responsible for overseeing respirator use in the health-care facility to ensure that respirators are worn when indicated.
2. Medical Surveillance: Health-care-facility workers should not be assigned a task requiring use of respirators unless they are physically able to do the work while wearing the respirator. A physician should determine what health and physical conditions are pertinent for the medical surveillance and periodically review the respirator wearer's medical status.
A physician should classify workers according to their ability to use the necessary respirators. A medical history and at least a limited physical examination are recommended. The medical history and physical examination should emphasize the evaluation of the cardiopulmonary system and should elicit any history of previous respirator use. This history can be an important tool to detect problems that might require further evaluation. The physical examination should seek to detect medical conditions that may be essentially asymptomatic. While chest roentgenograms and/or spirometry may be medically indicated in some determinations of fitness, these need not be routinely performed.
3. Training: Selecting the most protective respirator appropriate for a given hazard is important, but equally important is using the selected device properly each time it is necessary for personal respiratory protection. To help ensure proper use, both supervisors and health-care-facility workers should be trained in selection, use, and maintenance of respirators appropriate for personal protection against airborne tuberculosis. The training program should include instructional material and training covering at least the following elements:
- The reasons why personal respiratory protection is required.
- The nature, extent, and specific hazards of tuberculosis transmission in health-care facilities. The references provided in section IV. A starting on page 16 may aid in the preparation of this material that should include:
