Development of Guidelines for Screening and Diagnosing Latent Tuberculosis Infection among Healthcare Workers at Nongsonghong Hospital, Khon Kaen Province.

Abstract

      This action research study applied collaborative quality improvement concepts and two Plan-Do-Check-Act (PDCA) cycles. It aimed to investigate the situation, problems, obstacles, and needs; develop a guideline for screening and diagnosing latent tuberculosis infection (LTBI) among personnel; and evaluate the effectiveness of the guideline at Nong Song Hong Hospital, Khon Kaen Province. The study was conducted from April to November 2023, spanning 8 months. The sample consisted of 10 multidisciplinary team members, 4 experts, and 20 personnel who tried out the guideline from 5 departments, selected by purposive sampling; the guideline was then expanded to all 180 hospital personnel in the second cycle. Research instruments included the guideline for screening and diagnosing LTBI, a general information record form, a knowledge test, an opinion questionnaire on the appropriateness of the guideline, and a guideline adherence and indicator record form. Data were analyzed using descriptive statistics, content analysis, and pre-post comparison of knowledge using Paired t-test.

      The findings revealed that the previous hospital guideline could detect only active tuberculosis, with no risk classification and no interferon-gamma release assay (IGRA) testing; before implementation, 70.00% of personnel had been screened for symptoms. The developed guideline comprised five steps: risk classification and baseline assessment, symptom screening for active tuberculosis, IGRA testing, interpretation and diagnosis, and preventive treatment with follow-up, together with a workflow chart, laboratory procedures, and designated persons responsible for each step. Post-implementation evaluation showed that the mean knowledge score increased from 11.65 (SD = 2.94) to 17.40 (SD = 1.76), with 85.00% of personnel at a high level of knowledge. Opinions on the appropriateness of the guideline were at a high level (mean = 4.20). Symptom screening increased from 70.00% to 100.00% in the try-out group and reached 95.00% when expanded hospital-wide; 90.00% of personnel underwent IGRA testing, 22.22% of those tested were positive, and 82.86% of those diagnosed with LTBI received preventive treatment. Statistical testing revealed that knowledge scores after implementation were significantly higher than before at the .05 level (p < 0.001).