Text For Citation: 01 Item/Group: 001 Hazard: TB

Section 5 (a)(1) of the Occupational Safety and Health Act of 1970: The %% employer did not furnish employment and a place of employment which were free from recognized hazards that were causing or likely to cause death or serious physical harm to employees in that workers such as doctors, nurses, admitting clerks, radiology employees, respiratory therapists, housekeepers and dietary employees in the emergency room, Xray department, D2, and D3 were exposed to the hazard of being infected with tuberculosis through contact with patients who were or may be infected with tuberculosis in that employees of a health care facility were exposed to the exhaled air of individuals with confirmed or suspected TB disease and employees had exposure to a high hazard procedure performed on individuals with suspected or confirmed TB disease which has the potential to generate potentially infectious airborne respiratory secretions including (but not limited to) bronchoscopies and sputum inductions: a.The facility did not have a program in use for the early identification, isolation, and treatment of known or suspect TB patients. b.Exposed employees did not receive medical surveillance related to TB as defined by the Centers for Disease Control (MMWR 12/7/90). c.Known or suspect TB patients were not placed in AFB (acid fast bacilli) isolation rooms, nor did high hazard procedures take place in negative pressure treatment rooms. d.Employees have not been trained about TB or how to protect themselves from exposure. All of the above took place on or about October 21, 1993. Feasible and useful abatement methods for reducing this hazard, as recommended by the Centers for Disease Control, among others are: 1.Protocol for the early identification of individuals with active tuberculosis. 2.Medical surveillance (at no cost to the employees) including placement evaluation, administration and interpretation of the TB Mantoux skin tests, and periodic evaluations shall be offered to employees as follows: an initial baseline screening at the time of employment for all employees in the covered facilities; annually for all employees in the covered facilities; retesting every six months for workers with exposure. 3.Evaluation and management (at no cost to employees) of workers with a positive skin test, or with skin test conversion on repeat testing, or who are exhibiting symptoms of TB, including work restrictions for infectious employees. Workers who experience a TB exposure incident (exposure to a patient/client with infections TB for who infection control precautions have not been taken) shall also be managed according to CDC recommendations. 4.Placement of individuals with suspected or confirmed TB disease in an AFB (acid gast bacilli) isolation room. AFB isolation rooms for persons with suspected or confirmed infectious TB and areas in which high hazard procedures are performed on such individuals must be maintained under negative pressure and appropriately exhausted (either directly to the outside away from intake vents or through properly designed, installed, and maintained HEPA filters). 5.Training and information to ensure employee knowledge of such issues as the hazard of TB transmission, its signs and symptoms, medical surveillance and therapy, and site specific protocol's including the purpose and proper use of controls.