of the hospitals used surgical masks for personal respiratory protection. There were a total of 33 exposure events involving 1,031 health care workers (445 patient days). However, the rate of PPD conversion following exposure was only 0.97 percent. Although the authors indicate that their data show that practices in Minnesota hospitals were “reasonably consistent with critical elements of the 1990 CDC guidelines” full compliance was apparently uncommon.

McDiarmid and colleagues (49) reported on the results of OSHA inspections performed from May 1992 through October 1994. An OSHA database of reports (for 262/272 cases) as well as supplemental questionnaires completed by OSHA compliance officers (for 149/272 cases) were reviewed.

In May 1992 OSHA region II (New York, New Jersey, Puerto Rico, Virgin Islands) developed enforcement guidelines based on the CDC 1990 guidelines. In the fall of 1993 OSHA issued national guidelines (50). A total of 272 facilities were inspected by OSHA; of these 53 percent were in New York and New Jersey. Hospitals made up 45 percent of inspected facilities, nursing homes made up 17 percent, prisons made up 13 percent, shelters made up 5 percent, and other made up 20 percent (e.g., outpatient drug treatment centers, physician offices, Emergency Medical Services). Complaints of employees/unions prompted 71 percent of the inspections.

Overall 66/117 (56 percent) had a tuberculosis control program, and 77/97 (79 percent) screened patients/clients for tuberculosis on admission. A total of 60/117 (51 percent) had some form of tuberculosis isolation available, and 54/129 (42 percent) had negative-pressure isolation rooms. “Adequate” personal protective equipment was provided at 33/ 114 (29 percent) (surgical masks were provided at 21 percent of facilities, dust-mist respirators were provided at 38 percent, and no masks were provided at 14 percent). Seventy-nine percent performed at least annual PPDs. Overall hospitals had better compliance.

Only 54/101 facilities (53 percent) appropriately recorded positive PPD test results on the OSHA 2000 log. Following exposure incidents, facilities applied an average of 79 (standard deviation [SD] = 179) PPDs, finding mean of 0.75 (SD—1.5) converters, with 0.20 (SD—0.9) active cases of tuberculosis found among converters.

Forty-two percent of facilities received citations under the general-duty clause; 39 percent were cited for noncompliance with respiratory protection standard; 20 percent were cited for noncompliance with the recording and reporting standard. OSHA also requires room placarding— 10 percent of facilities were cited in violation of this.

The authors note a high degree of noncompliance during the study period; however, since most inspections were instigated by complaints, the selection of facilities may have been biased toward those with poorer



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