ReacciónWorldwide, 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. The World Health Organization (WHO) estimates that close to 54 million TB deaths were averted between 2000 and 2017 because of improved disease prevention and management, and service delivery; nevertheless, up to 10 million people continue to fall ill with TB every year.¹
One of the targets of the Sustainable Development Goals (SDGs)² for the period 2015–2030 is to end the global TB epidemic. In line with this target, the WHO End TB Strategy,³ approved by the World Health Assembly in 2014, calls for a 90% reduction in TB deaths and an 80% decrease in the TB incidence rate by 2030. The strategy emphasizes the need for prevention across all approaches, including infection prevention and control (IPC) in health care services and other settings where the risk of Mycobacterium tuberculosis transmission is high. IPC practices are vital to reduce the risk of M. tuberculosis transmission, by reducing the concentration of infectious droplet nuclei in the air and the exposure of susceptible individuals to such aerosols.
Initial WHO recommendations on TB IPC focused primarily on decreasing the risk of transmission in health care facilities in resource-limited settings .⁴ ⁵ These initial recommendations were then expanded in 2009 to provide further guidance on the use of specific measures for health care facilities, congregate settings and households.⁶ After the 2009 guidelines had been in effect for almost 10 years, the need for an update was anticipated, to provide a revised evidence assessment, reinforcing earlier recommendations and linking to core components of effective IPC programmes overall. The present updated guidelines also stress the importance of implementing IPC measures in a systematic and objective way that prioritizes consideration of the hierarchy of IPC controls. Thus, the interventions described here should not be implemented individually or in a way that dissociates them from other administrative and environmental controls, and personal protection; rather, they must be considered as an integrated package of IPC interventions to prevent M. tuberculosis transmission.
These guidelines do not attempt to create a parallel programme exclusively dedicated to TB IPC; instead they, emphasize the importance of building integrated, wellcoordinated, multisectoral action towards TB infection control across all levels of care, as well as in non-health care settings with a high risk of M. tuberculosis transmission. In doing this, as an initial step, these guidelines lay out general recommendations and good practice activities that are crucial for the establishment and effective functioning of all IPC programmes. These core components¹ of IPC programmes form a key part of WHO strategies to prevent current and future threats; strengthen health service resilience; help to prevent conditions such as health care-associated infections, including TB; and combat antimicrobial resistance.
The target audience for these guidelines includes national and subnational policymakers; frontline health workers; health system managers for TB, HIV and highlyprevalent noncommunicable disease programmes; managers of IPC services in inpatient and outpatient facilities; managers of congregate settings and penitentiary facilities; occupational health officials; and other key TB stakeholders.
The objective of these guidelines is to provide updated, evidence-informed recommendations outlining a public health approach to preventing M. tuberculosis transmission 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 to reach the targets of the “End TB Strategy”.
This document supersedes the WHO policy on TB infection control in health care facilities, congregate settings and households that was published in 2009.²
¹ Global tuberculosis report 2018 (WHO/CDS/ TB/2018.20). Geneva: World Health Organization); 2018 (http://apps.who.int/iris/bitstream/handle/10665/274453/9789241565646-eng.pdf?ua=1, accessed 18 December 2018).
² The SDGs were adopted by world leaders in September 2015 to end poverty, protect the planet and ensure prosperity for all as part of a new sustainable development agenda. Further information is available at: https://www.un.org/sustainabledevelopment/development-agenda/.
³ The End TB Strategy provides a global TB strategy framework, and sets the targets to reduce TB deaths by 95%, reduce TB incidence by 90% and prevent affected families facing catastrophic costs due to tuberculosis. Further information is available at: http://www.who.int/tb/ strategy/End_TB_Strategy.pdf?ua=1.
⁴ Guidelines for the prevention of tuberculosis in health care facilities in resource-limited settings (WHO/CDS/ TB/99.269). Geneva: World Health Organization; 1999 (http://www.who.int/tb/publications/who_tb_99_269. pdf?ua=1, accessed 18 December 2018).
⁵ Tuberculosis infection-control in the era of expanding HIV care and treatment – addendum to WHO guidelines for the prevention of tuberculosis in health care facilities in resource-limited settings. Geneva: World Health Organization (WHO); 1999 (http://apps.who.int/iris/ bitstream/handle/10665/66400/WHO_TB_99.269_ADD_ eng.pdf?sequence=2, accessed 18 December 2018).
⁶ WHO policy on TB infection control in health-care facilities, congregate settings and households (WHO/HTM/TB/2009.419). Geneva: World Health Organization; 2009 (http://apps.who.int/iris/ bitstream/handle/10665/44148/9789241598323_eng. pdf?sequence=1, accessed 18 December 2018).