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 including but not limited to staff nurses, respiratory therapists, maintenance mechanics, and environmental services personnel who were exposed to the hazard of being infected by tuberculosis through repeated prolonged indoor contact with patients/prisoners who may be infected with tuberculosis in that: %% (a) Room 303 and 401: Isolation rooms used to patients with active TB were not provided with ventilation to assure negative pressure with respect to the hallway. On or about 3/22/92. (b) Department of Corrections Unit: Seven of eight rooms on the floor were used for patients suspected of having TB and were not provided with ventilation to assure negative pressure with respect to the hallway. On or about 5/04/92. (c) Department of Corrections Unit: Environmental Service Personnel who enter and clean rooms occupied by active TB patients and those suspected of TB are not provided ppd skin patch tests at 6 month intervals. On or about 5/04/92. (d) Hospital Wide: Respiratory therapists who treat active TB patients without the protection of a containment booth or negative pressure are not provided ppd skin patch tests at 6 months intervals. On or about 4/14/92. %% Feasible and use abatement methods for reducing this hazard as recommended by the CDC include but are not limited to the following: %% 1. Medical Screening A. All employees in the facilities covered must be offered the Mantoux skin test free of charge and at a time and place convenient to the employee. All test procedures shall be conducted in accordance with standard medical practice. Frequency of testing shall be as follows: - At time of employment, unless there is a previous positive test or documented completion of adequate preventive therapy. - Every six (6) months for workers with frequent exposure to patients with TB or are involved with high hazard procedures. - annual testing for other workers. - After a TB exposure: that is, if a worker has been exposed to a potentially infectious TB patient for whom infection control procedures have not been taken. This will not be required when an employee's last skin test was within the previous three (3) months. If negative, the skin test shall be repeated twelve (12) weeks after exposure. %% 2. Work Removal When an employee is found to have current pulmonary or laryngeal TB, they shall be excused from work until adequate treatment is instituted, their cough is resolved and physician certifies that the person is no longer infectious. %% 3. Training and Education Employees shall be trained regarding the hazards and control of tuberculosis. At a minimum, the following subjects shall be discussed. - The cause and transmission of TB - Definition of "infectious' - The distinction between TB skin disease and TB infection - The purpose and interpretation of TB skin testing, including the significance of skin test conversion - The signs and symptoms of TB - The reporting mechanism of the signs and symptoms - The purpose of preventive therapy - The risk factors for TB disease development - The treatment of TB and the origin and prognosis of multi-drug resistant TB - The purpose of surveillance, and the recommended following up of positive skin tests - Site specific protocols %% Training for employees also includes: - The engineering controls in use in the person's work area - The critical role directly observed therapy (DOT) plays in preventing the emergence of multiple drug resistant strains of TB. %% The training shall be given to all employees in covered facilities upon initial employment and should be repeated annually thereafter. %% 4. Respiratory Isolation %% All covered facilities providing health care services to confirmed infectious TB patients must keep these patients in pulmonary isolation rooms. The pulmonary isolation room must be under negative pressure and exhausted to the outside away from intake vents, people and animals. If venting directly to outside is not possible the air must be exhausted through properly designed, installed and maintained HEPA facilities. %% %% %%