risk to be about 0.15 percent per year. (OSHA’s risk assessment is reviewed in Chapter 7.)

A few reports focus on correctional facilities. A 1994–1995 survey of correctional facilities noted that many responding facilities could not report skin test conversions because skin testing for employees was done by private physicians and the results were not communicated and entered into employee records (NIJ, 1996). A later survey found that more than half of state and federal prison systems and more than a third of the jail systems failed to report conversion data (NIJ, 1999).

At the Cook County Jail in Chicago, the facility began offering tuberculin skin testing to health care workers (mandatory) and correctional officers (voluntary) in 1994 (McAuley, 2000). Health care staff at the jail have documented 24 known exposure episodes involving workers and have concluded that these were associated with 10 documented and 30 possible skin test conversions, none of which involved health care workers. The test results for correction officers did not differ by the area of the facility in which they worked.

Outbreak Reports

This section reviews information from published reports of workplace outbreaks of tuberculosis. Most reports of outbreaks have involved units of hospitals including inpatient medical wards (general medical, HIV, infectious disease, and renal transplant units), surgical suites, emergency departments, laboratories, intensive care units, an autopsy room, radiology suites, an inpatient hospice, outpatient clinics, and bronchoscopy rooms (see Dooley and Tapper [1997], Garrett et al. [1999], and Appendix D).

Probable cases of workplace transmission of tuberculosis have also been reported in prisons and jails (Campbell et al., 1993; Pelletier et al., 1993; Prendergast et al., 1999; Bergmire-Sweat et al., 1996; Jones et al., 1999), a freestanding primary care clinic (Howell et al., 1989), long-term-care facilities (Stead, 1981; Munger et al., 1983; Stead et al., 1985; Brennen et al., 1988 [and possibly Steimke et al., 1994]), a residential HIV infection treatment facility (Hoch and Wilcox, 1991), homeless shelters (Nolan et al., 1991; Curtis et al., 2000; Moss et al., 2000), public health laboratories (Kao et al., 1997), a medical examiner’s office (Ussery et al., 1995), and a funeral home (Sterling et al., 2000a). In addition, outbreaks have been reported in settings where occupational exposure is not anticipated, including naval vessels and airplanes (DiStasio and Trump, 1990; Aguado et al., 1996).

Low-prevalence communities are not immune from outbreaks. For example, CDC investigators recently reported an outbreak in North Dakota. It involved a child from the Marshall Islands who transmitted M.

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