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 employees were exposed to: (a) On or about August 2,1994, Nurses, Respiratory Therapist, X-Ray Technicians, Environmental Service personnel and other employees were exposed to the hazard of being infected with tuberculosis (TB) in the performance of their job duties through repeated, prolonged, indoor contact with patients who were infectious, or suspected of being infectious, with TB in that employees had potential exposure to the exhaled air of individuals with suspected or confirmed TB disease and/or performed, or were exposed during performance of high-hazard procedures (e.g. aerosolized medication treatment, sputum induction procedures, housekeeping, medical screening and other duties and procedures) which may involve close contact with these individuals where: (1) Patient(s) with suspect or confirmed TB were not placed in negative pressure rooms to prevent exposure of employees in the facility to TB. (2) A protocol for early identification of individuals with active TB was not implemented. (3) Worker education and training to ensure employee knowledge of hazards of TB and compliance with appropriate controls was not and implemented for all employees exposed to TB. (4) Feasible engineering control measures were not fully implemented and maintained for employee protection from hazards of TB. Feasible and useful abatement methods for reducing this hazard include, but are not limited to the following: (1) Implement a protocol for early identification of individuals with active TB. (2) Implement feasible engineering controls as follows on the basis of qualitative risk assessment and the ability of each method to provide employee protection: (i) Place individuals with suspected or confirmed TB disease in AFB (acid fact bacilli) isolation/ holding/ interview/rooms./ and perform "high risk" procedures such as sputum inductions, bronchoscopy, and other treatments and aerosol generating procedures. (ii) Keep AFB isolation rooms / procedures rooms/ under negative pressure toinduce airflow into the room from all surrounding areas (e.g. adjoining hallways, offices, processing areas. ceiling plenums, plumbing chases, etc.) (iii) Monitor (demonstrate) direction of airflow frequently to assure maintenance of negative pressure, frequently, and after adjustment or maintenance is performed on the systems. (iv) Employ a combination of controls and workpractices to minimize spillage of contaminated air from AFB containment rooms/ isolation rooms/ procedures rooms when opening and closing doors and to assure door closure. NOTE: Air flow exhausted from isolation rooms must be transported through ducts and systems which are recognized as containing "biohazard air" and which are designed and operated to ensure maintenance of negative pressure during normal operations and during interruptions (e.g. power failures and required maintenance). (3) Provide worker education and training prior to initial assignment and at least annually, which includes at least the following elements; (i) Nature and transmissibility of TB (ii) Risk factors for disease development (iii) Signs, symptoms, diagnosis, and treatment of TB disease (iv) Institutional protocols (v) Engineering controls (vi) Workpractice controls, including personal hygiene protection (vii) Personal protective equipment References: 1. Centers for Disease Control and Prevention. Guidelines for preventing transmission of tuberculosis in health-care settings, with special focus on HIV related issues. MMWR 1990; 39(No. RR-17):1-29. 2. American Society of Heating, Refrigeration, and Air Conditioning Engineers. 1987 ASHRAE handbook: heating ventilating, and air-conditioning systems and applications. Atlanta, Georgia: American Society of Heating, Refrigeration, and Air ConditioningEngineers, Inc. 1987:23 1-23.12. ABATEMENT NOTE: MULTI-STEP ABATEMENT PLAN IS AS FOLLOWS; Step 1:(a) Institutional policy shall be developed and implemented for early identification of individuals/patients with active TB. (b) Employee training shall be developed and implemented. (c) A written detailed plan of abatement outlining a schedule for the implementation of engineering measures to control or reduce employee exposure to TB as referenced in this citation shall be submitted to the Area Director. This plan shall include, at minimum, target dates for the following actions which must be consistent with the abatement dates required by this citation. (1) Evaluation of engineering control options; (2) Selection of optimum control methods; (3) Procurement, installation, and operation of selected control measures;and (4) Testing or acceptance or modification/ redesign of controls. Abatement Plan Due (Step 1) 30 days Step 2:Abatement Shall have been completed by the implementation of engineering controls and upon verification of their effectiveness. NOTE: All proposed control measures shall be approved by a competent, technically qualified person. Thirty (30) day progress reports are required during the abatement period. Final Abatement Due (Step 2) 90 days