August 5, 2009
Mr. Craig Rowe, RN, BSN
Employee Health/Infection Control
Las Colinas Medical Center
6800 N. MacArthur Blvd.
Irving, TX 75039
Dear Mr. Rowe:
Thank you for your letter of May 6, 2009, to the Occupational Safety and Health Administration (OSHA). Your letter has been forwarded to the Directorate of Enforcement Programs (DEP) for a response. You specifically asked what OSHA's policy is regarding annual employee tuberculosis (TB) skin testing for health care workers (HCWs) who have a documented allergy to purified protein derivative (PPD) tuberculin. This letter constitutes OSHA's interpretation only of the requirements herein, and may not be applicable to any questions not delineated within your original correspondence.
Scenario: Your facility has had several employees who have had allergic reactions in the past to the TB skin test (TST)/PPD. Many facilities have chosen to do only an annual screening questionnaire for these employees, while your facility has opted for QuantiFERON-TB Gold (QFT-G) blood test in lieu of a PPD for those employees who have a documented allergy to the PPD.
Question: What is OSHA's position on the requirements for TB screening for employees who have a documented allergy to PPD?
Reply: OSHA's current compliance directive (CPL 02-00-106) references the 1994 Centers for Disease Control and Prevention (CDC) guidelines, which, as you are aware, do not address a recommended TST for individuals who have had an allergic reaction to a TSTPPD. The Agency's current means of enforcement of worker protection from TB in large part falls under the provisions set by Section 5(a)(l) of the Occupational Safety and Health (OSH) Act, the general duty clause. Your facility, which administers the QFT-G, a type of blood assay for Mycobacterium tuberculosis (BAMT), would adhere to the recommendations of the most recent CDC guidelines (Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005) and would be considered to meet the provisions of the general duty clause.
Thank you for your interest in occupational safety and health. We hope you find this information helpful. OSHA requirements are set by statute, standards, and regulations. Our interpretation letters explain these requirements and how they apply to particular circumstances, but they cannot create additional employer obligations. This letter constitutes OSHA's interpretation of the requirements discussed. Our enforcements guidance may be affected by changes to OSHA rules. Also, from time to time we update our guidance in response to new information. To keep apprised of such developments, you can consult the OSHA website at http://www.osha.gov. If you have any further questions, please feel free to contact the Office of Health Enforcement at (202) 693-2190.
Richard E. Fairfax, Director
Directorate of Enforcement Programs