title: TB infection prevention and control experiences of South African nurses--a phenomenological study.
abstract: BACKGROUND
  The tuberculosis (TB) epidemic in South Africa is characterised by one of the highest levels of TB/HIV co-infection and growing multidrug-resistant TB worldwide. Hospitals play a central role in the management of TB. We investigated nurses' experiences of factors influencing TB infection prevention and control (IPC) practices to identify risks associated with potential nosocomial transmission.
  
  
  METHODS
  The qualitative study employed a phenomenological approach, using semi-structured interviews with a quota sample of 20 nurses in a large tertiary academic hospital in Cape Town, South Africa. The data was subjected to thematic analysis.
  
  
  RESULTS
  Nurses expressed concerns about the possible risk of TB transmission to both patients and staff. Factors influencing TB-IPC, and increasing the potential risk of nosocomial transmission, emerged in interconnected overarching themes. Influences related to the healthcare system included suboptimal IPC provision such as the lack of isolation facilities and personal protective equipment, and the lack of a TB-IPC policy. Further influences included inadequate TB training for staff and patients, communication barriers owing to cultural and linguistic differences between staff and patients, the excessive workload of nurses, and a sense of duty of care. Influences related to wider contextual conditions included TB concerns and stigma, and the role of traditional healers. Influences related to patient behaviour included late uptake of hospital care owing to poverty and the use of traditional medicine, and poor adherence to IPC measures by patients, family members and carers.
  
  
  CONCLUSIONS
  Several interconnected influences related to the healthcare system, wider contextual conditions and patient behavior could increase the potential risk of nosocomial TB transmission at hospital level. There is an urgent need for the implementation and evaluation of a comprehensive contextually appropriate TB IPC policy with the setting and auditing of standards for IPC provision and practice, adequate TB training for both staff and patients, and the establishment of a cross-cultural communication strategy, including rapid access to interpreters.
authors.affiliation: Academic Unit for Infection Prevention and Control, Department of Interdisciplinary Health Sciences, Faculty of Health Sciences, University of Stellenbosch & Tygerberg Academic Hospital, Tygerberg Campus, 9th Floor, Tygerberg Hospital, Tygerberg 7505, Cape Town, South Africa. sissolak@telkomsa.net
authors.forename: Dagmar
authors.initials: D
authors.lastname: Sissolak
authors.forename: Frederick
authors.initials: F
authors.lastname: Marais
authors.forename: Shaheen
authors.initials: S
authors.lastname: Mehtar
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003428:Cross Infection / Q000517:prevention & control*; D006291:Health Policy; D006801:Humans; D009726:Nurses / Q000523:psychology*; D036301:Qualitative Research; D012307:Risk Factors; D013019:South Africa; D014376:Tuberculosis / Q000517:prevention & control* / Q000635:transmission