silence on requirements imposed by other federal or state laws does not alter employers’ obligations to comply with these laws.

Record Keeping

The proposed OSHA rule includes a variety of record-keeping requirements related to employee medical records, medical surveillance, employee training, engineering controls, confidentiality, record availability and transfer, and other matters. Among other purposes, these records would assist OSHA inspectors with assessing employer compliance with regulations. Many of the record-keeping requirements are consistent with standard operating procedures in larger organizations but might require new procedures for smaller organizations.

Controls Related to Patient Management

Table 4-2 summarizes the provisions of the 1994 CDC guidelines that relate specifically to the development and application of procedures for identifying, diagnosing, and treating people with tuberculosis. Again, points of difference with the 1997 proposed OSHA rule are noted in italics.

Identification of Persons with Tuberculosis

The 1994 CDC guidelines stress the critical importance of early identification, isolation, and treatment of individuals who may have infectious tuberculosis. They recommend that institutions develop protocols for such identification based on the prevalence and characteristics of tuberculosis in the populations served by the institution (CDC, 1994b). The guidelines also list common symptoms of tuberculosis but note that the “index of suspicion” will vary depending on the characteristics of the population served.

The 1997 proposed OSHA rule would require employers to develop a written tuberculosis control plan that included procedures for the prompt identification of individuals with suspected or confirmed infectious tuberculosis. OSHA’s commentary on the proposed rule notes that procedures will likely vary for different employers. It does not discuss the prevalence of tuberculosis in the population served as a factor to be considered in developing or applying these procedures.

The CDC guidelines recommend that hospitals receive laboratory analyses of sputum smears within 24 hours. The proposed OSHA rule has no parallel requirement, and the introduction to the proposed rule does not discuss the issue.

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