PLoS ONE
Volume 7, Issue 11, 2012

Adherence by Dutch Public Health Nurses to the National Guidelines for Tuberculosis Contact Investigation (Article) (Open Access)

Mulder C.* , Harting J. , Jansen N. , Borgdorff M.W. , van Leth F.
  • a KNCV Tuberculosis Foundation, The Hague, Netherlands, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
  • b Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
  • c KNCV Tuberculosis Foundation, The Hague, Netherlands
  • d Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands, Department of Infectious Diseases, Public Health Service, Amsterdam, Netherlands, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
  • e KNCV Tuberculosis Foundation, The Hague, Netherlands, Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands

Abstract

Objectives: To assess whether public health nurses adhered to Dutch guidelines for tuberculosis contact investigations and to explore which factors influenced the process of identifying contacts, prioritizing contacts for testing and scaling up a contact investigation. Methods: A multiple-case study (2010-2012) compared the contact investigation guidelines as recommended with their use in practice. We interviewed twice 14 public health nurses of seven Public Health Services while they conducted a contact investigation. Results: We found more individuals to be identified as contacts than recommended, owing to a desire to gain insight into the infectiousness of the index case and prevent anxiety among potential contacts. Because some public health nurses did not believe the recommendations for prioritizing contacts fully encompassed daily practice, they preferred their own regular routine. In scaling up a contact investigation, they hardly applied the stone-in-the-pond principle. They neither regularly compared the infection prevalence in the contact investigation with the background prevalence in the community, especially not in immigrant populations. Nonadherence was related to ambiguity of the recommendations and a tendency to act from an individual health-care position rather than a population health perspective. Conclusions: The adherence to the contact investigation guidelines was limited, restraining the effectiveness, efficiency and uniformity of tuberculosis control. Adherence could be optimized by specifying guideline recommendations, actively involving the TB workforce, and training public health nurses. © 2012 Mulder et al.

Author Keywords

[No Keywords available]

Index Keywords

anxiety Netherlands immigrant nursing practice human infection rate Guideline Adherence nurse attitude Young Adult Humans Adolescent male female tuberculosis Child, Preschool Public Health Practice prevalence Public Health Nursing Contact Tracing Article Contact investigation adult case study health care concepts practice guideline Child
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84869137950&doi=10.1371%2fjournal.pone.0049649&partnerID=40&md5=b9ccc81543755da3a0a56da3ceeebb60
DOI: 10.1371/journal.pone.0049649
ISSN: 19326203
Cited by: 7
Original Language: English