van der Westhuizen Helene-Mari, Dorward Jienchi, Roberts Nia, Greenhalgh Trisha, Ehrlich Rodney, Butler Chris C, Tonkin-Crine Sarah
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.
PLOS Glob Public Health. 2022 Jul 7;2(7):e0000292. doi: 10.1371/journal.pgph.0000292. eCollection 2022.
Implementation of TB infection prevention and control (IPC) measures in health facilities is frequently inadequate, despite nosocomial TB transmission to patients and health workers causing harm. We aimed to review qualitative evidence of the complexity associated with implementing TB IPC, to help guide the development of TB IPC implementation plans. We undertook a qualitative evidence synthesis of studies that used qualitative methods to explore the experiences of health workers implementing TB IPC in health facilities. We searched eight databases in November 2021, complemented by citation tracking. Two reviewers screened titles and abstracts and reviewed full texts of potentially eligible papers. We used the Critical Appraisals Skills Programme checklist for quality appraisal, thematic synthesis to identify key findings and the GRADE-CERQual method to appraise the certainty of review findings. The review protocol was pre-registered on PROSPERO, ID CRD42020165314. We screened 1062 titles and abstracts and reviewed 102 full texts, with 37 studies included in the synthesis. We developed 10 key findings, five of which we had high confidence in. We describe several components of TB IPC as a complex intervention. Health workers were influenced by their personal occupational TB risk perceptions when deciding whether to implement TB IPC and neglected the contribution of TB IPC to patient safety. Health workers and researchers expressed multiple uncertainties (for example the duration of infectiousness of people with TB), assumptions and misconceptions about what constitutes effective TB IPC, including focussing TB IPC on patients known with TB on treatment who pose a small risk of transmission. Instead, TB IPC resources should target high risk areas for transmission (crowded, poorly ventilated spaces). Furthermore, TB IPC implementation plans should support health workers to translate TB IPC guidelines to local contexts, including how to navigate unintended stigma caused by IPC, and using limited IPC resources effectively.
尽管医院内结核病传播给患者和医护人员造成了伤害，但卫生机构中结核病感染预防与控制（IPC）措施的实施情况往往不尽如人意。我们旨在回顾与实施结核病IPC相关复杂性的定性证据，以帮助指导结核病IPC实施计划的制定。我们对采用定性方法探索医护人员在卫生机构实施结核病IPC经验的研究进行了定性证据综合分析。我们于2021年11月检索了八个数据库，并辅以引文跟踪。两名评审员筛选了标题和摘要，并对潜在符合条件论文的全文进行了评审。我们使用批判性评估技能计划清单进行质量评估，采用主题综合法确定关键发现，并使用GRADE-CERQual方法评估综述结果的确定性。该综述方案已在PROSPERO上预先注册，注册号为CRD42020165314。我们筛选了1062篇标题和摘要，评审了102篇全文，综合分析纳入了37项研究。我们得出了10项关键发现，其中5项我们有高度信心。我们将结核病IPC的几个组成部分描述为一项复杂的干预措施。医护人员在决定是否实施结核病IPC时受到其个人职业结核病风险认知的影响，而忽视了结核病IPC对患者安全的贡献。医护人员和研究人员表达了多种不确定性（例如结核病患者的传染期）、关于什么构成有效的结核病IPC的假设和误解，包括将结核病IPC重点放在已知正在接受治疗的结核病患者身上，而这些患者传播风险较小。相反，结核病IPC资源应针对高传播风险区域（拥挤、通风不良的空间）。此外，结核病IPC实施计划应支持医护人员将结核病IPC指南转化为当地实际情况，包括如何应对IPC造成的意外污名，以及有效利用有限的IPC资源。
