Accompaniment: OSHA Proposes Tuberculosis Standard

Highlights of OSHA's Proposed Tuberculosis Standard

Posted November 1, 1997.

Editor's note: The U.S. Department of Labor provided the following fact sheet with its October 16, 1997, news release about the Occupational Safety and Health Administration's proposed standard to protect workers exposed to tuberculosis.

Tuberculosis (TB) is a contagious disease caused by inhalation of airborne particles containing the bacterium Mycobacterium tuberculosis. Occupational Safety and Health Administration (OSHA) estimates that as many as 13 million adults in the United States are currently infected with TB, and about five million workers are exposed at work. The proposed standard would cover those workers in more than 100,000 establishments, averting between 21,000-25,000 infections annually and between 138-190 deaths. Costs for the standard are $245 million annually, or $2,400 per establishment ($1,600 per small business establishment).

Scope -- Covers occupational exposure in the following establishments: (1) hospitals; (2) long-term care facilities for the elderly; (3) correctional facilities and other facilities that house inmates or detainees;(4) hospice facilities; (5) shelters for the homeless; (6) facilities that offer treatment for drug abuse; (7) facilities where high-hazard procedures are performed; (8) laboratories that handle specimens that may contain M. tuberculosis or process or maintain the resulting cultures or perform related activity that may result in the aerosolization of M. tuberculosis; (9) during the provision of social work, social welfare services, teaching, law enforcement or legal services if the services are provided in any of the work settings listed in (1) through (8), or in residences, to individuals who are in isolation or are segregated or otherwise confined due to having suspected or confirmed infectious TB; and (10) during the provision of emergency medical services, home health care or home-based hospice care.

Where the risk of TB infection is low, OSHA proposes an exemption from certain provisions of the standard. The standard includes less stringent requirements for facilities that: (1) do not admit or provide medical services to individuals with suspected or confirmed infectious TB; (2) have had no cases of confirmed infectious TB in the past 12 months; and (3) are located in a county that, in the past two years, had no cases of confirmed infectious TB reported in one year and fewer than six cases of confirmed infectious TB reported in the other year.

Employers in those work settings would need to prepare a written exposure control plan, provide baseline skin tests, make medical management available after an exposure incident, provide medical removal protection if necessary and provide information and training to employees with exposure potential and complying with record keeping requirements. Periodic medical surveillance and respiratory protection would not be required.

Exposure Control -- Calls for employers to identify employees who have occupational exposure to TB at their work setting. That determination would include a list of job classifications in which all employees have occupational exposure and a list of job classifications in which some employees have occupational exposure, including a list of tasks and procedures performed by these employees that involve occupational exposure. Employers would develop a written exposure control plan, which would be accessible to employees. The plan needs to be reviewed at least annually and updated whenever necessary to reflect new or modified tasks, procedures or engineering controls that affect occupational exposure, in addition to new or revised employee classifications with occupational exposure. The plan for all employers must include:

The exposure determination;
Procedures for providing employees with information about individuals with suspected or confirmed infectious TB, or about ventilation systems that could be anticipated to contain aerosolized M. tuberculosis; and
Procedures for reporting an exposure incident.

Additional elements are required for employers who transfer individuals with suspected or confirmed infectious TB; employers who admit those individuals or provide medical services to them; employers operating a laboratory; and employers who provide home health care or home-based hospice care.

Work Practices and Engineering Controls -- Requires employers to identify individuals with suspected or confirmed infectious TB and, except in settings where home health and home-based hospice care is being provided: (1) mask or segregate such individuals until transfer (to a facility that has isolation capabilities) or placement in an isolation room can be accomplished; (2) if transfer or placement can't be accomplished within five hours from the time of identification, then such individuals must be temporarily placed in isolation until placement or transfer can be accomplished. Negative pressure in isolation rooms must be maintained to reduce or eliminate exposures to employees. Ventilate isolation rooms or areas after they have been vacated by an individual with suspected or confirmed infectious TB for an appropriate period before allowing employees to enter without respiratory protection. Air should be exhausted from isolation rooms to the outside where it is safe to do so; otherwise, employers must use an HEPA filtration system before discharge or recirculation. Employers must also provide information about the hazard to any contractor who provides temporary or contract employees who may incur occupational exposure.

Respiratory Protection -- Mandates provision of respirators to employees who: (1) enter an isolation room in use for TB isolation; (2) are present during the performance of procedures or services for individuals with suspected or confirmed infectious TB who are not masked; (3) transport individuals with suspected or confirmed infectious TB in an enclosed vehicle or transports such an individual within the facility if the individual is not masked; (4)work on air systems or equipment that may reasonably be anticipated to contain aerosolized M. tuberculosis; (5) work in an area where an unmasked individual with suspected or confirmed infectious TB has been segregated or otherwise confined (e.g. awaiting transfer); or (6) work in a residence where an individual with suspected or confirmed infectious TB is known to be present.

The proposal also contains respirator provisions regarding approval by the National Institute for Occupational Safety and Health, filtering efficiency, fit testing, and fit checking.

Medical Surveillance -- Requires medical surveillance for all employees who have occupational exposure to TB. This includes medical evaluations and post-exposure follow-up as well as periodic tuberculin skin testing. Surveillance would take place:

(a) Before assignment to a job with occupational exposure, or within 60 days of the effective date of this standard, and then annually thereafter (includes medical history, TB skin test and physical examination, (if indicated).

(b) When an employee has signs or symptoms of TB (medical history, physical examination, TB skin test and medical management and follow-up).

(c) When an employee experiences an exposure incident (medical history, TB skin test - if negative, a second test three months later, medical management and follow-up, and a physical examination, if indicated).

(d) When an employee has a skin test conversion (medical history, physical examination, and medical management and follow-up).

(e) Within 30 days of termination of employment (TB skin test).

(f) At any other time a physician or licensed health care professional deems it necessary.

Hazard Communication and Training -- Calls for employers to label exhaust systems that may reasonably be anticipated to contain aerosolized M. tuberculosis, stating that contaminated air is present and that respiratory protection is required. Signs would be posted at entrances to isolation rooms or areas where procedures or services are being performed on individuals with suspected or confirmed infectious TB, indicating no admittance without an appropriate respirator. In addition, signs would be posted at the entrance to clinical and research labs where M. tuberculosis is present.

Employers would ensure each employee with occupational exposure participates in a training program, at no cost to the employee and at a reasonable time and place. Training would be provided: (a) before initial assignment to tasks where occupational exposure may occur; (b) within 60 days after the effective date of the standard; and (c) at least annually thereafter. Annual retraining is required unless the employer can demonstrate that the employee has the specific knowledge and skills required by the proposal. Retraining would need to be provided in any topic(s) where such specific knowledge and skills could not be demonstrated. The training program would include information such as an explanation of the contents of this standard, the general epidemiology of TB, signs and symptoms of TB, personal health conditions that increase an employee's risk of developing the disease, the employer's exposure control plan, respiratory protection and medical surveillance programs, procedures to follow if exposure incidents occur, and procedures to follow should an employee develop signs or symptoms of the disease.

Record keeping -- Specifies the following records: medical, OSHA illness and injury, training, and engineering control maintenance and monitoring. Medical records would be kept confidential and maintained for the duration of employment, plus 30 years. Medical records of employees who have worked for less than one year need not be retained, provided they are returned to the employee upon employment termination. Training records and engineering control maintenance and monitoring records would be maintained for three years.

Go to:

RiskWorld News Department

RiskWorld Home Page

Tec-Com Inc.

Highlights of OSHA's Proposed Tuberculosis Standard

Related Links

Go to: