Tuberculosis in the Workplace (2001) / Chapter Skim
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Pages 319-340
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, 92 historical perspectives, 27, 87 prevalence, 27, 87, 88, 92, 93, 98 risk assessment, 87, 88, 92, 93, 98, 192, 195, 202, 204, 213, 217, 219, 220, 223 skin tests, 30, 181
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, 193-194, 195-201, 203-205, 210, 213, 215 Aplisol, 180 Arkansas, 102 Asians/Pacific Islanders, 87, 197, 214, 215 Association of Professionals in Infection Control and Epidemiology, 63, 242, 243, 257 Atlanta, Georgia, 99, 124-126, 197, 204, 205, 206, 236-237, 247-248, 300 Attitudes, 43 complacency, 137-138 isolation of patients, psychological factors, 39-40 patient treatment preferences, 35, 144 stigma, 32, 144 workers, 44 Attorneys, 208 Autopsies, 26, 85, 95, 98, 149, 212 see also Medical examiners B Barnhart, Scott, 293-308 Bass, John, 179-188 Bathrooms in isolation rooms, 251, 257 INDEX BCG vaccination, 33, 126, 128, 130, 183, 202, 219, 220 Black persons, 87, 196, 197, 204, 210, 215, 219, 220, 244 Blueprint for Tuberculosis Vaccine Development, 311 Body weight, see Weight factors Bone, 27, 28 Boostering phenomenon, 33, 185-187 Boston, Massachusetts, 211, 214 Bovine tuberculosis, 24 BCG vaccine, 33, 126, 128, 130, 183, 202, 219, 220 Brain, 27, 28 Britain, see United Kingdom Bronchoscopy, 94, 95, 106, 121, 130(n.6) , 131, 145, 149, 190, 201, 215, 243, 263 Bureau of Mines, 45 Bureau of Prisons, 114 Burris, J.D., 271-292 Byssinosis, 285 C Cadavers, see Autopsies; Funeral homes; Medical examiners California, 6, 15, 20, 99-100, 118-119, 175, 201, 215, 256 Canada, 130(n.6)
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, 152-155, 252, 290 outbreaks, 8, 20, 37, 141, 145 prevalence, 64, 66 public health, 56-57, 65, 71-72, 131, 133, 134, 310, 312 record keeping, 64, 65, 68, 72, 109 respirators, 3, 19, 20, 57, 63, 71, 76-80, 145-146, 230, 232, 293, 295, 300, 301; see also "masks" supra skin tests, 3, 29, 30, 33, 57(n.2) , 58, 63, 64,66,67,68,69-70,71,142,183, 232 surveillance, 64-65, 109 symptoms, 64, 246 transmission of disease, 64, 65, 244 worker job and financial protections, 70-71 Centers for Disease Control and Prevention (CDC)
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, 221-222 BCG vaccination, 219, 220 latent tuberculosis, treatment, 35, 220 Colorado, 215 Community-level factors, 12, 15, 17-18, 106, 124, 135, 138, 139, 156 see also Local governments; Urban areas CDC guidelines, 9, 64, 66, 67, 69, 135, 146, 232, 236 definitional issues, 83-85 diagnosis, 29, 31, 38-39 elderly persons, 102 health care workers vs community at large, risk, 7, 10-11, 16, 81, 83-85, 88-89, 92, 98, 105, 135, 142, 189191, 192, 194-199, 201, 210, 213, 216, 232, 236 immigrants, 95-96 OSHA rule/standard, 9, 10, 52, 138, 139, 142 outbreaks, 84, 155 prevalence, 7, 9, 31, 52, 64, 67, 69, 132; see also "health care workers..." supra skin tests, 29, 31 Computer databases, see Databases Confidentiality, CDC guidelines/OSHA rule/standard, 64 Connecticut, 210, 278 Contact tracing, 11, 28, 70 DNA fingerprinting, 38, 59(n.4) , 84, 99, 101, 102, 104, 204, 244 skin tests, 29, 30 time factors/costs, 263, 264
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latent tuberculosis, 13(n.1) , 150 material health impairment, 284 occupational exposure, 82, 83(n.1)
