tions—mainly hospitals—that experienced tuberculosis outbreaks and then implemented multiple control measures in a fairly short period of time.

No national data on occupational risk of tuberculosis infection are available, and data from surveys, outbreak studies, and other sources are subject to various biases. Data are especially sparse for workplaces other than hospitals. This lack of information is troubling because many of these facilities serve people at increased risk of active tuberculosis—including people who are unemployed, homeless, or poor; people with human immunodeficiency virus (HIV) infection or AIDS or substance abuse problems; and recent immigrants from countries with high rates of tuberculosis. These other workplaces may lack the resources and expertise available to hospitals to assess the risk to workers and undertake appropriate precautions. External oversight may also be more limited.

After reviewing scientific and other literature, considering discussions held during the committee’s public meetings, and drawing on its members’ experience and judgment, the committee reached several conclusions in response to the questions posed to it. Again, the committee’s charge and resources did not provide for consideration of policy options and recommendations.

Question 1: Are health care and selected other categories of workers at greater risk of infection, disease, or mortality due to tuberculosis than others in the community in which they reside?

Through at least the 1950s, health care workers were at higher risk from tuberculosis than others in the community. Currently available data suggest where tuberculosis is uncommon or where basic infection control measures are in place, the occupational risk to health care workers of tuberculosis infection now approaches the level in their community of residence. Tuberculosis risk in communities has been declining since 1993. Overall, rates of active tuberculosis among health care workers are similar overall to those reported for other employed workers. Data do not allow comparisons of mortality risk, but health care workers and others with compromised immune function are at high risk of death if they contract multidrug-resistant disease.

The primary risk to health care, correctional, and other workers now comes from patients, inmates, or clients with unsuspected, undiagnosed infectious tuberculosis. Risk is influenced by the prevalence of tuberculosis in the community that the workplace serves and by the extent and type of worker’s contact with people who have infectious tuberculosis. The available data do not allow precise quantification of the risk to health care workers or conclusions about the historical or current risk to other categories of workers covered by the 1997 proposed OSHA rule.



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