TAC survey: TB infection control falls short in many clinics

Government must urgently conduct an infection control audit of all public facilities

TB remains the leading reported cause of death with over 33 063 deaths in 2015 according to a recent Statistics South Africa report (see note at end). The rate of new cases of active TB in South Africa remains extremely high at around 450 000 per year. TB can be spread through the air when people with active TB disease cough or sneeze. However, various infection control measures can be taken to reduce the risk of TB transmission.
 
“We have the knowledge and the tools to stop the spread of TB, but we aren’t using them,” says Sibongile Tshabalala, TAC Deputy General Secretary. “Instead what we see on the ground are horrendously packed clinics with all the windows shut. We don’t see any posters telling people to cover their mouths if they cough or sneeze. We see people with TB symptoms sitting among those without, coughing and not being offered masks or tissues.”
 
TAC branches in Eastern Cape, Free State, Gauteng, KwaZulu-Natal, Limpopo, Mpumalanga, and Western Cape engaged in the audit during TB month, March 2017. The following questions were answered by TAC members from local branches linked to each facility assessed:

1. Are the windows open?
2. Is there enough room in the waiting area?
3. Are there posters telling you to cover your mouth when coughing or sneezing?
4. Are you seen within 30 minutes of arriving at the clinic?
5. Are people in the clinic waiting area asked if they have TB symptoms?
6. Are people who are coughing separated from those who are not?
7. Are people who cough a lot or who may have TB given tissues or TB masks?

Based on the answers to these seven questions facilities were ranked RED (3+ questions answered “no”), ORANGE (1-2 questions answered “no”), or GREEN (0 questions answered “no”).
 
114 clinics were ranked RED, 29 clinics were ranked ORANGE, and 15 clinics were ranked GREEN.
 
TAC commends the 15 facilities that were ranked GREEN – Brealyn Clinic (EC), Daveyton East Clinic (GP), Eshowe Hospital (KZN), King DiniZulu Clinic (KZN), Letitia Bam Day Hospital (EC), Mjejane Clinic (MP), Mpoza Clinic (EC), Nelspruit Community Health Centre (MP), Nkensani Gateway Clinic (LP), Nolungile Youth Clinic (WC), Nomzano Clinic (EC), Qaukeni Clinic (EC), Senyorita Clinic (FS), Site B Clinic (WC), Thelkwane Clinic (MP). Our local branches linked to the 15 facilities will award them with certificates and urge them to remain at this level. However, if we wish to make progress against TB GREEN ratings should be the norm in the public healthcare system, not the exception.
 
An Excel sheet with the survey results can be accessed here. Pictures of some of the healthcare facilities surveyed will also be available on TAC’s facebook page here.
 
“TB and drug resistant TB remain an emergency in South Africa. It is essential that the government in its entirety commits to addressing this crisis and ensures that all our public spaces are at low risk of TB transmission,” says Anele Yawa, TAC General Secretary. “Clinics, hospitals, prisons, schools – these shouldn’t be places you get TB. But the reality is that they are. If the government is serious about ending TB, then infection control urgently needs to be made a priority.”
 
The problems highlighted in TB infection control through the audit are indicative of the wider crisis within the health system, where overstretched nurses at understaffed clinics lack the capacity and resources to engage effectively in infection control measures.
 
While we stress that this is by no means a scientific survey and the results are not generalisable to the rest of the public healthcare system, it does suggest that infection control is a significant problem in many public sector health facilities. As a result, we demand that government carries out a full audit of all public buildings in South Africa, including schools, clinics, hospitals, correctional facilities and home affairs facilities, to assess whether sufficient TB infection control measures are in place.

For more information:

The full TB infection control audit findings can be accessed here: http://tac.org.za/sites/default/files/news/TAC%20TB%20INFECTION%20CONTRO...
 
The TB infection control survey utilised can be accessed here: http://tac.org.za/sites/default/files/TB%20Infection%20Control%20Audit%2...
 
Pictures of selected facilities will be published on TAC’s facebook page: https://www.facebook.com/TreatmentActionCampaign
 
NOTE: Even though TB is the number one reported cause of death in South Africa according to official death notifications, many deaths attributed to TB and other causes are in people with HIV and HIV is thus underrepresented in death notifications. The Thembisa model of HIV in South Africa estimates that there is roughly 150 000 HIV-related deaths per year. A recent Medical Research Council report estimates around 150 000 HIV-related deaths in 2012. These estimates indicate that HIV is still the number one cause of death in South Africa.
 
Link to Stats SA report: http://www.statssa.gov.za/publications/P03093/P030932015.pdf

Source: TAC