| BackgroundChina is the second largest high TB burden countries in the world, there are about more than 1.1 million new cases of tuberculosis(TB) each year, at the same time,the incidence of multidrug-resistant tuberculosis is higher in our country, all of these have brought great challenges for TB control work. A large number of TB patients are being treated in the institutions of TB prevention and control,which makes the institutions of TB prevention and control become the risky environment of spreading TB, health care workers(HCW) have become suceptible to the mycobacterium tuberculosis and being the high-risk population suffering from tuberculosis due to the high exposure risk, research shows that the rate of mycobacterium tuberculosis infection and TB prevalence of health care workers are much higher than the general population.However, the TB control work in China started late, there is a lack of the sound TB infection control measures, coupled with the limitation of current-used disinfection measures, and lack of standard organization management measures and the poor personal, etc., strengthening the TB infection control work has become a pressing public health problems.To provide scientific reference for TB infection control, and to improve TB infection control work and ensure the occupational security of the health care workers, first of all there is a need to find out the status quo of TB infection control in health care facilities in China, analyze the effects of the TB infection control status to the TB prevalence of the health care workers and the relative risk factors of TB for the health care workers.ObjectivesUnderstand the the status quo of TB infection control of the TB prevention and control institutions in our country; Aquire the the TB prevalence of the health care workers in the selected region and analyze the relative TB prevalence factors; Provide reference for our country to further develop the TB infection control strategy and implement measures to reduce the TB prevalence of the health care workers.MethodsThis study used the cross-sectional study and was carried from February to October in 2013, considering the regional distribution of the eastern, central and western, as well as the human resources, working status and willingness to undertake the project and many other factors of the provincial institutions of TB prevention and control, use the method of the purposive sampling and combining the typical sampling,choose four provinces in the eastern, central and western regions, east respectively:Jiangsu, Zhejiang, Shandong, Liaoning, Central: Anhui, Jiangxi, Henan,Shanxi; West:Shaanxi, Yunnan, Gansu, Sichuan, a total of 12 provinces. Choose three cities from Each province, and four counties from each city,select an institution of TB prevention and control and and designated hospitals at the provincial, city and county levels respectively, TB department of the specialized subject hospital or the general hospital. Adopt the method of filling in the questionnaire by the unified training personnel in provincial institutions of the TB prevention and control, respectively, fill in three questionnaires as the TB infection control questionnaire for institutions of TB prevention and control, the staff questionnaire in the institutions of the TB prevention and control, and the TB health care worker survey list in 2011-2012 to collect the relative TB infection control data of the health care facilities, and carry out the survey of the relative TB infection control of the health care workers in these facilities, at the same time, collect the relative information of the TB health care workers in 2011-2012, analyze the present TB infection situation of the institutions of the TB prevention and control and explore the relationship between the TB infection control situation and the TB prevalence of the healthcare workers.We have carried out field investigation after the survey, to verify the questionnaire and fill in the TB infection control field questionnaire.ResultsThis study included 241 institutions of TB prevention and control, 9663 health care workers in the investigation. There are 153 (63.5%) institutions established infection control organisation, the number of the health care workers in 113 (46.9%)institutions can meet the needs of the local work, the median number of full-time health care workers responsible for the infection control is 2 people. 59 (24.5%)institutions have related special funds of the infection control work, the number of the special funds range from one thousand yuan to 149 thousand yuan, an average of 128 thousand yuan. 172 (71.4%) institutions have carry out the regular TB infection control on-the-job training, 165 (68.5%) institutions have carried out the TB health education activities, the median number of the health education activities in 2012 is 2.0 times. The waiting area layout in 70 (29.0%) institutions is unreasonable, mainly including the small waiting area space, poor ventilation, the unseparated waiting room and the outpatient, insufficient disinfection measures, etc. Most institutions have installed the ultraviolet lamp, and make the maintenance plan and on average,but the method of the installment and the maintenance are not reasonable.Of the included 9663 health care workers, there are 3391 (35.1%) doctors, 2648(27.4%) nurses, 1232(12.7%) experiment and radiation technicians, 2407 administrative and management people.The average age is 38 years old, the education condition with bachelor's degrees are the most, followed by junior college degree. The ward health care workers 2520 people (26.1%), the tuberculosis (TB) relative department staff 1866 people (19.3%), laboratory and radiology technicians 1592 people (16.5%), the department of administrative and management department 2742 people (28.4%), other departments including emergency, obstetrics and gynecology,surgery, medical, health, 943 people (9.8%), the average time of working in the current position is 16.7 years. The rate of TB prevalence in 2012 is 735/100000, the rate of prevalence in eastern region prevalence is 597/100000, the central region is 868/100000, the western region is 862/100000.The publicity and education of TB patients, the ventilation condition in the institutions of TB prevention and control, the way of installment and the maintain of the ultraviolet lamp and the age, the sex, professional category and the work duration of this job of the health care workers may be the influence factors of the TB prevalence of the health care workers.The TB risk of the older HCW is higher, The TB risk of the male health care workers is 2.01 times of the institutions with adequate isolation measures, the OR 95% CI value was (1.06, 3.80).The risk of the health care workers with working duration less than 20 years is higher than the health care workers with working duration more than 21 years.The risk of TB prevalence of nurses and doctors are respectively 5.63 times and 2.63 times of the administrative and management personnels, the OR 95% CI value was (2.24,14.13) and (1.18,5.88)respectively. The TB risk of the health care workers in institutions with poor publicity and education is 2.65 times that of the institutions with good publicity and education,the OR 95% CI value was (1.34, 5.27); The TB risk of health care workers in institutions with poorly ventilation was 3.10 times that of the institutions with good ventilation, OR 95% Cl value was (1.41, 6.79).Conclusions1. These aspects, managerial activities, administrative control measures,environmental and engineering control measures, personal protection, the publicity and education of TB patients and so on of TB infection control in institutions of TB prevention and control, have more or less problems related to HCW suffering from TB. There is a need to improve the TB infection control work, strengthen the screening, isolation and health education of patients, improve the layout of the institutions, ventilation, etc., in order to reduce the TB risk of the HCW.2. The TB prevalence of the HCW in the institutions of TB prevention and control is higher than the general population, the TB risk of the old HCW is higher than the young HCW, the TB risk of nurses and doctros are higher, the TB risk of male HCW is higher than the female HCW, the TB risk of the HCW with working duration less than 20 years is higher than the HCW with working more than 21years.The TB risk of HCW in facilities lack of publicity and education is higher than the medical staff with sufficient publicity and education institutions, the TB risk of HCW in facilities with poor ventilation is higher than that of the well ventilated institutions.3. There is a need to strengthen the health education related to the TB infection control for the HCW, and carry out the training evaluation and practice on a regular basis, and provide adequate medical respirator for the medical staff and fit experiment of masks on a regular basis, and enhance their consciousness of the personal protection against TB and further promote their personal protection.4. Health care facilities should increase the attention and the fund input to the TB infection control work, reduce the occupational risk of TB prevalence of the HCW. |
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