N95 Respirator Mask Required for Aerosol-Generating Procedures on TB Patients
Healthcare workers must wear N95 respirator masks (or equivalent respiratory protection with ≥95% filtration efficiency) when performing aerosol-generating procedures on patients with suspected tuberculosis. 1
Why N95 Respirators Are Necessary
The CDC guidelines explicitly state that personal respiratory protection should be used by persons present during cough-inducing or aerosol-generating procedures performed on patients with suspected or known infectious TB. 1
Key Performance Requirements
N95 respirators meet the specific criteria established for TB protection:
- Filter efficiency ≥95% for particles 1 μm in size (the size range of infectious TB droplet nuclei is 1-5 μm) 1
- Face-seal leakage ≤10% when properly fit-tested 1
- Available in multiple sizes to fit different facial characteristics 1
Why Other Options Are Inadequate
- Surgical masks (Option B): Designed to prevent respiratory secretions from leaving the mask, not to filter inhaled air; they do not provide a tight face seal and cannot adequately filter droplet nuclei in the 1-5 micron range 1
- Face shields alone (Option A): Provide eye protection but no respiratory filtration 1
- Gloves alone (Option C): Protect against contact transmission but provide zero protection against airborne droplet nuclei 1
Aerosol-Generating Procedures Requiring N95 Protection
The following procedures mandate N95 use for TB patients:
- Endotracheal intubation and suctioning 1
- Diagnostic sputum induction 1
- Bronchoscopy 1
- Aerosol treatments (e.g., pentamidine therapy) 1
- Irrigation of tuberculous abscesses 1
Complete PPE for Aerosol-Generating Procedures
While the N95 is the critical respiratory component, complete protection includes:
- Fitted N95 respirator (or PAPR if N95 fit-testing fails) 1
- Eye protection: goggles or full-face shields 1
- Disposable gown (AAMI level-III for high-risk procedures) 1
- Double gloves for high-risk situations 1
Critical Pitfalls to Avoid
Do not confuse patient masks with healthcare worker respirators: Patients with suspected TB should wear surgical masks when outside isolation rooms to prevent expulsion of droplet nuclei, but healthcare workers need N95 respirators to filter inhaled air. 1, 2
Never use respirators with exhalation valves on patients: These do not prevent droplet nuclei expulsion into the environment. 1, 2
Fit-testing is mandatory: Without proper fit-testing, gaps allow air to flow around the mask rather than through the filter, providing virtually no protection. 1
Environmental Controls Are Insufficient Alone
Even with proper ventilation (negative pressure rooms, ≥6-12 air changes per hour), respiratory protection remains necessary during aerosol-generating procedures because administrative and engineering controls cannot adequately protect healthcare workers from airborne droplet nuclei in these high-risk situations. 1, 3
The correct answer is D: N95 respirator mask.