Samuel Githui, the Msambweni Sub County TB and Leprosy Coordinator (sCTLC), was concerned. More than five health care workers in his sub county had developed Tuberculosis in the last three years. Samuel needed to find out why… and more importantly, how to stop it.
In April 2014, the USAID funded Tuberculosis Accelerated Response and Care (TB ARC) brought together Samuel and 12 other health workers for a capacity building training on Infection Prevention Control (IPC).
The training was facilitated by Godana Mamo, TB ARC Regional Officer – Coast, and aimed to help health care workers from the Coast to develop strategies that would reduce TB transmission within healthcare facilities.
At the training, Samuel and other attendants were trained on how to conduct baseline assessments in their respective facilities after which they would be required to develop a specific work plan to implement the outcomes of the baseline assessments.
After the training, Samuel did not rest on his laurels. He developed a proposal to the Kwale County government requesting for support to conduct an initial baseline assessment to gauge the level of IPC in selected health facilities within Msambweni Sub County.
With support from Dr Hajara El – Busaidy , the Kwale County Director of Health, Samuel’s proposal was funded by the Kwale County Government and the initial assessments begun shortly after.
Results from the assessment showed that most facilities offering TB Services in Msambweni regularly locked their windows and covered windows with thick curtains to “ensure privacy”. The assessment further showed that most services like issuing of TB drugs, Comprehensive Care Clinic (CCC) and clerking were being offered from a congested consultation room There was also no infection prevention committee and both infectious TB clients and immuno- compromised patients were often offered health services from the same room.
With no time to waste, Samuel shared the recommendations from his assessment with the various health facilities in Msambweni and strongly encouraged them to urgently implement some of the recommendations.
The Kinondo Kwetu Clinic in Msambweni with great support from its Health Management team was one of the health facilities that actioned some of the recommendations from the IPC baseline assessment.
To start with, all the critical infection points like the TB lab and consultation rooms were shifted to well ventilated rooms in the clinic. Additionally, cramped consultation rooms at Kinondo Kwetu were fitted with vented doors to maximize cross ventilation and immune compromised patients were scheduled on different clinic days to minimize contact with infectious TB patients. The clinic further established an infection prevention committee that meets regularly and staff at the clinic are sensitised regularly on infection prevention measures
With support from donors, the clinic was also able to put up new structures that took into account wind direction to offer natural ventilation that is essential for infection prevention.
Explaining the importance of natural ventilation for IPC, Samuel said, “Although the initial hospital structure was built without consideration of the wind direction to enhance room air exchanges, we sensitised the Kinondo Kwetu Clinic administration and the health workers to ensure that most of the critical service delivery points were not posing a risk of airborne infections to health care workers and the clients being served”
“I would recommend that when new structures for hospitals are being constructed, wind direction and other critical infection control strategies should be considered to ensure the hospital build does not become a source of infection to health care workers and the clients”, he added.
In order to share this success, Samuel worked with Christine Toya Mwazhige, a clinical officer at Kinondo Kwetu Clinic to develop an abstract that was presented and well received at the inaugural Kwale Scientific Conference
The successful implementation of an IPC Plan at Kinondo Kwetu shows that with support from county governments, donors and dedicated health care workers, it is possible to tackle some of the drivers of TB infection in the country,
Despite this success, more work still needs to be done and Samuel is currently developing a proposal to increase the scope of his baseline assessment to cover all the health facilities in Msambweni sub County. Results from the sub countywide assessment will then inform any changes that will be required to protect health care workers and patients from contracting TB within the health facilities.
With the technical support from TB ARC, dedicated health workers like Samuel and responsive county governments like Kwale, there is great hope that Kenya will be able to significantly reduce its TB Burden and its citizens will be able to live productive and healthy lives.