Guideline

WHO guidelines on tuberculosis infection prevention and control: 2019 update

Year of Publication

2019

Issuing Institution

WHO

Links

WHO IRIS,WHO IRIS

Recommendations

33 included recommendations

Triage of people with TB signs and symptoms, or with TB disease, is recommended to reduce M. tuberculosis transmission to health workers (including community health workers), persons attending health care facilities or other persons in settings with a high risk of transmission.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

Respiratory separation / isolation of people with presumed or demonstrated infectious TB is recommended to reduce M. tuberculosis transmission to health workers or other persons attending health care facilities

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

Prompt initiation of effective TB treatment of people with TB disease is recommended to reduce M. tuberculosis transmission to health workers, persons attending health care facilities or other persons in settings with a high risk of transmission

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Very low

Respiratory hygiene (including cough etiquette) in people with presumed or confirmed TB is recommended to reduce M. tuberculosis transmission to health workers, persons attending health care facilities or other persons in settings with a high risk of transmission.

Status

Updated

Recommended in favor

Strong

Certainty of evidence

Low

Upper-room germicidal ultraviolet (GUV) systems are recommended to reduce M. tuberculosis transmission to health workers, persons attending health care facilities or other persons in settings with a high risk of transmission.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Moderate

Ventilation systems (including natural, mixed-mode, mechanical ventilation and recirculated air through high-efficiency particulate air [HEPA] filters) are recommended to reduce M. tuberculosis transmission to health workers, persons attending health care facilities or other persons in settings with a high risk of transmission.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

Particulate respirators, within the framework of a respiratory protection programme, are recommended to reduce M. tuberculosis transmission to health workers, persons attending health care facilities or other persons in settings with a high risk of transmission.

Status

Updated

Recommended in favor

Conditional

Certainty of evidence

Very low

1a. Health care facility level The panel recommends that an IPC (infection prevention and control) programme with a dedicated, trained team should be in place in each acute health care facility for the purpose of preventing HAI (health care-associated infection) and combating AMR (antimicrobial resistance) through IPC good practices.

Status

Updated

Recommended in favor

Strong

Certainty of evidence

Very low

The panel recommends that evidence-based guidelines should be developed and implemented for the purpose of reducing HAI (health care-associated infection) (health care-associated infection) and AMR (antimicrobial resistance). The education and training of relevant health care workers on the guideline recommendations and the monitoring of adherence with guideline recommendations should be undertaken to achieve successful implementation

Status

Updated

Recommended in favor

Strong

Certainty of evidence

Very low

3a. Health care facility level The panel recommends that IPC (infection prevention and control) education should be in place for all health care workers by utilizing team- and task-based strategies that are participatory and include bedside and simulation training to reduce the risk of HAI (health care-associated infection) and AMR (antimicrobial resistance).

Status

Updated

Recommended in favor

Strong

Certainty of evidence

Moderate

4a. Health care facility level The panel recommends that facility-based HAI (health care-associated infection) surveillance should be performed to guide IPC (infection prevention and control) interventions and detect outbreaks, including AMR (antimicrobial resistance) surveillance with timely feedback of results to health care workers and stakeholders and through national networks.

Status

Updated

Recommended in favor

Strong

Certainty of evidence

Very low

4b. National level The panel recommends that national HAI (health care-associated infection) surveillance programmes and networks that include mechanisms for timely data feedback and with the potential to be used for benchmarking purposes should be established to reduce HAI (health care-associated infection) and AMR (antimicrobial resistance).

Status

Updated

Recommended in favor

Strong

Certainty of evidence

Very low

5a. Health care facility level The panel recommends that IPC (infection prevention and control) activities using multimodal strategies should be implemented to improve practices and reduce HAI (health care-associated infection) and AMR (antimicrobial resistance).

Status

Updated

Recommended in favor

Strong

Certainty of evidence

Very low

5b. National level The panel recommends that national IPC (infection prevention and control) programmes should coordinate and facilitate the implementation of IPC (infection prevention and control) activities through multimodal strategies on a nationwide or subnational level.

