ASSESMENT OF PREVENTIVE AND CONTROL MEASURES OF TUBERCULOSIS

INFECTION AMONG HEALTHCARE WORKERS AT MOMBASA COUNTY

HOSPITAL.

NAMEXXXXXXXXXXXXXXXXXXX

SHPE/XXXXP/2024

A RESEARCH SUBMITTED TO TECHNICAL UNIVERSITY OF KENYA IN

PARTIAL FULFILLMENT FOR THE REQUIREMENT FOR THE AWARD OF
DIPLOMA IN PHARMACEUTICAL TECHNOLOGY.
DECLARATION

This project is my original work and has not been presented for a diploma in any other institution.

Signature: ……………………………….Date……………………………………….

Supervisors’ Approval

I confirm that this study was carried out under my supervision.

Signature: ………………………………Date………………………………..

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ACKNOWLEDGEMENT
For this work to be accomplished, I wish to express my gratitude to the almighty God by whose power and

strength I have accomplished. I also wish to acknowledge The Technical University of Kenya for giving me

the opportunity to build my career. I would also like to thank my supervisor for the support he

accorded me during this period.

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TABLE OF CONTENT

Table of Contents
DECLARATION.............................................................................................................................. i

ACKNOWLEDGEMENT............................................................................................................... ii

TABLE OF CONTENT .................................................................................................................iii

ABBREVIATIONS AND ACRONYMS ....................................................................................... v

DEFINITIONS OF TERMS ........................................................................................................... vi

ABSTRACT ..................................................................................................................................vii

CHAPTER 1 -INTRODUCTION ................................................................................................... 1

1.1 Background to the study ............................................................................................................ 1

1.2 problem statement ..................................................................................................................... 3

1.3 justification ................................................................................................................................ 3

1.4 research questions...................................................................................................................... 5

1.5 objectives ................................................................................................................................... 6

1.5.1 Broad Objective .................................................................................................................. 6

1.5.2 Specific Objectives ............................................................................................................. 6

1.6 scope and limitation................................................................................................................... 7

CHAPTER 11-LITERATURE REVIEW ....................................................................................... 8

2.1 KNOWLEDGE OF HEALTH WORKERS ON TB AND ITS PREVENTION ...................... 8

2.2 THE MAJOR PREDISPOSING FACTORS TO THETRANSMISSION OF TB TO HEALTH CARE WORKERS 11

2.3 CHALLENGES FACED BY HALTH CARE WORKERS IN IMPLEMENTATION OF CONTROL MEASURES TO

PREVENT TB INFECTION ......................................................................................................... 13

CHAPTER 111-RESEARCH METHODOLOGY ....................................................................... 15

3.1 Study design ............................................................................................................................ 15

3.2 Study area ................................................................................................................................ 15

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3.3 Population ................................................................................................................................ 15

3.3.1 Inclusion Criteria .............................................................................................................. 15

3.3.2 Exclusion Criteria ............................................................................................................. 15

3.4 Variables .................................................................................................................................. 15

3.4.1 Dependent ......................................................................................................................... 15

3.4.2 Independent....................................................................................................................... 16

3.5 Sampling Techniques .............................................................................................................. 16

3.6 Sample size determination....................................................................................................... 16

3.7 Data collection instruments ..................................................................................................... 16

3.8Data collection Process ............................................................................................................ 16

3.9 Pre testing ................................................................................................................................ 17

3.10 Validity .................................................................................................................................. 17

3.11 Reliability .............................................................................................................................. 17

3.12 Data analysis.......................................................................................................................... 17

3.13 Ethical consideration ............................................................................................................. 17

4.0 REFERENCES ........................................................................................................................ 18

5.0 APPENDICES ......................................................................................................................... 29

5.1 WORK PLAN ...................................................................................................................... 29

5.2 BUDGET ............................................................................................................................. 30

5.3 CONSENT LETTER ........................................................................................................... 31

5.4 DATA COLLECTION TOOL ............................................................................................ 32

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ABBREVIATIONS AND ACRONYMS
TB- tuberculosis

HCWs- Health care workers

WHO-World health organization

NTLD-Unit – National TB, leprosy and lung disease unit

PPE – Personal protective equipment

MDR-TB- Multi- drug resistant tuberculosis

UN- United nation

MOH- Ministry of health

CDC- Center of disease control

TBRU- Tuberculosis research unit

HIV- Human immunodeficiency virus

AIDS- Acquired immunodeficiency syndrome

LTBI- Latent tuberculosis infection

BMI- Body mass index

HEPA- Highly efficient particulate filters

OPD- Out patient department

KBS- Kenya bureau of statistics

DHIS- Demographic health information system

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DEFINITIONS OF TERMS
Tuberculosis (TB) - a clinically active symptomatic disease caused by a bacteria belonging to the M. tuberculosis

complex.

