1. Are health care and selected other categories of workers at a greater risk of infection, disease, or mortality due to tuberculosis than others in the communities in which they reside?

2. What is known about the implementation and effects of the 1994 Centers for Disease Control and Prevention (CDC) guidelines for the prevention of tuberculosis in health care facilities?

3. What will be the likely effects on rates of tuberculosis infection, disease, and mortality of an anticipated OSHA standard to protect workers from occupational exposure to tuberculosis?

The committee’s charge from Congress for this limited study did not include the development of recommendations for regulatory policy. It also did not include an evaluation of the costs or cost-effectiveness of implementing a standard.

Overall, the committee concludes that tuberculosis remains a threat to some health care, correctional facility, and other workers in the United States. Although the risk has been decreasing in recent years, vigilance is still needed within hospitals, prisons, and similar workplaces, as well as in the community at large. Fortunately, tuberculosis control measures recommended by the CDC in response to tuberculosis outbreaks in health care facilities appear to have been effective. Available evidence suggests that where tuberculosis is uncommon or where basic infection control measures are in place, the occupational risk to health care workers of tuberculosis now approaches community levels, which have been declining. The primary risk to workers today comes from patients, inmates, or others with unsuspected and undiagnosed infectious tuberculosis.

The committee also concludes that an OSHA standard on occupational tuberculosis can have a positive effect if it meets three basic conditions: (1) it is consistent with tuberculosis control measures that appear to be effective, (2) it increases or sustains the level of compliance with those measures, and (3) it allows appropriate flexibility for organizations to adopt tuberculosis control measures appropriate to the level of risk facing workers. The committee expects that a standard will meet the first two conditions by sustaining or increasing the use of effective tuberculosis control measures. The committee is, however, concerned that if a final OSHA standard follows the 1997 proposed rule, it may not meet the third condition of allowing reasonable flexibility to adopt measures appropriate to the level of risk.

In 1994, CDC published its most extensive guidelines for preventing the transmission of tuberculosis in health care facilities (including health