RESPIRATORS, RECOMMENDATIONS, AND REGULATIONS - THE CONTROVERSY SURROUNDING PROTECTION OF HEALTH-CARE WORKERS FROM TUBERCULOSIS

Recent nosocomial outbreaks of tuberculosis have increased concern abo ut the occupational acquisition of tuberculosis by health care workers . The Centers for Disease Control and Prevention (CDC), Department of Health and Human Services, and the Occupational Safety and Health Admi nistration, Department of Labor, have issued recommendations and regul ations in an effort to decrease health care workers' risk for exposure to patients with infectious tuberculosis. Within the CDC, the Nationa l Center for Infectious Diseases, the National Center for Prevention S ervices, and the National Institute for Occupational Safety and Health collaborated to produce the 1994 Guidelines for Preventing the Transm ission of Tuberculosis in Health-Care Facilities. As stated in the Dra ft Guidelines, the major components of health care worker protection f rom Mycobacterium tuberculosis infection include administration or sou rce controls, engineering controls, and respiratory protective devices . We review the evolution of the seemingly conflicting recommendations for respiratory protective devices made by these Centers of the CDC a nd explain how the recommendations in the current CDC Guidelines were reached.