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Agents of change: The role of healthcare workers in the prevention of nosocomial and occupational tuberculosis.

Abstract Healthcare workers (HCWs) play a central role in global tuberculosis (TB) elimination efforts but their contributions are undermined by occupational TB. HCWs have higher rates of latent and active TB than the general population due to persistent occupational TB exposure, particularly in settings where there is a high prevalence of undiagnosed TB in healthcare facilities and TB infection control (TB-IC) programmes are absent or poorly implemented. Occupational health programmes in high TB burden settings are often weak or non-existent and thus data that record the extent of the increased risk of occupational TB globally are scarce. HCWs represent a limited resource in high TB burden settings and occupational TB can lead to workforce attrition. Stigma plays a role in delayed diagnosis, poor treatment outcomes and impaired well-being in HCWs who develop TB. Ensuring the prioritization and implementation of TB-IC interventions and occupational health programmes, which include robust monitoring and evaluation, is critical to reduce nosocomial TB transmission to patients and HCWs. The provision of preventive therapy for HCWs with latent TB infection (LTBI) can also prevent progression to active TB. Unlike other patient groups, HCWs are in a unique position to serve as agents of change to raise awareness, advocate for necessary resource allocation and implement TB-IC interventions, with appropriate support from dedicated TB-IC officers at the facility and national TB programme level. Students and community health workers (CHWs) must be engaged and involved in these efforts. Nosocomial TB transmission is an urgent public health problem and adopting rights-based approaches can be helpful. However, these efforts cannot succeed without increased political will, supportive legal frameworks and financial investments to support HCWs in efforts to decrease TB transmission.
PMID
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Authors

Mayor MeshTerms

Consumer Advocacy

Health Personnel

Keywords
Journal Title presse medicale (paris, france : 1983)
Publication Year Start




