IV. Considerations in the Selection of Respirators
A. Nature of the Hazard to Workers—In considering appropriate personal respiratory protection for health-care-facility workers potentially exposed to tuberculosis, NIOSH considered multiple issues pertaining to the hazard presented to these workers by exposure to aerosolized droplet nuclei in the workplace. These issues included, but were not limited to, the following:
1. The risks of acquiring and medical consequences due to tuberculosis infection (e.g., risk of developing clinical tuberculosis) (e.g., 61,62).
2. The efficacy, benefits, and risks of chemoprophylaxis with isoniazid of those infected with tuberculosis (e.g., illness due to INH+-induced hepatitis, death from hepatitis) (e.g., 61,62,63,64,65,66,67).
3. The risks and medical consequences of developing active tuberculosis (e.g., risk of death due to tuberculosis in treated and untreated infected persons, risk of transmitting tuberculosis to co-workers, family members, patients or clients, and the general public) (e.g., 61,62).
4. The nature of transmission and the relative risk of transmission due to the aerosolization of droplet nuclei from transmitters with differing generation rates of infectious tuberculosis particles. These were appraised for transmitters at varying locations and undergoing varying procedures in health- care facilities (e.g., 22,19,23,24,25,26,28,29,39,68).
5. The inherent practical limitations of personal respiratory protection programs, admission screening plans, tuberculosis skin-test surveillance programs, and infection-control programs (e.g., 61,66,69,70,71,72,73,74).
