News Release USDL: 96-49
Monday, February 12, 1996
Contact: Frank Kane (202) 219-8151
OSHA Issues New Enforcement Guidance To Protect
Workers Against Hazards Of Tuberculosis
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
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.)
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.