air must conform to at least Grade D of ANSI Standard Z86.1. For mobile use of these respirators, the air supply can come from a large laboratory-type cylinder (up to about 4 hours of use) or a much smaller, lighter, 45-cubic-foot cylinder (up to about 30 minutes of use). The latter cylinder is less than 2 feet long and about 8 inches in diameter.
However, any disadvantages of the respirators recommended in these guidelines should be evaluated in the context of the aggregate of other isolation precautions already accepted and in use for potential tuberculosis transmitters. The disadvantages cited must be balance against the hazard of tuberculosis infection that tuberculosis transmitters pose to healthcare-facility workers. The medical community has consistently proved willing to accept the burdens of isolation precautions previously recommended for tuberculosis to assure protection of patients and health-care workers.
It has been argued that hospital personnel will refuse to wear the respirators recommended in these guidelines. This attitude is not a new problem in health-care. Other well-established isolation precautions in health-care settings were initially viewed as inconvenient, burdensome, and deleterious to good patient care. Garner and Simmons have addressed this issue as follows (52):
All personnel-physicians, nurses, technicians, students, and others—are responsible for complying with isolation precautions and for tactfully calling observed infractions to the attention of offenders. Physicians should observe the proper isolation precautions at all times; they must teach by example. The responsibilities of hospital personnel for carrying out isolation precautions cannot be effectively dictated but must arise from a personal sense of responsibility.
In order to provide adequate motivation for respirator wear when it is indicated, personnel must be fully informed regarding the specific risks of tuberculosis infection for which personal respiratory protection is indicated. As noted in section V.D.3 starting on page 43, respirator wearers must receive training in the reasons for the need for wearing their respirator and the potential risks of not doing so. This training and written material would include a full disclosure of the nature, extent, and hazards of tuberculosis infection including
