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To reduce the risk of transmission of M. tuberculosis, air can be made less infectious through the use of three principles: dilution, filtration and disinfection. Environmental controls are aimed at reducing the concentration of infectious droplet nuclei in the air. This is achieved by using special ventilation systems to maximize airflow rates or filtration, or by using germicidal ultraviolet (GUV) systems to disinfect the air.
A set of administrative controls is the first and most important component of any IPC strategy. These key measures comprise specific interventions aimed at reducing exposure and therefore reducing transmission of M. tuberculosis. They include triage and patient separation systems (i.e. management of patient flows to promptly identify and separate presumptive TB cases), prompt initiation of effective treatment and respiratory hygiene.
The recommendations given below on TB-specific interventions are not envisioned as stand-alone measures; rather, they are components of a comprehensive hierarchy of controls, which in turn is a component of the overall framework of IPC practices, and depends on the adoption of a multimodal strategy. Thus, the adoption of several elements needs to be integrated.
The recommendations presented here are intended to inform and contextualize TB-specific IPC interventions and activities within national-level and local-level IPC policies and protocols. Therefore, the target audience includes national and subnational policy-makers, including health system managers for TB, HIV and other disease programmes; IPC services; inpatient and outpatient facilities; IPC and quality assurance programmes; associations of affected groups; managers of congregate settings and penitentiary facilities; and occupational health and other relevant stakeholders.
The objective of these guidelines is to provide updated, evidence-informed recommendations outlining a public health approach to preventing transmission of M. tuberculosis within the clinical and programmatic management of TB, and to support countries in their efforts to strengthen or build reliable, resilient and effective IPC programmes.
These updated guidelines focus on a package of interventions aimed at reducing the risk of M. tuberculosis transmission, and they supersede the 2009 recommendations (7). Overall, the recommendations cover health care and other groups outside the health care system; also, where possible, specific remarks and additional considerations are given, to highlight specific areas or processes required for the implementation of these recommendations within health care facilities and other, non-health care settings such as congregate settings, community settings and households.
With a burden of disease that accounts for more than 10 million new cases per year, of which less than two thirds are reported, tuberculosis (TB) continues to be a major global health threat (1). Although the global number of TB deaths fell by 42% between 2000 and 2017, and the annual decline in the global TB incidence rate is currently 1.5% (1), much action is needed to accelerate progress towards achieving global milestones to end TB (2).
These guidelines were developed in accordance with the process described in the WHO handbook for guideline development.³ Confidence in the certainty of the evidence underpinning the recommendations was ascertained using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The Guideline Development Group, an international group of experts, was convened to advise WHO in this process, to provide input into the scope of these guidelines and to assist the WHO Steering Group in developing the key questions.
Worldwide, tuberculosis (TB) continues to be the most important cause of death from a single infectious microorganism.¹ Although recent decades have witnessed increased efforts in the fight to end TB, fundamental gaps are hampering these efforts, particularly in resource-constrained settings and in settings with a high burden of disease.
