MDR-TB Treatment & Prevention

correction of the typo in my posting above: its "nurse:patient ratio"

Hi Julia,

Thanks for cross posting my question into the Nursing and Midwifery community. Just to add...it is difficult to come to a consensus with local authorities in the countries of former Soviet Union where we work, on these issues as they still follow the general Soviet staffing norms that is not adapted to MDR TB needs, as a result care is often not patient centred and inadequate. To the extent sometimes patients are injecting themselves as nurses are too busy and attendents are sometimes living in SS+ wards to do part of nursing care.

Would be appreciate if someone has any advice.

Thanks,

Stobdan

Dear Stobdan,

I think this is the issue of poor organization of care, not lacking resources. Unfortunately partially it comes from too rigid regulations as well as neglect of TB infection control principles.


Still in most former Soviet Union countries/regions TB services tend to rely on extencive hospitalisation with very long in-hospital stay which coexists with very poor quality of care.

Priority based rustructuring of TB services based on updated policies and TB IC hierarchy should be the solution.


I would recommend to your FSU partners to apply for the training course in Vladimir Center of Excellence for TB IC - those kind of problems are covered quite in detail in the agenda.
 
Hope it can help.
 
Dr. Grigory V. Volchenkov


Head Doctor
Vladimir Oblast TB Dispansery


Sudogodskoe shosse, 63
Vladimir 600023 RUSSIA

Dear Grigory,

Thanks for your response and suggestions. I fully agree with you it stems from all these factors you mentioned.

As far as TB IC is concerned, together with other partners we have just started to improve things but a long way to go. Our NTP colleagues are looking for training possibilities for their staff- I am glad to hear they could receive that at the Vladimir Center of Excellence for TB IC. Could they write to you for that or is there a focal person for that?

While IC aspect of it addressed, as we provide technical advise to the NTP would like to know what would be an optimal patient:nurse ratio for MDR TB services? at the moment at peak working hours from 9 AM to 3PM there only 3 nurses for about 50 patients which according to international/western standards is too many patients per nurse even for less demanding activities. I wonder in FSU centres of excellence like Vladimir Center, Latvia or Tomsk whats the ratio like?

Thanks,
Stobdan

Dear Stobdan,

In our TB hospital we have separated negative pressure patent rooms with upper
room UVGI for MDR TB patients, which are hospitalized to start SLD treatment
acoording to WHO recommended MDR TB treatment protocol. Average length of
in-hospital stay for these patients is 45 - 60 days. As soon as they tolerate
treatment well and convert smear they are discharched to continue DOT SLD
treatment at home or some (for whom we can not provide DOT at home) to
another hospital where they stay in separated floor for longer period. Few
patients are being descharged before smear conversion to continue out-patient
treatment at home if there is opportunity to prevent close contact with other
people.
Vast majoritty of these patients are in clinically stable condition and do not
require intencive care. The nurse:petient ratio is 3 nurses per 40 patients at
day time and 1 nurse per 40 patients during night time. If patient needs
intensive care which is extremely rare, he(she) is transfered to intrencive care
unit where this ratio is 1 nurce per 3 beds.  

Your partners can send the request by e-mail directly to me regarding  TB IC
course in Vladimir. We do quarterly ...

Dear Stobdan,

In our TB hospital we have separated negative pressure patent rooms with upper
room UVGI for MDR TB patients, which are hospitalized to start SLD treatment
acoording to WHO recommended MDR TB treatment protocol. Average length of
in-hospital stay for these patients is 45 - 60 days. As soon as they tolerate
treatment well and convert smear they are discharched to continue DOT SLD
treatment at home or some (for whom we can not provide DOT at home) to
another hospital where they stay in separated floor for longer period. Few
patients are being descharged before smear conversion to continue out-patient
treatment at home if there is opportunity to prevent close contact with other
people.
Vast majoritty of these patients are in clinically stable condition and do not
require intencive care. The nurse:petient ratio is 3 nurses per 40 patients at
day time and 1 nurse per 40 patients during night time. If patient needs
intensive care which is extremely rare, he(she) is transfered to intrencive care
unit where this ratio is 1 nurce per 3 beds.  

Your partners can send the request by e-mail directly to me regarding  TB IC
course in Vladimir. We do quarterly "general" TB IC as well as specialized TB IC
courses.

Best regards,
 Dr. Grigory V. Volchenkov


Head Doctor
Vladimir Oblast TB Dispansery


Sudogodskoe shosse, 63
Vladimir 600023 RUSSIA


phone/fax work: +7(4922)323265
mobile +7 920 625 3227; +7 919 018 9226

Dear Grigory,

Thanks for sharing experience of how your centre is managing these issues even though the nurse:patient ratio seems rather similar. Sure as you say, better organisation and approach to patient care (TB IC) could improve things.

However its an interesting comparision that in non-FSU settings especially western countries typically infectious diseases unit have a ratio of 1 nurse for about 5 patients. It would be very interesting to hear opinion of some HR or Nursing specialists on this.

Best,

Stobdan
p.s. Grigory, as for the IC training local NTP will contact you once they have finalised the idea to send their staff for training.

Dear Stobdan,

I think the Western European nurse/patient ratio for hospitalized patient with
infectious disease should not be applied for hospitalized TB patient in FSU
world both because of usual uncomparable clinical severity of most cases and of
resources available.
 
Regards,
 
Dr. Grigory V. Volchenkov


Head Doctor
Vladimir Oblast TB Dispansery


Sudogodskoe shosse, 63
Vladimir 600023 RUSSIA


phone/fax work: +7(4922)323265
mobile +7 920 625 3227; +7 919 018 9226

Dear Grigory,

I again agree with you that we cannot and should attempt to blindly transplant practices & norms from different contexts.

But my question is what is the minimum acceptable standards and why to compromise on this issue when we are moving forward on other issues like treatment, infection control, and why live with old standards & norms as we have to ensure a minimum acceptable quality of care.

In my experience I have encountered rigid HR norms in the FSU countries and wanted to have some evidence based arguements to advocate for required reforms on this issue.

Best,
Stobdan

Oops again a typo! I meant...
"we cannot and should NOT attempt to blindly transplant practices & norms from different contexts" :-)

Dear Stobdan,

You have raised a good question and we hope to get some more insights from the members on the important role of nurses in different settings. The ratio would be indoubtedly different in different setting. However one important aspect is the roles and responsibilities of nurses, nurses can play very important role in supporting patient and providing a care he or she deserves in a patient-friendly supportive DOT, checking for symptoms/signs of side-effects,educating patients and family members and improving adminstrative measures of IC. In many setting the full potential of nurses are not yet explored, nor applied.
All the best,
Masoud

Dear Masoud,
Thanks for your opinion on this issue. Indeed the role of nurses in many contexts is perhaps underutilised and for MDR TB care which demands closer up follow up of patients is even more relevant. An important underlying factor could be lack of 'patient-centred care' approach - in most low & middle income countries, which nfluences the quality of care & services including determining staff:patient ratio etc. Often we see traditional norms & standards of health services (often outdated) define the quality of care rather than needs of the patients.

Would be good to have opinion of others especially nursing & relevant experts.

Best,
Stobdan

p.s. Perhaps we need to cross post also on the Global Health Nursing & Midwifery: Community Home community

Thanks for sharing with the Nursing community! http://www.ghdonline.org/nursing/discussion/cross-post-nurse-patient-ratio-in...
Would be great to hear from nurses on this.