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I In t r o d u c t i o nn t r o d u c t i o n

Protectionrotection
Respiratoryespiratory
R P must be developed. Information and guidance
Programrogram
P E F H needed for the proper selection, use, and care of
Elementslements
Foror
Healthealth
these devices must be included.
Exposedxposed
Workersorkers
Too
C W E T
Careare
Tuberculosisuberculosis
T Respirator selection must be based on the
hazard to which the worker is exposed. More
From 1985 to 1992, the incidence of turberculosis (TB) protective respirators may be needed for cer-
in the general U.S. population increased approxi- tain high-risk procedures [CDC 1994, p. 99].
mately 14 percent, reversing a 30-year downward
trend. In 1993, 25,313 new cases of TB were reported The respirator user must be trained in the
in the U.S. [CDC 1994]. Associated with this resur- correct use of the respirator as well as its
gence were hospital outbreaks of TB, and the emer- limitations. This training must include instruc-
gence of multiple-drug-resistant TB. In response to tions for wearing and adjusting the respirator
and for checking the fit.
these public health threats, extensive efforts were
taken across the nation to improve TB-prevention and Respirators must be regularly cleaned and
TB-control programs. As a result of these measures, disinfected. Disposable respirators (cannot be
since 1992, there has been a consistent decline in the used by more than one person) must be dis-
number and incidence of TB (i.e., 7.4 cases per 100,000 carded if they are soiled or physically dam-
population and 19,855 total cases in 1997) and a aged (e.g., creased or torn). If the replaceable
decline in multiple-drug-resistant TB [CDC 1998b]. filter respirator is used by more than one
The public health and the occupational risks of TB person (that is, not assigned to one person
thus appear to be once again decreasing, but they permanently), it must be cleaned and disin-
remain very significant. fected after each use.

Health care workers exposed to patients with infec- Respirators must be stored in a convenient,
tious TB require protection from that disease. Be- clean, sanitary location. They must be stored so
cause the use of engineering controls (such as isola- they are protected from dust, harmful chemi-
tion rooms and ventilation) may not completely cals, sunlight, moisture, and excessive heat or
cold.
control the TB hazard, respiratory protection is
needed. Respirators that are used routinely must be
inspected during cleaning, and damaged or
When respirators are used, the Occupational Safety deteriorated parts must be replaced.
and Health Administration (OSHA) standard for
respiratory protection for M. tuberculosis [29 CFR* Appropriate surveillance must be maintained
1910.139] must be followed. OSHA has stated that for work area conditions and the degree of
+
it will promulgate a separate standard for TB; but worker exposure or stress. Any changes from
until then, the use of respirators for TB exposures the last evaluation must be identified and
will be enforced under the original respiratory evaluated.
protection program prescribed by OSHA in 29 CFR
1910.139 (see Appendix A). This program requires A regular inspection and evaluation (e.g.,
the following: yearly) must be conducted to determine the
continued effectiveness of the program.
Written Standard Operating Procedures (SOPs)
describing the selection and use of respirators A determination must be made that a worker

* Code of Federal Regulations. See CFR in references.
+ [29 CFR 1910.139] was formerly codified at [29 CFR 1910.134].

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