tuberculosis persist in a number of states and communities. The special vulnerability of people with suppressed immune systems is now recognized, and the threat of multidrug-resistant disease and the conditions that give rise to it (primarily, incomplete and inadequate treatment of tuberculosis) are clearly understood. The tuberculosis control components of community health programs are better funded and better focused on measures that prevent spread of the disease including directly observed therapy for patients with active tuberculosis.

For most hospitals, prisons, and other facilities, these external changes have decreased the likelihood that employees will see someone with diagnosed or undiagnosed active tuberculosis. These changes have also raised the visibility and understanding of the disease.

Nonetheless, with more than 17,000 cases reported nationally in 1999, tuberculosis remains a threat. Inattention to community and workplace measures to control and prevent transmission of M. tuberculosis could lead to another, potentially more serious resurgence of tuberculosis. Thus, it is important to assess how workplace tuberculosis control measures are being implemented and how well they are working.

The changing environment for workplaces makes it difficult, however, to assess the effects of workplace tuberculosis control programs. This difficulty is compounded by the practical problems of conducting rigorous, well-controlled research on these programs, which have often implemented multiple measures simultaneously. Nonetheless, after reviewing the literature (including theoretical arguments and mathematical models), considering discussions during the committee’s public meetings, and drawing on its members’ experiences and judgments, the committee reached several conclusions about, first, the implementation and, second, the probable effects of workplace tuberculosis control measures. Whether regulations may be needed to sustain or increase rates of compliance with tuberculosis control measures is considered in Chapter 7.

Implementation of Tuberculosis Control Measures

The information base for the following conclusions applies mainly to hospitals and to a lesser extent to prisons. The committee expects that the consistent, correct implementation of control measures may be more difficult in other institutions such as jails and homeless shelters, which generally lack the resources, oversight, and expertise available to hospitals. These workplaces may also differ in the degree to which managers and workers understand and accept tuberculosis as a risk and tuberculosis control measures as necessary.

Most reports reviewed by the committee predate the 1994 guidelines, but the basic measures recommended have remained reasonably stable.

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