Latent TB infection- the state of having a small number of M. tuberculosis bacteria in the body which are unable to

grow due to control by the immune system

HEPA filter- filter that provides a minimum removal efficiency of 99.97% of particles 0.3 micrometers in diameter.

Droplet nuclei- microscopic particles which are produced when a person with TB coughs, sneezes shouts or sings.

Infection, prevention and control- specific measures and work practices that reduce the likelihood of transmitting TB

Multidrug- resistant tuberculosis –TB caused by strains of M. tuberculosis which are resistant to both isoniazid

and rifampicin with or without resistance to other drugs.

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ABSTRACT
This study was carried out between April 2019 and June 2020. The broad objective will be an assesment of preventive and
control measures of TB infection among health care workers. The specific objectives was to assess the knowledge of health
workers on TB and its prevention, to find out the predisposing factors to the transmission of TB infection to health workers
and to find out the challenges faced by health workers in implementation of control measures to prevent TB infection.
Mugenda and Mugenda, (2003) formula of using 30% of the target population will be used to obtain the sample size. Using
this formula 30% of the 204 health workers working in Webuye County Hosspital will produce 61 health workers as the
sample size which will be used.

Descriptive cross sectional research design will be used; systematic sampling technique will be used to select respondents
among the health workers who work in Webuye county hospital. The study will include all health workers who have direct
contact with patients in their clinical areas and exclude health workers in non-clinical areas and who have no direct contact
with the patients. Permission to carry out the study will be obtained from the hospital management with approval from the
administration.

Data will be collected using structured questionnaires self-administered to the respondents by the researcher herself and
interview schedules and consent obtained from the respondents while safeguarding their confidentiality. Data will be
analyzed by excel 2010. Data will be presented using figures, graphs and charts to come out with a meaningful conclusion.
The findings and recommendations of the study will communicated to the health care workers.

vii
 CHAPTER 1: INTRODUCTION

1.1 Background to the study

Tuberculosis(TB) is caused by a bacterium known as Mycobacterium tuberculosis. It can be
transmitted in many forms or ways .M. tuberculosis is carried in air particles or droplets nuclei that
can be transmitted when persons with TB cough sneeze or speak (NTLD, 2015).

Tuberculosis remains a global public health problem affecting millions of people every year
(WHO, 2016). With the increasing incidence of drug resistance and HIV pandemic, TB control
efforts have now become even more challenging and this has led to a greater concern towards TB
infection control .Institutional settings including health care facilities, have been identified to be
at high risk of TB transmission (CDC, 2013).

The global incidence of TB at present is estimated to be 140 cases per 100000 populations. TB is
the ninth leading cause of death worldwide, and leading cause from a single infectious agent,
ranking above HIV/AIDS (WHO, 2017). Although the link between work in the health sector and
TB was previously suspected, TB has been recognized as an occupational hazard in healthcare
since 1950s (Baussano et al., 2011). Health care workers face an increased risk of contracting TB
due to occupational exposure to TB bacilli in their work environment and in communities where
they work and live. (Uden et al., 2017).

Many high burden TB countries, specifically those in Sub-Saharan Africa, also struggle with very
high prevalence of HIV infection, which confers a lifelong increased TB disease risk and poses a
great challenge to TB control in these countries. Health care workers in these countries exhibit
similar rates of HIV infection as the population (Tudor et al., 2014; Adams et al., 2015).

TB remains leading infectious killer. In 2016 there were an estimated 10.4 million new TB cases
worldwide, 10% of which were people living with HIV\AIDS. In the same year 2.5 million people
fell ill with TB in the African region accounting a quarter new TB cases worldwide. Seven
countries accounted for 64% of the new TB cases with India leading the count followed by
Indonesia, China, Philippines, Pakistan, Nigeria and South Africa (WHO, 2016).

1
TB remains to be a major cause of morbidity and mortality in Kenya. It affects all age groups but
has its greatest toll in the most productive age group of 15-44 years. In 2012 there were 99,159
new TB cases. In 2014 there were 1.5 million TB related deaths, 890,000 men, 480,000 women
and 140,000 children (MOH 2015).

TB has continued to increase in the country with major cities having high burden of TB, due to
mushrooming of informal settlements. The impact of the HIV epidemic and increasing prevalence
of drug-resistant disease on the picture of TB have highlighted the urgency of addressing TB
infection control practices in all settings where diagnosed and undiagnosed TB patients receive
care or other services (Guidelines for TB control, 2014).

The guidelines for infection control for health care workers are structured according to the standard
priorities of infection prevention and control practices, namely administrative control measures
which reduces health care workers and patients exposure, environmental control measures which
reduce the concentration of infectious droplet nuclei and personal protective equipment which
protects HCWs and patients in areas where the concentration of droplet nuclei cannot be
adequately reduced by administrative and environmental control measures (NTLD, 2015).

Other preventive measures entails health education to patients which include advising them to
cover their mouth when coughing or sneezing, wash hands after coughing or sneezing, not to use
public transportation and isolation may also be considered as a preventive measure.

