Radiation and Ventilation
to Control Tuberculosis
Produced in response to a need expressed by many tuberculosis control
officials for a technically oriented, practical guide to the use of
ultraviolet light and ventilation to control tuberculosis transmission.
Application of the techniques presented is best done as a collaborative
effort among tuberculosis control personnel, environmental health and
safety personnel, and physical plant management personnel.
A conscious attempt was made to make the information consistent with
current occupational health and safety requirements applicable to these
situations. However, the specifics of laws and regulations are constantly
evolving. To assure legal compliance, the prudent course is to consult
local occupational health officials.
click the link below for the complete text /PDF/
» Using ultraviolet
radiation to control TB
How Can UV Be Used in TB Control?
TB is transmitted through the air. A person with TB disease of the lungs or
larynx can release droplets containing Mycobacterium tuberculosis (M. tb) into the air
by coughing, sneezing, talking, or breathing. These droplets, called droplet nuclei, can
cause TB infection if inhaled by anyone who shares air with the person who has TB.
Ultraviolet Germicidal Irradiation - UVGI
Ultraviolet Germicidal Irradiation -
UVGI is the use of a type of UV radiation, known as UVC, which has been
shown to kill
or inactivate M. tb in air. Ultraviolet Germicidal Irradiation - UVGI is generated by specially designed
using uvc lamps
that often look something like a fluorescent light. There are two ways that
UV lamps are
used in TB control:
• Upper-room UVGI is the use of Ultraviolet Germicidal
Irradiation lamps directly in a room where there is
risk of M. tb being transmitted. It is a useful infection control technique
spaces that may be occupied by a person with TB, such as prison day rooms,
homeless shelters, and waiting rooms.
• In-duct UVGI is the use of UVGI lamps inside an air duct or air cleaner to
air before it is recirculated. It is a useful upgrade for mechanical systems
air from high-risk congregate areas that may be occupied by a person with
TB. However, in-duct UVGI is not equivalent to direct exhaust or high
particulate air (HEPA) filtration for isolation rooms and high-risk
Upper-room UVGI uses lamps mounted at an elevation of seven or more feet.
are designed so that upper-room air is irradiated and disinfected. Cleaned
mixes with the air in the lower part of the room and dilutes infectious
Radiation levels in the lower parts of the room should be measured to verify
are within recommended parameters.
Care should be taken in the design, installation, and maintenance of
because of safety concerns. Also, effectiveness can vary and every
installation is unique.
In-duct UVGI uses lamps mounted inside a duct perpendicular to airflow. An
designed, installed, and maintained in-duct UVGI system should effectively
most recirculated air. This will therefore significantly increase the
effectiveness of the
recirculating mechanical ventilation system in reducing the risk of M. tb
The UV intensities of lamps used inside a duct can be, and should be,
lamps used for upper-room UVGI. This is because the risk of UV overexposure
For a given airflow, the number and spacing of the lamps is selected to
ensure that air in
the duct is exposed to sufficient radiation. The exposure depends on the
intensity of the
radiation and the time of exposure.
A duct access door should be provided so that the lamps can be cleaned,
replaced. To prevent exposure to the lamps, electrical interlock should shut
off the lamps
whenever the duct access door is open.
In-duct UVGI is also used in self-contained air cleaning units.
UVGI can cause temporary harm to the eyes and skin. However, newer fixture
and compliance with guidelines can make UVGI use safe and effective.
Whenever UVGI is used, precautions should be taken to alert and protect
clients. Staff should also receive appropriate education. Warning signs in
languages should be posted on fixtures and wherever UVGI is used. For
HIGH INTENSITY ULTRAVIOLET ENERGY
PROTECT EYES AND SKIN
Wherever UVGI is used, a routine maintenance program should be implemented
ensure that lamps are checked and replaced regularly.
Lamps should be replaced once a year or as directed by the manufacturer.
Francis J. Curry National Tuberculosis Center
WAC 246-324-190 Provisions for patients
with tuberculosis. A licensee providing inpatient services for patients
with suspected or known infectious tuberculosis shall:
(1) Design patient rooms with:
(a) Ventilation to maintain a negative pressure condition in each
patient room relative to adjacent spaces, except bath and toilet areas,
(i) Air movement or exhaust from the patient room to the out-of-doors
with the exhaust grille located over the head of the bed;
(ii) Exhaust at the rate of six air changes per hour; and
(iii) Make-up or supply air from adjacent ventilated spaces for four or
less air changes per hour, and tempered outside air for two or more air
changes per hour;
(iv) Ultraviolet generator irradiation as follows:
(A) Use of ultraviolet fluorescent fixtures with lamps emitting wave
length of 253.7 nanometers;
(B) The average reflected irradiance less than 0.2 microwatts per
square centimeter in the room at the five foot level;
(C) Wall-mount type of fixture installed over the head of the bed, as
close to the ceiling as possible to irradiate the area of the exhaust grille
and the ceiling; and
(D) Lamps changed as recommended by the manufacturer; and
(b) An adjoining bathroom and toilet room with bedpan washer; and
(2) Provide discharge information to the health department of the
patient's county of residence.
[Statutory Authority: Chapter
71.12 RCW and RCW 43.60.040.
95-22-013, § 246-324-190, filed 10/20/95, effective 11/20/95.]
Washington Administrative Code
As of February, 2010