measuring the effectiveness of tb infection control in hiv settings · 2014-12-19 · measuring the...
TRANSCRIPT
Measuring the effectiveness of TB
infection control in HIV settings
Ginny Lipke, RN, MHA, ACRN, CIC TB/HIV Team
Division of Global HIV/AIDS
Centers for Disease Control and Prevention
Center for Global Health
Division of Global HIV/AIDS
Some definitions . . .
Monitoring is the periodic and timely collection
of data to determine if activities are being
implemented as planned.
Evaluation is a process to collect information to
determine if a program has achieved its goals and
objectives.
Many approaches to look at effectiveness
Surveillance
Performance Indicators
Process measures
Outcome measures
Surveys
Program evaluations
Operations research
4
Data sources for TB IC plan development
Performance Indicators/Measures
Indicators/Measures enable decision-makers
to assess progress towards the achievement
of intended outputs, outcomes, goals and
objectives
Key Question: Have health care workers
received training in TB infection control?
Indicator: All health care workers in the
facility have received recommended training
in TB infection control. ___ Yes ___ No
Intermediate Outcome Measures
Intermediate results of the program: trainings are
necessary but not sufficient
Have the trainings resulted in changes in behavior,
numbers reached with high quality services?
Examples:
% of clinic staff who incorporate TB infection control practices
routinely
% of blocked or broken windows now repaired and allowing full
natural ventilation
Data sources:
Infection control point persons walk around and observe staff
use of masks, staff provision of health education, etc.
Written record compiled weekly (or monthly) documents # of
windows inspected, repaired, locations, etc.
TB Infection Control M&E Tool for
Clinical Sites
• Designed for daily/weekly use by
ICP
• 32 item assessment covers:
– Managerial
– Administrative
– Environmental
– PPE
• Facilitates recognition of areas
that need improvement
Single Hospital Dashboard St. Francis Baseline
St. Francis 6 months
St. Francis12 months
National IC Policy available
IC Practitioner assigned
IC Committee formed
Written IC plan available
TB IC practices monitored daily
TB IC training for all staff done
Facility has an Occupational Health program
Sputum samples collected away from others
Staff receive evaluation for TB at least annually
HIV-infected staff are reassigned if they request
Staff monitors natural and/or mechanical airflow daily
Patient waiting areas outdoors or with cross-ventilation
Surgical masks available and worn by coughing patients
Done, available or desired outcomeNot done or available, or not right
District Manager’s Dashboard Clinic 1 Clinic 2 Clinic 3 Clinic 4 Clinic 5
National IC Policy available
IC Practitioner assigned
IC Committee formed
Written IC plan available
TB IC practices monitored daily
TB IC training for all staff done
Facility has an Occupational Health program
Sputum samples collected away from others
Staff receive evaluation for TB at least annually
HIV-infected staff are reassigned if they request
Staff monitors natural and/or mechanical airflow daily
Patient waiting areas outdoors or with cross-ventilation
Surgical masks available and worn by coughing patients
Done, available or desired outcomeNot done or available, or not right
Outcome measures
Example indicators:
Reduced transmission of TB to health care workers
Reduced transmission of TB to patients
Prompt TB treatment initiation
Data sources:
Surveillance of active TB cases among health care workers
TB surveillance data
Repeated TST surveys of health care workers
Investigations of TB cases (e.g., MDR-TB cases)
Surveillance for TB in HCWs Harare, Zimbabwe
Two hospitals in Harare conducting surveillance of
HCWs who develop TB
The surveillance log includes the following fields:
Name, date of TB test, type of test, results, pulmonary or extra
pulmonary, date of treatment initiation, medications, date of
treatment completion, date of cure, date HCW allowed to return
to work
Infection control practitioner (ICP) stores the log in a
locked cabinet in a locked office to protect employee
confidentiality
Getting started: effectiveness measures for your facility
Every TB infection control program (and plan) should be accompanied by an M&E plan
“If it is not documented, it didn’t happen!”
Review your TB register to develop background information for measures
Propose one or more measures to monitor and the interventions and data that should be collected
Start with the simplest TB IC measures first because these are easier to attain and will give staff a sense of accomplishment when achieved
Prioritize your measures based on what is needed and what is practical to do in your facility
Contact Information
Ginny Lipke [email protected]
TB IC Training Resources
http://www.cdc.gov/globalaids/Resources/pmtct-
care/tuberculosis-infection-control.html