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, 84, 99, 101, 102, 104, 204, 244 Drug abuse, 7, 14, 81, 103, 211, 220-221 see also Alcohol abuse CDC guidelines, implementation and effects, 244, 246, 252 injection abusers, 30, 246 OSHA rule/standard, 60, 208 Drug resistance, 18, 120, 138, 309, 312 CDC guidelines, implementation and effects, 109, 111, 112, 113, 115, 121, 126-127, 131, 234, 242, 250-251, 312 CDC guidelines/OSHA rule/ standard, 64, 66, 73 correctional facilities, 121 health care workers infected, 7, 89, 91-92, 96, 98, 103, 115, 201 historical perspectives, 4, 5, 6, 11, 1314, 15, 19, 23, 154-155, 201, 231 immigrants, 121 mortality, 28, 96, 221, 222, 223 risk assessment, 89, 91-92, 96, 98, 103, 191, 201, 209, 222, 223 surgical treatment, 18 treatment, 40, 41 Drug treatment, 1, 12, 17-18, 22, 24, 82, 126, 155, 186-187, 221-223, 300, 309, 310, 311, 312 see also Case management; Vaccines active tuberculosis, 40-42; see also Drug resistance adherence, 36, 41, 155, 221, 222, 311 alcohol abuse and, 35 attitudes of patients, 35, 144
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, 155, 302 Dust-mist / dust-mist-fume respirators, 119, 126, 128, 239, 243, 252, 254, 256, 257, 295, 297, 301, 304 E Economic factors, 43, 287 see also Cost factors; Funding; Socioeconomic status fines and penalties, 20-21, 47, 55, 274, 275, 276, 290 OSHA rule/standard, 49, 54-55 unemployed persons, 7, 15, 43-44, 89, 153-154, 222 worker job and financial protection, 70-71 Education see also Students dental schools, 113, 260-261 325 health care professionals, 37, 46, 57, 62, 106, 115, 119, 125, 133, 216, 231, 232, 236, 259, 262, 266 mentally retarded persons, 209-210 OSHA, 272 patients with latent tuberculosis, 3536, 65, 106 public, 45, 312 workers, general, 44, 46, 54-55, 65, 109, 115, 116, 232, 262, 266, 274, 294, 304-306, 310 Elderly persons, 101-102, 208, 222, 223 see also Nursing homes infection likelihood, 27(n7) , 28 infection rates, 87 OSHA rule/standard, 61 skin tests, 30 Embalming, 26, 61, 104, 116, 212-213 Emergency departments, 95, 118, 122, 135, 260 CDC guidelines, 58, 73 CDC guidelines, implementation and effects, 112, 129-130, 140, 231, 237, 250, 252, 256, 260, 262 OSHA rule/standard, 60, 62, 140, 208 skin tests, 130, 260 Ending Neglect: The Elimination of Tuberculosis in the United States, 11, 12, 21, 41, 144, 154, 155, 309313 Endotracheal suctioning, 190 Enforcement, 4, 5, 19, 20-21, 46, 56, 59, 133, 140, 234, 274-276, 278 see also Inspection of facilities; Litigation CDC powers lacking, 142 fines and penalties, 20-21, 47, 55, 274, 275, 276, 290 state and local government worker safety, cost of, 53 Engineering controls, 8-9, 110, 120, 300, 301 see also Isolation policies, rooms, and areas; Ventilation CDC guidelines, 3, 57, 63, 64, 65, 68, 74-76 CDC guidelines, implementation and effects, 129-131, 134, 135, 136, 230, 232, 238-239, 245, 250-251, 257, 261, 293, 301, 302 defined, 74
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government surveys and databases, 86-92 worldwide, 22 Ethnicity, see Immigrants; Race/ethnicity Europe, 199 BCG vaccination, 33 United Kingdom, 217 Executive Order 11612, 47 Executive Order 12196, 288 Executive Order 12866, 47, 50-51, 281, 283 Executive orders, other, 48, 53, 281 F Family members, 91, 95-96 CDC guidelines, 56-57, 153 isolation of patients from, 39-40 OSHA mortality estimates, 153 outbreak defined, 84 skin tests, 29 visits to patients, 23, 40, 56-57, 62, 79, 208,245,257 Federal Advisory Council on Occupational Safety and Health, 47, 273 Federal Coal Mine Health and Safety Act, 46 INDEX Federal government, 1, 5, 12, 