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. Note that our enforcement 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 OSHA's website at http://www.osha.gov.
April 4, 1995
James Perry, P.A.-C Manager,
Employee Health Services
1150 Varnum Street, N.E.
Washington, D.C. 20017-2180
Dear Mr. Perry:
This letter is in response to your request for information concerning the Occupational Safety and Health Administration's (OSHA) protocol for risk assessment in healthcare facilities. For compliance purposes, OSHA is currently enforcing a compliance memorandum written in October of 1993. That memorandum is based upon the 1990 CDC Guidelines. I understand that you already have a copy of the memorandum. OSHA is currently reviewing a compliance directive that will replace the 1993 memorandum. The compliance directive incorporates the October 1994 CDC Guidelines.
The 1994 CDC Guidelines recommend PPD skin tests every six to twelve months for intermediate risk facilities. The guidelines offer no further recommendations on testing frequency at intermediate risk facilities. The classification of risk as used by the CDC applies to both a facility and areas within that facility. If a facility, as a whole, treats more than six patients with active TB per year then it would be considered an intermediate risk facility. This characterization would apply even if no department within that facility treated more than six patients per year.
We have examined the frequency of testing recommendations for intermediate risk facilities and interpret the guidelines as follows:
1. If there are not individual departments within an intermediate risk facility where more than six TB patients per year are treated, the frequency of testing would be annually.
2. Departments or areas within an intermediate risk facility that treat more than six TB patients per year must conduct PPD testing every six months. The remainder of the facility would fall back under the annual testing requirement.
If you have any further questions please contact Richard Fairfax of my staff at (202) 219-8036.
Ruth McCully, Director
Office of Health Compliance Assistance
March 3, 1995
Director of Health Compliance
200 Constitution Avenue, N.W.
Washington, D.C. 20210
Dear Ms. McCully:
I am writing to get clarification of OSHA's protocol for conducting a Tuberculosis (TB) Risk Assessment in a healthcare facility. The Federal Register of October 28, 1994 outlines the Center for Disease Control and Prevention guidelines. What is unclear to me is the criteria for assigning risk to an institution. Specifically, my question is this: Can an institution be considered low risk if it admits more than six patients with active TB annually, given that no area of the institution admits more than five patients with active TB annually?
One other question that I would like your written opinion on is: Given the scenario above, would this institution be required to conduct PPD testing every six months throughout the hospital or would annual testing be adequate?
I posed these questions to Mr. Richard Fairfax, one of your staff members. He informed me that a letter to you was needed if I wished a written opinion. I do wish a written opinion on this matter, as it is central to the completion of my risk assessment.
James Perry, PA-C
Manager Employee Health Services