title: Infection control and tuberculosis in health care workers: an assessment of 28 hospitals in South Africa.
abstract: Twenty-eight public hospitals in the Free State Province, South Africa.
  
  
  
  To examine the association between tuberculosis (TB) infection control (IC) scores in Free State hospitals and the incidence of TB disease among health care workers (HCWs) in 2012.
  
  
  
  A cross-sectional survey and mixed-methods analysis of TB IC policies, practices and infrastructure using a comprehensive, 83-item IC audit and observation tool.
  
  
  
  As the total IC score increased, the probability of TB in an HCW at that hospital decreased. When adjusted for other covariates in multivariate analysis, if the total score of a hospital increased by one unit, the odds of an HCW having TB decreased by 4.9% (95%CI 0.9-8.8). Significant associations were also seen for the personal protective equipment (PPE) score, where odds decreased by 11.5% (95%CI 1.8-20.1) for each unit increase in score. Administrative score, environmental score and miscellaneous score were not statistically significant in the multivariate model.
  
  
  
  These findings reaffirm that overall IC and PPE are essential to protect HCWs from acquiring TB. More attention to TB IC is required to protect the health care workforce and to stop the South African TB epidemic.
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver.
authors.forename: L M
authors.initials: LM
authors.lastname: O'Hara
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver.
authors.forename: A
authors.initials: A
authors.lastname: Yassi
authors.affiliation: Division of Medical Microbiology and Infection Control, Vancouver Coastal Health, Vancouver, British Columbia, Canada.
authors.forename: E A
authors.initials: EA
authors.lastname: Bryce
authors.affiliation: Centre for Health Systems Research & Development, University of the Free State, Bloemfontein.
authors.forename: A Janse
authors.initials: AJ
authors.lastname: van Rensburg
authors.affiliation: Centre for Health Systems Research & Development, University of the Free State, Bloemfontein.
authors.forename: M C
authors.initials: MC
authors.lastname: Engelbrecht
authors.affiliation: National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, School of Health Systems and Public Health, University of Pretoria, Pretoria.
authors.forename: M
authors.initials: M
authors.lastname: Zungu
authors.affiliation: Provincial Occupational Health Unit, University of the Free State, Bloemfontein, South Africa.
authors.forename: L E
authors.initials: LE
authors.lastname: Nophale
authors.affiliation: Division of Respiratory Medicine and Institute for Heart and Lung Health, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: J M
authors.initials: JM
authors.lastname: FitzGerald
mesh_terms: D003430:Cross-Sectional Studies; D006282:Health Personnel; D006779:Hospitals, Public / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control*; D015999:Multivariate Analysis; D016273:Occupational Exposure / Q000517:prevention & control*; D016134:Organizational Policy; D000067393:Personal Protective Equipment / Q000706:statistics & numerical data; D013019:South Africa / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014376:Tuberculosis / Q000453:epidemiology / Q000517:prevention & control*