| Background Tuberculosis is still one of the major infectious diseases that seriously harm human health.Health care workers(HCWs)in tuberculosis(TB)facilities are at high risk of infecting TB.Effective measures for TB infection control in medical facilities can effectively reduce the risk of TB infection among HCWs.The county level facilities in our country play an important role in discovering and curing TB patients.Due to the large number of TB facilities,HCWs in county level,and the huge workload,the risk of TB infection is greater among HCWs in the county level.At present the guiding role of Chinese TB infection control standard or guidelines for the county level facilities is limitted,and these standards or guidelines cannot meet the need of county level facilities under different systems.Moreover no principle or standard can be refered to for reconstruction or extension or new construction.Therefore,a mode of TB infection control in county level facilities that suits the local conditions and conforms to TB infection control standards is a pressing needed.On the basis of furtherly understanding the implementation status of TB infection control measures in further implementation in TB facilities,we found problems,explored the important factors that affect TB infection control measures.And according to the standard of TB infection control,in combination with the practical situation,we found the model that suited to the county level facilities,which could provide strong support for the implementation of tuberculosis infection control in county level facilities and the reduction of TB infection risk among HCWs,and provide a solid basis for the establishment of policies and its promotion.Objective 1.To further analyze the exsiting data and the data of newly investigated county level facilities on the implementation of TB infection control,deeply understanding the implementation status of TB infection control in TB facilities and finding problems.2.To explore the factors influencing the implementation of TB infection control measures.3.To esatablish evaluation modes for TB infection control in TB facilities,and make evaluation of the implementation of TB infection control in county level facilities.4.To establish a county-level mode for county level facilities based on the results of exsiting data mining and field investigation,also in reference to TB infection control standards.Method 1.We conducted the survey in county level facilities of 12 counties by observation and investigation to obtain the information about the general information,the implementation of organization management of TB infection control,the implementation of separating measures,early detection and early treatment,promotion,personal protective measures in the departments of ambulatory care,laboratories and wards,and other items;In the departments of ambulatory care,laboratories and wards,using equipment to measure the volume of rooms,the wind speed and area of inlets/outlets of rooms,the distance from the ground to the ultraviolet lamps,the radiation intensity of ultraviolet lamps and other items.2.For existing data and the data investigated,using descriptive analysis,logistic regression method and principal component analysis to analyze the implementation of TB infection control in TB facilities and its influence factors,and to establish evaluation modes of TB infection control measures and make evaluation for county level facilities.3.Based on the results of data mining and field survey,using the method of expert argumentation to establish a county-level mode conforming to TB infection control standards.Results 1.Of 212 facilities,26.4%had the special funds for TB infection control,34.4%carried out the evaluation of TB infection control,47.6%placed spittoons with cover in the departments of ambulatory care,3.8%monitored the ventilation in laboratories,14.2%regularly carried out the fit test of respirator for HCWs.Thereinto,the implementation rates in county level facilities were respectively 22.4%,22.4%,46.7%,3.9%and 11.2%.2.Of county level TB facilities in 12 counties,only two regularly monitor and do the maintenance of ventilation,or carried out risk evaluation and had improvement plan after evaluation;1 facilities provided surgical masks for patients in the departments of ambulatory care;2 facilities placed spittoon with cover and disinfectant in the departments of ambulatory care;2 facilities provided surgical masks for visitors in the wards;2 facilities installed mechanical ventilation equipment in the departments of ambulatory care;1 facilities regularly monitored the ventilation in the departments of ambulatory care.No facilities carried out routine cough screening for patients,placed spittoon with a cover and disinfectant in the wards,monitored the ventilation in the wards,installed mechanical ventilation equipment in the wards,carried out the fit test of reparatory for HCWs.The architectural layout of ambulatory care and wards were unreasonable.Medical staff and patients shared one access.The cleaning area,the semi-polluted area and the polluted area in ambulatory care and wards were not clear.No special tuberculosis ambulatory care and waiting area were exsited,and the route of treatment was not optimized.3.The associated factors of the TB infection control