Respiratory Protection in Health-Care Settings
Last Updated: April 2006
||Respiratory Protection in Health-Care
All health-care settings need an infection-control program designed
to ensure prompt
- airborne precautions, and
of persons who have suspected or confirmed tuberculosis (TB) disease.
There are three levels of TB infection control in health-care settings.
The first level of the infection-control hierarchy, administrative
controls, should minimize the number of areas where exposure to
Mycobacterium tuberculosis may occur.
The second level, environmental controls, should reduce the concentration
of airborne M. tuberculosis. These administrative and environmental
controls should also reduce, although they do not eliminate, the
risk in the few areas where exposures can still occur (e.g., airborne
infection isolation [AII] rooms and rooms where cough-inducing or
aerosol-generating procedures are performed).
Because persons entering these areas may be exposed to airborne
M. tuberculosis, the third level of the hierarchy is the
use of respiratory protective equipment in situations that pose
a high risk for exposure.
Considerations for Selection of Respirators
The overall effectiveness of respiratory protection is affected
by 1) the level of respiratory protection selected (e.g., the assigned
protection factor), 2) the fit characteristics of the respirator
model, 3) the care in using the respirator, and 4) the adequacy
of the training and fit-testing program.
Particulate filter respirators certified by the Centers for Disease
Control and Prevention’s (CDC) National Institute for Occupational
Safety and Health (NIOSH) that can be used for protection against
airborne M. tuberculosis include
- Nonpowered respirators with N95, N99,
N100, R95, R99, R100, P95, P99, and P100 filters (including disposable
- Powered air-purifying respirators (PAPRs) with high-efficiency
The most essential attribute of a respirator is the ability to
fit the varying facial sizes and characteristics of health-care
workers (HCWs). Assistance with selection of respirators can be
done by referring to peer-reviewed research and through consultation
with respirator fit-testing experts, CDC, occupational health and
infection-control professional organizations, respirator manufacturers,
and from participation in advanced respirator training courses.
Implementing a Respiratory Protection Program
If respirators are used in a health-care setting, the Occupational
Safety and Health Administration (OSHA) requires the development,
implementation, administration, and periodic reevaluation of a respiratory
protection program. The most critical elements of a respiratory
protection program include 1) assignment of responsibility, 2) training,
and 3) fit testing. All HCWs who use respirators for protection
against M. tuberculosis infection should be included in the
respiratory protection program.
The health-care setting should develop a policy on the use of respirators
by visitors. Visitors to AII rooms and other areas with patients
who have suspected or confirmed infectious TB disease may be offered
respirators (e.g., N95 disposable respirators) and should be instructed
by an HCW on the use of the respirator before entering an AII room.
To be effective and reliable, respiratory protection programs must
include at least the following elements:
- Assignment of responsibility to one person with sufficient knowledge
who is given the authority and responsibility to manage all aspects
of the program.
- Standard operating procedures that include information and guidance
for the proper selection, use, and care of respirators.
- Screening by a physician or other licensed health-care professional
of all HCWs who might need to use a respirator for pertinent medical
conditions at the time they are hired, and then re-screening periodically.
- Annual training of HCWs with specific focus on prevention, transmission,
- Selection of filtering facepiece respirators approved by CDC/NIOSH.
- Fit testing performed during the initial respiratory protection
program training and periodically thereafter, in accordance with
federal, state, and local regulations.
- Inspection and maintenance of respirators according to manufacturer
- Evaluation of the respirator program periodically to ensure
its continued effectiveness.
Information on the development and management of a respiratory
protection program is available in technical training courses that
cover the basics of respiratory protection. Such courses are offered
by OSHA, the American Industrial Hygiene Association, the American
Conference of Governmental Industrial Hygienists, universities,
manufacturers, and private contractors.
The Centers for Disease Control and Prevention (CDC) is not a regulatory
agency; CDC recommendations on infection control provide evidence-based
guidance. For regulations in your area, refer to state and local
regulations and contact your local Occupational Safety and Health
Administration (OSHA) office. A directory of OSHA offices may be
found at www.osha-slc.gov/html/RAmap.html.
CDC. Guidelines for preventing the transmission of Mycobacterium
tuberculosis in health-care settings, 2005. MMWR 2005; 54(No.
Occupational Safety and Health Administration. Occupational safety
and health standards, subpart I—personal protective equipment.
Respiratory protection. Title 29, Code of Federal Regulations 2003.
CDC Division of Tuberculosis Elimination:
CDC National Institute for Occupational Safety and Health:
Occupational Safety and Health Administration:
State TB control offices: www.cdc.gov/nchstp/tb/pubs/tboffices.htm
American Industrial Hygiene Association:
American Conference of Governmental Industrial Hygienists: www.acgih.org
Infection Control in Health-Care Settings: