title: A national infection control evaluation of drug-resistant tuberculosis hospitals in South Africa.
abstract: BACKGROUND
  The importance of infection control (IC) in health care settings with tuberculosis (TB) patients has been highlighted by recent health care-associated outbreaks in South Africa.
  
  
  OBJECTIVE
  To conduct operational evaluations of IC in drug-resistant TB settings at a national  level.
  
  
  METHODS
  A cross-sectional descriptive study was conducted from June to September 2009 in all multidrug-resistant (MDR-TB) and extensively drug-resistant TB (XDR-TB) facilities in South Africa. Structured interviews with key informants were completed, along with observation of IC  practices. Health care workers (HCWs) were asked to complete an anonymous knowledge, attitudes and practices (KAP) questionnaire. Multilevel modeling was used to take into consideration the relationship between center and HCW level variables.
  
  
  RESULTS
  Twenty-four M(X)DR-TB facilities (100%)  were enrolled. Facility infrastructure and staff adherence to IC recommendations were highly varied between facilities. Key informant interviews were incongruent with direct observation of practices in all settings. A total of 499 HCWs were enrolled in the KAP evaluation. Higher level of clinical  training was associated with greater IC knowledge (P < 0.001), more appropriate attitudes (P < 0.001) and less time spent with coughing patients (P < 0.001). IC practices were poor across all disciplines.
  
  
  CONCLUSIONS
  These findings demonstrate a clear need  to improve and standardize IC infrastructure in drug-resistant TB settings in South Africa.
authors.affiliation: School of Nursing, Johns Hopkins University, Baltimore, Maryland 21205, USA. jfarley@son.jhmi.edu
authors.forename: J E
authors.initials: JE
authors.lastname: Farley
authors.forename: C
authors.initials: C
authors.lastname: Tudor
authors.forename: M
authors.initials: M
authors.lastname: Mphahlele
authors.forename: K
authors.initials: K
authors.lastname: Franz
authors.forename: N A
authors.initials: NA
authors.lastname: Perrin
authors.forename: S
authors.initials: S
authors.lastname: Dorman
authors.forename: M
authors.initials: M
authors.lastname: Van der Walt
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003428:Cross Infection / Q000175:diagnosis / Q000517:prevention & control* / Q000635:transmission; D003430:Cross-Sectional Studies; D054908:Extensively Drug-Resistant Tuberculosis / Q000175:diagnosis / Q000517:prevention & control* / Q000635:transmission; D005260:Female; D019983:Guideline Adherence; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000193:education / Q000592:standards; D006761:Hospitals / Q000592:standards; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000592:standards; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control*; D007318:Inservice Training; D007407:Interviews as Topic; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D013019:South Africa; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000517:prevention & control* / Q000635:transmission; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000517:prevention & control* / Q000635:transmission; D055815:Young Adult