Project Title: Factors Influencing Health Care Workers' Adherence to Work Site Tuberculosis Screening and Treatment Policies

Principal Investigator(s): Heather Joseph, MPH and Robin Shrestha-Kuwahara, MPH1

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.

Contact Information:
Heather Joseph, MPH
Health Scientist
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