TB Cases and Health Care Approach Essay
TB Cases and Health Care Approach Tuberculosis is a disease caused by the bacteria Mycobacterium tuberculosis. This disease is estimated to infect at least one third of the world’s population based on the report of the World Health Organization (WHO, 2000). All health care personnel who come in contact with patients infected with tuberculosis have a risk for contracting the disease. Nursing professionals, in particular, are not spared.In lieu of this apparent threat of nursing professionals becoming infected with tuberculosis, several studies were conducted to prove whether or not the risk is real and to determine what measures can be done to avoid contracting the disease.Lopes, et al.
(2008) conducted a study entitled “risk among nursing professionals from central brazil.” The purpose of their study was to evaluate the occupational risk for TB infection in nursing professionals employed at an infectious disease referral center in Central Brazil. The target population consisted of all nursing professionals who were currently working in the said referral center.Initially, in the first phase of the study, the sample size consisted of 233 nursing professionals and among these; only 128 nursing professionals met the inclusion criteria and were found to be eligible. The method of the collection of data in this particular study was done through face to face interviews with the subjects.
Questions with regards to their jobs such as their nursing category and their length of practice were asked. Other questions asked were with regards to the exposure or any contact of the subjects with patients who had tuberculosis, as evidenced by positive smears, in the last year as well as if they had a history of being given a BCG vaccine for tuberculosis. The subjects were given the TST or tuberculin skin test using the Mantoux technique.
The skin induration at the site where the test was administered is measured by two trained nurses after 48 to 72 hours. The skin test was read as negative if the induration measured less than 10mm. The subjects who had negative skin test results were enrolled in the annual skin testing, which marks the second phase of the study. Positive skin tests were considered if the induration measured more than 10mm.
However, among the subjects who had received a previous dose of the BCG vaccine as early as two years ago, the induration at the site where the test was performed should measure to at least 15mm before these subjects were regarded to have a positive skin test result. Subjects who were found to have an induration of 10 within 48 to 72 hours were retested after 14 days. Among the subjects who were retested, a positive result meant that they had a skin induration at the site where the test was done that measures more than or at least equal to 10mm. During the second phase of the study, if the readministration of the skin test showed an induration that was read as more than or equal to 10mm among the subjects who were found to have a negative skin test result earlier, these subjects were classified as converters. The data gathered from the interviews and the tuberculin skin test results were analyzed using the Epiinfo and the SPSS programs as well as Fischer exact test and chi-squared tests were used to evaluate the differences among proportions.
This study showed that a majority of the nursing professionals in the particular health care center were shown to have a positive skin test result. It can be stated that exposure to individuals who are infected with tuberculosis places a health care provider at risk for having the infection.Nurses, in particular, should try to avoid direct contact with these infected patients through the use of proper protection such as the wearing of face masks, gloves or gowns. The infection control committee of a certain health care facility should be informed of the presence of a tuberculosis infected person so that infection control measures could be administered promptly to avoid the further spread of the disease not only to health care personnel but to other patients as well. Dick et al. (2007) conducted a study entitled “Primary health care nurses implement and evaluate a community outreach approach to health care in the South African agricultural sector” This particular study was done in order to describe and evaluate the implementation of the effect of lay health worker recruitment, training and deployment on successful treatment completion by new smear-positive TB patients among permanent farm dwellers as well as to assess the impact on TB case finding and retreatment cases.
The study was also undertaken in order to give a summary of the insights as well as the experiences of the key stakeholders in the intervention or the experimental group and also to evaluate the cost of the project of the lay health workers in concurrence with the local program on TB-control, in addition to evaluating the effectiveness of the said project.This study was conducted in 211 rural farming communities in South Africa and included all farm workers that live in these selected farms, who are at least 15 years of age, and had started tuberculosis therapy from November 2000 to October 31, 2001. All in all, the number of tuberculosis positive subjects who were enrolled in the study was 164, 89 of whom were newly infected cases. The sampling method used was through randomization of the farms. This study was composed of three phases. The first phase involved the farming community. The farm workers were informed of the purpose of the study and were taught the basic information with regards to tuberculosis through an information session.
