India: Sewri TB Hospital: Healthcare Workers are vulnerable to TB and they deserve to be protected

As healthcare workers die of TB - physicians, health organisations, TB groups, public health experts, and associations of healthcare workers - call for urgent action.

The recent death of a TB-treating physician due to drug-resistant TB (DR-TB) is a tragic example of healthcare workers in Sewri Hospital losing their lives due to inadequate infection control measures.

As the death toll rises, health organisations, TB groups, public health experts, human rights lawyers, trade unions and most importantly associations of healthcare workers have come together to write to the Union Health Minister, Minister of Public Health (Maharashtra) and the Municipal Commissioner of Brihanmumbai Municipal Corporation (BMC), calling for urgent action to reduce the risks of healthcare workers contracting tuberculosis at Sewri Hospital – Asia’s largest TB hospital. Increasingly, healthcare workers in high burden settings such as Sewri Hospital, have occupationally acquired TB, and several have developed active drug-resistant disease.

Despite the increased vulnerability, the persistent shortage of protective equipment like respirators and apathy to infection control measures in Sewri Hospital have outraged healthcare workers, the TB and public health community.

The letter expresses concern regarding the shortage of personal protective equipment i.e. N-95 respirators, and the lack of implementation of infection control practices at the Sewri Hospital. The callous attitude of the Indian government towards its healthcare workers is disturbing, especially given that investment in infection control measures is much lower compared to the
cost of diagnosing and treating drug-resistant TB cases, not accounting for the cost to the patient and his or her family.

The letter draws attention to several measures that health and local authorities can take to protect workers from tuberculosis in healthcare settings. Keeping in mind the Central TB Division’s, Ministry of Labour’s, Ministry of Health’s and BMC’s obligations under the law and national policies the letter calls for:

1. That N-95 respirator masks that are critical to protect the health and safety of healthcare workers in Sewri Hospital be provided to them in adequate quantities. Patients should also be provided with surgical masks.
2. Respirator fit testing and training programmes should also be organized in Sewri Hospital to ensure that healthcare workers are properly trained and motivated in the correct technique of using these masks to ensure their effectiveness.
3. Healthcare workers should be regularly screened (bi-annually) for TB symptoms and provided access to early correct diagnosis (through drug sensitivity testing) and treatment for TB (including DR-TB drugs) free of cost.
4. Other effective infection control measures be implemented without delay in Sewri Hospital. In particular, environmental controls such as adequate amount of air changes per minute, linear flow of air away from patients to the outside environment (not towards staff), so designing or moving beds in wards and opening windows or directing fans taking this into account, can be very effective.
5. ‘Workers eligible for compensation’ should include all those performing a service who are at risk of TB exposure (facility and community based), including those on contract and without formal remuneration.
6. Raise awareness among healthcare workers covered by the Employees' State Insurance Act about their rights - including compensation due to workplace transmission of TB - under the law.
7. The Ministry of Labour should ensure that the ‘National Policy on Safety, Health and Environment at Workplace’ is applied and implemented in Sewri Hospital and across the health sector to achieve its objective of reducing incidence of work related fatalities and diseases.
8. It is also unacceptable that health care facilities are sources of increased TB transmission, particularly drug-resistant strains in India. In Sewri hospital, which receives a large number of suspected DR TB patients, improved management of TB cases is the need of the hour and therefore all patients should receive correct diagnosis (through drug sensitivity testing) and started on effective treatment to reduce infectivity very rapidly.

The letter strongly urges the government to pay urgent attention to infection control and prevention of TB transmission in Sewri TB Hospital. The success of a TB Control Programme is dependent on healthy, motivated and experienced health care workers who provide effective TB care on the front-line.

To download the letter, click here.