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

Executive Order 12196 %% 1-201(a) The head of the agency shall: Furnish to employees places and conditions of employment that were free from recognized hazards that were causing or were likely to cause death or serious physical harm in that employees were exposed to: Employees including, but not limited to Immigration Officers, Deportation Officers, Special Agents, Examiners, and Attorneys were exposed to the hazard of being infected with tuberculosis through repeated, prolonged indoor contact with inmates/clients who may be infected with tuberculosis in that: (a) St. Elizabeth's Hospital facility - No respiratory isolation rooms under negative pressure with respect to the hallway were available for aliens with suspect or confirmed active tuberculosis. Those with known active tuberculosis were housed with other aliens in common areas and rooms. (b) 4th floor, 4420 N. Fairfax Dr., Arlington, Virginia Aliens with active tuberculosis were kept (not isolated from others in the population) in holding cells that were under negative pressure with the respect to the office area and the exhaust air was recirculated through the general building ventilation without HEPA filtration. (c) Detention and Deportation - Employee duties included, but were not limited to transporting aliens with active tuberculosis in vehicles; performing interviews in small improperly ventilated rooms; and fingerprinting. There were no procedures for respiratory isolation and aliens with active tuberculosis were not required to cover their mouths and noses. (d) Investigations - Employee duties included, but were not limited to the arrest, transport, and interviewing of aliens with confirmed or suspect active tuberculosis. No respiratory isolation procedures were in effect and aliens with active tuberculosis were not required to cover their mouths and noses. (e) Litigation - Employee duties included, but were not limited to interviewing aliens with confirmed active tuberculosis in small, improperly ventilated rooms. No respiratory isolation procedures were in effect and aliens with active tuberculosis were not required to cover their mouths and noses. (f) Examination - Employee duties included, but were not limited to interviewing aliens with confirmed or suspect tuberculosis in small, improperly ventilated rooms, and fingerprinting. No respiratory isolation procedures were in effect and aliens with active tuberculosis were not required to cover their mouths and noses. (g) Throughout the facility - Procedures had not been established to prevent infection with tuberculosis and, in the event of a positive Mantoux skin test, appropriate follow-up procedures were not provided by the agency. Feasible and useful abatement methods for reducing this hazard, as recommended by the Center for Disease Control, among others are: (1) Each facility should designate an appropriately trained official responsible for operating a TB prevention and control program in the facility. (2) Protocol for the early identification of individuals with the active tuberculosis. (3) Medical surveillance (at the cost of employees) including preplacement 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 covered employees in the facility; and annually for all covered employees in the facility. (4) Evaluation and management (at no cost to employees) of workers with a positive skin test, or with 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 an inmate/client with infectious TB for whom infection control precautions have not been taken) shall also be managed according to CDC recommendations. (5) Placement of individuals with suspected or confirmed TB disease in an AFB (acid fast bacilli) isolation room. AFB isolation rooms for persons with suspected of confirmed infectious TB must be maintained under negative pressure relative to the outside of the room and approximately exhausted (either directly to the outside away from intake vents or through properly designed, installed, and maintained HEPA filters). (6) 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 protocols including the purpose and proper use of controls. (7) Inmates are transferred frequently. Thus, record systems for tracking and assessing the status of persons with TB and tuberculosis infection in the facilities are required.