OpiniãoThese guidelines have been developed to provide updated, evidence-informed recommendations on tuberculosis (TB) infection prevention and control (IPC) in the context of the global targets of the Sustainable Development Goals (SDGs) and the World Health Organization (WHO) End TB Strategy. The notion and practice of IPC encompasses a set of broader, practical, evidence-based approaches to preventing the community from being harmed by avoidable infections, preventing health care-associated infections (HAI), implementing laboratory biosafety and reducing the spread of antimicrobial resistance (AMR). The IPC concept is used throughout these guidelines – in the context presented here, it refers to a group of interventions aimed at minimizing the risk of Mycobacterium tuberculosis transmission in health care and other settings.
The recommendations given in this document followed an updated assessment of the effect of specific interventions, including extensive deliberation by a Guideline Development Group over the course of 1 year. In view of this, the recommendations described here supersede the 2009 WHO policy on TB infection control in health care facilities, congregate settings and households.¹
The interventions presented here are not new, they replicate those described in earlier WHO guidelines;¹ what is new is the focus on the spectrum of measures as a “package” of interventions. These updated guidelines continue to emphasize the need to implement the hierarchy of infection control as a systematic and complex approach for strengthening IPC and reducing the risk of M. tuberculosis transmission. In particular, they draw attention to the core components of IPC² as a set of essential elements (i.e. core components) or minimum IPC standards that should be implemented across settings and across the various levels of care, for the effective and efficient functioning of IPC activities and practices.
These guidelines contain seven main chapters and a set of annexes;³ there is also an Executive Summary that includes a list of the recommendations. Chapter 1 outlines the rationale for developing these guidelines, the objective and the intended audience. Chapter 2 presents the WHO policy recommendations, along with a summary of the evidence, the rationale behind the recommendations and specific implementation considerations for each intervention. Chapter 3 is intended for national authorities and policy-makers to become aware of and to adopt IPC core components for the establishment and effective functioning of IPC programmes and practices. Chapter 4 describes the methods used to develop the guidelines according to WHO standard procedures. Chapters 5 and 6 provide a synopsis of the judgements of the Guideline Development Group, and emphasize what is needed from current research to better inform future recommendations. These chapters also outline the processes for publication and dissemination of the guidelines.
Annex 3 summarizes complementary systematic reviews aimed at describing the risk of developing TB infection and progressing to TB disease in specific at-risk populations – health workers and individuals living in TB-affected households or spending time in congregate settings – compared with the general population (Background questions 1 and 2). It also briefly describes the effect of treatment on infectiousness (Background question 3).
As stated earlier, the interventions described under each recommendation are not intended as stand-alone interventions; rather, they are to be implemented as a full IPC package. To properly implement these guidelines, all recommendations should be read alongside the remarks and implementation considerations that follow each recommendation.
¹ 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).
² Guidelines on core components of infection prevention and control programmes at the national and acute health care facility level. Geneva: World Health Organization; 2016 (http://www.who.int/gpsc/core-components.pdf, accessed 18 December 2018).
³ The annexes include a complete list of participants of the Guideline Development Group meeting, a summary of declarations of interest, a summary of a series of complementary systematic reviews aimed at describing the risk of developing TB infection or progressing to TB disease in specific at-risk populations, and a brief description of the effect of treatment on infectiousness.