Elective operative procedures on patients who have active TB should be delayed until the patient is no longer infectious.
	If operative procedures must be performed, they should be done, if possible, in operating rooms with anterooms. For operating rooms without anterooms, the doors to the operating room should be closed, and traffic into and out of the room should be minimal to reduce the frequency of opening and closing the door.
	Attempts should be made to perform the procedure at a time when other patients are not present in the operative suite and when a minimum number of persons are present (i.e. at the end of the day).
	When operative procedures (or procedures requiring a sterile field) are performed on patients who may have active TB, the respirator must protect both the sterile field from droplet nuclei from the healthcare worker and from the infectious droplet nuclei generated by the patient. Thus, the HEPA respirator which has an exhalation valve is not suitable for use is such circumstances. A N-95 mask meets both criteria of protecting the sterile field and protecting the healthcare worker. The healthcare worker must be fit tested before using N-95 respirator for use in Airborne Precautions.
	If MDR-TB is confirmed or suspected in a patient undergoing an operative procedure (especially if significant aerosols will be generated, as in sawing or irrigating of infected tissue), the operating room staff may wish to use powered air-purifying- respirators (PAPRs) in lieu of HEPA/N-95 respirators so as to maximize their degree of personal respiratory protection.
	Hospital Epidemiology must be notified immediately if a patient with active TB is scheduled for an operative procedure 8-4636.