Background:  The importance of infection control (IC) in healthcare settings withMycobacterium tuberculosis (TB) patients has been highlighted by recent healthcare-associated outbreaks in South Africa.  Operational evaluations of IC within drug-resistant TB settings at a national level have not been conducted. Methods: A cross-sectional descriptive study was conducted from June to September 2009 in all M(X)DR-TB facilities in South Africa. Structured interviews with key-informants were completed along with observation of IC practices. Healthcare workers (HCWs) were asked to complete an anonymous knowledge, attitudes and practices (KAP) questionnaire. Multilevel modeling was used to examine the relationship between center and HCW level variables. Results: Twenty-four M(X)DR-TB facilities (100%) were enrolled. Facility infrastructure and staff adherence to IC recommendations was highly varied between facilities. Key-informant interviews were incongruent with direct observation of practices in all settings. A total of 499 HCWs were enrolled in the KAP evaluation. Higher level of clinical training was associated with greater IC knowledge (p<.001), more appropriate attitudes (p<0.001) and less time spent with coughing patients (p<.001). IC practices were poor across all disciplines. Conclusion:  These findings demonstrate a clear need to improve and standardize IC infrastructure in drug-resistant TB settings in South Africa.

Susan Dorman, MD, SOM.