 At a major medical center, a registered nurse cares for an undiagnosed TB patient. As a result of this exposure, she develops multi-drug resistant tuberculosis. The nurse is forced to give up her job for two years and undergoes three years of treatment, which includes the removal of half a lung. Five medical personnel are present during a three hour autopsy. Afterward, they convert from negative to positive TB skin tests. Two of these infected workers develop active TB eight weeks after testing positive. In both of these real-life cases, TB was transmitted through the air from patient to worker. Proper use of certified respirators could have prevented these potentially life-threatening infections. The National Institute for Occupational Safety and Health presents Respirators. Your TB Defense. For much of the 20th century, tuberculosis was a major public health concern. TB sanatoriums could be found in all major cities and a generation of researchers work to eradicate this highly contagious, highly debilitating and potentially fatal disease. Their efforts paid off. Effective drug interventions were developed and the medical community gained valuable insight into the mechanics of TB infection and transmission. The number of TB cases in the U.S. began to decline at a rapid pace. With good reason, many believed that the war against tuberculosis was over, one at last. But more recently, the incidence of TB actually showed an increase, reversing this decade's long trend. The number of reported TB cases rose considerably from 1985 to 1992. Despite the rigorous infection control standards of today's healthcare facilities, there have been documented outbreaks of tuberculosis in modern hospitals. Many workers have developed the disease during the course of such outbreaks and a small number have even died. Although drugs used to treat TB are usually safe and effective, they may cause side effects in some people. Some TB bacteria have become resistant to the very antibiotics that were once so effective at halting the disease. TB caused by these bacteria is known as multi-drug resistant tuberculosis or MDR-TB. As with many infectious diseases, the key to reducing the spread of tuberculosis in healthcare settings is prevention. Tuberculosis is a serious disease that primarily affects the lungs, although it can affect other parts of the body as well. It is usually transmitted by droplets in the air. Tuberculosis bacteria can be released into the air whenever a person with active TB coughs, speaks, sneezes, or merely breathes. Infection can be detected by a TB skin test. The infection itself may remain dormant for an indefinite period of time, often not causing disease. However, infection can lead to active disease. Symptoms of active TB include cough, fever, chills, and weight loss. The first line of defense against the spread of TB in a healthcare facility is to identify, isolate, and properly treat contagious patients. Nearly all TB patients will become non-contagious given appropriate treatment. Special ventilation that removes bacteria from the air and bacteria killing ultraviolet lights can also help stop the spread. In addition to these primary control measures, special protection is necessary when you are in close contact with a contagious TB patient. For these situations, a very specific form of protection is needed. The respirator. A respirator is a device that protects the wearer from harmful airborne agents. Depending on design, respirators either purify or supply the air breathed by the user. A respirator can be a half mask, full face piece, hood, or helmet. When working in an environment where the air is contaminated with TB bacteria, wearing a respirator can reduce your chances of becoming infected with TB. There are a lot of different strains up here. Just the most important thing is, be careful and realize that this is an airborne serious disease. Your organization's infection control committee or respirator program administrator will determine when respirators should be worn and which employees are required to wear them. Furthermore, OSHA, the Occupational Safety and Health Administration, currently requires the use of respirators whenever specific hazardous respiratory exposures can occur. OSHA further mandates that only certified respirators should be used. Respirators are certified by NIOSH, the National Institute for Occupational Safety and Health. All certified respirators are given a certification number found on the approval label. The label also contains other important information about the features and limitations of the respirator. Make sure that you are familiar with these specifications before using the respirator. Approval information can be found on the filter, container, or instruction sheet. Respirators that protect against TB have several different designs. Some designs are better suited to certain work environments than others. A respirator that is appropriate and effective for a given situation may not be the best choice under different conditions. Although your program administrator will ultimately decide what kind of respirator should be used in a given environment, you should always be familiar with the types of respirators used for TB protection. Respirators that protect against TB fall into one of two main categories, air purifying and atmosphere supplying. There are two types of air purifying respirators. The first type of air purifying respirator is called non-powered particulate. Particulate respirators remove small particles such as the bacteria that cause TB from the air you breathe. This type of respirator is also known as a disposable filtering facepiece. These respirators should be promptly discarded when they begin to wear or become soiled. Some models achieve this through the use of replaceable filters as seen here. Particulate respirators offer protection in TB isolation rooms as well as other areas that may require respiratory protection. Whether their filters are replaceable or disposable, non-powered particulate respirators tend to be lightweight and do not restrict mobility. They are also the lowest cost type of respirator available. However, if a particulate respirator contains an exhalation valve, it should not be used in a sterile field such as an operating room. An exhalation valve allows droplets and particles exhaled by the worker to escape, which can potentially contaminate the surgical field. Therefore, if conditions warrant respiratory protection during an operation, make sure your respirator is not equipped with such a valve. Another kind of air purifying respirator is known as a PAPR, or Powered Air Purifying Respirator. These respirators use a motorized blower to pass contaminated air through a highly efficient filter. The blower is powered by a battery pack attached to the wearer, usually at the waist. The filter removes airborne contaminants and supplies purified air to a facepiece, hood, or helmet. PAPRs offer an advanced level of respiratory protection and should be used when disposable or replaceable half-masks do not provide adequate protection. Your employer should perform a risk assessment at your facility to determine when the use of PAPRs may be necessary. Like other respirators, a half-mask PAPR can be worn in conjunction with a face shield for protection against body fluids. As with some non-powered particulate respirators, powered air purifying respirators should not be used during sterile procedures because they exhaust air contaminated by the user. And those are the air purifying respirators that protect against TB. When it comes to atmosphere supplying respirators, there is one main type you need to know about. The positive pressure supplied air respirators should be used when greatest protection is needed. Supplied air respirators use compressed air from a stationary source. This air is delivered through a pressurized hose to a half-mask or full facepiece. Again, your employer will determine when this advanced form of respiratory protection is necessary. Whichever respirator you must wear on the job, always make sure that it is NIOSH certified. You should also be aware that a surgical mask is not a respirator. Research has shown that such masks do not effectively filter out TB bacteria and have poor fit qualities. Most respirators come in three sizes, and you will undergo a formal fit test to determine which respirator fits you best. A fit check is something you do yourself every time you put on a respirator. This is done to ensure that you have put it on correctly. Manufacturers' recommendations for fit checking are usually found in the packaging. Be aware that any type of facial hair from stubble to beards compromises the fit of a respirator. If you have facial hair, you should use a respirator that does not rely on a tight face seal, such as a hooded PAPR. For individuals with latex allergy or sensitivity, the latex seals found on many disposable respirators can cause reactions, such as rash. If you experience an allergic reaction, talk to your employer about using a latex-free respirator or one without a face seal. Your respirator will require routine cleaning, inspection and other maintenance. Always follow the manufacturer's instructions when performing any such tasks. The manufacturer's recommendations should also be followed when it comes to disinfecting your respirator. Of course, disposable respirators cannot be disinfected and should only be assigned to one person. They should simply be discarded and replaced once they show signs of wear or soiling. While they are in use, all respirators should be stored in an area where they are protected from damage and contaminants, such as individual bins. If you have specific questions about respiratory protection, you should consult your facility's program administrator. OSHA requires that a formal respirator program be in place at every facility where respiratory protection is necessary. Your employer must provide a qualified administrator to run all aspects of the program. If you experience any problems with your respirator, like discomfort or difficulty communicating with coworkers, consult your program administrator for possible solutions or alternatives. Never take it upon yourself to discontinue respirator use for any reason. Here at the hospital, we train all of our workers here in orientation. They go through the orientation program and we tell them all about tuberculosis, the fact that it is airborne and that they're going to need to wear specific type of respirators. We feel that we need to be vigilant at all times and they need to know how to wear the respirator and when to wear it. All respirator programs are required to provide standard operating procedures in writing in the following areas. Permissible practices for respirator use, respirator program administration, respirator selection, inspection of respirators, cleaning and maintenance of respirators, storage of respirators, training in respiratory protection, fit testing of respirators, respirator program evaluation, medical surveillance of respirator users. Most respiratory issues that you encounter on the job will be addressed by these policies. Should you require any additional information, contact NIOSH at 1-835-NIOSH. Proper respirator usage not only protects your health, but also ensures your ability to care for those who need it the most. More than just your own life may depend on it. Respiratory protection is not merely a sidebar or an add-on to your daily duties. It's just as valid and necessary as all the other safety precautions that you take every day without the slightest doubt of their importance. Respiratory protection is no different. Learn the respirator defense. Understand why it is so critical and practice it without fail so that you can be counted among the healthcare professionals who fought tuberculosis and won.