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Tuberculosis in the Workplace (2001)

Chapter: Appendix A Study Origins and Activities

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Suggested Citation:"Appendix A Study Origins and Activities." Institute of Medicine. 2001. Tuberculosis in the Workplace. Washington, DC: The National Academies Press. doi: 10.17226/10045.
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A
Study Origins and Activities

In November 1999, the U.S. Congress directed the Secretary of Health and Human Services to contract with the National Academy of Sciences (NAS) for a study of the Occupational Safety and Health Administration’s (OSHA’s) rule making related to occupational exposure to tuberculosis (P.L. 106–113, Conference Report 196–749). The report was requested within 14 months of the legislation. The study was neither to delay issuing of the final rule nor to be delayed pending the rule’s publication. (OSHA released the standard after the committee completed its work.)

The agreement between the U.S. Department of Health and Human Services (DHHS) and the Institute of Medicine (IOM; the health policy arm of NAS) allowed the study to began officially on April 1, 2000. To undertake the requested study, the IOM appointed an 11-member committee of experts that met in April, August, and September 2000.

The legislative conference language listed three sets of questions. First, are health care workers at a greater risk of infection, disease, and mortality due to tuberculosis than individuals in the general community within which they reside? If so, what is the excess risk due to occupational exposure? Second, can the occupationally acquired risk be quantified for different work environments, different job classifications, etc., as a result of implementation of the 1994 guidelines of the Centers for Disease Control and Prevention (CDC) for the prevention of tuberculosis transmission at the work site or the implementation of specific parts of the CDC guidelines? Third, what effect will the implementation of OSHA’s proposed tuberculosis standard have on minimizing or eliminating the risk of infection, disease, and mortality due to tuberculosis?

Suggested Citation:"Appendix A Study Origins and Activities." Institute of Medicine. 2001. Tuberculosis in the Workplace. Washington, DC: The National Academies Press. doi: 10.17226/10045.
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For clarity in presenting its analysis, the committee slightly edited the questions as follows. (1) Are health care and selected other categories of workers at greater risk of infection, disease, and mortality due to tuberculosis than others in the community within which they reside? If so, what is the excess risk due to occupational exposure? Can the risk be quantified for different work environments and different job classifications? (2) What is known about the implementation and effects of CDC guidelines to control worker exposure to tuberculosis in hospitals, correctional facilities, and other work settings? (3) Given what is known about the CDC guidelines, what will be the likely effects on tuberculosis infection, disease, or mortality of an OSHA rule to protect workers from occupational exposure to tuberculosis?

Although the revised questions broadened the scope of the committee’s work beyond health care workers, most of the information identified by the committee focused on health care workers, mainly hospital employees. The committee arranged for five background papers that appear as Appendixes B, C, D, E, and G in this report. It also conducted a 1-day workshop and a half-day public meeting to solicit oral and written statements from interested organizations. Both these meetings were open to the public. The agendas are listed below.

INSTITUTE OF MEDICINE COMMITTEE ON REGULATING OCCUPATIONAL EXPOSURE TO TUBERCULOSIS

Public Meeting Lecture Room, National Academy of Sciences 2101 Constitution Avenue NW, Washington, DC. Monday, August 7, 2000

AGENDA

1:00 pm

Welcome and Overview of Meeting

Walter Hierholzer, M.D., Committee Chair

1:10

Panel 1

Service Employees International Union, AFL-CIO

William Borwegen, M.P.H.

Occupational Health and Safety Director

American Federation of State, County, and Municipal Employees

James August, M.P.H.

Assistant Director for Research and Health Services

Suggested Citation:"Appendix A Study Origins and Activities." Institute of Medicine. 2001. Tuberculosis in the Workplace. Washington, DC: The National Academies Press. doi: 10.17226/10045.
×

 

American Nurses Association

Karen A.Worthington, M.S., R.N., COHN-S

Senior Occupational Safety and Health Nurse Specialist

New York State Public Employees Federation

Jonathan Rosen, M.S., C.I.H.

Director, Occupational Safety and Health Department

2:00

Panel 2

American Hospital Association

Roslyne D.W.Schulman, M.H.A., M.B.A.

Senior Associate Director, Policy Development

Gina Pugliese, R.N., M.S.

Director, Premier Safety Institute

American Association of Homes and Services for the Aged

Linda Bunning, R.N., N.H.A.

Director of Residential Services, Presbyterian Homes, Inc.

American Academy of Pediatrics

Jeffrey R.Starke, M.D.

Member, AAP Committee on Infectious Diseases

Baylor College of Medicine

American Public Health Association Occupational Health and Safety Section

Melissa A.Mc Diarmid, M.D., M.P.H.

Professor of Medicine

Director, Occupational Health Project, University of Maryland

3:00

Break

3:20

Panel 3

National Tuberculosis Controllers Association

Betty L.Gore, R.N., M.S.N., C.I.C.

Nurse Consultant, Tuberculosis Control Program

South Carolina Department of Health and Environment

California Department of Health

Robert Harrison, M.D.

California Department of Health Services

Chief, Occupational Health Surveillance and Evaluation Program

American Society for Microbiology

Mary Gilchrist, Ph.D.

Director, University Hygienic Laboratory, University of Iowa

Cook County Department of Corrections

James McAuley, M.D.

Medical Director, Cermak Health Services

Suggested Citation:"Appendix A Study Origins and Activities." Institute of Medicine. 2001. Tuberculosis in the Workplace. Washington, DC: The National Academies Press. doi: 10.17226/10045.
×

4:10

Panel 4

Veterans Administration

Gary Roselle, M.D.

National Program Director for Infectious Diseases

Chief, Medical Services, Cincinnati VA Medical Center

American College of Occupational Medicine

John Balbus, M.D.

