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U.S. Department of Health and Human Services


Core Curriculum on Tuberculosis, 2000

Chapter 8
Infection Control in Health Care Settings

Personal Respiratory Protection

The third level of the hierarchy is the use of personal respiratory protection. In some settings for example, TB isolation rooms and rooms where cough-inducing procedures are done administrative and engineering controls may not fully protect health care workers  from infectious droplet nuclei. Health care workers should use personal (particulate) respirators in these settings. The Occupational Safety and Health Administration (OSHA) requires the use of certified respirators when respiratory protection is needed. Only particulate respirators that have been certified by the National Institute for Occupational Safety and Health (NIOSH) should be worn for TB protection. A respiratory protection program that teaches health care workers how and when to use personal respirators should be included in all infection control programs.

Some people confuse surgical masks and personal (particulate) respirators. Surgical masks are designed to prevent the respiratory secretions of the person wearing the mask from entering the air. Particulate respirators are designed to filter the air before it is inhaled by the person wearing the respirator. Patients suspected of having or known to have TB should never wear a respirator that has an exhalation valve, because this type of respirator does not prevent expulsion of droplet nuclei into the air.

Inpatient Settings. Precautions to prevent the airborne transmission of tubercle bacilli are particularly important during and immediately after procedures that stimulate coughing (e.g., sputum collection, sputum induction, bronchoscopy, and aerosolized pentamidine treatments) by persons at risk for TB. Persons who carry out these procedures should wear personal respirators, and the procedures should be done in rooms or booths with negative air pressure in relation to adjacent rooms or hallways. The air from these rooms should be exhausted directly to the outside and away from intake sources.

Outpatient Settings. HCWs who work in outpatient settings, such as medical and dental offices, should use personal respiratory protection when working with patients who have, or who are strongly suspected of having, infectious TB. This includes using personal respirators when visiting the home of an infectious TB patient.

EMS personnel should wear respiratory protection when transporting patients suspected or confirmed to have TB. If feasible, the windows of the vehicle should be kept open. The heating and air-conditioning system should be set on a nonrecirculating cycle.


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination -

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