News Release USDL: 97-366
Thursday, October 16, 1997
Contact: Bill Wright (202)219-8151
Proposal would save at least 130 lives each year
OSHA PROPOSES TB STANDARD TO PROTECT 5.3 MILLION
More than 130 lives would be saved annually under
a proposed new Occupational Safety and Health
Administration (OSHA) standard to protect workers
exposed to tuberculosis, Secretary of Labor Alexis
M. Herman announced today.
The proposed standard helps protect an estimated
5.3 million workers in more than 100,000 hospitals,
homeless shelters, long-term care facilities for
the elderly, detention facilities, certain laboratories
and other work settings with a high risk of TB infection.
Implementation of the proposed standard would prevent
70-90 percent of work-related tuberculosis (TB)
"The battle against TB is far from over," said
Herman. "While the rate of active TB in the general
population has declined overall during the past 40
years, the risk for the workers who care for clients
and patients infected with TB continues to be high,
and in some areas is growing.
"Of even greater worry now," she said, "is the emergence
of a new and deadly form of the disease that is
resistant to current treatment. Infection with
these multidrug-resistant strains can lead to
severe lung damage and is often fatal. One of my
top priorities is to ensure a safe and healthful
workplace. We must do all in our power to protect
workers against this deadly disease."
OSHA estimates that the proposed standard would
prevent between 21,000 and 25,000 infections per
year and save from $89 million to $116 million in
medical costs for treatment of
tuberculosis and lost production caused by
employee absence from work and disabilities
associated with active cases of TB.
Tuberculosis is a contagious disease caused by
inhaling airborne particles containing the bacterium
Mycobacterium tuberculosis. Generally, these
particles are generated when an infected person
coughs, speaks or sneezes. The disease most
commonly affects the lungs although it can affect
several organs of the body, including the brain,
kidneys and bones. Left untreated, the infection
multiplies and destroys the affected tissues, leading
to serious illness or death.
The proposed standard comes on the heels of
nationwide enforcement procedures issued by
OSHA during February 1996, which reflected
revised guidelines by the Centers for Disease
Control (CDC) to prevent transmission of TB,
including drug-resistant strains of the disease.
CDC and OSHA rely on identifying individuals with
suspected infectious TB and isolating them.
OSHA's proposal has incorporated the basic
elements of the revised CDC recommendations
for health care facilities, such as written
exposure control plans, procedures for early
identification of individuals with suspected
or confirmed infectious TB, procedures for
investigating employee skin test conversions
and employee education and training. The major
difference between OSHA's proposal and the CDC's
guidelines is that a final OSHA standard would be
enforceable. Additionally, there are differences
in the areas of risk assessment, medical surveillance
and respiratory protection.
"We want to give employers clearly defined steps
to protect their workers while, at the same time,
assuring workers that steps will be taken to help
protect them against this deadly disease," said
Greg Watchman, OSHA's acting assistant secretary.
"This proposed rule represents OSHA's best ideas
for preventing workplace transmission of TB.
However, we are seeking broad public participation
through a series of hearings to ensure that the
final rule is refined and tailored to address the
many different types of workplaces it would cover."
The proposal incorporates basic infection control
provisions designed to reduce occupational risks
for exposed workers. It would require employers
to develop a written exposure control plan and
identify and isolate individuals with suspected
or confirmed infectious TB or transfer them to
facilities with isolation capabilities. The
proposed standard would also require the installation
of engineering controls in some facilities, such as
negative pressure isolation rooms or areas that would
reduce or eliminate exposures to employees. Other
provisions in the proposed standard include tuberculin
skin testing, hazard communication and training and
Respiratory protection would also be required by
the proposal under specific conditions. Respirators
selected for use must be approved by the National
Institute for Occupational Safety and Health (NIOSH).
"The proposed standard, following CDC recommendations,
would allow the use of low-cost respirators that can
be used multiple times," Watchman said. "We believe
that, in combination with other controls, respirators
are effective in preventing TB transmission."
More than five million workers in approximately
100,000 establishments would be covered by this
standard, including: hospitals, long-term care
facilities for the elderly, correctional facilities
and other facilities that house inmates or detainees,
hospice facilities, shelters for the homeless,
facilities that offer treatment for drug abuse,
facilities where high-hazard procedures are performed
and laboratories that handle TB specimens or process
or maintain the resulting cultures.