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1.2 Problem statement
Tuberculosis has been recorded as a global problem in the world. Most of the health care workers
taking care of the patients are the majority exposed to the transmission of TB and are at risk of
getting TB (WHO, 2014).

The global incidence of TB at present is estimated to be 140 cases per 100,000 populations. TB is
the ninth leading cause of death worldwide, and the leading cause from a single infectious agent,
ranking above HIV\AIDS (WHO, 2017).

Although the link between work in the health sector and TB was suspected previously, TB has
been recognized as an occupational hazard in the health care since 1950s ( Baussano et al., 2011)

Many high TB burden countries, especially those in the Sub-Saharan Africa, also struggle with a
very high prevalence of HIV infection, which confers a lifelong increased TB disease risk and
poses a great challenge to TB control in these countries. Health workers in these countries exhibit
similar rates of HIV infection as the population (Claasens, 2013, Tudor et al, 2014).

TB remains a major cause of morbidity and mortality in Kenya. It affects all age groups but has its
greatest toll in the most productive age group of 15-44 years. The major factor responsible for the
large TB disease burden in Kenya is the concurrent HIV epidemic (MOH, 2009).

Kenya has been listed as a multi-drug resistance TB (MDR-TB) high burden country and is
estimated to detect 72% of bacteriologically confirmed TB and 80% of all cases. In 2015, the
estimated prevalence of all forms of TB was 233 per 100,000 populations while the mortality from
all forms of TB was 20 per 100,000 populations (WHO, 2016).

Thirty percent of annual TB deaths occur in slum areas of Webuye County due to poor housing
standards that encourage spread of the disease and high HIV prevalence standing at 25% where 60
% of HIV patients in the county have TB. In 2014 the county had 2,141 cases of TB and an incident
rate of 190 cases per 100,000 people which ranked it among the top 20 in TB incidence rate
(KDHIS, 2016).

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1.3 Justification
140 cases per 100000 population has been recorded, most of them are health care workers taking
care of the patients while they are exposed to the transmission of TB and are at a greater risk of
getting TB (WHO, 2011).

Despite the knowledge the health care providers have concerning TB the number of new cases of
TB transmission among health care workers still is at peak (MSF-FRANCE, 2016). This study will
support the TB research unit (TRBU) a multidisciplinary, multinational consortium of
investigators and institutions with expertise in the areas of epidemiology, microbiology and
immunity to conduct clinical studies on host pathogen interactions in TB.

Efforts for preventing occupationally acquired TB focus on the primary prevention triad of
administrative controls, engineering controls and respiratory protection. This has been augmented
by secondary prevention measures such as screening and treatment of both latent and active TB
infection in health care workers. In low resource settings, these measures are often poorly
resourced (Tudor et al., 2013; Flick et al., 2017).

The benefits of the study to be carried out are the study will be helpful in preventing the spread of
TB the health care setting.

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1.4 Research questions
1) What knowledge do the health care workers have about TB and its prevention?
2) What are the predisposing factors to the transmission of TB infection to health care
workers?
3) What problems health care workers face in implementation of control measures to prevent
TB?

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1.5 Objectives

1.5.1 Broad Objective

To establish the effectiveness of control measures to prevent tuberculosis infection among health
care workers.

1.5.2 Specific Objectives

1. To assess the knowledge of health care workers on tuberculosis and its prevention.
2. To find out the predisposing factors to the transmission of TB infection among health care
workers.
3. To establish the problems health care workers face in implementation of control measures
to prevent TB infection.

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1.6 Scope and limitation
The study is going to make a contribution to the discourses on the effectiveness of control measures
taken by health care workers in prevention of TB. It will help to fill the critical gaps in translational
TB research to provide tools needed to advance new health care interventions in TB endemic
counties.

The study potential limitations are inadequate resources to conduct the study, limited time and low
response from the intended respondents.

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CHAPTER TWO-LITERATURE REVIEW
2.0. OVERVIEW

According to the ministry of the health TB is an infectious disease that is caused by a bacterium
called Mycobacterium tuberculosis (MOH, 2014). According to Med lexicon’s dictionary TB is a
specific disease caused by infection with Mycobacterium tuberculosis, the tubercle bacillus which
can affect almost any tissue or organ of the body, the most common site of the disease being the
lungs. Harries et al., contend that, the risk of infection depends on the susceptibility of the host,
the extent of exposure and the degree of infectiousness of the index case. When an individual
inhales the infectious aerosols, the bacilli lodge into the alveoli where they multiply and form a
primary lesion (Harries et al., 2010). Under normal condition, in most of the cases, the immune
system either clears the bacilli or arrests the growth of bacilli within the primary lesion in which
case the host is said to harbor latent TB infection (LTBI). However, in 5-105 of the cases, the
bacilli overwhelm the immune system resulting in a primary TB written a few months to years. In
the rest post primary occurs when re-infection occurs or the latent TB infection is reactivated
National TB, leprosy and lung disease unit (NLTD unit 2011). A number of guideline documents
have been established over the past decades on preventing occupational transmission of TB
infection in the health care workers. However, direct evidence for the effectiveness of these
controls is limited particularly in low and middle-income countries (Schmidt et al., 2018).