During this phase, the selection and identification of a possible lay health worker on the farm was done through the collaborative decision of the farm dwellers and the assistance of the project leader, who was a registered nurse. The second phase of the study involved the chosen lay health workers who were trained on how to become a lay health worker, to be familiar with family health including HIV and AIDS, to be acquainted with how to administer home based care as well as to give first aid treatment and to know not only the signs and symptoms of a tuberculosis infection but also how to treat the infection. The monthly visits, supervision and the provision of support of the project leader marked the start of the last phase of the study. The data extrapolated from the study was analyzed using the intention-to-treat and chi-square tests. This particular study showed that successful treatment rates for newly diagnosed tuberculosis cases were seen among the farms that had resident lay health workers as compared to the farms that did not. An increase in the detection of new tuberculosis cases were also demonstrated among the farms that had a resident lay health worker. The cost for the training and the recruitment of a lay health worker were found to be affordable even to the farm dwellers.
There have been a lot of published studies that show the fact that nurses or nurse professionals are over worked and over burdened by the increasing demand for their work in providing care for patients. This study very interestingly points out that not all burdens of health care service should be shouldered by the nurses alone. The more experienced and knowledgeable nursing professionals can group together to train more individuals in becoming lay health care workers. The addition of the lay health workers to the decreased number of health service professionals may significantly add to the improvement of health care not only in farms but also in various communities of different towns. The primary form of health care that a lay health care worker provides will decrease the influx of patients to the out-patient department of a particular hospital, or even among clinics and ultimately decrease the workload of the nursing professional assigned in the area.In order to identify and to describe the challenges as well as the remedies which were perceived by the nurses in Omaheke, a region of Namibia, in providing tuberculosis treatment and enhance treatment outcomes, Zwavamwe & Ehlers (2008) conducted a study entitled “Implementing a community-based tuberculosis program in the Omaheke Region of Namibia: Nurses’ perceived challenges” for this purpose. The other goals of the study include: to determine the nurses’ perceived requirements for the implementation as well as the advantages or disadvantages that comes with implementing a community-based tuberculosis programme in this area; to make recommendations for implementing an effective community-based tuberculosis programme as well as improving tuberculosis outcomes in this region.
This study is a quantitative type of study. No sampling was done order to attain subjects for this study but the entire population of 40 nurses who worked in the clinics and the hospital’s ward and outpatient department were included. Data was collected using a structured interview schedule. The questions that were asked were with regards to the personal information of the subject. This information included the age, gender, qualifications and work experiences of each subject. Other questions that were asked were with regards to their perception on what challenges were encountered in dealing with tuberculosis in their region and how should they address these problems; what their suggestions were with regards to the successful implementation of a community-based care for tuberculosis in their region as well as what the advantages or disadvantages are of implementing a community-based care for tuberculosis in their region.
In the analysis of the data, Epi Info 2000, Descriptive Statistics and Microsoft Excel was used.This study showed that the nurse subjects were able to identify what the main challenges for the successful implementation of tuberculosis treatment and care in the Omaheke region were. The challenges identified were classified as being patient-related, access-related, knowledge related and tuberculosis burden of disease related. The challenges encompassing patient related factors which include alcohol and drug abuse, evasion from treatment, poverty that may take account the scarcity or lack of food to eat after taking the anti-tuberculosis drugs. Other factors include the nurse’s access-related challenges. These challenges include the nurses’ inability to visit the patients in the community suffering from tuberculosis. On the other hand, access-related challenges may also include the patients’ inability to reach the tuberculosis services provided for in hospitals or clinics.
