Compliance towards infection control practices – a cross sectional study in designated microscopy centres of Davangere, Karnataka

Introduction

Tuberculosis is a global health, affecting millions of people in the world more in India, China etc. ¹ Tuberculosisis communicable disease caused by acid fast bacilli Mycobacterium tuberculosis. In order to decrease the incidence of TB we need to control the spread of infection. One of the strategies of the Revised National Tuberculosis Control Programme (RNTCP) to achieve control is by increasing the case detection rate through a nationwide network of laboratories, known as Designated Microscopy Centers (DMC), which perform sputum microscopy for acid-fast bacilli (AFB). ²One of the main roles involved in spread of infection are inadequate knowledge and false practices of the lab technicians in the DMC.³ Direct sputum microscopy which is done in DesignatedMicroscopy centers is a relatively low risk activity as long as safe work practices are implemented properly. In addition to airborne transmission, the sputum collected for laboratory investigations can also be a potential source of  infection if not properly disinfected and disposed of. ⁴ Proper sputum collection, smear preparation, regular cleaning of work benches and proper sputum container/applicator sticks/slides disinfection and disposal practices are recommended to ensure that microscopy laboratory technicians are not exposed to aerosols from sputum specimensand also to prevent the contamination of surrounding environment. Careful attention to laboratory practices can also reduce opportunities for cross contamination, hence will contribute the quality of routine patient specimen testing.⁵ Universal work precautions involve the use of protective barriers such as gloves, gowns, aprons, masks, or protective eye wear, which can reduce the risk of the health care worker’s skin or mucous membranes to potentially infective materials. This system of infection control is, therefore, very important if the risk of transmission of infections in the laboratory is to be minimized, as they may not be aware of outcome of specimens until they are investigated or contaminated instruments in the laboratory.⁶ The purpose of this study was to assess the awareness and practices towards TB infection control among sputum microscopy center’s personnel.

Materials and methods

Study design – Cross sectional hospital-based study

Study area – Davanagere taluka

Sample size – All the lab technicians working in 8 DMCs of Davanagere Tuberculosis Unit

Study duration – 2 months from 01/03/2018 to 30/04/2018

Method of data collection – observation and pretested semi-structured questionnaire was used to collect data from DMCs lab technicians after approval from institute’s IERB, DTO and informed oral consent from the participants. Information regarding sputum sample collection, personal protection and disinfection awareness and practices was collected.

Data Analysis - Data was entered in MS-EXCEL and analyzed. Data is presented in appropriate tables and figures.

Results

In yes category, one lab technician tested one time and another one tested for three times.

Discussion

The study showed that majority of lab technicians had the knowledge of infection control but poor in practices. The similar study in Kannur Dist. Kerala showed that majority of lab technicians in government setup had good knowledge compared to private setups, but private lab technicians are good enough in infection control practices including waste segregation and management^[2]. The similar study about sputum disposal and waste management in DMCs conducted in two districts of Bihar state showed there is need for emphasis on worker safety among lab technicians and proper patient counseling regarding safe sputum disposal^[7]. A study about Biosafety knowledge and practices among laboratory technicians in Yemen showed fair to poor biosafety knowledge and practices among laboratory staff as well as weak commitment to Biosafety policies ^[8]. A similar study in Nigeria showed deficit in the awareness of safety precautions among laboratory personnel and demonstrates that attitude and practice of safety rules are unsatisfactory^[9]. A study done in Karachi, Pakistan showed lack of awareness regarding good lab practices and Biosafety measures among lab technicians in Karachi, Pakistan^[10]. Another study done in Riyadh, Saudi Arabia showed poor compliance and practices and also poor safety measures taken by lab technicians^[11]. A study was done in Nepal about KAP of Health care workers including laboratory technicians showed overall knowledge and practices on TB infection control were not satisfactory^[12]. A cross sectional study done in Ethiopia about Knowledge and Practices of Health Workers including laboratory technicians about MDR TB showed low knowledge and self-reported practice score among health workers^[13]. The study concludes that majority of the lab technicians in DMC settings have good knowledge, but they are poor in infection control practices.

Conclusion and Recommendations

Infection control practices needs to be improved in all DMCs with special attention towards personal protection equipment and waste segregation and disinfection. There is a need for routine screening for latent TB infection among lab technicians, also there should be a routine monitoring of infection control practices in DMCs.