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2.1 KNOWLEDGE OF HEALTH WORKERS ON TB AND ITS PREVENTIONs
Infection control remains a key challenge for tuberculosis control program with an increased risk
of TB transmission among health care workers, especially in settings with inadequate TB infection
control measures. Poor knowledge among health care workers and inadequate control practices
may lead to the increased risk of TB transmission (BMC, 2017). Most researchers have reported
that no specific TB infection control programs were being used in health care facilities. Harries et
al., (2013) evaluated the impact of multiple administrative measures which were implemented in
40 districts and mission hospitals in Malawi following adoption of infection control guidelines.
The study revealed that the infection control guidelines were uniformly implemented and the
median compliance with various measures was 76% (range: 3% to 100%). Aiumlaor,et al.,(2010)
contend that although 97% of health care workers were aware of TB infection control policies only
52% used personal protection measures (e.g. respirators) and only 72% implemented respiratory
isolation for TB cases. Failure to use personal protection equipment was associated with a 26 fold
(95%: 11.06 to 6.64) increased risk of TB disease among health care workers (Harries et al., 2011).
This implies that the use of personal control measures vary from country to country. Despite the
effort to control this deadly disease, the prevalence and mortality rates still rise steadily leaving
most people in their economically productive ages vulnerable (Mbayaki, 2015).

Tuberculosis infection control is an essential but often overlooked component of a comprehensive

infection control program in resource –limited settings with high HIV prevalence and poor TB
infection control practices. Mycobacterium tuberculosis can be rapidly transmitted to patients and
health care workers (WHO, 2009). A descriptive cross-sectional study was conducted in two
districts in Kenya. Retrospective view of TB registers was performed at Makindu and Kiambu
district hospitals. Makindu and Kiambu had 91 and 450 health care workers respectively. As from
registers 6,275 sputum smears were examined. Kiambu reported 11 cases while Makindu reported
5 cases of TB among health care workers. All the HCWs were using coats when handling patients,
specimens and contaminated materials however, there were no high-efficiency particulate air
filters (HEPA) masks being used at the facilities. Although surgical masks as part of standard
personal protective equipment at both hospitals were available, it was noticed that some health

9
care workers from both in-patient and out-patient departments did not use them. It was also
observed that there was poor adherence to hand hygiene recommended guidelines (MOH, 2013).
Overall knowledge and practices of health care workers on TB infection control might be
satisfactory but effective infection control measures including regular skill-based training and/or
orientation for all categories of HCWs can improve infection control practices in health facilities
(CDC, 2013). Several studies have reported poor TB infection control measures in health facilities.
Further, health care workers are practicing these measures without adequate infection control
training and often lack knowledge on TB infection control. This is likely to contribute to the
increased risk of TB transmission (Kanjee et al.,2011).

10
2.2 THE MAJOR PREDISPOSING FACTORS TO THE TRANSMISSION OF TB TO
HEALTH CARE WORKERS
Daniel states that health care workers are at risk of contracting TB infection in the workplace. This
risk has been declining in decades in those health facilities where modern infection control
measures are in place. A large portion of the current and recent risk to health care workers of TB
infection is the result of exposure to unsuspected cases of infectious TB or to exposure in
circumstances of poor ventilation (NTP, 2012). American journal of infection control (2016),
conducted hospital based contact investigations of 55 serial sputum smear positive TB patients and
771 health care workers from 2006-2013. Health care workers who made contact with TB patients
in the absence appropriate airborne precautions were evaluated using interferon gamma release
assays to identify TB infection. Twenty-nine HCWs (3.8%) were newly diagnosed with TB
infection. The 10 TB patients responsible for the transmission had duration of contact of more than
7 days by multivariate analysis. According to journal of clinical epidemiology (2013), it has it that
health care worker with frequent contact and those with BMI<19 kg\m were at a high risk of
acquiring active TB. Transmission of TB is always pronounced in locations such as medical wards
and microbiology laboratories.

In India control of TB transmission among health care workers is still neglected in Indian hospitals
which lead to increased rate of active TB among health care workers which is due to
underutilization of rapid diagnostic procedures (Central TB Division, India, 2010).

Some of the predisposing factors to the transmission of TB include delay in diagnosis and
treatment of TB in hospitalized patients (Greenaway et al., 2010). Underutilization of rapid
diagnostic techniques, failure to isolate infectious TB cases routinely, unrecognized drug
resistance among the mycobacterium strain, lack of recommended engineering and environmental
standards (Menzies et al., 2011). Large number of TB patients being handled in crowded areas,
poorly ventilated wards and waiting rooms has also greatly led to transmission of tuberculosis
among health care workers (OSHA, 2012).

