at increased risk, wider adoption of directly observed therapy, declining rates of human immunodeficiency virus (HIV) infection or AIDS, and improved implementation of tuberculosis control measures in hospitals, prisons, and, perhaps, other congregate settings.

Despite progress in efforts to control and prevent tuberculosis in the community, a few big cities still count hundreds of cases each year and occasional workplace outbreaks of the disease continue to be documented. In 1997, only two percent of the U.S. population lived in counties that might be described as “tuberculosis free,” meaning that they had had no cases of tuberculosis in 5 years (Geiter, 1999; see also note in Chapter 6). Continued community and workplace efforts to prevent and control tuberculosis should help enlarge this percentage. Conversely, neglect of tuberculosis control measures could help create the conditions for a new, potentially more dangerous resurgence of the disease.

Conditions for an Effective OSHA Standard

Given the limited information and time available to the committee as well as the uncertainty about the actual content of a final standard, the committee concluded that it could not reasonably develop any quantitative estimate of the likely health effects of an OSHA standard. Instead, it identified three assumptions or conditions that would have to be met for an OSHA standard to have positive effects on tuberculosis infection, disease, and mortality.

Condition 1. Implementation of workplace tuberculosis control measures as recommended by CDC and proposed by OSHA must contribute meaningfully to prevention of the transmission of Mycobacterium tuberculosis in hospitals and other covered workplaces.

Condition 2. An OSHA standard must sustain or increase the level of adherence to workplace tuberculosis control measures, especially in high-risk institutions and communities.

Condition 3. An OSHA standard must allow reasonable flexibility to adapt tuberculosis control measures to fit differences in the level of risk facing workers.

Condition 1. Does implementation of tuberculosis control measures as recommended by CDC and proposed by OSHA help prevent transmission of M. tuberculosis in hospitals and other covered workplaces?

Overall, the committee finds that recommended tuberculosis control measures are effective. In Chapter 6, the committee concluded that more attentive implementation of these measures contributed to the ending of outbreaks of tuberculosis in hospitals and to the prevention of new outbreaks.

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