16-17, 18, 45, 310 see also Centers for Disease Control and Prevention; Legislation; National Institute for Occupational Safety and Health; Occupational Safety and Health Administration; Office of Technology Assessment; Regulations and standards; terms beginning "Executive..." Agency for International Development, 312 Bureau of Mines, 45 Bureau of Prisons, 114 Department of Labor, 20 employees of, 52-53, 54-55, 58, 61, 288 Immigration and Naturalization Service, 21, 101, 121 Mine Safety and Health Administration, 60 OSHRC, 277 surveys and databases, 86-92, 110-115 Veterans Administration, 101, 102, 176, 246-247 Filters, see High-efficiency particulate air filters; Masks; Personal respiratory protection Fines and penalties, 20-21, 47, 55, 274, 275, 276, 290 see also Litigation Fit testing and fit, respirators, 77-79, 146148, 149, 293, 296, 297-299, 304-306 Florida, 6, 201, 205, 212, 215 Food and Drug Administration, 180, 183 Foreign countries, see International perspectives Foreign origin, see Immigrants Friends CDC guidelines, 56-57 skin tests, 29 visits to patients, 23, 40, 56-57, 62, 79, 208,245,257 Funding, 5, 17, 18, 54-55, 310 community programs, 138 risk defined, 83 urban hospitals, 82 Funeral homes, 90-91, 104, 121, 212 embalming, 26, 61, 104, 116, 212-213 OSHA rule, 61 skin testing, 61, 116
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, 131, 145, 149, 190, 201, 215, 243, 263 CDC guidelines, 2-3, 4, 8, 18-21, 29, 30, 56-57, 61, 67, 69, 73, 138, 173, 190-191, 231, 232, 234 CDC guidelines, implementation and effects, 109, 110-113, 115-136, 121, 122, 125, 127-131, 142, 174, 230231, 234-266 committee study at hand, goals and methodology, 7, 16, 92-93, 173-174 community at large vs health care workers, risk, 7, 10-11, 16, 81, 8385, 88-89, 92, 98, 105, 135, 142, 189-191, 192, 194-199, 201, 210, 213, 216, 232, 236 dental clinics and schools, 113, 232, 260-261 drug-resistant tuberculosis, 7, 89, 9192, 96, 98, 103, 115, 201 education, general, 44, 46, 54-55, 65, 109, 115, 116, 232, 262, 266, 274, 294, 304-306, 310 education, professionals, 37, 46, 57, 62, 106, 115, 119, 125, 133, 216, 231, 232, 236, 259, 262, 266; see also "students" infra historical perspectives, 2-3, 5, 7, 15, 18-20, 86, 199-200 HIV infected workers, 28, 106, 204 housekeeping staff, 98, 200, 202, 205, 206, 259 infected with tuberculosis, 1, 2, 6, 8891 isolation of patients; see Isolation rooms and areas obstetrics and gynecology, 99, 204 occupational exposure defined, 82 OSHA rule/standard, 4, 29, 59, 60, 61, 62, 69, 73, 138, 142-144, 152, 154, 173, 208, 287 outreach workers, 41, 91, 215 psychiatric facilities, 61, 101, 220 respiratory therapists, 94, 206, 215, 259 risk assessment, 85-86, 88-99, 102, 103, 104, 105-106, 107, 142-144, 189-229 see also "community" supra
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, 300, 301, 302, 304 students, medical, 62, 85, 99, 100, 196, 287, 216-217, 259, 287 WHO guidelines, 23 Health Care Financing Administration, 51, 118 Medicaid, 53 Medicare, 51, 53, 118 HEPA, see High-efficiency particulate air filters Hepatic system, see Liver damage Hierarchy of controls, 57, 58, 76, 129, 134, 136, 145, 148, 230, 293, 300, 302 see also Administrative controls; Engineering controls; Personal respiratory protection High-efficiency particulate air filters (HEPA) , 59-60, 148, 230, 236, 242, 254, 256, 257, 258, 261, 297, 301, 302, 304, 305, 306 Hispanics, 87, 196, 197, 215 Mexico, immigrants from, 6, 15, 87, 89, 195, 201 Puerto Ricans, 196, 