Tuberculosis in the Workplace (2001) / Chapter Skim
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Appendix F Respiratory Protection and Control of Tuberculosis in Health Care and Other Facilities
Appendix F Respiratory Protection and Control of Tuberculosis in Health Care and Other Facilities
Pages 293-308
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From page 293... ...
One exception and the major area of controversy involves the requirement for annual fit testing of individuals who use or may use personal respirators. The next sections of this paper describe the basic components of a respiratory protection program, the types of respiratory protection devices used to prevent transmission of tuberculosis; and methods for fit testing the devices.
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A quantitative analysis showed that there is an asymptotic effect of noncompliance with program elements (Harber et al., 1999~. That is, a high protection factor of the device itself cannot compensate for programmatic failure or individual worker behavior deficits.
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, whereas atmosphere-supplying respirators provide an independent source of air. The 1994 CDC guidelines established performance criteria for respirators employed to prevent transmission of M
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In contrast, most negative-pressure respirators require inhalation effort by users to create negative pressure within the mask. For these devices, if a leak exists at the facial sealing surface, the mask will draw in ambient untreated air.
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Pending publication of the occupational tuberculosis standard, they are subject, instead, to special regulations that do not mandate annual testing. The 1997 proposed OSHA rule on tuberculosis would require annual fit testing.
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In a quantitative pit test, the concentration of a marker material inside and outside the mask is determined empirically. Quantitative fit testing is more accurate but requires trained personnel and relatively complex equipment.
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Bitrex, an extremely bitter compound sometimes used to deter children from eating poisonous household products, may offer a good alternative. Except during nonhuman laboratory testing in research settings, fit testing cannot be performed with the actual exposure agent of concern (mycobacteria)
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Although the hospitals continued to care for substantial numbers of patients with tuberculosis, health care worker exposure incidents and tuberculosis skin test conversions dropped substantially. Table F-1 summarizes the control measures implemented.
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The tuberculin skin test conversions among house staff dropped from 10 percent preimplementation to 0 percent to 2 percent for time intervals after implementation of the administrative controls and engineering controls but before the provision of new respirators. The authors felt that administrative controls were the main reason for the improvements observed.
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The survey did not cover fit testing. In all of the reports cited above, the implementation of tuberculosis control measures was associated with low levels of tuberculosis transmission among health care workers in hospitals where tuberculosis was prevalent.
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Two papers have modeled the potential for respirators to reduce risk for tuberculin skin test conversion based on data from a series of elegant experiments by Riley and colleagues (Riley et al., 1959, 1962~. First, Riley and colleagues noted the rate at which nurses converted their skin tests in tuberculosis wards and calculated on the basis of their expected minute ventilation the estimated concentration of infectious particles in the air of these wards.
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From page 304... ...
more sophisticated respirators may be needed. EVIDENCE OF EFFECTS OF WORKER TRAINING AND FIT TESTING Among health care infection control experts, the effectiveness of respirators is less controversial than the well-established view in the occupational health world that real-world effectiveness requires that respirator use be part of a broader respiratory protection program with quite specific elements.
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From page 305... ...
In that study, a hospital recruited workers to participate in one of three respirator training programs and to be tested afterward on their ability to correctly adjust the respirator's fit and seal. They concluded that training was important but that it did not matter much whether the training included direct fit testing or a classroom demonstration of proper fit checking prior to each use of a respirator.
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From page 306... ...
CONCLUSION Respiratory protection, particularly requirements for routine annual fit testing, is one of the most contentious elements of the 1997 proposed OSHA regulation on occupational tuberculosis. The challenge for policy makers is to craft reasonable, cost-effective policies in this area that (1)
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et al. Dramatic decreases in tuberculin skin test conversion rate among employees at a hospital in NYC.
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From page 308... ...
Respiratory protection devices. American Journal of Infection Control.
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