Principal Investigator(s): Heather Joseph, MPH and Robin
Project Dates: 2001-2003
Project Overview: Despite the known risk of tuberculosis (TB)
to health care workers (HCWs), research suggests that many are not fully
adherent to local TB infection control policies. Focus group discussions were
conducted with both clinical and nonclinical staff to identify factors
influencing HCWs' adherence to policies for routine tuberculin skin tests
(TSTs) and treatment of latent TB infection (LTBI).
Objectives: To identify factors that influence HCWs' adherence
to routine TST and LTBI treatment policies
Target Audience: Health care workers in U.S. public health
departments and hospitals
Methods: Sixteen focus group discussions were conducted
with clinical and nonclinical staff at 2 hospitals and 2 health departments.
Participants were segmented by adherence to TST or LTBI treatment policies.
In-depth, qualitative analysis was conducted to identify facilitators and
barriers to adherence.
Results: Among all focus groups, common themes included the
perception that the TST was mandatory, the belief that conducting TSTs at the
work site facilitated adherence, and a general misunderstanding about TB
epidemiology and pathogenesis. Adherent groups more commonly mentioned
facilitators, such as the perception that periodic tuberculin skin testing was
protective and the careful tracking and counseling services provided by
employee health (EH). Barriers, such as the logistic difficulty in obtaining
the TST, the perception that LTBI treatment was harmful, and a general distrust
of EH, emerged consistently in nonadherent groups. This information may be used
to develop more effective interventions for promoting HCW adherence to TB
prevention policies. Informed efforts can be implemented in coordination with
reevaluations of infection control and EH programs that may be prompted by the
publication of the revised TB infection control guidelines issued by the
Centers for Disease Control and Prevention in 2005.
Heather Joseph, MPH
Centers for Disease Control and Prevention
Division of Tuberculosis Elimination
1600 Clifton Road, NE, Mailstop E-10
Atlanta, GA 30333
Joseph H, Shrestha-Kuwahara R, Lambert L, Wilce M et al.
Factors influencing health care
workers' adherence to work site screening and treatment policies. American Journal
of Infection Control Dec 2004; 32(8): 456-461.
1 Division of Tuberculosis Elimination, Centers for Disease Control and Prevention