197, 219, 252 Historical perspectives, 1, 4-6, 15-16, 17, 19, 23, 25, 43, 45-46, 87, 116, 120121, 124, 154-155 age factors in prevalence, 27, 87 CDC guidelines, 2-3, 4, 5-6, 8, 18-20, 43, 56, 57, 230, 231, 233-234 CDC guidelines, implementation and effects, 108, 124, 132, 133, 135-136, 231, 251, 254, 261-262 CDC reports of active tuberculosis, 86-87 complacency, 137-138 correctional facilities, 5, 6, 14, 15-16, 18 country comparison studies, 92 drug-resistant tuberculosis, 4, 5, 6, 11, 13-14, 15, 19, 23, 154-155, 201, 231 epidemiology of tuberculosis, 4-5, 6, 10,11,12,13,14,82,87-88,90, 131-132, 133, 138, 231 funding, 17, 18 INDEX health care facilities and workers, 2-3, 5, 7, 15, 18-20, 86, 199-200 hospitals, 5, 199 inspection of facilities, 117 mortality, 4, 14, 15, 19, 106, 221-223 OSHA rule/standard, 3-4, 5-6, 7, 19, 4547, 56, 57, 108-109, 150-151, 278 outbreaks,l,ll,l5, 16, 82, 108, 133, 139, 141, 155, 194, 199, 202, 230, 295, 300 public health efforts, 11, 17, 23, 43, 155, 201-202, 231 prevalence, 27, 86-93, 131-132, 133, 138, 150-151 risk assessment, 82, 86-93, 105-106, 189-190, 194-200, 216-217, 219 skin tests, 179-180, 181 state government role, 5.
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, 140, 174, 215, 231, 233, 234-259, 261-266, 301-302 CDC studies, 91-92, 96, 110-113, 114, 214 contract employees, 53-54, 62, 141, 208, 288-289 employees infected, 5, 30, 91-92, 199207, 215, 234 employment duration, 126 historical perspectives, 5, 199 inspections of, 117-119, 133-134, 252 intensive care units, 95, 256 isolation of patients; see Isolation rooms and areas OSHA rule/standard, 53-54, 60, 73, 94-95, 138, 139, 140-156, 252, 287 outbreaks, 7, 8, 82, 91, 95, 97, 98-100, 106, 120, 123, 124-129, 131, 133, 203, 204-205, 212, 221, 234-245, 261, 301, 302 risk assessment, 52, 81, 82, 86, 93, 9495, 97-100, 102, 103, 104-105, 106, 199-207, 215, 222, 243 skin tests, 30, 62, 93, 94, 102, 117, 120, 124, 125-126, 128, 129, 151-152, 199-207, 215, 231-266 (passim) , 300, 301, 302 socioeconomic status of employees, 126, 200, 204 state regulation, 53 Veterans Administration, 101, 102, 176 329 Housekeeping staff, 98, 200, 202, 205, 206, 259 Human immunodeficiency virus, see HIV I Illinois, 6, 115, 131, 196, 244, 302 Immigrants, 7, 11, 14, 15, 22, 121, 135, 155, 156, 311, 312 see also Developing countries; specific groups BCG vaccination, 33, 126, 128, 130, 183,202,219,220 CDC guidelines, 11, 57, 130, 246, 261 community-level factors, 95-96 detainees, 101, 121, 208 diagnosis, 22, 29, 33, 38, 311 European, 33, 199 Filipino, 6, 15, 87, 89, 195 geographic factors, 6 Hispanics, 87, 196, 197, 215 Mexican, 6, 15, 87, 89, 195, 201 medical school graduates, 99 OSHA rule/standard, 60 outbreak caused by family member, 95-96 prevalence, 22, 30, 192, 195, 199, 201 public health measures, 12, 22-23, 156 risk assessment, 81, 82, 87, 89, 91, 9596, 99, 107, 192, 195, 199, 201, 202, 204, 214, 215 skin tests, 29, 33, 311 Vietnamese, 6, 15, 87 Immigration and Naturalization Service, 21, 101, 121 Immune system, 26-27, 28, 40, 41, 106, 120, 191, 199, 216-220, 223, 244 see also HIV macrophages, 26-27 skin tests and, 33, 180-183, 185 time factors, 30, 215 tubercules, 27 Implementation of controls, see Administrative controls; Engineering controls; Hierarchy of controls; Personal respiratory protection Injection drug abusers, see Drug abuse
