In this case, the deceased individual had had AIDS and partially treated tuberculosis. A sputum culture was positive on the day of death. Close family members were exposed but not infected. The mortuary employee who embalmed the body subsequently developed tuberculosis, and the organism was shown by RFLP typing to be identical to that of the cadaver. Aerosolization from the airway during the embalming process was suggested as a possible means of transmission. One other case of well-documented transmission of M. tuberculosis during embalming, again with identical strains of tubercle bacilli as determined by RFLP typing, has recently been reported in abstract form (77).

Summary of Risk in Other Than Hospital Based Health Care Workers

The data are too few to permit any generalizations about the magnitude of the occupational tuberculosis risk for health care workers in nonhospital situations. There probably is a risk, and it probably varies with the incidence of tuberculosis in the populations served by the facilities. Although data in this regard are scarce, ventilation, recognition of cases of tuberculosis, and isolation procedures may be less adequate in nonhospital settings than in hospital settings. It is also possible that workers in these settings may have community-based infection risks that differ from those of hospital employees. Table C-11 summarizes the annual risks of infection calculated from three studies deemed adequate to support this calculation.

Risk Assessment by the Occupational Safety and Health Administration

OSHA has proposed a rule to enforce infection control measures on all facilities employing health care workers (45). As part of its proposal OSHA

TABLE C-11. ARI with M. tuberculosis for Three Populations of Nonhospital-Based Health Care Workers (HCWs) as Calculated Directly from Reported Surveillance Studies with Sufficient Data to Permit This Calculation

Health Care Setting (Reference)

Year

Calculated ARI of HCWs (%/year)

Nursing homes, North Carolina (51)

1980–1985

0.21

Prisons, New York State (53)

1991–1992

Exposed workers

2.6

Nonexposed workers

1.4

Prisons, New York City (59)

1990

Exposed workers

6.6

Nonexposed workers

5.5



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