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Tuberculosis in the Workplace
facilities might also be subject to OSHA sanctions under enforcement procedures based on the general-duty-clause of the agency’s statute (see Chapter 3 and Appendix E). In addition, health care facilities that fail to follow CDC guidance might be more vulnerable to lawsuits by patients or others who contract tuberculosis in a facility. Employees who acquire active tuberculosis (and sometimes tuberculosis infection) through occupational exposure are covered under workers’ compensation laws that preclude litigation against an employer (see Chapter 3 and Appendix E).4
Unlike some guidelines directed at health care practitioners, the 1994 CDC guidelines do not have a “sunset” provision that specifies a date after which users should not rely on the guidelines. These and similar provisions acknowledge that scientific knowledge is always advancing and that those who develop clinical practice guidelines should have a process to review and update recommendations to reflect current scientific evidence and changing circumstances (IOM, 1992; CDC, 1996a). As noted earlier, the agency recently began a reexamination of the 1994 guidelines.
PROPOSED OSHA RULE ON OCCUPATIONAL EXPOSURE TO TUBERCULOSIS
OSHA’s mission, described in Chapter 3, differs from that of CDC. In addition, its rules must meet statutory, judicial, and administrative criteria that do not apply to CDC guidelines. In developing rules, OSHA must, however, consider available guidelines, research, and other information. For example, the agency incorporated basic elements of the 1994 CDC guidelines in the 1997 proposed rule. OSHA also notes that in enforcing a final rule on tuberculosis, it would ordinarily defer to subsequently updated CDC guidelines that had provisions in conflict with the rule.
OSHA concluded that the CDC guidelines were not an enforceable alternative to the proposed rule. Nonetheless, in the commentary (preamble) on the proposed rule, the agency asks for comments on this alternative, including how “compliance and efficacy” could be determined (62 FR 201 at 54227 [October 17, 1997]).
The proposed OSHA rule also includes nonmandated guidance on certain topics. These include the writing of the required exposure control plan, the use of ultraviolet germicidal irradiation lighting systems, and
As described in Chapter 2, laboratory tests that can “fingerprint” strains of tuberculosis may help in evaluating whether the workplace is the source of tuberculosis in a patient or health care worker. Nonetheless, such testing in not always feasible, and it may not rule out exposure from a source in the community. As described elsewhere in this chapter, the proposed OSHA rule would provide certain financial protections for workers diagnosed with tuberculosis without requiring proof of its origin in the workplace.