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, 150 education of patients, 35-36, 65,106 HIV patients, treatment of latent tuberculosis, 34, 35 OSHA rule/standard, 88,121,152-153 pregnant patients, treatment of, 35 prevalence, 88,152-153, 216-218, 220, 221 public health measures, 34, 35 risk assessment, 35-36 treatment, 24, 34-36, 42, 57(n.2) , 121, 144, 150, 152-153, 156, 216, 220, 221, 223, 241 Legislation, 20, 69(n.7)
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, 59-60, 148, 230, 236, 242, 254, 256, 257, 258, 261, 297, 301, 302, 304, 305, 306 N95 respirators, 8, 77, 111, 118, 119, 125, 133, 145, 147, 148, 149, 254, 255, 295, 296, 297, 300, 301, 304, 305, 306 OSHA rule, 73, 74, 76, 78, 79, 145-146, 147, 148, 149, 282 surgical, 111, 112, 115, 120, 122, 126, 127, 128, 133, 234, 235, 238, 240, 242, 243, 245, 251-256 (passim) , 296, 300, 301, 302, 304 Material impairment of health, 4849, 50 Medicaid, 53 Medical examiners, 53, 60, 61, 208 autopsies, 26, 85, 95, 98, 149, 212 Medicare, 51, 53, 118 Medication, see Drug resistance; Drug treatment MedLine, 192, 233 Mental health facilities, see Psychiatric facilities Mental retardation, 209-210 Methodology, see Research methodology Metropolitan areas, see Urban areas Mexico, immigrants from, 6, 15, 87, 89, 195, 201 Miami, Florida, 126, 150, 198, 205, 214, 234, 261, 300 Michigan, 103, 211 Migrant workers, CDC guidelines, 57 Military personnel, 88, 94, 95, 194, 196, 197, 205, 206, 217, 220 Veterans Administration, 101, 102, 176, 246-247 Milk, ovine tuberculosis, 24 Mine Safety and Health Administration, 60 Mine workers, 45, 46, 60 Minnesota, 100, 207, 252 Minority groups, see Immigrants; Race/ ethnicity
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, 203, 302 CDC guidelines, 8, 109, 112, 118, 119, 125, 127, 128, 130(n.6) , 234, 236, 238, 239, 242, 243, 252, 253, 254, 256-257, 302 WHO guidelines, 23 Netherlands, 220 New Jersey, 6, 113, 117, 252, 255 New York City, 6, 15, 87, 91, 122, 127-128, 192, 196, 202-203, 204, 205, 206, 209, 210-211, 213, 214, 215, 220221, 222, 235, 237-240, 248, 250, 255-256, 260-261, 262, 301 New York State,6,15,117, 118, 209, 252, 278 New York State Public Employees Federation, 175 N95 respirators, 8, 77, 111, 118, 119, 125, 133, 145, 147, 148, 149, 254, 255, 295, 296, 297, 300, 301, 304, 305, 306 NIOSH, see National Institute for Occupational Safety and Health North Carolina, 151, 208-209, 214 Nursing homes inspections of, 117-118 isolation rooms, 118 risk assessment, 15, 101-102, 104, 208209, 213 skin tests, 30, 117, 208-209 Nursing personnel, 23, 37, 41, 175, 303 CDC guidelines, 78 CDC guidelines, implementation and effects, 111, 122, 125, 236, 240, 254, 259, 261-262, 263, 264 OSHA regulation, 53, 54, 62 risk assessment, 85, 91, 93, 98, 99, 102, 103, 104, 105, 196, 199-206 (passim)
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, 152-155, 252, 290 community-level factors, 9, 10, 52, 138, 139, 142 confidentiality, 64 contract employees, 53-54, 60, 62,141, 208, 288-289 correctional facilities, 3, 53, 60, 63, 89(n.5) , 138, 152 diagnosis, 37, 64-65, 72-74; see also "skin tests" infra drug abusers, 60, 208 drug treatment, 58, 73,109,150,153, 154 emergency departments, 60, 62,140, 208 enforcement, 19, 20-21, 46, 47, 59, 116-118, 133, 140, 141, 234, 271, 272, 274-276, 280 epidemiological estimates, 10, 88 fines and penalties, 20-21, 47, 55, 274, 275, 276, 290 funeral homes, 61 general-duty clause, 47, 53, 59, 108, 117, 140, 141, 252, 273, 276, 279, 280, 288 health care workers and facilities, 4, 29,59,60,61,62,69,73,138,142144, 152, 154,173, 208, 287; see also specific job categories infra and supra historical perspectives on rule/ standard, 3-4, 5-6, 7,19, 4547, 56, 57, 108-109, 150-151, 278 HIV patients, 61 home care, 60, 62, 289 homeless shelters, 3, 21, 60, 63,117, 208 hospices, 60, 62, 208 hospitals, 53-54, 60, 73, 94-95,138, 139, 140-156, 252, 287 immigrants, 60 inspection of facilities, 53, 55, 72,116118, 252-253, 274-276, 288 333 isolation rooms, 73-74, 75, 76, 130(n.6)