Lack of recommended personal protection equipment, financial and logistic constraints in

implementing infection control measures, and absence of national guideline for screening and
treatment of latent TB infection among health care workers all contribute to high rates of TB
particularly among health care workers (Christopher et al.,2010).Poor knowledge and attitude,

11
with perceived lack of vulnerability to TB among health workers and poor compliance with routine
screening for TB among health care workers need to be addressed (Clague et al., 2013).
Surveillance of high risk health care workers and appropriate infrastructure modifications may be
important to prevent interpersonal TB transmission in health care facilities (WHO, 2015).

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2.3 CHALLENGES FACED BY HALTH CARE WORKERS IN IMPLEMENTATION OF
CONTROL MEASURES TO PREVENT TB INFECTION
According to Akyol, (2011), he explained that health workers are faced with various occupational
risks as far as TB infection is concerned. Though there are standard procedures to follow to avoid
being infected, a number of challenges ranging from lack of logistics, human resource and other
related factors professionals have been attributed to non-availability of required resource materials
such as masks, gloves, and disinfectants amongst others (NTP, 2010). Health care workers have a
higher frequency of TB exposure than the general population and have therefore an occupational
TB risk that infection prevention and control aims to reduce. Health care workers are aware of
their risk of TB and use various measures to reduce their risk of infection (WHO, 2015). Health
care workers find it challenging to employ measures to minimize such risks and a lack of clear
guidelines contributes to these challenges. HCWs and patients behavior further complicate the use
of TB infection and control measures (Miranda et al., 2014).

In Jackson’s (2012) view, he states that understaffing is a major inhibiting factor. Junior and
temporary staff work without supervision because of lack of manpower especially experienced
ones to ensure well as enforce infection control practices. This partly contributes to increasing
rates of infection among professionals especially junior staff. The literature suggests that junior
knowledge is a major factor for all health workers (Jackson, 2012).

In a survey conducted in Eritrea to find out about compliance of infection control practices among
health care workers, it was estimated that, there was low compliance due to factors such as
inadequate and inconveniently located sinks, inadequate hand washing and lack of time. Also 50%
respondents indicated that they preferred to wear gloves but did not change them in between
contacts due to scarcity because the gloves protected them and not their patients (Rigbe et al.,
2010). Furthermore, improper gloving has been cited as a reason for poor hand hygiene because
contaminated gloves must be removed in accordance with infection control measures. Non-
adherence will lead to infection spread as there is high risk of microbial transmission (Buisson,
2011).

13
A qualitative study conducted among HCWs in hospitals KwaZulu- Natal categorized the
challenges facing TBIC implementation into 3 areas: (1) lack of resources, (2) distrust of infection
control efforts by HCWs, and (3) a disproportionate focus on personal respiratory protection.
These areas portray a system in which the managers of health care facilities struggle to comply
with policies that lack resources to implement, in circumstances where the burden of workplace
safety is placed on inadequately trained and HCWs (Love day M, et al., 2013)

The poor level implementation of TBIC activities in low and middle income countries is
substantial challenge affecting efforts to reduce tuberculosis transmission to HCWs. TBCI
activities are inadequately supported by effective managerial control measures (Reid et al., 2013).
In facilities with effective managerial controls, administrative and environmental controls are often
neglected, forcing the main responsibility for the protection of staff onto individual HCWs. It is in
this context that the overreliance on personal respiratory protection has been reported (Public
health policy 2013); however, supply of respirators may be irregular, HCWs are unaware how to
use them correctly, and fit testing is not available. Fears, stress, avoidance of tuberculosis patients,
leaving the profession, and other negative responses result from this situation (Zelnick and Gibbs
2013).

From the literature reviewed, many studies both quantitative and qualitative have explored how
tuberculosis has become a major occupational risk for health care workers in contemporary times
to the extent that more and more health are becoming patients rather than specialist to attend to
such patients.

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CHAPTER THREE-RESEARCH METHODOLOGY

3.1 Study design

Descriptive cross sectional study design will be used. Descriptive research attempts to describe the
situation as it occurs in its natural settings.

3.2 Study area

Webuye county hospital is a government health facility Webuye town, Webuye East Sub location
in Bungoma County. The facility serves a catchment population of 41,739 people (KBS 2009) and
it also offer basic and emergency, curative and preventive service. The economic activity carried
within the area is business and trading.

3.3 Population
The target population will be the 204 the health workers in Webuye County Hospital.

3.3.1 Inclusion Criteria

The study will include health workers who have direct contact with patients in their clinical areas.

3.3.2 Exclusion Criteria

The study will exclude health workers in non-clinical areas and those without direct contact with
the patients.

3.4 Variables
Dependent and independent variables will be used.

3.4.1 Dependent
The dependent variables are to assess the knowledge of health care workers on TB infection and
prevention this is to determine whether the health workers have adequate knowledge to prevent
TB transmission, to find out the predisposing factors to the transmission of TB infection to health
care workers this will determine factors like underutilization of rapid diagnostic procedures among
others and to find out the challenges faced by health care workers in implementation of control

15
measures to prevent TB infection this will outline reasons why health care workers find it
challenging to employ measures to minimize risks of contracting tuberculosis.

3.4.2 Independent
The independent variable will be effectiveness of control measures to prevent TB infection among
health care workers.

3.5 Sampling Techniques

Systematic sampling will be used to choose respondents from the target population by deciding on
an Nth item then making a sampling frame from the key departments and choosing the items until
the required sample size is obtained.

3.6 Sample size determination

Mugenda and Mugenda. (2003) formula of using 30% of the target population will be used to
obtain the sample size. This reduces biasness and increases representation.

Therefore 30/100*204

61 health workers

3.7 Data collection instruments

Structured questionnaires self-administered by the researcher will be used to collect data from the
respondents .The researcher will be present to clarify any issue in case of difficulty. Face to face
interview will also be conducted by the researcher.

3.8Data collection Process

The structured questionnaires will be administered to the health care workers working in clinical
areas where there is risk of contracting TB e.g. isolation wards, laboratories, outpatient department
and comprehensive care center and also face- face interviews will conducted those health care
workers by the researcher herself.

16
3.9 Pre testing
The questionnaire will be pre-tested on a few respondents before the actual data collection process,
in order to identify any problems for accuracy during the final process of data collection

3.10 Validity
An instrument is said to be valid when it measures what it claims to measure or the extent to
Which it predicts accurately. To ensure validity, pre-test study will be done to ten randomly
selected respondent’s .Research experts including the supervisor will be consulted to ensure
that the instrument measures what it was intended to measure and a peer review was done.

3.11 Reliability
Reliability is the ability of the instrument to consistently yield the same results when repeated
measurements will be taken of similar individuals under the same conditions. Reliability will be
ensured by pre-testing of questionnaires, availability of the researcher to answer any question
asked and through interviews.

3.12 Data analysis

Data will be analyzed by Microsoft Office excel 2010 and will be presented using graphs, figures
and charts to come out with a meaningful conclusion.

3.13 Ethical consideration

An authorizing permit will be obtained from the National commission of science and technology
innovation (NACOSTI). The study will be approved by the school authority and consent will be
obtained from the sub county health promotion officer and health management team of Webuye
county hospital. Participants in the study will be purely on voluntary basis and all through the
process of data collection; confidentiality will observed and feedback will be communicated.

17
CHAPTER FOUR

4.0 RESULTS

This chapter deals with analysis and presentations of research

findings.Presentations are in forms of frequency tables, charts, graphs and
percentages.The findings were analysed as per the study objectives

4.1 SOCIO-DEMOGRAPHIC DATA

4.1.1 AGE

15(25%) of the respondent were from age group 26-31 years,28(46%) of the
respondents were from age group 32-37 years, while 18(29%) of the respondent
were from age group 38-43 years.

AGE

26-31 years 2nd Qtr 38-43years

4.1.2 PROFESSION

18
All of them were health care workers from various departments of the hospitals
who were able to handle TB patients at different levels. 32(52%) were Nurses,
10(16%) were Medical Officers, 8(13%) were Nutritionists while 11(19%) were
Pharmaceutical Technologists.

PROFESSION

Nurses Medical officers Nutrionists Pharmaceutical Tech

19
4.1.3 DEPARTMENT OF WORK

31(50%) of the HCW came from the TB Wards, 14(23%) of the HCW came from the

Out patient department, 16(27%) of the HCW came from the Comprehensive Care
Clinic.

DEPARTMENT OF WORK

TB Wards Out Patient CCC

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4.1.4 LEVEL OF TRAINING

Most of the respondents were of diploma level at 35(57%), 22(36%) were of

bachelors level,4(7%) were of masters level

LEVEL OF TRAINING

Diploma Bachelors Masters

21
4.1.5 DURATION OF EMPLOYMENT

18(30%) of the respondents were between 5-10 years, 30(49%) of the respondents
were 10-15 years while 13(21%) of the respondents were employed over 15 years.

DURATION OF EMPLOYMENT

5-10years 10-15years 15years and above

22
CHAPTER FIVE

5.1 KNOWLEDGE ON TB AND ITS PREVENTION

The HCWs were able to identify TB as a bacterial disease, which is transmitted

through air particles or droplet nuclei from one person to the another through air.

5.2 PREDISPOSING FACTORS TO THE TRANSMISSION OF TUBERCULOSIS

Most of the HCWs were exposed to suspected cases of infectious TB while the
infectious TB patients were being handled in crowded and poorly ventilated
rooms.

