N95 vs. Surgical Mask for TB PPE

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Apparently the IC specialists at my hospital have decided that surgical masks are an appropriate form of PPE for dealing with pts who have TB. However all of the research I have done the CDC and WHO all say N95 is a minimum requirement needed for precautions. Does anyone else work for a hospital with a similar policy? What would you do: get your own n95, wear 2 surgical masks at once?? I just want to adequately protect myself and I don't think a surgical mask would cut it.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I have NEVER heard of such a thing....all recommendations are for a N95.

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Apparently the IC specialists at my hospital have decided that surgical masks are an appropriate form of PPE for dealing with pts who have TB. However all of the research I have done the CDC and WHO all say N95 is a minimum requirement needed for precautions. Does anyone else work for a hospital with a similar policy? What would you do: get your own n95, wear 2 surgical masks at once?? I just want to adequately protect myself and I don't think a surgical mask would cut it.

http://www.cdc.gov/tb/education/corecurr/pdf/chapter7.pdf

Th CDC is your friend.

See p 212 for the difference between respirators (to prevent you fro breathing in droplets) and surgical masks. It says:

"The minimum respiratory protection is a filtering face-piece respirator and must be selected from those approved by CDC/National Institute for Occupational Safety and Health (NIOSH) under Title 42 CFR, Part 84. It must meet one of the following specifications:

• Nonpowered air-purifying respirators (N95, N99, N100, R95, R99, R100, P95, P99, and P100), including disposables;

• Powered air-purifying respirators (PAPRs) with high-efficiency filters; or

• Supplied-air respirators.

It is important that respirators fit different face sizes and features properly. It is also important to understand the difference between respirators and surgical masks.

Respirators are designed to protect HCWs and other individuals from inhaling droplet nuclei (Figure 7.9). Surgical masks are designed to reduce the number of droplets being exhaled into the air by persons with infectious TB disease when they breathe, talk, cough, or sneeze (Figure 7.10). Persons suspected or confirmed to have infectious TB disease should be given, and encouraged to use, a surgical mask to minimize the risk of expelling droplet nuclei into the air."

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Your IC specialists are absolutely wrong. With the increased risk of multidrug resistant TB, an appropriate respirator is mandatory (N95, even N100 for deadly forms in USA, FPP2 pr FPP3 in EEC - same masks). 2 surgical masks will not be an efficient filter. Please folow the CDC recommandations. Nurses with unappropriate surgical masks have been infected. Plesae do wear N95 only,and check the recommandation with your specialists. Regards Anita

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I can't remember what the micron size of a TB is off the top of my head, but there's no way in hell a "surgical mask" filters them.

OP, are you sure you have your "IC Specialists" recommendations right? If so, what is their rationale? Inquiring minds need to know...

(And what Infnurse said... MDRTB is a BFD.)

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Specializes in Hospital Education Coordinator.

Talk to your CNO and/or Infection Control nurse, and present the documentation you have from CDC. Be proactive

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I can't remember what the micron size of a TB is off the top of my head, but there's no way in hell a "surgical mask" filters them.

)

Just curious. If you can't remember the size, then how do you know they can't filter?

P.s- I am completely with the N95 mask.

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Tuberculosis

Mycobacterium tuberculosis is a fairly large rod-shaped bacterium. The rods are 2-4 microns in length and 0.2-0.5 microns in width. TB is spread from person to person through the air. When a person with infectious TB coughs or sneezes, tiny particles containing Mycobacterium tuberculosis are expelled into the air. These particles, called droplet nuclei, are about 1 to 5 microns in diameter. Droplet nuclei can remain suspended in the air for several hours, depending on the environment. The most effective droplet nuclei tend to have a diameter of 5 micron. Droplet nuclei are generated during talking, coughing and sneezing. One cough can generate 3000 droplet nuclei. Talking for 5 minutes can generate 3000 droplet nuclei and singing can generate 3000 droplet nuclei in one minute. Sneezing generates the most droplet nuclei by far (tens of thousands), which can spread to individuals up to 10 feet away.

See also http://198.246.124.22/niosh/nas/RDRP/appendices/chapter6/a6-30.pdf

These efficiencies are also compared with

the efficiency of a typical noncertified surgical mask, originally

designed to protect patients from 4 µm or larger droplets expelled

by health care workers.

(4)

As incidences of Mycobacterium tubercu-losis (TB) infection began to rise in health care facilities, surgical

masks were used, but were insufficient to protect the workers from

infected patients. In 1993 the Centers for Disease Control and

Prevention (CDC) issued guidelines requiring that respirators used

for the prevention of infection from TB have a minimum of 95%

efficiency for 1 µm particles when tested at 50 L/min through the

respirators.

(5)

Since all filter materials are more efficient at 1 µm

than at the most penetrating particle size, the new 42 CFR Part 84

regulations permit all certified respirators to be used in health care

industries against TB exposure. Therefore, the performance of

N95 respirators was studied not only with solid particles, but also

with bacteria having size and shape similar to TB. In this study

N95 respirator filters were tested with bacteria, NaCl, and poly-styrene latex (PSL) particles, and procedures similar to those used

previously were applied.

(6–9)

The N95 respirators were also tested

at a flow rate lower than the certification flow rate of 85 L/min to

examine their performance at a breathing rate that is typical for

health care workers.

(10

Results (diagrams) are significative. If you wear your surgical mask doing some activity inside the TBpatient's room, filtration rate is 71%. No comment. For particle sizes above 0.75 µm, the filtration efficiencies of all tested respirators are 99.5% or higher.

It should be noted that these

efficiencies do not consider face seal leakage. The pressure drop

across the filter material encourages external air to bypass the filter

and enter the respirator wearer’s breathing space through any face

seal leak that may be present. Appropriate face seal fit is measured

by quantitative fit-testing.

So wear your right tight fitting N95 mask.

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