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, 76, 145, 295, 296, 304, 305 risk assessment, 294, 300, 304 time factors, 124, 146-147, 304 Pharmaceuticals, see Drug resistance; Drug treatment Philippines, immigrants from, 6, 15, 87, 89, 195
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elimination of tuberculosis, defined, 135(n.8) historical perspectives, 27, 86-93, 131132, 133, 138, 150-151 immigrants, 22, 30, 192, 195, 199, 201 latent tuberculosis, 88, 152-153, 216218, 220, 221 OSHA estimates, 27, 88, 94-95, 150154 OSHA rule/standard, 64, 88, 138 skin tests and, 30, 31, 144, 183, 184185, 199-207 state-level, OSHA estimates, 88, 150151 Prisons, see Correctional facilities Privacy, see Confidentiality 335 Private sector, 6, 44, 54-55, 108 diagnosis and treatment research, 312 OSHA rule/standard, 52, 272, 278 state rule, 53, 278 Professional education, see Education Psychiatric facilities, 101, 220 OSHA rule/standard, 61 Psychological factors, see Attitudes Public health, 1, 12, 21-23, 24, 45, 82, 83, 86, 154, 309, 310 see also Case management; Community-level factors; Contact tracing; Outbreak investigations; Surveillance CDC guidelines, 56-57, 65, 71-72, 131, 133, 134, 310, 312 CDC guidelines, implementation and effects, 231, 232, 256 correctional inmates, 311 educational efforts, 45, 312 historical perspectives, 11, 17, 23, 43, 155, 201-202, 231 immigrants, 12, 22-23, 156 latent tuberculosis treatment, 34, 35 milk, 25 OSHA rule/standard, 65, 71-72, 79, 138, 271, 290 outreach workers, 41, 91, 215 skin tests, 32 Public Health Service, 220 Public Law 91-596, see Occupational Health and Safety Act Public Law 106-113, 173 PubMed (MedLine)
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, 82, 264, 271, 276, 277-278, 280, 282, 283-286, 288, 289 INDEX mine workers, 45, 46, 60 National Advisory Committee on Occupational Safety and Health, 46, 273 National Commission on Correctional Health Care, 58 NIOSH certification of respirators, 8, 19,20,46,77,79,118,119,122, 145, 254, 295, 296-298, 301, 306 respirators, general, 294 skin tests, 29, 180, 195 treatment, directly observed therapy, 17, 22, 35, 41, 82, 119, 132, 139, 153 treatment observation, state requirements, 41 tuberculin as cure, 180 voluntary standards, 9-10, 54-55, 57, 58, 108, 121, 138, 276 WHO guidelines, 23 Regulatory Flexibility Act, 281 Renal system, see Kidneys Research methodology, 7, 46, 92-93, 248 see also Epidemiology; Risk levels and assessment annual risk of infection (ARI) , 193194 committee study at hand, goals and methodology, 2, 7-9, 16-17, 173178, 189, 191 controlled studies, 6-7, 20, 122-124 databases, 85, 86-92, 111, 192, 214, 233, 247, 252, 253 literature review, 192-194, 233 mail surveys, 110 OSHA, 272-273 outbreak reports, 96-97, 105, 119-120 time factors, 7, 137, 192 Resistance, see Drug resistance Respirators, see Personal respiratory protection Respiratory isolation, see Administrative controls; Centers for Disease Control and Prevention (CDC)
