Tuberculosis in healthcare workers and infection control measures at primary healthcare facilities in South Africa

PLoS One. 2013 Oct 2;8(10):e76272. doi: 10.1371/journal.pone.0076272. eCollection 2013.


Background: Challenges exist regarding TB infection control and TB in hospital-based healthcare workers in South Africa. However, few studies report on TB in non-hospital based healthcare workers such as primary or community healthcare workers. Our objectives were to investigate the implementation of TB infection control measures at primary healthcare facilities, the smear positive TB incidence rate amongst primary healthcare workers and the association between TB infection control measures and all types of TB in healthcare workers.

Methods: One hundred and thirty three primary healthcare facilities were visited in five provinces of South Africa in 2009. At each facility, a TB infection control audit and facility questionnaire were completed. The number of healthcare workers who had had TB during the past three years was obtained.

Results: The standardised incidence ratio of smear positive TB in primary healthcare workers indicated an incidence rate of more than double that of the general population. In a univariable logistic regression, the infection control audit score was significantly associated with reported cases of TB in healthcare workers (OR=1.04, 95%CI 1.01-1.08, p=0.02) as was the number of staff (OR=3.78, 95%CI 1.77-8.08). In the multivariable analysis, the number of staff remained significantly associated with TB in healthcare workers (OR=3.33, 95%CI 1.37-8.08).

Conclusion: The high rate of TB in healthcare workers suggests a substantial nosocomial transmission risk, but the infection control audit tool which was used did not perform adequately as a measure of this risk. Infection control measures should be monitored by validated tools developed and tested locally. Different strategies, such as routine surveillance systems, could be used to evaluate the burden of TB in healthcare workers in order to calculate TB incidence, monitor trends and implement interventions to decrease occupational TB.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Cross Infection / epidemiology*
  • Cross Infection / prevention & control*
  • Cross Infection / transmission
  • Cross-Sectional Studies
  • Health Facilities*
  • Health Personnel*
  • Humans
  • Incidence
  • Infection Control / standards*
  • Risk Factors
  • South Africa / epidemiology
  • Surveys and Questionnaires
  • Tuberculosis / epidemiology*
  • Tuberculosis / prevention & control*
  • Tuberculosis / transmission

Grants and funding

This study was funded by University Research Corporation (URC) Grant FY09-G03-4710 under USAID Contract No. GHS-I-00-03-00032-00 (TASCII TB South Africa). The authors had full control over the data and did not have an agreement with the funders that may have limited the completion of the study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.