Abstract

South Africa (SA) has the highest incidence of tuberculosis (TB) in the world; it is the leading cause of death in SA. TB is a common cause for presentation to Cecilia Makiwane Hospital, a tertiary-level public hospital in the Eastern Cape. Adherence to TB infection prevention control (IPC) measures was sub-optimal. The aim of this quality improvement (QI) project was to make sustainable improvements in TB IPC measures in the medical in-patient department. QI methodology using four consecutive Plan-Do-Study-Act cycles was used. We focused on increasing the numbers of: patients correctly isolated, ‘Airborne Precaution’ signs placed above patients’ beds, and patients wearing surgical face masks. The strategy for change focused on education in different formats, including formal in-service training delivered to nurses and doctors, a hospital-wide TB awareness week with engaging activities and competitions, and a World TB Day provincial solidarity march. Pre-intervention (October 2016), a mean of 2% of patients wore face masks, 21% were correctly isolated and 11% had an airborne precaution sign. Post intervention (May, 2017), the compliance improved to 17%, 50% and 25% respectively. Despite multiple interventions, improvement is not yet stable. We have learned that to increase the likelihood of change being sustainably adopted, it is important to spend time identifying key stakeholders, and to work with, not in parallel to, existing teams or structures. It is necessary to work with ward staff directly (for on-the-ground training) in addition to senior clinicians and managers, which ensures change is adopted into hospital policy. Sustainable change takes time, especially if stigma is a significant barrier to change. Next steps include training the hospital’s IPC nurse to conduct an institutional TB risk assessment and formulating an TB IPC standard operating procedure.