Quality improvement project

Protecting our personnel from tuberculosis

REBEKKA:-
1) please write something for this BACKGROUND starting paragraph.
2) choose some photos - one for each section.
3) Supply the references 1 2 3 and any others you think we should have.
4) I’m going to put in the video that the OJTs did.

Background

Right from the start of our healthcare and training services, we have done X.
Why.

Previous efforts or QIPs?

Room for improvement?

Plan

  • Plan’s objective: using educational and monitoring means, improve our personnel’s compliance with the wearing of personal protective equipment (PPE) against tuberculosis (TB) within places of detention (PoD).

    • Specific: yes:-

      • monitoring: observation in person and through pictures;

      • training:-

        • presentation about TB, focussing on transmission rate and improvement through protection,

        • video project for our On-the-Job Trainees (OJTs);

    • Measurable: yes:-

      • pre-QIP: pictorial evidence in photographs of personnel without masks;

      • start of QIP: observation during week one, counting percentage of personnel wearing masks;

      • end of QIP: observation during week six, counting percentage of personnel wearing masks.

    • Achievable: yes:-

      • scope: narrow;

      • success: deemed if there’s an improvement in mask compliance in week six compared with week one.

    • Relevant: yes:-

      • TB is endemic in the Philippines in general; [1]

      • the Philippines has the highest rate of multi-drug-resistant TB (MDRTB) in Asia; [2]

      • TB within prisons (both in the Philippines and worldwide) is a hot public health issue. [3]

    • Time-defined: yes, six weeks.

  • Personnel: led by Dr Rebekka Huebner, supervised by Dr Rachael Pickering.

Do

  • Do the project:-

    • Intervention: teaching sessions for our regular staff and four current OJT nurse assistants covering:-

      • overview of TB;

      • airborne mode of transmission;

      • risk in closed settings such as PoDs;

      • importance of PPE in reducing occupational exposure and transmission;

      • overview of FFP2 vs FFP3 masks and correct usage (donning/doffing);

      • conducted informal baseline assessment of existing knowledge and attitudes towards PPE use.

    • Material: short educational video developed by OJTs under supervision including the following topics:-

      • TB basics (pathophysiology, transmission, risk);

      • PPE focus (mask types, correct fitting and indications for use);

      • TB in PoDs (epidemiology, overcrowding, ventilation and increased transmission risk).

    • Monitoring:-

      • direct observation of PPE compliance during clinical duties;

      • photographic documentation of mask use in custodial environment;

      • compliance surveying (mask worn vs not worn).

  • X Detail any problems: objective assessment of PPE compliance was challenging, as staff behaviour appeared to be influenced by a doctor´s presence. Compliance was generally higher when I was present and wearing a mask, suggesting a potential Hawthorne effect, while photographic evidence indicated that some staff members were less likely to wear masks when unsupervised. In addition, one staff member who had frequently been observed not wearing a mask during the baseline period was not present during the week 6 observations. Given the small size of the team, the absence of a single individual had a substantial impact on the overall compliance percentage and may therefore have led to an overestimation of the apparent improvement in mask compliance.

Study

  • Study the data:-

    • Week 1: mask compliance of personnel was observed to be ~70%:-

      • inconsistent PPE use was observed between different staff members;

      • the lowest compliance was during non-clinical interactions and in corridors;

      • there was better compliance when the observer/clinical lead was present.

    • Week 6: mask compliance of personnel was observed to be 100%:-

      • this was a relative improvement of 42%;

      • this improved figure may have been affected by the absence of one of the less compliant staff members who had been present during week 1;

      • during one non-clinical interaction (distribution of food as part of our feeding program), the masks were not brought along, though this was realised and masks were sent for before entering the PoD.

  • Summarise our learning:-

    • observed compliance may not accurately reflect routine practice, particularly in a small team where individual staff behaviour can substantially influence overall compliance rates;

    • education improved awareness but did not fully eliminate inconsistent behaviour;

    • behavioural change was influenced strongly by supervision and environment rather than knowledge alone;

    • wearing of masks remains unpopular and will require ongoing monitoring.

Act

  • Actions already made:-

    • FFP3 masks are now stored within the medicine bags carried by the team, ensuring that masks are readily accessible before entering poorly ventilated areas within police stations. This avoids the need to open the medical equipment case outside the facility solely to access PPE.

    • FFP3 masks are also stored in the food bags to ensure that masks are readily available during the feeding programme.

    • Mask compliance expectations have been incorporated into the induction process for new OJTs, including showing the educational video created during this QIP and emphasising the importance of appropriate PPE use in TB-risk environments.

    • Visual reminders have been introduced by attaching signs stating “Wear a mask in closed areas with poor ventilation” to the equipment bags as a prompt before entering higher-risk areas.

  • Additional action(s) required:-

    • Continue monitoring compliance, particularly during the non-clinical interactions as the weekly feeding programme, where masks were more likely to be forgotten.

    • Repeat audit at six-monthly intervals.

    • Consider periodic refresher training sessions.

    • Explore anonymous feedback to identify barriers to mask use

References

1 X

2 X

3 X

…let the wise listen and add to their learning,
    and let the discerning get guidance…
Proverbs 1:5