ers of tuberculosis infection now approaches the level in their community of residence. Tuberculosis risk in communities has been declining since 1993. Overall, rates of active tuberculosis among health care workers are similar overall to those reported for other employed workers. Comparable data are not available to compare mortality risk. Whatever the origins of their disease, health care workers and others with compromised immune systems are at high risk of death if they contract multidrug-resistant tuberculosis. The limited information available to the committee and the changing epidemiology of tuberculosis did not allow the committee to make quantitative estimates or comparisons.

The potential for exposure to tuberculosis in health care and other facilities varies within and across communities. In general, where the disease is more common, health care and others workers are at higher risk of coming into contact with people who have infectious tuberculosis. The U.S. population is, however, mobile, and visitors and new residents can bring tuberculosis with them into communities where the disease is rare. Should a hospital or other worker encounter such an unexpected person, she or he may be at higher risk than colleagues in high-prevalence inner cities, who are more likely to be familiar with and alert to the signs and symptoms of tuberculosis.

The occupational risk of exposure to tuberculosis varies with job category and work environment. Only some health care, correctional, and other workers are reasonably anticipated to have contact with people with tuberculosis, even in facilities that treat or admit such individuals. For example, many administrative and other personnel in hospitals have little contact with patients of any sort and little chance of exposure to contaminated air. For those with direct patient contact, the risk of tuberculosis infection and disease is also not uniform. Although data are not completely consistent, the risk tends to be higher for those who work on wards where patients with suspected or confirmed tuberculosis are admitted and for those whose jobs involve aerosol-generating procedures such as bronchoscopies. For these workers, in particular, the effectiveness of workplace tuberculosis control measures matters.

Workers at particular risk from occupationally acquired tuberculosis infection include those with HIV infection or AIDS or other conditions associated with suppression of normal functioning of the immune system. Data about cases of tuberculosis among health care and other workers are limited, but those with HIV infection or AIDS (or other conditions affecting the immune system) are disproportionately represented in reports of tuberculosis cases and deaths during hospital and prison outbreaks of multidrug-resistant disease. CDC guidelines recommend that health care workers with HIV infection be counseled about the risk of contact with patients who have tuberculosis and be offered assignments that minimize such contact (CDC, 1994b).



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