Chapman Helena J, Veras-Estévez Bienvenido A, Pomeranz Jamie L, Pérez-Then Eddy N, Marcelino Belkys, Lauzardo Michael
University of Florida College of Medicine, Gainesville, Florida, USA.
MEDICC Rev. 2017 Jan;19(1):16-22. doi: 10.37757/MR2017.V19.N1.4.
INTRODUCTION Health care workers have an increased risk of infection due to occupational Mycobacterium tuberculosis exposure, including multidrug-resistant strains. Health care workers' risk of developing tuberculosis is greater than that of the general population, whether in low-, intermediate- or high-incidence countries. Adherence to infection control measures (administrative controls, environmental controls, and personal respiratory protection) is essential to reduce risk of disease transmission between suspected tuberculosis patients and health care workers, but for different reasons, both objective and subjective, adherence is low. Identifying the causes of low adherence is a prerequisite to effective programming to reduce risk. OBJECTIVE Identify perceived barriers to adherence to tuberculosis infection control measures among health care workers in the Dominican Republic. METHODS During August 2014, a qualitative study was conducted in two tertiary-level hospitals in different regions of the Dominican Republic. A semi-structured interview guide of nine questions was developed, based on the scientific literature and with consensus of clinical experts. Nine semi-structured interviews were conducted with a purposive sample of seven physicians (five men, two women) and two baccalaureate nurses (both women) working in the emergency medicine, internal medicine or nursing departments of those institutions. Question topics included clinical experience of M. tuberculosis infection and disease; knowledge of disease transmission and preventive practices; clinical management strategies; and perceptions of effectiveness of directly observed treatment, short-course, and disease coping strategies. RESULTS Perceived barriers were described as: 1) sense of invincibility of health care workers; 2) personal beliefs of health care workers related to direct patient communication; 3) low provider-to-patient ratios in hospitals; 4) absence of tuberculosis isolation units for patients within hospitals; and 5) limited availability of protective masks for health care workers. CONCLUSIONS Our results highlight that perceived barriers at the individual or institutional level may hinder how health care workers understand and comply with preventive strategies to reduce risk of tuberculosis transmission. Addressing these barriers by strengthening infection control program infrastructure and implementing educational interventions within institutions may reduce risk of nosocomial tuberculosis transmission to health care workers. KEYWORDS Health care providers, infection control, infectious disease transmission, health care associated infection, nosocomial infection, Mycobacterium tuberculosis occupational exposure, occupational health, qualitative research, tuberculosis, Dominican Republic.
引言
医护人员因职业接触结核分枝杆菌（包括耐多药菌株）而面临更高的感染风险。无论在低发病率、中等发病率还是高发病率国家，医护人员患结核病的风险都高于普通人群。坚持感染控制措施（管理控制、环境控制和个人呼吸防护）对于降低疑似结核病患者与医护人员之间疾病传播的风险至关重要，但由于客观和主观等不同原因，依从性较低。确定依从性低的原因是制定有效计划以降低风险的先决条件。
目的
确定多米尼加共和国医护人员在遵守结核病感染控制措施方面所察觉到的障碍。
方法
2014年8月，在多米尼加共和国不同地区的两家三级医院进行了一项定性研究。基于科学文献并经临床专家达成共识，制定了一份包含九个问题的半结构化访谈指南。对在这些机构的急诊科、内科或护理部门工作的七名医生（五名男性，两名女性）和两名本科护士（均为女性）进行了有目的抽样的九次半结构化访谈。问题主题包括结核分枝杆菌感染和疾病的临床经验；疾病传播和预防措施的知识；临床管理策略；以及对直接观察短程治疗有效性的看法和疾病应对策略。
结果
1）医护人员的无敌感；2）医护人员与患者直接沟通相关的个人信念；3）医院中医护人员与患者的比例较低；4）医院内没有针对患者的结核病隔离单元；5）医护人员防护口罩供应有限。
结论
我们的结果表明，个人或机构层面察觉到的障碍可能会阻碍医护人员理解和遵守降低结核病传播风险的预防策略。通过加强感染控制计划基础设施并在机构内实施教育干预来解决这些障碍，可能会降低医护人员发生医院内结核病传播的风险。
关键词
医护人员；感染控制；传染病传播；医疗相关感染；医院感染；结核分枝杆菌职业暴露；职业健康；定性研究；结核病；多米尼加共和国
