title: Implementation of tuberculosis infection prevention and control in Mozambican health care facilities.
abstract: METHODS
  District and urban health care facilities in three provinces (Manica, Sofala, Tete) in central Mozambique.
  
  
  OBJECTIVE
  To assess the level of implementation of selected tuberculosis infection prevention and control (TB-IPC) measures.
  
  
  METHODS
  In a cross-sectional study of TB-IPC implementation in 29 health care facilities, we assessed TB clinics, laboratories, out-patient departments and medical and TB wards. Assessment included selected managerial, administrative and environmental measures and the availability and use of respiratory protective equipment (N95 respirators).
  
  
  RESULTS
  Guidelines for diagnosis and treatment of (presumptive) TB patients were not present in all facilities. Staff instructed patients on sputum collection in 91%, but only 4% observed it. Using a pragmatic '20% rule', 52% of the rooms assessed had adequate ventilation. Potentially, this could be increased to 76%. Three quarters of the health care workers had N95 respirators. Only 36% knew how to use it correctly.
  
  
  CONCLUSIONS
  Implementation of TB-IPC measures showed wide variations within health care facilities. Relatively simple measures to improve TB-IPC include the availability of guidelines, opening doors and windows to improve ventilation, and training and support on correct N95 respirator use. However, even relatively simple measures are challenging to implement, and require careful attention in and evaluation of the implementation process.
authors.affiliation: Health Alliance International, Technical Assistance Unit, Maputo, Mozambique; PHTB Consult, Tilburg, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Brouwer
authors.affiliation: Ministry of Health, Maputo, Mozambique.
authors.forename: E
authors.initials: E
authors.lastname: Coelho
authors.affiliation: Ministry of Health, Provincial Directorate, Tete, Mozambique.
authors.forename: C
authors.initials: C
authors.lastname: das Dores Mosse
authors.affiliation: Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: van Leth
mesh_terms: D003428:Cross Infection / Q000517:prevention & control; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000453:epidemiology; D006268:Health Facilities / Q000706:statistics & numerical data*; D006282:Health Personnel; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000458:organization & administration*; D009073:Mozambique / Q000453:epidemiology; D010045:Outpatients; D014376:Tuberculosis / Q000453:epidemiology / Q000517:prevention & control*; D012122:Ventilators, Mechanical