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News Release USDL: 96-49
Monday, February 12, 1996
Contact: Frank Kane (202) 219-8151

The Occupational Safety and Health Administration (OSHA) today issued new enforcement guidance to protect workers against hazards posed by tuberculosis (TB), including drug-resistant strains of the disease.

"OSHA has taken this action to control occupational exposures to TB because the incidence of the disease has increased 14 percent since 1985, reversing a 30-year downward trend," said Assistant Secretary of Labor for OSHA, Joseph A. Dear. "Outbreaks have occurred in hospitals, correctional institutions, nursing homes and residential care facilities for AIDs patients. Drug-resistant strains pose an added threat.

"Twelve health care workers have died and several hundred workers were infected and required medical treatment after workplace exposure to TB," Dear said.

Specific control measures recommended by the Centers for Disease Control and Prevention (CDC) and required by OSHA contributed to a drop in the nation's TB cases in 1994 and 1995.

"But we still have to continue the fight," Dear said. "This new compliance directive reflects the latest CDC guidelines and will help us maintain effective control while we work toward proposing a TB standard later this year."

The compliance directive (OSHA Instruction CPL 2.106) supersedes a compliance memorandum issued Oct. 8, 1993. That memorandum had been based principally on guidelines for preventing the transmission of TB in health care settings issued by CDC in 1990. CDC revised the guidelines in October, 1994, and the OSHA compliance directive reflects those revised guidelines.

The directive and the CDC guidelines detail widely recognized and accepted standards of protection employers should follow in carrying out their responsibilities under the Occupational Safety and Health Act.

OSHA will continue to inspect for occupational exposure to TB in response to employee complaints, related fatalities or catastrophes, or as part of all industrial hygiene inspections conducted in workplaces where the CDC has identified workers as having a greater incidence of TB infection than in the general population.

Those workplaces are as follows:

• health care facilities (Including hospitals where patients with confirmed or suspected TB are treated or to which they have been transported. Coverage of non-hospital health care facilities such as doctor's offices and clinics includes only personnel present during performance of high hazard procedures on suspect or active TB patients. Dental health care personnel are covered by the directive only if they treat suspect or active patients in a hospital or correctional facility.)

• correctional institutions

• long-term care facilities for the elderly

• homeless shelters (Homeless shelters must establish protocols that provide for rapid early identification followed by immediate transfer of suspect cases if the shelters have elected not to treat these patients.)

• drug treatment centers

The directive spells out inspection procedures as well as steps to be taken to protect the inspecting compliance officers from hazards of exposure to TB.

It also says that employers can be cited for violations of:

• The general duty clause of the Occupational Safety and Health Act [Section (5)(a)(1)]. This requires the employer to furnish employment or a place of employment free from recognized hazards likely to cause death or serious physical harm to employees exposed to TB. (In the case of federal facilities, Executive Order 12196, Section 1-201(a) would apply.)

• The respiratory protection standard (29 CFR 1910.134)

• The standard on accident prevention signs and tags (29 CFR 1910.145)

• The standard on access to employee exposure and medical records (29 CFR 1910.20)

• The standard on recording and reporting occupational injuries and illnesses (29 CFR 1904)

The directive provides examples of feasible and useful methods of abating the hazard if Section (5)(a)(1) is cited. These include early identification of individuals with active TB, engineering controls, medical surveillance of employees including initial examinations, periodic evaluations and reassessments following exposures or changes in health, case management of infected employees, and worker education and training.

The respiratory protection standard requires the employer to provide respirators when such equipment is necessary to protect the health of the employee.

The TB directive identifies certain circumstances where respirators are required. Those circumstances are the same as those that were specified in the October, 1993, compliance memorandum and that are specified in the CDC guidelines. Respirators are required when:

• Workers enter rooms housing individuals with suspected or confirmed infectious TB;

• Workers are present during the performance of high hazard procedures on individuals who have suspected or confirmed infectious TB; or

• Emergency-medical-response personnel or others transport, in a closed vehicle, an individual with suspected or confirmed TB.

The 1994 CDC guidelines specified standard performance criteria for respiratory protection for TB. Subsequently the National Institute for Occupational Safety and Health (NIOSH), partly in response to the CDC criteria, issued revised certification requirements for particulate respirators.

Based on these requirements, OSHA recognized in the directive that the minimally acceptable level of respiratory protection is the Type 95 respirator. The Type 95 respirator is considerably less expensive than the high-efficiency particulate air (HEPA) respirator and is currently available. If a facility chooses, they may continue to use HEPA respirators.

If a facility chooses to use disposable respirators, their reuse is permitted as long as the respirator maintains its structural and functional integrity and the filter material is not physically damaged or soiled.