With regards to the challenges related to the burden of disease of tuberculosis, epidemics caused the HIV or human immunodeficiency virus may increase the influx of patients seeking health care service in the hospitals and subsequently increasing the workloads of nurses. Knowledge-related challenges include the decreased number of nurses, the lack of knowledge with regards to any information on tuberculosis, the lack of political support in promoting the dissemination of information on tuberculosis of the community, and the poor level of community participation.Admittedly, the nurses who participated in the study claimed that they too are in need of more knowledge with regards to tuberculosis. This study makes it relatively clear that it is not only the nursing professionals who need to learn more about a particular disease, the community should also take part in trying to figure out and learn from the disease that affects them. Factors that seem to be a challenge in the implementation of a community-based tuberculosis program should be addressed at all levels before success can be attained.
Kim and Crittenden (2005) published a study entitled “Risk Factors for Tuberculosis Among Inmates:A Retrospective Analysis.” The purpose of this seven-year period study was to examine the risk factors associated with tuberculosis infection among inmates as well as to determine the association of ethnicity and gender with these risk factors. Randomly selected individuals formed the two groups of study samples. One was called the non-TB group, composed of 372 male inmates and 106 female inmates who totaled to 478 cases. The other group formed was known as the TB group, which is composed of 353 male and 88 female inmates that totaled to 441 cases.
The independent variables noted among the two groups include age, race, gender, marital status, educational attainment level, socioeconomic standing, illicit drug and alcohol use, HIV infection status, number of times imprisoned, natures of the criminal charges, and current jail time span. The data was collected using a retrospective analysis of the database of the TB clinic and the Correctional Institution Management Information System. Data analysis for the study was done using bivariate analyses involving analysis of variance, post hoc comparisons between means and proportions, t-tests, and chi-square tests.
The findings of this particular study showed that inmates with tuberculosis were more likely to be white, unmarried, of lower educational attainment level, destitute, use illicit drugs or alcohol, positive or unknown HIV infection status, fewer yet longer jail times and commit less serious crimes. With regards to gender, this study showed that incarcerated women with tuberculosis infection are more likely to be unmarried, younger, have shorter current jail time spans and commit less serious crimes. This study shows that tuberculosis infection among prisons or detention facilities should also be controlled and treated as the inmates do not permanently stay in the prison. Once an untreated tuberculosis infected ex-felon is released back to society, the risk of spreading the infection to the community is apparent.
Hosoglu “Tuberculosis among health care workers in a short working period” by Salih, Abdullah Cetin Tanrikulu, Canan Dagli, and Serife Akalin, was published in 2005. This study was conducted in order to find the risk and features of tuberculosis among health care workers in a certain hospital in Turkey. This was a retrospective study involving clinical tuberculosis cases that were included through a thorough review of hospital records from 1986 to 2000 which totaled to up to fifteen years. The records of the subjects who were diagnosed as having tuberculosis were retrieved from the Department of Chest Diseases and the hospital personnel office and through the cooperation of the health care workers and the hospital employees. The demographic data collected included the age, gender, line of work, years of employment, department to which the subject was employed, the medical history as well as the family’s history of tuberculosis and the form of past tuberculosis infection including the inclusive dates of illness, sputum results, history of drug and overall outcome. The study adhered to the guidelines in the diagnosis of tuberculosis, which was established with at least 2 clinical features (fever, sputum, weakness, weight loss, night sweating, and 1 of the following criteria:  acid-fast bacilli (AFB) positivity,  culture positivity,  histologic evidence,  a radiologic finding. A health care worker was diagnosed as having a nosocomial form of tuberculosis if it was established that the said health care worker had no evidence or history of close contact to persons infected with tuberculosis outside of the hospital. The results of the study showed that in the study period, a total of 22 health care workers were diagnosed as having nosocomial, or hospital acquired, active tuberculosis.