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children, 30 community-level factors, 29, 31 contact tracing and, 29, 30 correctional facilities, 95, 99-101, 114, 115, 117, 215, 311 cost factors, 71, 142, 144, 261-262, 263, 264, 265 dental schools, 113 elderly persons, 30 emergency departments, 130, 260
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, 58, 64, 70, 115, 126, 181, 185-186, 203, 235, 236, 255, 258, 304 vaccines, effects on, 33 Sneezing, 1, 13, 25, 259 INDEX Social factors, 43, 104, 311 see also Community-level factors; Contact tracing; Family members; Friends positive skin tests causing stigma, 32, 144 Social service workers, 115-116 OSHA rule/standard, 60, 61, 208 risk assessment, 98 Society for Healthcare Epidemiology of America, 112, 176, 242, 243, 253, 302 Society for Occupational and Environmental Health, 239 Socioeconomic status, 81, 85, 91, 93, 107 see also Homeless persons and shelters hospital personnel, 126, 200, 204 unemployed persons, 7, 15, 43-44, 89, 153-154, 222 South Carolina, 129 Spear, Robert, 293-308 Sputum smears, 25, 37, 38, 41, 72, 73, 112, 124, 125, 126, 234-240 (passim) , 246, 247, 248-249, 256, 258, 263, 264, 265 risk assessment, 83, 98, 103, 190, 194, 195, 201, 210 time factors, 256, 264 Standards, see Regulations and standards State governments, 20, 45-46, 117, 140, 309, 310, 312 accreditation and licensure, 6, 53, 82, 140, 141 control programs, general, 8, 17, 18, 69(n.7)
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Louis, Missouri, 198, 205, 206, 250, 266 Stop TB Initiative, 312 Strategic Plan for Tuberculosis Training and Education, 310 Streptomycin, 40 Students dental, 113, 260-261 medical, 62, 85, 99, 100,196, 287, 216217,259,287 other, 95-96, 196 Substance abuse, see Drug abuse Surgical masks, 111, 112, 115, 120, 122, 126, 127, 128, 133, 234, 235, 238, 240, 242, 243, 245, 251-256 (passim) , 296, 300, 301, 302, 304 Surgical treatment, 18, 79-80, 95 organ transplants, 30, 95 Surveillance, 11, 81, 86-93,107,110-116, 216-219 see also Diagnosis; Mortality; Prevalence; Record keeping CDC guidelines, 64-65,109 CDC guidelines, implementation and effects, 129,133,153, 236 correctional facilities, 114 federal government surveys and databases, 86-92, 110-115 nursing homes, 102 OSHA rule/standard, 64-65,109, 274 skin tests, 29, 33, 34, 83,144 Symptoms, 37-39, 118,135,136,155, 221, 245 CDC definition of active tuberculosis, 83 CDC guidelines, 64, 246 coughing, 1, 13, 25, 26, 37,103,131, 190, 245, 246, 259 OSHA rule/standard, 64 sneezing, 1,13, 25, 259 339 T Tennessee, 100 Testing, see Diagnosis; Skin testing; Sputum smears Texas, 6,113, 209-210 Time factors autopsies, 98 committee study at hand, 137,173 contact tracing, 263, 264 correctional facility, length of stay, 115 diagnosed patients, transfer from health care facilities, 73-74 diagnosis, 29, 30, 33, 34, 38-39, 58, 64, 70 drug treatment, 17-18, 22, 34, 35, 36, 4041, 143(n.1)
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isolation rooms, 11, 60, 75, 76, 121, 130-131, 199, 230, 232, 238, 250, 251, 254, 256-257; see also Negative-pressure isolation rooms nursing homes, 208 OSHA rule/standard, 60, 75, 76 risk assessment, 190, 199, 212, 213, 221 Vermont, 15, 87 Veterans Administration, 101, 102, 176, 246-247 Vietnam, immigrants from, 6, 15, 87 Virgin Islands, 252 Visitors of patients, 23, 40, 56-57, 62, 79, 208,245,257 Voluntary standards, 9-10, 54-55, 57, 58, 108, 121, 138, 276 see also Centers for Disease Control and Prevention (CDC) guidelines; Centers for Disease Control and Prevention (CDC)
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