care units in prisons, jails, and certain other settings). The guidelines present a three-level hierarchy of tuberculosis control recommendations comprising

  1. administrative controls (in particular, protocols for early identification, isolation, and treatment of individuals with infectious tuberculosis),

  2. engineering controls (in particular, negative-pressure ventilation of isolation rooms for patients with infectious tuberculosis), and

  3. personal respiratory protection (primarily use of specially designed facemasks to prevent inhalation of infectious particles).

The CDC guidelines, which followed statements issued in 1982 and 1990, also set forth a risk assessment process that defines five categories of facilities (or areas of facilities) based on the risk of tuberculosis transmission. The guidelines recommend fewer tuberculosis control measures for the facilities in the “minimal” and “very low” risk categories. The risk assessment process for a facility covers the profile of tuberculosis in the community, the numbers of tuberculosis patients examined or treated in different areas of the facility, and the tuberculin skin test conversion rates for workers in different areas of the facility or in different job categories. The process also takes into account evidence of person-to-person transmission of tuberculosis resulting in active disease as well as information from medical record reviews or workplace observations that suggests possible problems in tuberculosis control measures. In the summer of 2000, CDC began a reassessment of its guidelines for health care facilities, and the results are expected in mid-2002.

1997 Proposed OSHA Rule

When the committee began work in April 2000, OSHA expected to publish the final standard on occupational tuberculosis in July. Subsequently, OSHA indicated that publication would likely occur by the end of the year 2000, which would follow the committee’s final meeting in September 2000. Thus, the committee had to undertake its analyses without knowing the content of the final regulations. It is possible that the new Administration will not issue any final standard.

By law, OSHA can directly regulate only private employers and, with certain restrictions, federal agencies. Through agreements with states that choose to participate, OSHA regulations may also be applied to employees of state and local governments. About half the states have entered into such agreements.

In its 1997 proposed rule on occupational tuberculosis, OSHA followed the 1994 CDC guidelines in most respects. Also, OSHA concluded that the CDC guidelines in their original form were not specific and direc-

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