Status

Updated

Recommended in favor

Strong

Certainty of evidence

Low

6a. Health care facility level The panel recommends that regular monitoring/ audit and timely feedback of health care practices according to IPC (infection prevention and control) standards should be performed to prevent and control HAI (health care-associated infection) and AMR (antimicrobial resistance) at the health care facility level. Feedback should be provided to all audited persons and relevant staff.

Status

Updated

Recommended in favor

Strong

Certainty of evidence

Low

6b. National level The panel recommends that a national IPC (infection prevention and control) monitoring and evaluation programme should be established to assess the extent to which standards are being met and activities are being performed according to the programme’s goals and objectives. Hand hygiene monitoring with feedback should be considered as a key performance indicator at the national level.

Status

Updated

Recommended in favor

Strong

Certainty of evidence

Moderate

The panel recommends that the following elements should be adhered to in order to reduce the risk of HAI (health care-associated infection) and the spread of AMR (antimicrobial resistance): (1) bed occupancy should not exceed the standard capacity of the facility; (2) health care worker staffing levels should be adequately assigned according to patient workload.

Status

Updated

Recommended in favor

Strong

Certainty of evidence

Very low

8b. The panel recommends that materials and equipment to perform appropriate hand hygiene should be readily available at the point of care.

Status

Updated

Recommended in favor

Strong

Certainty of evidence

Very low

In multidrug-resistant tuberculosis or rifampicin-resistant tuberculosis (MDR/RR-TB) patients who have not been previously treated for more than 1 month with second- line medicines used in the shorter MDR-TB regimen or in whom resistance to fluoroquinolones and second-line injectable agents has been excluded, a shorter MDR-TB regimen of 9–12 months may be used instead of the longer regimens

Status

Retired

Recommended in favor

Conditional

Certainty of evidence

Very low

In multidrug-resistant tuberculosis or rifampicin-resistant tuberculosis (MDR/RR-TB) patients on longer regimens, the performance of sputum culture in addition to sputum smear microscopy is recommended to monitor treatment response. It is desirable for sputum culture to be repeated at monthly intervals

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

Antiretroviral therapy is recommended for all patients with HIV and DR-TB requiring second-line antituberculosis drugs, irrespective of CD4 cell count, as early as possible (within the first 8 weeks) following initiation of antituberculosis treatment

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Very low

In patients with rifampicin-resistant tuberculosis (RR-TB) or multidrugresistant TB (MDR-TB), elective partial lung resection (lobectomy or wedge resection) may be used alongside a recommended MDR-TB regimen.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

Health education and counselling on the disease and treatment adherence should be provided to patients on tuberculosis (TB) treatment

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

A package of treatment adherence interventions may be offered to patients on TB treatment in conjunction with the selection of a suitable treatment administration option

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

One or more of the following treatment adherence interventions (complementary and not mutually exclusive) may be offered to patients on TB treatment or to health-care providers: tracers and/or digital medication monitor

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

One or more of the following treatment adherence interventions (complementary and not mutually exclusive) may be offered to patients on TB treatment or to health-care providers: material support to the patient

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Moderate

One or more of the following treatment adherence interventions (complementary and not mutually exclusive) may be offered to patients on TB treatment or to health-care providers: psychological support to the patient

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

One or more of the following treatment adherence interventions (complementary and not mutually exclusive) may be offered to patients on TB treatment or to health-care providers:staff education

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

The following treatment administration options may be offered to patients on TB treatment: Community- or home-based directly-observed treatment (DOT) is recommended over health facility-based DOT or unsupervised treatment

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Moderate

The following treatment administration options may be offered to patients on TB treatment: directly-observed treatment (DOT) administered by trained lay providers or healthcare workers is recommended over DOT administered by family members or unsupervised treatment

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

The following treatment administration options may be offered to patients on TB treatment: Video-observed treatment (VOT) may replace directly-observed treatment (DOT) when video communication technology is available, and it can be appropriately organized and operated by health-care providers and patients

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

Patients with multidrug-resistant tuberculosis (MDR-TB) should be treated using mainly ambulatory care rather than models of care based principally on hospitalization

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

A decentralized model of care is recommended over a centralized model for patients on multidrug-resistant tuberculosis (MDR-TB) treatment

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low