Index:Niosh tb guidelines.pdf

Title	NIOSH Recommended Guidelines for Personal Respiratory Protection of Workers in Health-Care Facilities Potentially Exposed to Tuberculosis
Year	1992
Location	Atlanta, Georgia
Source	pdf
Progress	Proofread—All pages of the work proper are proofread, but not all are validated
Transclusion	Fully transcluded

Pages (key to Page Status)

i ii iii iv v vi vii viii ix x 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 - - -

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, Air-Line, 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