Assessing the implementation of the national tuberculosis infection control guidelines in Bangladesh: A qualitative study

Background: In response to the World Health Organization's (WHO) recommendation to reduce people's exposure to TB in the health care facilities, congregate settings and households, the national TB control program of Bangladesh developed the national guidelines for tuberculosis infection control in 2011. This study aimed to assess the implementation of TB infection control measures in health care settings. Methods and materials: We conducted a qualitative study at eleven health care facilities: eight TB specialty hospitals and three tertiary care teaching hospitals in Bangladesh between February to June 2018. We conducted 59 key-informant interviews (KII) to understand barriers and opportunities for implementation of the tuberculosis infection control guidelines. We also conducted a facility assessment survey and examined TB infection control practices. Results: The healthcare workers were unaware of the national TB infection control guidelines. There was no TB infection control plan or committee at the facilities we examined. Presumptive TB patients triage checklist was absent in all facilities. However, we observed patients triaging and separations in TB specialty hospitals. Routine cough etiquette devices were provided to the TB patients mentioned in the KIIs which was consistent with findings from observations. All the facilities were naturally ventilated with an average 92 air changes per hour during the study period. Four hospitals had mechanical ventilation. Conclusion: This study identified poor implementation of TB infection control healthcare measures in the study facilities. The limited knowledge about the guidelines resulted in poor adherence to it. To improve the TB infection control practices, initiatives should be taken from the hospital's higher authorities as well as from the national-level policymakers.