In its commentary on the proposed rule, OSHA recognizes that protective measures need to be tailored to different kinds of workplaces. To clarify the responsibilities of several kinds of employers, OSHA presents several charts outlining what the proposed rule would require. These charts cover (1) work settings where individuals with suspected or confirmed infectious tuberculosis are admitted or provided medical services; (2) work settings where early identification and transfer procedures are used for those with suspected or confirmed infectious tuberculosis; (3) employers that serve individuals who have been isolated due to suspected or confirmed tuberculosis or individuals who work in areas where air contaminated with tuberculosis likely exists; (4) home health care and home-based hospice care; (5) emergency medical services; (6) clinical and research laboratories; and (7) personnel agencies.
In facilities that rely on outside contractors to provide nursing, food service, and other kinds of workers, several different employers may share responsibilities for implementing certain protective measures. For example, a hospital may provide skin testing for its own employees while requiring each outside contractor to test contract workers. Alternatively, a contractor may be able to arrange for the hospital to provide required skin testing and other employee health services. Responsibility for some protective measures—such as the provision of isolation rooms—cannot be shared.
The specific objective of the 1997 proposed OSHA rule is to protect employees rather than patients, prisoners, visitors, or volunteers.6 The rule does not cover independent, nonemployed, nonincorporated physicians (see Chapter 3). Facilities may, however, require these physicians to certify compliance with certain measures (e.g., up-to-date skin test or successful treatment for recent infection or active disease) before they grant them privileges to see patients in the facility. Likewise, although medical, nursing, and other students are apparently not covered by the rule, the health care facilities in which they train may require that their sponsoring schools take responsibility for skin testing and certain other measures. Residents are considered employees for purposes of occupational safety and health regulation. Chapter 3 and Appendix E discuss more generally the scope of OSHA regulations.
The proposed OSHA rule would provide certain job and financial protections for employees with suspected or confirmed infectious tuberculosis that are not provided for in the CDC guidelines. These are described below in the section on administrative controls.
Depending on several factors, such as the receipt of significant in-kind compensation (e.g., free meals), a volunteer may sometimes be considered a worker for purposes of OSHA regulations (see Appendix E).