There was delay in diagnosis and treatment of TB in hospitalized patient which led
to high risk of transmission of TB.

Infectious TB cases were not routinely isolated due to the poor infrastructure at the
hospital.

Poor knowledge and attitude with lack of vulnerability of TB among HCW led to
transmission of TB.

Lack of recommended personal protection equipments to protect the health care

workers.

23
5.3 CHALLENGES FACED BY HEALTH CARE WORKERS IN IMPLEMENTATION OF
CONTROL MEASURES TO PREVENT TB INFECTION.

Most health care workers are at higher risk of becoming patients rather than
specialists to attend to TB patients.

Fear, stress and avoidance of tuberculosis patients leaving a negative results from
the situation.

Health care facilities struggle to comply with policies that lack resources to
implement them.

Temporary staff and junior work without supervision because of lack of man power
especially experienced ones to ensure well enforced infection control practices.

The health care workers find it challenging to employ measures to minimize

infection risks when they lack clear guidelines to tackle the challenges.

24
CHAPTER SIX

6.1 CONCULUSION

The study found out that prevention and control measure of TB infection among
health care workers were poor.The findings indicated that most HCW were at a
high risk of getting infected with TB.

The hospital did not have enough control measure to prevent HCW from
contracting TB.

Most of the HCW were not motivated to handle TB patients, since they did not have
the right equipments for handling patients.

There workload were unfavourable to there health because they would be have
contact with TB patients for long hours.

The hospital did not have High efficiency particulate Air-filters(HEPA) masks to be
used in the facilities.

25
6.2 RECOMENDATIONS

The HCWs should adhere to the National guidelines for screening and treatment of
latent TB infection among HCWs.

Compliance to a routine screening for TB among health care workers

Hospitals should ensure appropriate infrastructure modification are available to

prevent interpersonal TB transmission ni health care facilities.

Well ventilated areas of working with personal protective equipments to avoid

transmission from TB patients

Utilization of rapid diagnostic techniques used in TB patients.

Implementing way and means of TB infection preventive and control measures.

26
4.0 REFERENCES31

Akyol 2011. The various occupational risks faced by health care workers in prevention of
tuberculosis infection.

Claassens MM, Van Schalkwyk C, du Toit E, et al. tuberculosis in health care workers and
infection control measures at primary health care facilities in South Africa. PLos one
2013; 8-e76272

Guidelines for prevention of tuberculosis in health care facilities in resource limited setting
WHO 2014.

Harries AD, Maher D, Nunn P. Practical and affordable measures for the protection of health
care workers from tuberculosis in low income countries. Bull world health organ 2011.

Kenya Ministry of health. Division of leprosy, tuberculosis and lung disease annual report 2011.

Miranda Eliana and Frank Van article 2014. Challenges faced by health care workers in
implementation of TB infection control

Stop TB department, WHO: management of tuberculosis training of health facility staff, Geneva
2011

Tuberculosis infection control in the Era of expanding HIV care and treatment CDC-WHO 2014.

Tudor C, Van der Walt M, Bruce Margot B, et al. tuberculosis among health care workers in
Kwazulu-Natal, South Africa: a retrospective cohort analysis. BMC public health 2014; 14:891.

27
Zelnick JR, Gibbs A, Loveday M, et al. health care workers perspective on workplace safety,
infection control and drug resistant tuberculosis in a high burden HIV setting. J public
health policy 2013; 34: 3880-402

Central TB division, Government of India.TB in India 2010 RNTCP status report.

Kanjee Z, Catterick K, Moll AP, Amico KR, Friedland GH. Tuberculosis infection control
in rural South Africa: survey knowledge, attitude and practice in hospital staff. J Hosp Infect.
2011; 79(4):333-338. Doi.

Woith W, Volchenkov G, Larson J. Barriers and motivators affecting tuberculosis infection

control practices of Russian health care workers. Int J Tuberculosis, lung disease. 2012.

Christopher DJ, Daley P, Armstrong L, James P, Gupta R, Premkumar B, et al. Tuberculosis

infection among young nursing trainees in South India. PLoS ONE 2010; 5: e 10408.

Baussano I, Nunn P, William B, Pivetta E, Bugiani M, ScanoF. 2011. Tuberculosis among health
care workers.

Flick RJ, Munthali A, Simon K, Hosseinipour M, Kim MH, Mlauzi L, Kazembe PN, Ahmed
2015. Assessing infection control practices to protect health care workers and patients
from transmission Mycobacterium tuberculosis.

