The TB control program should be based on a three-level hierarchy of control measures and include:
- Administrative measures
- Environmental controls
- Use of respiratory protective equipment
The first and most important level of the hierarchy, administrative measures, impacts the largest number of people. It is intended primarily to reduce the risk of uninfected people who are exposed to people who have TB disease.
The second level of the hierarchy is the use of environmental controls to reduce the amount of TB in the air. The first two control levels of the hierarchy also minimize the number of areas in the health care setting where exposure to TB may occur.
The third level of the hierarchy is the use of respiratory protective equipment in situations that pose a high risk of exposure to TB. Use of respiratory protection equipment can further reduce the risk for exposure of health care workers.
The plan should include an exposure determination at defined intervals for all employees who may have occupational exposure to tuberculosis. Additionally, it should provide for engineering controls and work practice controls for procedures that potentially may aerosolize Mycobacterium tuberculosis, including these procedures:
- Endotracheal intubation
- Other respiratory procedures
- Open abscess irrigation
- Sputum induction
- Aerosol treatments that induce coughing
For laboratory workers, procedures that are at high-risk of producing aerosols include:
- Handling unfixed tissues in surgical pathology or autopsies
- Processing specimens in the microbiology section from patients with suspected or confirmed tuberculosis