Table 4 Provider perspectives into barriers for implementation of airborne infection control guidelines at DR-TB centers, Karnataka, India, 2016-17
Categories | Codes/ Themes | Verbatim quotes |
|---|---|---|
Health system level | Poor coordination leading to lack of ownership | “The programme gives us a one-time grant to set up the ward and other required modifications; however there is no supply of consumables [ex. masks and disinfectants] by the programme at any point of time.” (male doctor) “We are not directly involved in the implementation of the TB prevention programme. We supplement it as a part of the teaching institution attached to that.” (male doctor) “N95 mask has to be supplied to all the medical and para medical staff by the hospital or program. There should be some display material provided by the program regarding cough hygiene and nutrition.” (male doctor) “We have placed an indent for these items required many a times but they are not supplied. We have even brought it to the notice of the district programme officials; however, it was told that it is the responsibility of the hospital to provide these.” (male doctor) “As per my rough estimate, we require about 300 odd N95 masks a month if it has to be used properly among all cadres of staff. Who has to supply this when each costs atleast a dollar per piece? There is always a tussle going on between the programme officials and the hospital authorities regarding the resources. The problem lies in “who has to do it at the end of the day?” (male doctor) |
Ineffective or non-existent Infection control (IC) committees | “We don’t have any regular meetings of the IC Committee as such.” (male doctor) “AIC of DR-TB wards are not addressed separately and no special measures are taken for AIC in these wards.” (female doctor) “They [housekeeping staff] really don’t know about personal protection. Most of them use after seeing us wearing the masks.” (female nurse) “There are also no set protocols and guidelines for the trainings.” (male doctor) “We don’t have a microbiologist required for the functioning of the IC committee” (male doctor) | |
Vacant posts | “The medical officer post is vacant here. There is an acute shortage of staffs, only few nurses against the sanctioned number.” (male doctor) “Medical officers get trained and they leave after working here for some time and getting an experience.” (male doctor) “Medical officers are recruited on contractual basis and are poorly paid. There is no risk allowance for working in DR TB center.” (male doctor) | |
Individual level | Attitudes of health care delivery staff | “I don’t think exhaust fans are useful. The number of patients are very much less here, may be around 8-10 patients at the maximum. In that case for infection control, we don’t need these things.” (male doctor) “N95 masks are available only for the doctors; cloth masks are made available for the nurses and housekeeping staff.” (male doctor) “I don’t feel any risk to the nursing staff. None amongst us have suffered from any type of Tuberculosis.” (male nurse) |