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Tuberculosis (TB) infection control (IC) is key in controlling TB transmission in health facilities in Lithuania. This article presents a project that aimed at supporting health care facilities in Lithuania in implementing TB-IC. The project consisted of 1) facility TB-IC assessments, 2) development of facility TB-IC plans, 3) TB-IC training and 4) site visits. We assessed the impact of these activities through a self-assessment questionnaire. The project resulted in limited improvements. Most progress was seen in administrative and managerial activities. Possible reasons for the limited improvements are challenges with funding and the lack of supportive legislation and a national TB-IC plan.
La lutte contre l'infection tuberculeuse (TB-IC) est la clé du contrôle de la transmission de la TB dans les structures de santé de Lituanie. Cet article présente un projet qui a visé à soutenir les structures de soins de santé de Lituanie dans la mise en Åuvre de la TB-IC. Le projet a consisté en : 1) l'évaluation des structures de TB-IC, 2) l'élaboration de plans pour ces structures de TB-IC, 3) la formation à la TB-IC et 4) visites de sites. Nous avons évalué l'impact de ces activités par un questionnaire d'autoévaluation. Le projet a abouti à des améliorations limitées. Les progrès les plus importants ont été vus dans les activités d'administration et de gestion. Les raisons possibles de ces améliorations limitées sont des problèmes relatifs au financement et au manque de soutien légal, ainsi qu'à l'absence d'un plan national de TB-IC.
El control de la infección tuberculosa (TB-IC) constituye una medida fundamental en el control de la transmisión de la TB en los establecimientos de salud en Lituania. En el presente artículo se describe un proyecto encaminado a prestar apoyo a los establecimientos sanitarios en la ejecución de las normas de la TB-IC. El proyecto comportaba las siguientes medidas: 1) la evaluación del TB-IC en las instituciones; 2) la elaboración de planes de TB-IC en los establecimientos; 3) la capacitación en esta esfera; y 4) las visitas a los centros. Se examinó la repercusión de estas intervenciones mediante un cuestionario de autoevaluación. Con el proyecto se alcanzaron mejoras de un alcance limitado. La mayor parte del progreso se observó en las actividades administrativas y de gestión. Entre las posibles razones de este resultado modesto se cuentan las dificultades de financiamiento, la falta de una legislación de apoyo y de un plan nacional de TB-IC.
RESUMO
INTRODUCTION: In 2012, the tuberculosis (TB) notification rate among Romanian TB facility doctors and nurses was 7.2 times higher than in the general population. This indicates that transmission is ongoing inside TB facilities and that TB infection control measures are insufficient. To help prevent nosocomial TB transmission a project was implemented that aimed at providing nationwide tailor-made technical assistance in TB infection control (TB-IC) in TB treatment facilities, including the development of TB infection control plans. The objective of the present article is to describe the implementation of the project and to discuss successes and challenges. STUDY DESIGN: The project was an implementation study using two methods of evaluation: (1) a cross sectional questionnaire study; and (2) collection of information, during the training, on challenges related to infection control and to the project implementation. METHODS: The project team developed a TB facility infection control (TB-IC) plan template, together with the Romanian experts. The template was discussed and agreed upon with the experts at a meeting and thereafter distributed by email to all TB facilities. Afterwards, a training of trainers (TOT) seminar was organized which included the provision of information about different training methods, as well as information about TB-IC. The TOT was followed by training for key TB-IC providers. Information about use of the TB-IC template was gathered through a self-administered questionnaire sent to all participants of the expert meeting and the training (42 people). Additionally, non-systematized discussions were held on broader challenges in TB-IC implementation during the training. RESULTS: Within the project 42 key TB-IC service providers were trained in TB-IC, including 9 who were trained at a TOT seminar. The trainees were specialists working at the national level, such as country TB coordinators, or at the TB facility level: TB doctors, epidemiologists, laboratory specialists and maintenance engineers. Out of 42 key TB-IC service providers who were trained, only eighteen responded to the questionnaire (no reminders were sent). Out of these, 14 had used the TB-IC plan template after the project team disseminated it to them by email. The remaining four TB-IC service providers indicated that they were planning to use the template to develop or update their facility TB-IC plans. Related to the use of TB-IC plan template, the following broader challenges in TB-IC were identified: a lack of authority of the individuals responsible for TB-IC to implement the TB-IC measures, lack of training among facility epidemiologists on TB, underdeveloped system for reporting TB in healthcare workers, difficulties with triage of the TB suspects, and poor facility infrastructure hampering implementation of TB-IC measures. DISCUSSION: Implementing TB-IC plans in Romanian health care facilities proved to be challenging, mainly due to the fact that the national infection control plan for TB was not yet adopted at the time of project implementation, and therefore there was neither a regulatory framework to support TB facility-IC planning nor any related budget allocations for the implementation of the facilities' TB-IC plans. Nonetheless, most respondents who answered the questionnaire (18 of 42 responded) indicated that they had started using the TB-IC plan template, which represents a full package of infection control measures that, when implemented effectively and in its entirety, may be expected to reduce nosocomial transmission. The study's limitations are: very low survey response rate, thus there is a likelihood of responder bias.