tive enough to be adopted directly as a regulatory standard. The proposed rule, therefore, differs from the CDC guidelines in certain ways. First, the proposed rule is written to be enforced and, therefore, tends to be more specific and directive than the CDC guidelines. Second, it would cover a broader group of employers and employees. Third, it is intended to protect employees and not, for example, patients, prisoners, or visitors. Fourth, it sets forth very restrictive criteria for defining “low-risk” employers that would not be expected to implement all the rule’s requirements.

The 1997 proposed OSHA rule defines a category of employers that would be exempt from some of its requirements, but the qualifying criteria are narrower than those set forth in the 1994 CDC guidelines. Specifically, a facility must neither admit nor provide medical services to individuals with suspected or confirmed tuberculosis, it must have had no confirmed cases of infectious tuberculosis during the previous 12 months, and it must be located in a county that has had no confirmed cases of infectious tuberculosis during 1 of the previous 2 years and less than six cases during the other year. Even if a facility had admitted no tuberculosis patients in the preceding 12 months, had no tuberculosis cases in its service area, and had a policy of referring those with diagnosed or suspected tuberculosis, that facility could not qualify for this “lower risk” category if the surrounding county had reported one case of tuberculosis in each of the preceding 2 years.

ASSESSMENT AND CONCLUSIONS

Context: Changing Tuberculosis Case Rates and Community and Workplace Responses

The committee’s conclusions need to be understood in context. This context includes the changing epidemiology of the disease over the past two decades, the evolution of community and institutional responses to the perceived threat of tuberculosis, and the persistence of geographic variations in community levels of tuberculosis.

Resurgent Tuberculosis, 1985–1992

Between 1985 and 1992, reported cases of tuberculosis increased by 20 percent, from 22,201 in 1985 to 26,673 in 1992. The case rate per 100,000 population increased by more than 12 percent, from 9.3 in 1985 to 10.5 in 1992. The number of deaths rose from 1,752 in 1985 to 1,970 in 1989. In the early 1980s, about 0.5 percent of new tuberculosis cases were resistant to the two major antituberculosis drugs, isoniazid and rifampin. By 1991, that figure had risen to 3.5 percent.



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