170 workplaces including 94 health care facilities, 48 correctional and law enforcement facilities, and 28 social service agencies. The results reported for the 16 responding acute-care hospitals were, overall, the most consistent with the CDC guidelines. Just over half of the correctional and law enforcement facilities were reported to have a written tuberculosis control plan. Of the social service agencies (which were not covered by the 1994 CDC guidelines for health care facilities), only one respondent reported a written tuberculosis control plan or a worker training program. For all organizations, the lowest levels of practice consistent with the 1994 CDC guidelines were reported for respiratory protection programs. Half of the 16 hospitals, less than 10 percent of the 23 long-term facilities for the elderly, 20 percent of the 28 mental health facilities, and 20 percent of 48 correctional and law enforcement facilities reported such programs. The responses to the AFSCME survey come from a very small, nonrandom set of respondents and must be viewed with considerable caution. They do, however, help explain organized labor’s continuing concern about the protections being offered workers, particularly those outside hospitals.

In 1997, researchers from Johns Hopkins University asked attendees at a national funeral director’s convention to complete a risk assessment questionnaire and undergo tuberculin skin testing (Gershon, 1998). Approximately 800 funeral home employees completed the survey and consented to a tuberculin skin test. This group included 500 embalmers, who have the highest risk of exposure. Only 16 percent of the embalmers reported consistently wearing any kind of face mask during embalming procedures. About half reported some kind of training about tuberculosis during their career; less than 20 percent reported such training in the preceding 12 months. Nonetheless, the researchers concluded that most were reasonably knowledgeable about the disease. Overall, these data supported findings from a smaller pilot study of 123 Maryland embalmers that also showed limited adoption of measures for the prevention of transmission of M. tuberculosis (Gershon et al., 1995b).

Taken together, survey results suggest, at a minimum, two conclusions. First, institutional departures from recommended tuberculosis control policies and procedures were common, if not the norm, in the late 1980s and early 1990s. Second, institutions—at least hospitals and correctional facilities—were taking tuberculosis control measures more seriously and reporting substantially higher rates of implementation of recommended measures in later years. As discussed below, written policies may not be consistent with routine practices.

Facility Inspections or Visits

Although limited in some respects by the lack of a specific standard on occupational tuberculosis, OSHA can inspect health care and other



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