reviewed in Chapters 5 and 6 suggests that the 1982 and 1990 CDC guidelines were not widely implemented and that lapses in infection control likely contributed to the workplace outbreaks of tuberculosis reported in the late 1980s and early 1990s. The 1994 CDC guidelines appear to be more widely accepted and adopted, albeit with some gaps between formal policies and day-to-day practices. Except to the extent that they have been incorporated as requirements by other public or private agencies, the steps recommended by CDC are voluntary.

On the basis of logic and experience, the committee expects that an OSHA standard would sustain or increase the rate of compliance with mandated tuberculosis control measures. First, a national standard is likely to motivate more organizational adherence to tuberculosis control measures than can be achieved by voluntary guidelines, variable state laws, or the threat of bad publicity or litigation in the event of a tuberculosis outbreak. The committee believes that most organizations want to do right as defined by laws, guidelines, ethical principles, and lessons of science or experience. It also believes that compliance with recommended practices can usually be increased by the threat of citation and financial penalties that lies behind regulations.

Second, as argued by OSHA, the committee agrees that a standard will be clearer, more hazard specific, and easier to enforce than either the general-duty clause in OSHA’s statute or OSHA’s existing standards on respiratory protection. Unlike OSHA’s general-duty clause, a standard allows the agency to identify and require actions to abate workplace risks in advance. Unlike OSHA’s general standard on respiratory protections, a tuberculosis standard would, in certain respects, be specific to this biologic hazard (e.g., by describing types of hazardous situations—such as entering an isolation room—and identifying respirators or respirator characteristics appropriate to these situations).

Third, by providing a firmer basis for OSHA enforcement actions, a standard should also put workers on stronger ground in identifying and challenging an employer’s inadequate implementation of the tuberculosis control measures specified by the standard. Such a challenge need not involve an actual complaint to OSHA. Notifying an employer of deficiencies may be sufficient to prompt corrective action.

One caveat needs to be mentioned, however. State and local government hospitals and other facilities would not be covered by an OSHA standard unless a state had an approved OSHA plan for enforcing the standard in these facilities. The facilities might, however, be subject to other infection control requirements, for example, those set forth in state licensure laws. Also, if a facility such as a state or local correctional used a private contractor to run the facility’s medical department, that private contractor would be covered by the standard for its activities and employees.

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