implementation showed that,training of pre-service and in-service could promote the implementation of administrative measures(OR2.673,95%CI 1.267-5.638)and environment engineering measures(OR 3.296,95%CI 1.389-7.823)in the departments of ambulatory care,environment engineering measures(OR 3.492,95%CI 1.544-7.896)in the departments of laboratories,and the implementation of personal protection(OR 2.405,95%CI 1.189-4.864).In addition,the implementation of risk evaluation and the improvement measures after evaluation,brought TB infection control into examination could promote administrative measures(OR2.888,95%CI 1.005-8.297)in the departments of ambulatory care,environment engineering measures(OR3.954,95%CI 1.434-10.906)in wards,the implementation of personal protective(OR 2.449,95%ci 1.130 5.305).4.In this study,16 indexes of organizational management measures were integrated into 6 principal component factors,5 indexes of personal protective measures were integrated into 3 composition factors,and the evaluation models of organizational management and personal protective were established according to the principal component factors and its variance contribution rates.For facilities with the departments of ambulatory care and laboratories:14 indexes of administrative measures were integrated into 7 principal component factors,12 indexes of environment and engineering measures were integrated into 5 principal component factors,and two comprehensive evaluation models were established according to the principal component factors and its variance contribution rates;For facilities with the departments of ambulatory care,laboratories and wards,23 indexes of administrative measures were integrated into 8 principal component factors,19 indexes of environment and engineering measures were integrated into 5 principal component factors,and two comprehensive evaluation models were established according to the principal component factors and its variance contribution rates.The evaluation models were verified by data from county level TB facilities in 12 counties,and the results of the comprehensive evaluation were basically in line with the actual survey results.5.Based on the results of principal component analysis and associated factors of the implementation of TB infection control measures of the existing data,and the results of TB infection control survey in county level facilities,key measures of organization management,administrative measures,environment and engineering,personal protective measures were needed to implement.According to the principles of independence,isolation and ventilation,the mode conforming to the standard of tuberculosis infection control for county level facilities was established.Conclusion In this study,data included two parts.One was the existing data acquired from a large survey on TB infection control in different levels and different types of facilities in China.The other was acquired from a comprehensive and detailed investigation was conducted on the comprehensive methods of observation,inspection,checking records and inquiries.Further analysis found the implementation of TB infection control measures was deficit in all level facilities,especially in the county level.We found that the implementation of bringing TB infection control into the examination,early detection and early treatment for patients,placing spittoons with cover and disinfectant in the department of ambulatory care and wards,motoring ventilation in the wards and the implementation of protective measures among HCWs were worse,in comparison with the analysis results of data mining.In addition,the layout of most buildings was unreasonable.HCWs and patients shared the same channels.Clean zones,semi-contamination zones and contamination zones were mixed in the departments of ambulatory care,laboratories and wards.No Separated waiting rooms were established.Clinic route was not optimized.The tuberculosis outpatient care were shared with other disease outpatient care.And using the exsiting data firstly we ananlyzed the influence factors for TB infection control.The implementation of two pre-service and in-service training for medical staff could promote administrative measures could promote the implementation of TB infection control,and so did the implementation of risk evaluation and the improvement measures after evaluation,brought TB infection control into examination.In this study,evaluation models for TB infection control was proposed for the first time.Indexes of organizing management measures and administrative measures,environment and engineering measures,personal protective measures were integrated,and 7 comprehensive evaluation models were established according to the principal component factors and its variance contribution rates,which could make objective evaluation of TB infection control in TB facilities.In summary of the above conclusions,reference to TB infection control standardoperating procedures,combined with the location situation,the TB infection control mode for the county level facilities were established,which provided evidence of theimplementation of key measures in the case of limited resource,and provided a referable mode for building construction or renewal in the county level facilities. |
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