Tuberculosis in the Workplace (2001) / Chapter Skim
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In November 1999, the U.S. Congress requested that the National Academy of Sciences undertake a short-term study to examine the risk of tuberculosis among health care workers and the possible effects of federal guidelines and regulations intended to protect workers from this risk.
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The committee is, however, concerned that if a final OSHA standard follows the 1997 proposed rule, it may not meet the third condition of allowing reasonable flexibility to adopt measures appropriate to the level of risk. CDC GUIDELINES AND THE PROPOSED OSHA RULE 1994 CDC Guidelines In 1994, CDC published its most extensive guidelines for preventing the transmission of tuberculosis in health care facilities (including health
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The risk assessment process for a facility covers the profile of tuberculosis in the community, the numbers of tuberculosis patients examined or treated in different areas of the facility, and the tuberculin skin test conversion rates for workers in different areas of the facility or in different job categories. The process also takes into account evidence of person-to-person transmission of tuberculosis resulting in active disease as well as information from medical record reviews or workplace observations that suggests possible problems in tuberculosis control measures.
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The 1997 proposed OSHA rule defines a category of employers that would be exempt from some of its requirements, but the qualifying criteria are narrower than those set forth in the 1994 CDC guidelines. Specifically, a facility must neither admit nor provide medical services to individuals with suspected or confirmed tuberculosis, it must have had no confirmed cases of infectious tuberculosis during the previous 12 months, and it must be located in a county that has had no confirmed cases of infectious tuberculosis during 1 of the previous 2 years and less than six cases during the other year.
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Guidelines and Regulations In 1990, CDC issued new guidelines for tuberculosis control measures in health care facilities. In 1993, in response to calls from health care and other workers, OSHA began to enforce some tuberculosis control measures under its general powers to protect worker safety and under other regulations related to airborne hazards.
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In addition, some state licensure agencies and private accrediting organizations required tuberculosis control measures. Decreasing Rates of Disease The epidemiology of tuberculosis has changed substantially since the early 1990s.
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Risk is influenced by the prevalence of tuberculosis in the community that the workplace serves and by the extent and type of worker's contact with people who have infectious tuberculosis. The available data do not allow precise quantification of the risk to health care workers or conclusions about the historical or current risk to other categories of workers covered by the 1997 proposed OSHA rule.
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The adoption of written tuberculosis control policies does not, however, always translate into consistent dayto-day practice. Implementation is probably most complete for administrative controls including procedures for promptly identifying, isolating, diagnosing, and adequately treating people with active tuberculosis.
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Conscientious implementation of tuberculosis control measures does not guarantee that transmission will never occur, but it appears to reduce risk significantly, especially in high-prevalence areas. Question 3: What will be the likely effects on rates of tuberculosis infection, disease, and mortality of an anticipated OSHA standard to protect workers from occupational exposure to tuberculosis?
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In addition, by providing a firmer basis for OSHA enforcement actions, a standard should put workers on stronger ground in identifying and challenging an employer's inadequate implementation of mandated tuberculosis control measures. The committee is concerned, however, that if an OSHA standard follows the 1997 proposed rule, it may not meet the third condition of allowing organizations reasonable flexibility to adopt tuberculosis control measures appropriate to the level of risk facing workers.
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Surveys, investigations of outbreaks, and facility inspections all pointed to institutional lapses in tuberculosis control measures including inattention to the signs and symptoms of infectious tuberculosis, delays in the initiation of appropriate evaluation and treatment, and improper ventilation of isolation rooms. lust as community neglect interacted with workplace neglect to set the stage for workplace outbreaks of tuberculosis, it now appears that community control measures have interacted with workplace control measures to help end outbreaks of tuberculosis and reduce the potential for new ones.
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research to tackle the problem of patient and provider failure to follow treatment recommendations. If implemented, many of the recommendations from that IOM report especially those related to better diagnostic tests and treatments for latent infection would benefit workplace as well as community-based tuberculosis control programs.
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