28
5.0 APPENDICES

5.1 WORK PLAN

ACTIVITIES OF THE April Ma June July August Sept
MONTH y
Identification of research
topic and consulting
supervisor
Background information
,problem statement,
literature review and
consultation
Research methodology

Proposal Submission

29
5.2 BUDGET
ITEM UNIT QUANTITY RATE TOTAL
Foolscaps 1 @1400 1400.00
Biro pen 10 @20 200.00
Pencils 8 @25 200.00
Rubber 4 @20 80.00
Ruler 3 @30 90.00
Flash disk 1 @2000 2000.00
Bundles 6GB @1000 6000.00
Field book 2 @100 200.00
Printing and binding 6000.00
File 1 @150 150.00
Total 16320/=

30
5.3 CONSENT LETTER

STEPHANI MANDA

TECHNICAL UNIVERSITY OF KENYA

P.O. BOX 52428,

NAIROBI.

TO WHOM IT MAY CONCERN.

Dear respondent,

RE: REQUEST FOR PARTICIPATION IN A RESEARCH STUDY.

31
I am a student at Technical University of Kenya. As part of my studies, I am conducting a research
on preventive and control measures of tuberculosis infection among health workers in Webuye
county hospital.

Therefore, I would appreciate if you take a few minutes of your time to kindly answer the following
questions in regard to the objectives of the study. All the information provided will be purely used
for academic purposes and your identity will be treated with confidentiality.

Your assistance will be highly appreciated.

Yours faithfully,

Stephani Manda

SHPE/04319P/2016

5.4 DATA COLLECTION TOOL

Questionnaire on the effectiveness of control measures to prevent tuberculosis infection.

I am a student at Technical University of Kenya and I would like to collect data of a study on
preventive and control measures of TB infection. Your response and information will be highly
appreciated and will be confidential and only used for the purpose of the study. Thank in you in
advance.

Instructions

1. Do not write your name on this paper.

2. Put a tick for the appropriate answer where indicated and enter your response in the spaces
provided.
3. Attempt all questions to the best of your knowledge.

32
PART A

SOCIO DEMOGRAPHIC INFORMATION

1. AGE……………………………

20-25 ( ) 26-31 ( ) 32-37 ( ) 38-43 ( ) 44-49 ( ) 50+ ( )

2. Profession ………………………………………………………………………

3. Department of work………………

Nursing ( ) Laboratory ( ) TB Wards ( ) Outpatient clinic ( ) CCC ( )

Others specify………………………………………………………………………

4. Level of training

Certificate ( ) Diploma ( ) Bachelors ( ) Masters ( )

5. Duration of employment…………………………………………………………

PART B

Knowledge on TB and its prevention

1. What is tuberculosis?

A. Viral diseases

B. Bacterial disease

C. Fungal disease

2. How is tuberculosis transmitted?

A. Through food.

33
 B. Through air particles or droplets nuclei.

C. Through skin contact

3. How does tuberculosis spread?

A. Person to person through air.

B. Proper ventilation.

C. Use of personal protection.

4. How can health care worker contract tuberculosis?

…………………………………………………………………………………………….

…………………………………………………………………………………………….

……………………………………………………………………………………………...

5. Are you aware of preventive measures taken to control tuberculosis?

A. Yes ( ) B. No ( )

If No why………………………………………………………………………………………

PART C

Predisposing factors to the transmission of tuberculosis

1. What are some of the risk factors to the transmission of tuberculosis in your department?

A. Poor ventilation.

B. Understaffing.

C. Inadequate protection equipment

Others
specify………………………………………………………………………………........................
............................................................................................................................................................

34
2. How do you control tuberculosis in your department?

A. Isolation of TB patients

B. Waste management

C. Early identification of TB patients

Others specify………………………………………………………………………………………

3. What can be done to reduce the risk of TB spread in your department?

………………………………………………………………………………………………………
………………………………………………………………………………………………………
………………………………………………………………………………………………………

4. What can the hospital do to control TB transmission in your workplace?

………………………………………………………………………………………………………
………………………………………………………………………………………………………
………………………………………………………………………………………………………
………………………………………………………………………………………………………

5. How do you refer TB cases?

………………………………………………………………………………………………………
………………………………………………………………………………………………………
……………………………………………………………………………………………………

PART D

Challenges faced by health workers in implementation of control measures to prevent

tuberculosis infection.

1. Are you motivated to handle TB patients?

A. No

35
 B. Yes

If yes, how………………………………………………………………………................

………………………………………………………………………………………………..

2. Do you have the equipment to handle TB patients?

A. No ( ) B. yes ( )

If no how do you handle TB patients……………………………………………………….

………………………………………………………………………………………..

…………………………………………………………………………………………

3. Does the hospital put preventive measures against TB?

A. Yes ( ) B. No ( )

If yes, how…………………………………………………………………………………….

……………………………………………………………………………………………………..

4. How long do you have contact with patients?

A. Whole day

B. 8 hours

C. 4hours

D. 2hours

5. Is the workload favorable to your health?

A. Yes ( ) B. No ( )

If no what should be done………………………………………………………………

36
………………………………………………………………………………………………………
………………………………………………………………………………………………………
……………………………………………………………………………………………..

5.5 MAP OF THE STUDY AREA

IEBC REVISED MAP OF BUNGOMA COUNTY

37
38