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Health-E
Poor infection control puts health workers at risk
Anso Thom
July 2, 2008
DURBAN - Workers at health facilities are increasingly infected with tuberculosis (TB) and multi-drug resistant TB (MDR TB) as they come into close and lengthy contact with infected patients, the first national TB conference heard yesterday (Wednesday).

Delegates attending a skills session presented by the SA HIV Clinicians Society spoke of nurses, bus drivers, laundry workers and kitchen workers being infected with TB and MDR TB, with reports of deaths.

Presenters cautioned that some of these infections could have been acquired in the community, but follow-up testing has shown that some of the infections could be traced to patients who had come into contact with the workers.

Poor infection control measures such as poor ventilation, non-availability of appropriate masks and forced institutionalization of TB patients were largely to blame, said delegates.

One of the presenters, Dr Natalie Beylis of the National Health Laboratory Services reminded delegates that two of the 54 people who died when extensively-drug resistant (XDR) TB was first identified in Tugela Ferry were health workers. HIV positive health workers are at higher risk of TB infection, as is the case in the broader community.

A doctor from Chris Hani Baragwanath Hospital said that five staff members treating more than 16 000 inmates at a nearby prison had become infected over the past two years, two of them with MDR TB.

A bus driver who has for years been transporting patients in a poorly ventilated bus from the hospital to a step-down facility next door, was also recently infected with TB.

The doctor revealed that MDR TB patients were taken to Sizwe TB hospital 40 km away in ambulances and buses that were in no way equipped to protect the staff transporting them.

Another doctor from a hospital in rural KwaZulu-Natal said every month they sent 200 MDR TB patients to King George Hospital in Durban on an overnight bus.

"They are transported in the same bus as patients going to see other specialists at the tertiary hospitals, including HIV positive patients. The best infection control we could put in place under the circumstances was to put the MDR patients at the back of the bus.

"We are really sitting on a time bomb, we know about it, but we need to ask whether anybody is listening out there," the doctor asked.

"We need to put the issue of infection control more firmly on the agenda. We are the ones getting infected, but I remind myself every day not to think about it too much or I wouldn't be able to continue with my job," he said.

A colleague who works at the same rural hospital said 100 people working in the hospital, including nurses, laundry workers, kitchen workers and cleaners, had contracted TB since 2000.

A health worker employed at an HIV clinic at one of Johannesburg's large hospitals said it took her two months to get the hospital managers to buy a box of masks after their chief nurses was infected with MDR TB and died.

A nurse working at an MDR facility in the Eastern Cape said it was becoming increasingly difficult to recruit staff. "Health workers are often HIV positive and there is no way you can expose them to the risk," she said.

A counselor working in the Eastern Cape described the situation at the TB hospitals as out of control.

"We see patients deliberately trying to infect health workers as they are angry and frustrated at being locked up. When things get out of hand you try to meet with the patients to hear their grievances and you will find 140 patients trying to cough on you at the same time," she said.

She said they on occasion had to call the police to protect doctors tasked with assessing whether patients were allowed to go home.

Health workers all spoke of poor or no infection control measures in their facilities. Often, where ventilation systems or UV lights had been installed, they were out of order or inadequate.

"I always find it laughable that when we have one meningococcal meningitis case then there is an uproar. The patient is placed in a side room and prophylaxis is given to everyone who came into contact with the patient, but TB is just ignored," commented a doctor.

Various delegates have called for the conference to take a strong stand in the urgent need for effective infection control.



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