The proposed standard would also cover occupational
exposure to workers involved in social work, social
welfare services, teaching, law enforcement or legal
services. However, the proposal would only cover
those services if provided in any of the settings
previously mentioned, or in residences, to individuals
who are isolated, segregated or confined due to
suspected or confirmed infectious TB. Finally, the
standard would also apply to workers providing emergency
medical services, home health care or home-based hospice
Tuberculosis is a national concern, occurring in
every state among people in every age group, and
among both low-wage and high-wage workers. However,
employers with facilities
that are located in counties where the risk
of TB infection is low would be subject to fewer
requirements. The proposal would permit an employer
to implement a more limited program if the facility
(1) doesn't admit or provide medical services to
persons with suspected or confirmed infectious TB,
(2) has had no cases of confirmed infectious TB in
the past 12 months, and
(3) is located in a county that, in the past two
years, had reported no case of confirmed infectious
TB in one year and fewer than six cases of confirmed
infectious TB reported in the other year.
These employers would be responsible only for
preparing a written exposure control plan, providing
baseline skin tests and making medical management
available after an exposure incident. They would
also need to provide medical removal protection if
necessary, and give information and training to
employees with potential occupational exposure,
while complying with pertinent recordkeeping
requirements. Periodic medical surveillance
and respiratory protection would not be required.
Annual costs for implementing the standard are
estimated to be $245 million, or about $2,400
per establishment. Because the standard would
have a significant impact on small businesses
(averaging approximately $1,600 per small entity
or establishment), it underwent a joint review
involving OSHA, the Small Business Administration
and the Office of Management and Budget. OSHA also
has held a series of meetings to discuss development
of the proposal with 33 stakeholder groups representing
labor unions, professional organizations, trade
associations, governmental agencies and employer
OSHA will continue to work with representatives of
drug treatment facilities and homeless shelters to
ensure that a final standard, and its subsequent
enforcement, would not impose unreasonable burdens
on these facilities. Public hearings will also
provide time for discussion of homeless shelter
issues. Finally, OSHA has contracted for a special
study regarding implementation of the proposed
standard in homeless shelters.
OSHA was first petitioned for a permanent standard
for occupational exposure to TB in August 1993 by a
coalition of labor unions in light of a resurgence
in the number of reported
active TB cases nationwide. (The 7-year
period ending in 1992 showed a 20 percent
increase in the number of TB cases in the
United States). The petitioners included
the Service Employees International Union,
American Federation of State, County and
Municipal Employees, Local 1199 National
Health and Human Services Employees Union,
American Federation of Teachers and the
American Federation of Government Employees.
The petitioners contended that TB guidelines
issued by CDC in 1990 were not being fully
implemented in relevant work settings.
As an interim measure, OSHA issued nationwide
enforcement procedures in October 1993 (revised
in February 1996) for certain limited work settings.
On Jan. 26, 1994, the agency announced its plan to
develop a proposed rule. In developing the proposal,
OSHA staff have visited affected industries, met with
stakeholders and sought peer review of the risk
Public comment periods and public hearings are
scheduled to provide an opportunity for interested
parties to submit their comments and concerns on
the provisions of the proposed
standard. Public hearings are scheduled to begin
in Washington, D.C., on Feb. 3, 1998, (beginning
at 10 a.m. on the first day, and 9 a.m. each
succeeding day). Hearings will be held in
the auditorium of the Department of Labor
(Frances Perkins Building), 200 Constitution
Avenue, NW, Washington, D.C. Subsequent
additional public hearings will be held in other
U.S. locations. A Federal Register notice will
be issued upon determination of the locations
and dates of those hearings.
Comments on the proposed standard, as well as
notices of intent to appear at hearings, testimony
and documentary evidence should be submitted in
quadruplicate to the Docket Officer, Docket No.
H-371, Room N-2625, U.S. Department of Labor,
200 Constitution Ave., N.W., Washington, D.C.
20210. Comments of 10 pages or less may be
transmitted by fax to (202) 219-5046.
The tuberculosis proposed standard is scheduled
for publication in the Oct. 17, 1997, Federal Register.
Highlights of OSHA's Proposed Tuberculosis Standard
Tuberculosis is a contagious disease caused by inhalation of
airborne particles containing the bacterium Mycobacterium
tuberculosis. 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
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
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:
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).
When an employee has signs or symptoms of TB
(medical history, physical examination, TB skin test and
medical management and follow-up).
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).
When an employee has a skin test conversion
(medical history, physical examination, and medical
management and follow-up).
Within 30 days of termination of employment (TB skin test)
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.
Recordkeeping -- 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.