Evaluation of N95 respirator use as a tuberculosis control measure in a resource-limited setting

A 150-bed public Brazilian hospital that serves as reference hospital for tuberculosis (TB) patients.

To evaluate the use of personal respiratory protection by health care workers (HCWs) as a measure to reduce TB occupational risk.

One hundred and forty-five HCWs were randomly observed for the use of a N95 respirator when entering high-risk areas or performing high-risk procedures.

N95 respirators were infrequently used, even for high-risk procedures such as endotracheal intubation (25%) and respiratory aspiration (12%), and in high-risk areas such as the respirology ward (69.2%), emergency department (29.5%), intensive care unit (8.8%), and TB room isolation (39.5%). Facial-seal leakage was observed in 39% of HCWs due to failure to wear the mask with a tight facial fit as directed.

Respirator use as a sole control measure is inadequate in any setting and is not cost-effective in resource-limited settings. Alternative or additional measures are clearly needed in hospitals with a high incidence of active TB admissions, specially following recent recommendations from the WHO, which consider personal respiratory protection as the third line of defense for TB control, indicated when TB risk cannot be adequately reduced by administrative and engineering controls.