2;8(10):e76272. doi: 10.1371/journal.pone.0076272. eCollection 2013.
Challenges exist regarding TB infection control and TB in hospital-based healthcare workers in South Africa. However, few studies report on TB in non-hospital based healthcare workers such as primary or community healthcare workers. Our objectives were to investigate the implementation of TB infection control measures at primary healthcare facilities, the smear positive TB incidence rate amongst primary healthcare workers and the association between TB infection control measures and all types of TB in healthcare workers.
One hundred and thirty three primary healthcare facilities were visited in five provinces of South Africa in 2009. At each facility, a TB infection control audit and facility questionnaire were completed. The number of healthcare workers who had had TB during the past three years was obtained.
The standardised incidence ratio of smear positive TB in primary healthcare workers indicated an incidence rate of more than double that of the general population. In a univariable logistic regression, the infection control audit score was significantly associated with reported cases of TB in healthcare workers (OR=1.04, 95%CI 1.01-1.08, p=0.02) as was the number of staff (OR=3.78, 95%CI 1.77-8.08). In the multivariable analysis, the number of staff remained significantly associated with TB in healthcare workers (OR=3.33, 95%CI 1.37-8.08).
The high rate of TB in healthcare workers suggests a substantial nosocomial transmission risk, but the infection control audit tool which was used did not perform adequately as a measure of this risk. Infection control measures should be monitored by validated tools developed and tested locally. Different strategies, such as routine surveillance systems, could be used to evaluate the burden of TB in healthcare workers in order to calculate TB incidence, monitor trends and implement interventions to decrease occupational TB.
南非医院医护人员的结核感染控制和结核问题存在挑战。然而，很少有研究报告非医院医护人员（如初级或社区医护人员）的结核情况。我们的目标是调查初级保健设施中结核感染控制措施的实施情况、初级保健工作者中涂阳结核的发病率，以及结核感染控制措施与医护人员各类结核之间的关联。
2009 年在南非五个省份的 133 个初级保健机构进行了调查。在每个机构都完成了结核感染控制审计和机构问卷调查。获取了过去三年中患有结核的医护人员人数。
初级保健工作者涂阳结核的标准化发病率比普通人群高出一倍以上。在单变量逻辑回归中，感染控制审计评分与医护人员报告的结核病例显著相关（OR=1.04，95%CI 1.01-1.08，p=0.02），员工人数也显著相关（OR=3.78，95%CI 1.77-8.08）。在多变量分析中，员工人数与医护人员的结核仍然显著相关（OR=3.33，95%CI 1.37-8.08）。
医护人员结核发病率高表明存在严重的医院内传播风险，但所使用的感染控制审计工具作为衡量这一风险的指标并不能充分发挥作用。应使用在当地开发和测试的经过验证的工具来监测感染控制措施。可以使用不同的策略，如常规监测系统，来评估医护人员结核负担，以计算结核发病率、监测趋势并实施干预措施来减少职业性结核。
