Guideline: Infection Prevention and Control Guidelines for TB, MDR-TB and XDR-TB » What is Personal Respiratory Protection?

11. What is Personal Respiratory Protection?


Personal protection refers to the use of respirators that contain a special filter material that protects the wearer from inhaling the bacilli. They are used as the last resort where the managerial, administrative and environmental controls have not completely eliminated the risk. The use of respirators can further reduce this risk in these settings.

1. Respirator masks: Respirator masks are designed to filter out the droplet nuclei thus protecting health care workers and visitors from inhaling the droplet nuclei. They are most appropriately used for short-term protection against high-risk exposures e.g. during sputum inducing procedures and bronchoscopy. The recommended respirator is the type that covers the mouth and nose and is fitted with a special particulate filter to filter out very small particles. NIOSH certified N95 or greater or E.U. specified filtering face piece FFP2 or greater are recommended for use in health care settings.

These face masks have a capacity to filter small particles thus protecting against inhaling infectious droplet nuclei. The N95 respirator has a filter efficiency level of 95% or more against particulate aerosols oil free when tested against 0.3 μm particles. The “N” indicates that the mask is not resistant to oil; the “95” refers to a 95% filter efficiency. The FFP2 respirator has a filter efficiency level of 94% or more against 0.4 μm particles and is tested against both oil and oil free aerosols.

Fit testing must be performed on all health care workers to determine which type or size of respirator fits properly. It makes use of a noxious substance that is sprayed in a hood covering the head

  • If the individual can smell the substance, it means the respirator does not fit well
  • If the individual cannot smell the substance, it means the respirator fits well.

Once the correct type and size has been determined for an individual, fit testing does not need to be repeated.


11.1 How to Put on and test Seal an N95 Respirator Mask?


  • Wash your hands using soap and water or clean with hand sanitizer
  • Inspect the mask to ensure that it is not damaged.
  • Cup the respirator in your hand with the nosepiece at your fingertips, allowing the headbands to hang freely below your hand    Position the nosepiece under your chin with the nosepiece up
  • Pull the top strap over your head resting it high at the back of your head. Pull the bottom strap over your head and position it around your neck below your ears
  • Place fingertips of both hands at the top of the metal nosepiece. Mould the nosepiece (using two fingers of each hand) to the shape of your nose.
  • Cover the front of the respirator with both hands, being careful not to disturb its position.
  • Exhale sharply and adjust if leaking
  • Inhale deeply and adjust if leaking


Seal checking is performed to check if the respirator is sealing the face off properly and that air is not leaking between the face and the respirator. This should be done every time the respirator is worn.

  • Positive seal-check: Exhale sharply. A positive pressure inside the respirator means that there is no leakage. If there is leakage, adjust the position and/or the tension straps. Retest the seal. Repeat the steps until the respirator is secured properly.
  • Negative seal-check: Inhale deeply. If there is no leakage, negative pressure will make the respirator cling to your face. Leakage will result in loss of negative pressure due to air entering through gaps in the seal. Adjust the position and/or the tension straps and check for damage. Retest the seal. Repeat the test until the respirator is secured properly.


11.2 How to Remove an N95 Mask?


  • Wash hands using soap and water
  • Avoid touching the front part of the mask with wet and greasy hands
  • Support the front part of the mask and remove by lifting the top and then the bottom elastic over the head.

Respirators are disposable but can be re-used repeatedly over the course of an 8 hour shift for up to 5 days, if they are properly stored in a clean dry place, used by one person, not soiled or wet, do not contain holes, tears or damaged in any other way. If the respirator has been breached it must be disposed of and a new respirator should be used.

Things to avoid

  • Do not write on the mask.
  • Do not store in a plastic bag
  • Do not leave mask hanging around your neck.
  • Do not fold and do not share