TB incurable” (WHO, 2000a, p. 2). Twenty-two countries4 account for nearly three-quarters of all new cases of the disease, and WHO has targeted them for special attention and assistance (WHO, 2000a).
WHO recently issued guidelines for the prevention of tuberculosis in health care facilities in resource-limited settings (WHO, 1999). The measures emphasize relatively inexpensive control measures involving natural ventilation (e.g., opening windows and providing special open-air areas for people waiting for care or visiting infectious patients). The focus is on firstline district health care facilities that lack the resources to support more expensive measures such as negative-pressure isolation rooms and personal respirators, which are advised only for referral facilities. Tuberculin skin testing is recommended only in research settings and at sites that offer preventive therapy for latent infection. Although these recommendations are aimed at resource-poor countries, they may also, under some circumstances, be relevant for some settings in this country. For example, crowded, underfunded homeless shelters may, when weather permits, have people with suspected tuberculosis wait outside in fresh air until transportation and treatment can be arranged.
Although tuberculosis is still a major killer in poor countries, 50 years of effective drug treatment has greatly reduced the toll that the disease takes in the United States. Nonetheless, the resurgence of the disease in the mid-1980s and early 1990s and the rise of multidrug-resistant disease demonstrate that tuberculosis remains a threat that public health programs cannot afford to ignore. Likewise, outbreaks of the disease in hospitals, prisons, and other facilities have underscored the potential for harm to nurses, doctors, guards, and others who work with people at increased risk of tuberculosis.
Will government mandates be effective in protecting health care and other workers from tuberculosis? The final chapter of this report considers this question. The next five chapters provide the foundation for that assessment by reviewing the basic features of the disease and its treatment, describing the legal context for OSHA regulations, comparing the regulations proposed by OSHA in 1997 with the voluntary guidelines published by CDC in 1994, examining the historical and recent occupational risk of tuberculosis, and evaluating the implementation and effects of the 1994 CDC guidelines.