N95 Respirator Mask Required for Aerosol-Generating Procedures on TB Patients
Healthcare workers must wear N95 respirator masks (or equivalent NIOSH-certified respirators with ≥95% filtration efficiency) when performing aerosol-generating procedures on patients with suspected tuberculosis. 1
Why N95 Respirators Are Necessary
Inadequacy of Other PPE Options
Surgical masks do not provide adequate protection for healthcare workers during aerosol-generating procedures because they lack a tight facial seal and cannot effectively filter droplet nuclei in the 1-5 micron size range that contains M. tuberculosis. 1
Face shields alone offer no respiratory protection against airborne droplet nuclei. 1
Gloves alone provide no protection against inhalation of infectious particles. 1
Specific N95 Requirements
The CDC guidelines specify that respirators used for TB protection must meet these performance criteria:
Filter efficiency ≥95% for particles 1 micron in size at flow rates up to 50 L/minute 1
Face-seal leakage ≤10% when properly fit-tested 1
Available in at least three sizes to accommodate different facial characteristics 1
Must be qualitatively or quantitatively fit-tested for each healthcare worker 1
Aerosol-Generating Procedures Requiring N95 Protection
Healthcare workers must wear N95 respirators when present during these high-risk procedures on suspected 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 N95 is the critical respiratory component, complete PPE should include:
- Fitted, NIOSH-certified N95 mask (or PAPR if available for long procedures) 1
- Eye protection: goggles covering sides of eyes or full-face shields 1
- Disposable AAMI level-III surgical gown or coveralls 1
- Double high-cuffed surgical gloves 1
- Hand hygiene before and after donning/doffing PPE 1
Critical Pitfalls to Avoid
Improper Fit Testing
39% of healthcare workers demonstrate facial-seal leakage due to failure to wear masks with tight facial fit, rendering the N95 essentially ineffective. 2
Each healthcare worker must be fit-tested for each different type of N95 respirator model used. 3
Workers should perform user seal checks each time they don the respirator. 1
Confusing Patient vs. Healthcare Worker Masks
Patients with suspected TB should wear surgical masks (not N95 respirators) when outside isolation rooms to prevent expulsion of droplet nuclei. 1, 4
Patients should never wear respirators with exhalation valves, as these do not prevent transmission. 1, 4
Healthcare workers need N95 respirators to filter inhaled air; patients need surgical masks to contain exhaled droplet nuclei. 1
Surgical Procedures Requiring Dual Protection
When performing operative procedures on TB patients, the respirator must protect both the surgical field AND the healthcare worker from infectious droplet nuclei. 1
N95 respirators with exhalation valves do not protect the sterile field and should not be used in these situations. 1
Environmental Controls Are Insufficient Alone
Mathematical modeling demonstrates that environmental controls (negative pressure rooms, ventilation) alone cannot adequately reduce exposure during aerosol-generating procedures. 5
N95 respirators provide an essential additional layer of protection when administrative and engineering controls may not fully protect healthcare workers from airborne droplet nuclei. 1
Proper ventilation with ≥10 air changes per hour should be used in conjunction with, not as a replacement for, N95 respirators. 6
Regulatory Requirement
- Healthcare facilities using respiratory protection for TB prevention are required by OSHA to develop, implement, and maintain a comprehensive respiratory protection program that includes all healthcare workers who use respirators. 1
Answer: D. N95 respirator mask