The most important measures appear to be administrative controls, in particular, policies and procedures aimed at promptly identifying, isolating, and treating people with infectious tuberculosis.

In addition to the CDC guidelines, hospitals may have been influenced by OSHA’s efforts to enforce the adoption of tuberculosis control measures under the agency’s general-duty clause and its respiratory protection standard. Likewise, after 1997, the expectation that a permanent OSHA standard would be issued may have played a role. Some state regulatory agencies and private accrediting organizations were also enforcing infection control requirements during the 1990s.

Because most of the information located by the committee dealt with hospitals, the committee could not reach conclusions about the effectiveness of tuberculosis control measures in these workplaces. To various degrees, these workplaces differ from hospitals and each other in physical environments, resources available, populations served, and range of tasks undertaken by different categories of workers. These workplaces may also differ in the level of management and worker understanding and acceptance of the threat of tuberculosis and the need for control measures. In principle, however, basic control measures such as screening to promptly identify and isolate those with symptoms and signs of tuberculosis should help prevent transmission of M. tuberculosis in prisons and other congregate settings serving populations at increased risk of tuberculosis.

Tuberculosis control measures cannot be expected to prevent all worker exposure to the disease. In areas with moderate to high levels of tuberculosis, occasional worker exposure to patients with infectious tuberculosis can be expected. For example, opportunities for exposure will exist in emergency departments and other “intake” areas before infectious individuals are recognized and isolation protocols can be applied and completed. Furthermore, not all individuals with infectious tuberculosis have easily recognized symptoms or signs of the disease, so workers may be exposed to them for some time before tuberculosis is suspected and diagnosed. Conscientious implementation of tuberculosis control measures does not guarantee that transmission will never occur, but it appears to reduce risk significantly, especially in high-prevalence areas.

Condition 2. Will an OSHA standard help sustain or increase the level of adherence to effective workplace tuberculosis control measures?

As the past decade’s outbreaks of tuberculosis recede in memory and cost control continues as a priority for community and occupational health programs, the potential once again exists for communities and workplaces to neglect the control measures that helped end workplace outbreaks and reverse increases in tuberculosis case rates. The information



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