The nurses and workers of the Departments of Infectious Diseases and Internal Medicine were found to have had the highest risk for being susceptible to contract the infection.The results of this study could be considered similar to the results found in other studies with regards to the increase in the risk of tuberculosis transmission and infection among nursing professionals. However, it is alarming to note that this study proved that the nurses and the paramedics who were working in this particular hospital had no formal education or training with regards their protection and safety from acquiring a tuberculosis infection.
One of the determinants to fend off this risk is through the education of nurses and other health care workers about tuberculosis, its transmission, treatment, and most importantly, prevention. The dissemination of information about certain diseases and the education of any health care worker would result to the decrease in the transmission of hospital acquired infection. If an individual contracts the illness within the confines of his or her work in a certain hospital, he or she may help spread the infection as this individual goes out of the hospital and gets in contact with other people. The risk of passing on the disease to the other members of the family, including the children, is a great probability. To successfully combat the spread of hospital acquired infections, protective gear should be worn at all times. The practice of universal precautions in a particular hospital or health center facility is advocated.
Proper knowledge not only about the basic structure of a disease but also about the pathology of a certain disease is excellent and may lead to a better formulation of a specific control program that may be successful in eventually eradicating certain diseases that are considered as endemic worldwide. In summary of the literature provided, it would be safe to assume that the best practice for the nurse with regards to tuberculosis infection is to attain proper information of the tuberculosis disease, to disseminate the information gathered and to practice proper safety measures to protect one’s self from contracting not only tuberculosis but also other diseases that can be acquired through the work place. The procurement of knowledge on what the tuberculosis disease is, what it can do to a person, how it can change how a person lives his or her life, what the risk factors are for a person to acquire the illness as well as to find out who is at risk, how to treat the disease, the outcomes of the disease, and how the disease spread may be prevented is the key structure with which the increased risk for nursing professionals could be deterred. Through education, the proper protective measures can be used.
These measures include the wearing of gloves, gowns or masks. The prompt placement of a person diagnosed to have advanced stages of tuberculosis in a negative pressure room would only be possible if the health care worker or nurse is knowledgeable on the management of the disease. Once the nursing professionals are properly educated, they can share their knowledge and expertise in the training of lay health care workers that resides in specific areas of the community. These lay health workers can help debunk the number of patients that are flooding the clinics, hospitals, or even the out-patient department who have symptoms of the disease. The decrease in the number of the patients that the nurses who are working in these areas would cause the nurses to have more time to spend on the other patients who are in need of critical care.
The other benefits that can be obtained through the training of the lay health workers are varied. Early detection and treatment of the disease can be obtained through the help of the lay health workers and subsequently, help decrease or control the spread of the infection within the community. The collaborated results that were gathered from these literatures provided can be applied not only in cases involving tuberculosis infections but also to other diseases that can be spread to unsuspecting persons.
It is the responsibility of the nursing professionals to nurse patients back to their health. It is because of this duty that the nursing professionals should be very cautious with regards to patient care and take specific measures in ensuring their protection from the acquisition of any illness in taking care of their own health.References:Dick, J.
, Clarke, M., Van Zyl, H. & Daniels, K. (2007) Primary health care nurses implement andevaluate a community outreach approach to health care in the South African agricultural sector. International Nursing Review 54, 383–390Hosoglu, S.
, Tanrikulu, A.C., Dagli, C & Akalin, S. Tuberculosis among health care workers in a short working period. American Journal of Infection Control, 33 (1). doi:10.1016/j.
ajic.2004.07.013Kim, S. & Crittenden, K.S. (2005) Risk Factors for Tuberculosis Among Inmates: A Retrospective Analysis.
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(2007) Risk among Nursing Professionals from Central Brazil. American Journal of Infection Control. 36 (2.) doi:10.1016/j.ajic.2007.
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who.int/inf-fs/en/fact104.htmlZvavamwe, S. & Ehlers, V.J. (2008) Implementing a Community-based Tuberculosisprogramme in the Omaheke Region of Namibia: Nurse’s perceived challenges.
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