NIOSH Recommended Guidelines for Personal Respiratory Protection of Workers in Health-Care Facilities Potentially Exposed to Tuberculosis/Summary
Summary
These guidelines present the recommendations of the National Institute for Occupational Safety and Health (NIOSH) regarding effective and reliable personal respiratory protection for workers in health-care-facilities who are potentially exposed to tuberculosis. NIOSH concludes that any tuberculosis infection in workers in health-care-facilities due to occupational transmission is unacceptable. With or without clinical disease, tuberculosis infection is a material impairment of these workers’ health and establishes a finite probability of developing clinical tuberculosis. Additionally, treatment of tuberculosis-infected workers with isoniazid (INH) for prophylactic purposes presents these treated workers with another significant risk of undesirable isoniazid-associated heaith effects (e.g., isoniazid-associated hepatitis).
In any place where workers are potentially exposed to droplet nuclei from a tuberculosis transmitter, the first and highest priority is to reduce the probability of exposure through the use of administrative controls (e.g., rapid identification, early treatment, and isolation of potential tuberculosis transmitters; limiting access to acid-fast bacilli (AFB) isolation rooms; other isolation precautions) implemented in conjunction with engineering controls (¢.g., negative-pressure ventilation for AFB isolation rooms to contain any airborne hazard to these rooms; booths, hoods, tents, or other devices for containing droplet nuclei at the source—i.e., a person with infectious pulmonary tuberculosis).
However, it is unlikely that the exposure of workers to droplet nuclei can be completely controlled at the infectious source even where these techniques are implemented to a high degree of efficiency. Therefore, when confirmed or potential tuberculosis transmitters are present, use of effective and reliable personal respiratory protection is indicated to assure to the extent possible, the prevention of transmission. This personal respiratory protection is necessary to reduce the risk that workers in health-care-facilities become infected with tuberculosis due to inhalation of droplet nuclei. So that employers can determine whether effective personal respiratory protection is indicated for health-care-facility workers, NIOSH recommends that confirmed or potential tuberculosis transmitters be rapidly identified with an Admissions Screening Plan as discussed in section V.B starting on page 37. Then, for a limited range of specific hazardous locations and procedures indicated in Table 3 starting on page 40, when confirmed or potential tuberculosis transmitters are present or potentially present, NIOSH recommends that NIOSH-certified, powered, halfmask respirators equipped with high-efficiency particulate (HEPA) filters always be used by all potentially exposed workers in conjunction with an effective respiratory protection program. For the most hazardous locations and procedures indicated in Table 3 starting on page 40, NIOSH recommends that, at a minimum, NIOSH-certified, positive-pressure, air-line, halfmask respirators always be used in conjunction with an effective respiratory protection program.
Prudent public health practice to fully protect workers dictates that the respirator and respiratory protection program selected should offer the efficacy and reliability of protection equal to or exceeding those recommended in Table 3 starting on page 40. These NIOSH guidelines also include general recommendations for implementing a personal respiratory protection program that is essential for achieving effective and reliable personal respiratory protection when such protection is indicated.