Twenty years ago I attended a class on respiratory protection at the Occupational Safety and Health Administration (OSHA) Training Institute (Health and Safety, October 2006), and I learned that airborne droplets and vapors can carry antigens. At that time, the National Institute for Occupational Safety and Health (NIOSH) had approved a protective device (a polyvinyl chloride half mask with canisters) for organic airborne mists and vapors, but it was not used by patients or staff. The cloth or paper masks currently in use do nothing to protect the wearer and might even increase the risk of contamination by airborne mists, droplets, or vapors. The only approved mask is the N95 respirator used in tuberculosis cases. Hospitals are now doing their best to follow the Centers for Disease Control and Prevention (CDC) and OSHA protocols. Why do the CDC and OSHA allow hospitals to use respiratory-protection devices that are not approved by NIOSH and let methicillin-resistant Staphylococcus aureus (MRSA) spread among health care workers?

James J. Maddix, RN

Mason, MI

Author Bill Borwegen responds: According to the CDC, MRSA is not airborne but is contracted by touching contaminated surfaces and skin. Handwashing and disinfecting room surfaces are therefore critical. OSHA requires health care workers to wear NIOSH-approved N95 respirators for protection against all hazardous airborne particles smaller than 5 micrometers, such as Mycobacterium tuberculosis (see http://www.cdc.gov/ncidod/dhqp/gl_isolation.html for the CDC's isolation precautions). The confusion develops when we are told by institutions that we need only to protect against large droplets (those larger than 5 micrometers, propelled by cough or sneeze) by keeping 3 ft. away from the patient or wearing a surgical mask within 3 ft. of the patient. But surgical masks are not respirators and won't protect against airborne transmission of particles smaller than 5 micrometers. Employers must conduct a fit test of N95 respirators when employees are hired and then at least annually thereafter. Employees who believe they are not being protected should contact their supervisor, union, or local OSHA office (http://www.osha.gov). Hospital environmental services staff should make sure that these measures are taken, but these workers are usually the most poorly paid and trained-one reason why, according to the CDC, we have 2 million nosocomial infections and 90,000 related deaths each year.