Measuring the effectiveness of TB

infection control in HIV settings

Ginny Lipke, RN, MHA, ACRN, CIC TB/HIV Team

Division of Global HIV/AIDS

Centers for Disease Control and Prevention

Center for Global Health

Division of Global HIV/AIDS

Some definitions . . .

Monitoring is the periodic and timely collection

of data to determine if activities are being

implemented as planned.

Evaluation is a process to collect information to

determine if a program has achieved its goals and

objectives.

Many approaches to look at effectiveness

Surveillance

Performance Indicators

Process measures

Outcome measures

Surveys

Program evaluations

Operations research

4

Data sources for TB IC plan development

Performance Indicators/Measures

Indicators/Measures enable decision-makers

to assess progress towards the achievement

of intended outputs, outcomes, goals and

objectives

Key Question: Have health care workers

received training in TB infection control?

Indicator: All health care workers in the

facility have received recommended training

in TB infection control. ___ Yes ___ No

Intermediate Outcome Measures

Intermediate results of the program: trainings are

necessary but not sufficient

Have the trainings resulted in changes in behavior,

numbers reached with high quality services?

Examples:

% of clinic staff who incorporate TB infection control practices

routinely

% of blocked or broken windows now repaired and allowing full

natural ventilation

Data sources:

Infection control point persons walk around and observe staff

use of masks, staff provision of health education, etc.

Written record compiled weekly (or monthly) documents # of

windows inspected, repaired, locations, etc.

TB Infection Control M&E Tool for

Clinical Sites

• Designed for daily/weekly use by

ICP

• 32 item assessment covers:

– Managerial

– Administrative

– Environmental

– PPE

• Facilitates recognition of areas

that need improvement

Single Hospital Dashboard St. Francis Baseline

St. Francis 6 months

St. Francis12 months

National IC Policy available

IC Practitioner assigned

IC Committee formed

Written IC plan available

TB IC practices monitored daily

TB IC training for all staff done

Facility has an Occupational Health program

Sputum samples collected away from others

Staff receive evaluation for TB at least annually

HIV-infected staff are reassigned if they request

Staff monitors natural and/or mechanical airflow daily

Patient waiting areas outdoors or with cross-ventilation

Surgical masks available and worn by coughing patients

Done, available or desired outcomeNot done or available, or not right

District Manager’s Dashboard Clinic 1 Clinic 2 Clinic 3 Clinic 4 Clinic 5

National IC Policy available

IC Practitioner assigned

IC Committee formed

Written IC plan available

TB IC practices monitored daily

TB IC training for all staff done

Facility has an Occupational Health program

Sputum samples collected away from others

Staff receive evaluation for TB at least annually

HIV-infected staff are reassigned if they request

Staff monitors natural and/or mechanical airflow daily

Patient waiting areas outdoors or with cross-ventilation

Surgical masks available and worn by coughing patients

Done, available or desired outcomeNot done or available, or not right

Outcome measures

Example indicators:

Reduced transmission of TB to health care workers

Reduced transmission of TB to patients

Prompt TB treatment initiation

Data sources:

Surveillance of active TB cases among health care workers

TB surveillance data

Repeated TST surveys of health care workers

Investigations of TB cases (e.g., MDR-TB cases)

Surveillance for TB in HCWs Harare, Zimbabwe

Two hospitals in Harare conducting surveillance of

HCWs who develop TB

The surveillance log includes the following fields:

Name, date of TB test, type of test, results, pulmonary or extra

pulmonary, date of treatment initiation, medications, date of

treatment completion, date of cure, date HCW allowed to return

to work

Infection control practitioner (ICP) stores the log in a

locked cabinet in a locked office to protect employee

confidentiality

Getting started: effectiveness measures for your facility

Every TB infection control program (and plan) should be accompanied by an M&E plan

“If it is not documented, it didn’t happen!”

Review your TB register to develop background information for measures

Propose one or more measures to monitor and the interventions and data that should be collected

Start with the simplest TB IC measures first because these are easier to attain and will give staff a sense of accomplishment when achieved

Prioritize your measures based on what is needed and what is practical to do in your facility

Contact Information

Ginny Lipke ibt2@cdc.gov

TB IC Training Resources

http://www.cdc.gov/globalaids/Resources/pmtct-

care/tuberculosis-infection-control.html