TB Centre, London School of Hygiene and Tropical Medicine, London, UK
TB Centre, London School of Hygiene and Tropical Medicine, London, UK.
BMJ Glob Health. 2021 Oct;6(10). doi: 10.1136/bmjgh-2021-007124.
Elevated rates of tuberculosis in healthcare workers demonstrate the high rate of ) transmission in health facilities in high-burden settings. In the context of a project taking a whole systems approach to tuberculosis infection prevention and control (IPC), we aimed to evaluate the potential impact of conventional and novel IPC measures on transmission to patients and other clinic attendees.
An individual-based model of patient movements through clinics, ventilation in waiting areas, and transmission was developed, and parameterised using empirical data from eight clinics in two provinces in South Africa. Seven interventions-codeveloped with health professionals and policy-makers-were simulated: (1) queue management systems with outdoor waiting areas, (2) ultraviolet germicidal irradiation (UVGI) systems, (3) appointment systems, (4) opening windows and doors, (5) surgical mask wearing by clinic attendees, (6) simple clinic retrofits and (7) increased coverage of long antiretroviral therapy prescriptions and community medicine collection points through the Central Chronic Medicine Dispensing and Distribution (CCMDD) service.
In the model, (1) outdoor waiting areas reduced the transmission to clinic attendees by 83% (IQR 76%-88%), (2) UVGI by 77% (IQR 64%-85%), (3) appointment systems by 62% (IQR 45%-75%), (4) opening windows and doors by 55% (IQR 25%-72%), (5) masks by 47% (IQR 42%-50%), (6) clinic retrofits by 45% (IQR 16%-64%) and (7) increasing the coverage of CCMDD by 22% (IQR 12%-32%).
The majority of the interventions achieved median reductions in the rate of transmission to clinic attendees of at least 45%, meaning that a range of highly effective intervention options are available, that can be tailored to the local context. Measures that are not traditionally considered to be IPC interventions, such as appointment systems, may be as effective as more traditional IPC measures, such as mask wearing.
医护人员中结核病发病率升高表明，在高负担国家的卫生机构中，结核病传播率很高。在一个采取整体系统方法进行结核病感染预防和控制（IPC）的项目中，我们旨在评估常规和新型 IPC 措施对患者和其他就诊者传播的潜在影响。
我们开发了一个基于个体的患者在诊所内移动、等候区通风和传播的模型，并使用来自南非两个省份的 8 个诊所的经验数据进行了参数化。模拟了七种干预措施（与卫生专业人员和决策者共同制定）：（1）带有户外等候区的队列管理系统，（2）紫外线杀菌照射（UVGI）系统，（3）预约系统，（4）打开窗户和门，（5）诊所就诊者佩戴外科口罩，（6）简单的诊所改造和（7）通过中央慢性药物配给和分发（CCMDD）服务增加长期抗逆转录病毒治疗处方和社区药物收集点的覆盖范围。
在模型中，（1）户外等候区将就诊者的传播减少了 83%（IQR76%-88%），（2）UVGI 减少了 77%（IQR64%-85%），（3）预约系统减少了 62%（IQR45%-75%），（4）打开窗户和门减少了 55%（IQR25%-72%），（5）口罩减少了 47%（IQR42%-50%），（6）诊所改造减少了 45%（IQR16%-64%），（7）增加 CCMDD 覆盖范围增加了 22%（IQR12%-32%）。
大多数干预措施使就诊者传播率的中位数降低至少 45%，这意味着有一系列非常有效的干预选择可供选择，可以根据当地情况进行调整。传统上不被认为是 IPC 干预措施的措施，例如预约系统，可能与更传统的 IPC 措施（如佩戴口罩）一样有效。
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