Tuberculosis infection prevention and control: why we need a whole systems approach

• Published in: Infectious diseases of poverty Vol. 9; no. 1; pp. 56 - 4
• Main Authors: Kielmann, Karina, Karat, Aaron S, Zwama, Gimenne, Colvin, Christopher, Swartz, Alison, Voce, Anna S, Yates, Tom A, MacGregor, Hayley, McCreesh, Nicky, Kallon, Idriss, Vassall, Anna, Govender, Indira, Seeley, Janet, Grant, Alison D
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 25.05.2020; BioMed Central; BMC
• Subjects: Analysis; Antimicrobial agents; Clinics; Disease transmission; Drug resistance; Drug-resistant tuberculosis; Epidemiology; Global health; Health facilities; Health policy; Health system; Humans; Infection control; Infection Control - methods; Infection prevention and control; Infections; Managers; Microbial drug resistance; Mycobacterium tuberculosis - physiology; Opinion; Prevention; Primary Prevention - methods; Public health; South Africa; Systems Analysis; Tuberculosis; Tuberculosis - prevention & control; Workers; South Africa; Health system; Drug-resistant tuberculosis; South Africa; Infection prevention and control
• ISSN: 2049-9957; 2095-5162; 2049-9957
• DOI: 10.1186/s40249-020-00667-6

Infection prevention and control (IPC) measures to reduce transmission of drug-resistant and drug-sensitive tuberculosis (TB) in health facilities are well described but poorly implemented. The implementation of TB IPC has been assessed primarily through quantitative and structured approaches that treat administrative, environmental, and personal protective measures as discrete entities. We present an on-going project entitled Umoya omuhle ("good air"), conducted in two provinces of South Africa, that adopts an interdisciplinary, 'whole systems' approach to problem analysis and intervention development for reducing nosocomial transmission of Mycobacterium tuberculosis (Mtb) through improved IPC. We suggest that TB IPC represents a complex intervention that is delivered within a dynamic context shaped by policy guidelines, health facility space, infrastructure, organisation of care, and management culture. Methods drawn from epidemiology, anthropology, and health policy and systems research enable rich contextual analysis of how nosocomial Mtb transmission occurs, as well as opportunities to address the problem holistically. A 'whole systems' approach can identify leverage points within the health facility infrastructure and organisation of care that can inform the design of interventions to reduce the risk of nosocomial Mtb transmission.