Recommendations for TB respiratory protection.

After a long decline, tuberculosis is making a comeback. Because of this risk, several government agencies have developed in-depth recommendations designed to minimize the transmission of tuberculosis. 1990 CDC guidelines have formed the basis for most current recommendations, but those guidelines are undergoing revision. Great controversy surrounds the recommendations, particularly in the area of respiratory protection. According to NIOSH, the inability to adequately fit-test and fit-check disposable respirators is a major flaw that could compromise their ability to protect the wearer. OSHA has been enforcing guidelines for occupational exposure to TB under several existing standards, especially its respiratory protection standard (29 CFR 1910.134), and is currently enforcing the use of dust/mist/fume respirators. The agency can be expected to issue a National Compliance Directive upgrading required respiratory protection to HEPA filters. The author recommends implementing recommendations for appropriate administrative and engineering controls and using low-maintenance, reusable, half-face elastomeric respirators with disposable filter cartridges for employees in identified high-risk, exposure situations.