TB Elimination

April 2010 www.cdc.gov/tb Page 1 of 2 

Respiratory Protection in Health-Care Settings

Introduction

All health-care settings need an infection-control 

program designed to ensure prompt

n detection, 

n airborne precautions, and 

n treatment 

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

n Nonpowered respirators with N95, N99, 

N100, R95, R99, R100, P95, P99, and P100 

filters (including disposable respirators); and 

n	Powered air-purifying respirators (PAPRs) 

with high-efficiency filters. 

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 infectioncontrol 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. 
April 2010 www.cdc.gov/tb Page 2 of 2 

Safer . Healthier . People 

Note

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.

References

CDC. Guidelines for preventing the transmission of 

Mycobacterium tuberculosis in health-care settings, 

2005. MMWR 2005; 54(No. RR-17). 

www.cdc.gov/mmwr/pdf/rr/rr5417.pdf

Occupational Safety and Health Administration. 

Occupational safety and health standards, subpart 

I—personal protective equipment. Respiratory 

protection. Title 29, Code of Federal Regulations 

2003. Section 1910.134.

www.osha.gov/pls/oshaweb/owadisp.show_

document?p_table=STANDARDS&p_id=12716

Additional Resources

Websites:

CDC Division of Tuberculosis Elimination: 

www.cdc.gov/tb

CDC National Institute for Occupational Safety and 

Health: www.cdc.gov/niosh/topics/tb

Occupational Safety and Health Administration:

www.osha-slc.gov/SLTC/tuberculosis/index.html

State TB control offices: 

www.cdc.gov/tb/links/tboffices.htm

American Industrial Hygiene Association: 

www.aiha.org

American Conference of Governmental Industrial 

Hygienists: www.acgih.org

Fact Sheet:

Infection Control in Health-Care Settings: 

www.cdc.gov/tb/publications/factsheets/prevention/

ichcs.htm

To be effective and reliable, respiratory protection 

programs must include at least the following 

elements:

n Assignment of responsibility to one person 

with sufficient knowledge who is given the 

authority and responsibility to manage all 

aspects of the program. 

n Standard operating procedures that include 

information and guidance for the proper 

selection, use, and care of respirators. 

n 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. 

n Annual training of HCWs with specific 

focus on prevention, transmission, and 

symptoms. 

n Selection of filtering facepiece respirators 

approved by CDC/NIOSH. 

n Fit testing performed during the initial 

respiratory protection program training and 

periodically thereafter, in accordance with 

federal, state, and local regulations. 

n Inspection and maintenance of respirators 

according to manufacturer instructions. 

n 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.