Center for Risk Science and Public Health, George Washington

University Medical Center

American Thoracic Society

Edward Nardell, M.D.

Associate Professor of Medicine, Harvard Medical School

Tuberculosis Control Officer, Massachusetts Department of

Health

Society for Healthcare Epidemiology of America

Patrick Brennan, M.D.

Hospital Epidemiologist, University of Pennsylvania

Association for Professionals in Infection Control

Rachel Stricof, M.T., M.P.H.

Epidemiologist, New York State Department of Health

5:10

Public Comment Period

Adjourn

INSTITUTE OF MEDICINE WORKSHOP ON REGULATING OCCUPATIONAL EXPOSURE TO TUBERCULOSIS

Lecture Room, National Academy of Sciences 2101 Constitution Avenue NW, Washington, DC. Tuesday, August 8, 2000

AGENDA

8:30 am

Welcome, Workshop Objectives

Walter Hierholzer, M.D., Committee Chair

Professor Emeritus of Internal Medicine, Infectious Diseases

and Epidemiology, Yale University

8:40–9:40

Occupational Exposure to Tuberculosis: Evidence Review

Thomas Daniel, M.D.

Professor Emeritus of Medicine and International Health

Case Western Reserve University

Discussant:

George Comstock, M.D., Dr. P.H.

Professor of Epidemiology

Johns Hopkins University

Suggested Citation:"Appendix A Study Origins and Activities." Institute of Medicine. 2001. Tuberculosis in the Workplace. Washington, DC: The National Academies Press. doi: 10.17226/10045.
×

9:40–10:40

Strengths and Limitations of Tuberculin Skin Testing:

Evidence Review

John Bass, Jr., M.D.

Chair, Department of Medicine

University of South Alabama

Discussant:

C.Fordham von Reyn

Professor of Medicine

Section Chief, Infectious Disease Section

Dartmouth, Hitchcock Medical Center

10:40–11:00

Break

11:00–12:15

Personal Respirators and Tuberculosis Control: Evidence

Review

Phillip Harber, M.D.

Professor, Department of Family Medicine

Chief, Occupational and Environmental Medicine

University of California, Los Angeles

Discussants:

Lisa Brosseau, Ph.D.

Associate Professor, Division of Environmental &

Occupational Health, University of Minnesota

Barry Farr, M.D.

Professor of Internal Medicine, University of Virginia

12:15pm

Lunch in Refectory (tickets in meeting folder)

1:30–3:30

1994 CDC Guidelines: Preventing Transmission of

Tuberculosis in Health-Care Facilities

Effects of the CDC Guidelines: Evidence Review

Keith Woeltje, M.D., Ph.D.

Assistant Professor, Section of Infectious Diseases,

Department of Medicine, Medical College of Georgia

Lessons Learned at the CDC

Amy Curtis, Ph.D.

Epidemiologist, CDC Division of TB Elimination

and

Lisa Panlilio, M.D.

Medical Epidemiologist, CDC Hospital Infections Program

Discussants:

Gina Pugliese, R.N.

Director, Premier Safety Institute, Premier Health System

James August, M.P.H.

Assistant Director for Research and Health

American Federation of State, County, and Municipal

Employees

Suggested Citation:"Appendix A Study Origins and Activities." Institute of Medicine. 2001. Tuberculosis in the Workplace. Washington, DC: The National Academies Press. doi: 10.17226/10045.
×

3:30–3:50

Break

3:50–4:30

Ethical Issues in Regulating Workplace Exposure to TB

Ronald Bayer, Ph.D.

Professor of Public Health, Columbia University

4:30

Public Comment and Continued Discussion

5:00

Adjourn

Suggested Citation:"Appendix A Study Origins and Activities." Institute of Medicine. 2001. Tuberculosis in the Workplace. Washington, DC: The National Academies Press. doi: 10.17226/10045.
×
Page 173
Suggested Citation:"Appendix A Study Origins and Activities." Institute of Medicine. 2001. Tuberculosis in the Workplace. Washington, DC: The National Academies Press. doi: 10.17226/10045.
×
Page 174
Suggested Citation:"Appendix A Study Origins and Activities." Institute of Medicine. 2001. Tuberculosis in the Workplace. Washington, DC: The National Academies Press. doi: 10.17226/10045.
×
Page 175
Suggested Citation:"Appendix A Study Origins and Activities." Institute of Medicine. 2001. Tuberculosis in the Workplace. Washington, DC: The National Academies Press. doi: 10.17226/10045.
×
Page 176
Suggested Citation:"Appendix A Study Origins and Activities." Institute of Medicine. 2001. Tuberculosis in the Workplace. Washington, DC: The National Academies Press. doi: 10.17226/10045.
×
Page 177
Suggested Citation:"Appendix A Study Origins and Activities." Institute of Medicine. 2001. Tuberculosis in the Workplace. Washington, DC: The National Academies Press. doi: 10.17226/10045.
×
Page 178
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Before effective treatments were introduced in the 1950s, tuberculosis was a leading cause of death and disability in the United States. Health care workers were at particular risk. Although the occupational risk of tuberculosis has been declining in recent years, this new book from the Institute of Medicine concludes that vigilance in tuberculosis control is still needed in workplaces and communities. Tuberculosis in the Workplace reviews evidence about the effectiveness of control measures—such as those recommended by the Centers for Disease Control and Prevention—intended to prevent transmission of tuberculosis in health care and other workplaces. It discusses whether proposed regulations from the Occupational Safety and Health Administration would likely increase or sustain compliance with effective control measures and would allow adequate flexibility to adapt measures to the degree of risk facing workers.

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