NIOSH Recommended Guidelines for Personal Respiratory Protection of Workers in Health-Care Facilities Potentially Exposed to Tuberculosis

by Centers for Disease Control and Prevention

Centers for Disease Control

---

 

NIOSH Recommended Guidelines

for

Personal Respiratory Protection

of Workers in Health-Care Facilities

Potentially Exposed to Tuberculosis

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
Centers for Disease Control
National Institute for Occupational Safety and Health
Atlanta, Georgia

 

September 14, 1992

[DISCLAIMER]

DISCLAIMER

 

Mention of the name of any company or product does not constitute

endorsement by the National Institute for Occupational Safety and Health.

This document is in the public domain and may be freely copied or reprinted.

Copies of this and other NIOSH documents are available from:

Publications Dissemination, DSDTT

National Institute for Occupational Safety and Health

4676 Columbia Parkway

Cincinnati, Ohio 45226

(513) 533-8287

For information about other occupational safety and health problems, call

1-800-35-NIOSH

Contents

 

Foreword ....................................................................................................................................................................................................................................................

iii

 

Summary ....................................................................................................................................................................................................................................................

iv

 

List of Abbreviations ....................................................................................................................................................................................................................................................

viii

 

Acknowledgments ....................................................................................................................................................................................................................................................

ix

 

I. Introduction ....................................................................................................................................................................................................................................................

1

A. Current Epidemiology and Control of Tuberculosis ....................................................................................................................................................................................................................................................

1

B. The Mandates to NIOSH in the Occupational Safety and Health Act of 1970 ....................................................................................................................................................................................................................................................

4

C. The Principle of Public Health Prudence ....................................................................................................................................................................................................................................................

5

 

II. Mode of Airborne Transmission and Potential for Worker Exposure ....................................................................................................................................................................................................................................................

6

A. Airborne Transmission of Tubercule Bacilli ....................................................................................................................................................................................................................................................

6

B. Health-Care-Facility Workers' Potential for Exposure to Tuberculosis ....................................................................................................................................................................................................................................................

8

 

III. Methods for Worker Protection—Controlling Airborne Transmission of Tuberculosis ....................................................................................................................................................................................................................................................

10

A. Previous Recommendations for Personal Respiratory Protection ....................................................................................................................................................................................................................................................

10

B. The "Hierarchy of Controls" ....................................................................................................................................................................................................................................................

10

 

IV. Considerations in the Selection of Respirators ....................................................................................................................................................................................................................................................

16

A. Nature of the Hazard to Workers ....................................................................................................................................................................................................................................................

16

B. Potential Respirator Leakage ....................................................................................................................................................................................................................................................

18

C. Hazardous Face-Seal Leakage ....................................................................................................................................................................................................................................................

19

D. Hazardous Leakage Through Filters ....................................................................................................................................................................................................................................................

22

E. Powered, HEPA-Filter Halfmask and Positive-Pressure, Air-Line, Halfmask Respirators ....................................................................................................................................................................................................................................................

23

F. Practical Disadvantages of the Recommended Respirators ....................................................................................................................................................................................................................................................

25

G. Surgical Masks and Other Disposable Particulate Respirators ....................................................................................................................................................................................................................................................

27

 

V. NIOSH Recommendations for Personal Respiratory Protection ....................................................................................................................................................................................................................................................

31

A. Summary of Conclusions and Recommendations ....................................................................................................................................................................................................................................................

31

B. Identifying Confirmed or Potential Tuberculosis Transmitters in a Health-Care Facility ....................................................................................................................................................................................................................................................

37

C. Selection of Minimal Acceptable Personal Respiratory Protection ....................................................................................................................................................................................................................................................

38

D. Implementing a Personal Respiratory Protection Program ....................................................................................................................................................................................................................................................

42

1. Standard Operating Procedures ....................................................................................................................................................................................................................................................

42

2. Medical Surveillance ....................................................................................................................................................................................................................................................

42

3. Training ....................................................................................................................................................................................................................................................

43

4. Face-Seal Fit Testing and Fit Checking ....................................................................................................................................................................................................................................................

45

5. Respirator Inspection, Cleaning, Maintenance, and Storage ....................................................................................................................................................................................................................................................

45

6. Surveillance of the Health-Care Facility and Exposures of Workers in Health-Care-Facilities ....................................................................................................................................................................................................................................................

46

7. Respirator Selection ....................................................................................................................................................................................................................................................

46

8. Pereodic Evaluation of the Personal Respiratory Protection Program ....................................................................................................................................................................................................................................................

47

 

References ....................................................................................................................................................................................................................................................

48

 

List of Figures

 

Figure 1—Example A of a NIOSH-Certified, Powered, HEPA-Filter, Halfmask Respirator ....................................................................................................................................................................................................................................................

34

Figure 2—Example B of a NIOSH-Certified, Powered, HEPA-Filter, Halfmask Respirator ....................................................................................................................................................................................................................................................

35

Figure 3—Example C of a NIOSH-Certified, Powered, HEPA-Filter, Halfmask Respirator ....................................................................................................................................................................................................................................................

36

 

List of Tables

 

Table 1—Requirements for and Essential Roles of Fit Tests and Fit Checks ....................................................................................................................................................................................................................................................

20

Table 2—Summary Comparison of Three Respirator Categories Evaluated for Protection of Health-Care-Facility Workers Potentially Exposed to Tuberculosis ....................................................................................................................................................................................................................................................

29

Table 3—NIOSH Recommendations for Minimal Acceptable Personal Respiratory Protection for Health-Care-Facility Workers Potentially Exposed to Tuberculosis ....................................................................................................................................................................................................................................................

40