A respiratory protection program has several components, of which the respirator (mask) device is only one (Vesley, 1995; Schaefer, 1997). Other elements include

  • Assessment of individual worker’s exposure to a hazard

  • Selection of appropriate respirator for that exposure

  • Proper maintenance and storage of reusable respirators

  • Employee education and training

  • Medical certification of worker’s ability to wear respirator safely

  • Periodic audit of the respirator program

  • Designation of individual responsible for program

In addition to explaining the rationale for respirator use and the proper way to use a respirator, the education and medical evaluation components of a respirator program should explain potential adverse effects of respirator use, such as interference with voice, breathing discomfort, and stress.

A respiratory protection program involves several steps in a sequential process (Harber et al., 1999). These steps, designed for other industries but generally applicable to tuberculosis control programs, include the following:

  • Identifying work sites with potential for significant exposure to an airborne hazard

  • Identifying specific workers at risk and any characteristics that might make them especially at risk from the hazardous agent

  • Determining the magnitude of the risk by work site and worker tasks

  • Identifying a respirator that will prevent inhalation of the hazardous agent in the airstream

  • Assessing adequacy of respirator fit (i.e., proportion of airflow actually going through the filter medium rather than between the respirator seal and the wearer’s face)

  • Ensuring that exposed workers actually use the respirator and use it correctly

The last element is crucial. A perfect respirator is of little value unless the proper worker uses it at the proper time. While this is intuitively obvious, not all analyses have considered this broad perspective. A quantitative analysis showed that there is an asymptotic effect of noncompliance with program elements (Harber et al., 1999). That is, a high protection factor of the device itself cannot compensate for programmatic failure or individual worker behavior deficits.

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