PMID- 28256382
OWN - NLM
STAT- MEDLINE
DA  - 20170303
DCOM- 20170406
LR  - 20170406
IS  - 2213-0276 (Electronic)
IS  - 0755-4982 (Linking)
VI  - 46
IP  - 2 Pt 2
DP  - 2017 Mar
TI  - Agents of change: The role of healthcare workers in the prevention of nosocomial 
      and occupational tuberculosis.
PG  - e53-e62
LID - S0755-4982(17)30054-4 [pii]
LID - 10.1016/j.lpm.2017.01.014 [doi]
AB  - Healthcare workers (HCWs) play a central role in global tuberculosis (TB)
      elimination efforts but their contributions are undermined by occupational TB.
      HCWs have higher rates of latent and active TB than the general population due to
      persistent occupational TB exposure, particularly in settings where there is a
      high prevalence of undiagnosed TB in healthcare facilities and TB infection
      control (TB-IC) programmes are absent or poorly implemented. Occupational health 
      programmes in high TB burden settings are often weak or non-existent and thus
      data that record the extent of the increased risk of occupational TB globally are
      scarce. HCWs represent a limited resource in high TB burden settings and
      occupational TB can lead to workforce attrition. Stigma plays a role in delayed
      diagnosis, poor treatment outcomes and impaired well-being in HCWs who develop
      TB. Ensuring the prioritization and implementation of TB-IC interventions and
      occupational health programmes, which include robust monitoring and evaluation,
      is critical to reduce nosocomial TB transmission to patients and HCWs. The
      provision of preventive therapy for HCWs with latent TB infection (LTBI) can also
      prevent progression to active TB. Unlike other patient groups, HCWs are in a
      unique position to serve as agents of change to raise awareness, advocate for
      necessary resource allocation and implement TB-IC interventions, with appropriate
      support from dedicated TB-IC officers at the facility and national TB programme
      level. Students and community health workers (CHWs) must be engaged and involved 
      in these efforts. Nosocomial TB transmission is an urgent public health problem
      and adopting rights-based approaches can be helpful. However, these efforts
      cannot succeed without increased political will, supportive legal frameworks and 
      financial investments to support HCWs in efforts to decrease TB transmission.
CI  - Copyright (c) 2017 Elsevier Masson SAS. All rights reserved.
FAU - Nathavitharana, Ruvandhi R
AU  - Nathavitharana RR
AD  - TB Proof, Cape Town, South Africa; Beth Israel Deaconess Medical Center, Division
      of Infectious Diseases, Boston, MA 02215, USA. Electronic address:
      [email protected]
FAU - Bond, Patricia
AU  - Bond P
AD  - TB Proof, Cape Town, South Africa.
FAU - Dramowski, Angela
AU  - Dramowski A
AD  - TB Proof, Cape Town, South Africa; Paediatric Infectious Diseases, Stellenbosch
      University, Department of Paediatrics and Child Health, Cape Town, South Africa.
FAU - Kotze, Koot
AU  - Kotze K
AD  - TB Proof, Cape Town, South Africa; East London Hospital Complex, East London,
      South Africa.
FAU - Lederer, Philip
AU  - Lederer P
AD  - TB Proof, Cape Town, South Africa; Massachusetts General Hospital, Division of
      Infectious Diseases, , Boston, MA 02215, USA.
FAU - Oxley, Ingrid
AU  - Oxley I
AD  - Nelson Mandela Metropolitan University, Dietetics Division, , Port Elizabeth,
      South Africa.
FAU - Peters, Jurgens A
AU  - Peters JA
AD  - TB Proof, Cape Town, South Africa; London School of Hygiene and Tropical
      Medicine, Faculty of Infectious and Tropical Diseases, Clinical Research
      Department, London, UK.
FAU - Rossouw, Chanel
AU  - Rossouw C
AD  - TB Proof, Cape Town, South Africa.
FAU - van der Westhuizen, Helene-Mari
AU  - van der Westhuizen HM
AD  - TB Proof, Cape Town, South Africa; East London Hospital Complex, East London,
      South Africa.
FAU - Willems, Bart
AU  - Willems B
AD  - TB Proof, Cape Town, South Africa; Stellenbosch University, Division of Community
      Health, Faculty of Medicine and Health Sciences, , Cape Town, South Africa.
FAU - Ting, Tiong Xun
AU  - Ting TX
AD  - TB Proof, Cape Town, South Africa; Clinical Research Center, Sarawak General
      Hospital, Kuching, Sarawak, Malaysia.
FAU - von Delft, Arne
AU  - von Delft A
AD  - TB Proof, Cape Town, South Africa; School of Public Health and Family Medicine,
      Faculty of Health Sciences, University of Cape Town, 7925 Observatory, South
      Africa.
FAU - von Delft, Dalene
AU  - von Delft D
AD  - TB Proof, Cape Town, South Africa.
FAU - Duarte, Raquel
AU  - Duarte R
AD  - Institute of Public Health, Porto University, EpiUnit, Portugal; Centro
      Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal.
FAU - Nardell, Edward
AU  - Nardell E
AD  - Brigham and Women's Hospital, Division of Global Health and Social Medicine,
      02115 Boston, MA, USA.
FAU - Zumla, Alimuddin
AU  - Zumla A
AD  - TB Proof, Cape Town, South Africa; University College London, and NIHR Biomedical
      Research Centre, University College London Hospital, Division of Infection and
      Immunity, London, UK.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Review
DEP - 20170228
PL  - France
TA  - Presse Med
JT  - Presse medicale (Paris, France : 1983)
JID - 8302490
SB  - IM
MH  - *Consumer Advocacy
MH  - Cross Infection/epidemiology/*prevention & control/transmission
MH  - Female
MH  - *Health Personnel/education
MH  - Human Rights
MH  - Humans
MH  - Infection Control/legislation & jurisprudence/organization & administration
MH  - Infectious Disease Transmission, Patient-to-Professional/prevention & control
MH  - Infectious Disease Transmission, Professional-to-Patient/prevention & control
MH  - Laboratory Personnel
MH  - Latent Tuberculosis/epidemiology
MH  - Male
MH  - Occupational Diseases/epidemiology/*prevention & control
MH  - Occupational Exposure
MH  - Occupational Health Services/organization & administration
MH  - Return to Work
MH  - Risk Factors
MH  - Students, Medical
MH  - Tuberculosis/epidemiology/*prevention & control/transmission
EDAT- 2017/03/04 06:00
MHDA- 2017/04/07 06:00
CRDT- 2017/03/04 06:00
PHST- 2016/11/07 [received]
PHST- 2017/01/04 [revised]
PHST- 2017/01/17 [accepted]
AID - S0755-4982(17)30054-4 [pii]
AID - 10.1016/j.lpm.2017.01.014 [doi]
PST - ppublish
SO  - Presse Med. 2017 Mar;46(2 Pt 2):e53-e62. doi: 10.1016/j.lpm.2017.01.014. Epub
      2017 Feb 28.

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