Index
A
Accreditation and licensure, 6, 53, 58, 82, 117, 140, 141
Acquired immunodeficiency disease, see HIV
Active tuberculosis, 1, 8, 13, 23, 27–28, 88–92, 95–96, 100, 109, 132, 217
see also Drug resistance;
Mortality;
Outbreaks;
Symptoms;
Transmission of disease
compared to latent disease, 25
defined, 83
diagnosis, 25, 30, 32, 33, 37–40, 156;
see also Radiographs;
Sputum smears
general population, risk assessment data, 86–88
medical students, 85
nursing students, 84
OSHA estimates, 152–153
Administrative controls, 8–9, 86, 98–99, 203
see also Isolation policies, rooms, and areas;
Record keeping;
Regulations and standards
CDC guidelines, 3, 8, 57, 63–74, 104–106, 143, 192, 230, 231, 232, 245–246, 293
CDC guidelines, implementation and effects, 108, 109–116, 120–124, 128, 129, 131, 133–134, 140, 234, 235, 238, 241, 246–250, 263–266, 301, 302
inspection of facilities, 117–119
OSHA rule/standard, 10, 59–60, 63–72, 140, 142–144, 149
outbreaks, 8, 134, 135, 136, 145, 262–263, 300, 301
regulatory burden, 10, 138, 144
Administrative Procedure Act, 280
Adolescents, 27, 87, 196, 219, 220
African Americans, see Black persons
Age factors
see also Adolescents;
Children;
Elderly persons
active tuberculosis treatment, 40
CDC guidelines, implementation and
correctional workers, 210
country comparisons, 27(n7), 92
historical perspectives, 27, 87
prevalence, 27, 87, 88, 92, 93, 98
risk assessment, 87, 88, 92, 93, 98, 192, 195, 202, 204, 213, 217, 219, 220, 223
Agency for International Development, 312
AIDS, see HIV
Airflow, see Ventilation
Ambulatory care facilities, 81, 95, 103, 121, 212
CDC guidelines, 58, 109, 129, 252
American Academy of Pediatrics, 175
American Association of Homes and Services for the Aged, 175
American Board of Emergency Medicine, 122
American College of Chest Physicians, 57
American College of Occupational Medicine, 176
American Federation of State, County and Municipal Employees, 115–116, 174
American Hospital Association, 63, 111, 175, 253
American Nurses Association, 175
American Public Health Association, 175
American Society for Microbiology, 175
American Thoracic Society (ATS), 13(n.1), 35, 57, 58, 121, 153, 176
Annual risk of infection (ARI), 193–194, 195–201, 203–205, 210, 213, 215
Aplisol, 180
Arkansas, 102
Asians/Pacific Islanders, 87, 197, 214, 215
Association of Professionals in Infection Control and Epidemiology, 63, 242, 243, 257
Atlanta, Georgia, 99, 124–126, 197, 204, 205, 206, 236–237, 247–248, 300
Attitudes, 43
complacency, 137–138
isolation of patients, psychological factors, 39–40
patient treatment preferences, 35, 144
workers, 44
Attorneys, 208
Autopsies, 26, 85, 95, 98, 149, 212
see also Medical examiners
B
Barnhart, Scott, 293–308
Bass, John, 179–188
Bathrooms in isolation rooms, 251, 257
BCG vaccination, 33, 126, 128, 130, 183, 202, 219, 220
Black persons, 87, 196, 197, 204, 210, 215, 219, 220, 244
Blueprint for Tuberculosis Vaccine Development, 311
Body weight, see Weight factors
Boostering phenomenon, 33, 185–187
Boston, Massachusetts, 211, 214
Bovine tuberculosis, 24
BCG vaccine, 33, 126, 128, 130, 183, 202, 219, 220
Britain, see United Kingdom
Bronchoscopy, 94, 95, 106, 121, 130(n.6), 131, 145, 149, 190, 201, 215, 243, 263
Bureau of Mines, 45
Bureau of Prisons, 114
Burris, J.D., 271–292
Byssinosis, 285
C
Cadavers, see Autopsies;
Funeral homes;
Medical examiners
California, 6, 15, 20, 99–100, 118–119, 175, 201, 215, 256
Canada, 130(n.6)
Case law, see Litigation
Case management, 11, 72–74, 154, 309, 310
see also Clinical practice guidelines
directly observed therapy, 17, 22, 35, 41, 82, 119, 132, 139, 153
multidisciplinary, 41
Centers for Disease Control and Prevention (CDC), 309, 310, 311, 312
active tuberculosis defined, 83
control practices, surveys, 110–115
hospital studies, 91–92, 96, 110–113, 114, 214
immigrant causing outbreak, 95–96
international collaboration, 312
latent tuberculosis defined, 13(n.1)
mortality reports, 86–91, 92, 96, 153
outbreak reports, 8, 20, 37, 91, 95–96, 119–121, 123–131, 133–136, 141, 145, 230, 231–245, 261, 262, 302
skin test demonstration project, 19, 91–92
Centers for Disease Control and Prevention (CDC) guidelines, 1, 2–4, 5–6, 8, 9, 11, 16, 43, 56–58, 72–74, 173, 177, 108–136, 293
administrative controls, 3, 8, 57, 63–74, 104–106, 143, 192, 230, 231, 232, 245–246, 293
ambulatory care, 58, 109, 129, 252
community-level factors, 9, 64, 66, 67, 69
confidentiality, 64
contract employees, 236
correctional facilities, 2–3, 19, 57, 58
see also“skin tests” infra
drug-resistant tuberculosis, 64, 66, 73
drug treatment, 35, 37, 73, 109, 234, 235, 241, 248, 302
enforcement powers lacking, 142
engineering controls, general, 3, 57, 63, 64, 65, 68, 74–76
friends of patients, 56–57
health care facilities and workers, 2–3, 4, 8, 18–21, 29, 30, 56–57, 61, 67, 69, 73, 138, 173, 190–191, 231, 232, 234;
see also specific job categories infra and supra
historical perspectives, 2–3, 4, 5–6, 8, 18–20, 43, 56, 57, 230, 231, 233–234
HIV, health care workers infected with, 28, 106
HIV patients, skin tests, 30
isolation rooms, 73–74, 75, 76, 109, 111–112, 145, 245–246
laboratory personnel, 30, 58, 112, 118
latent tuberculosis, general, 121, 153
local governments, 66, 68, 232, 310, 312
long-term care facilities, 232, 246
see also “respirators” infra
nurses, 78
OSHA rule/standard compared to, 9, 43, 56–60, 62–80, 138–146 (passim), 152–155, 252, 290
outbreaks, 8, 20, 37, 141, 145
public health, 56–57, 65, 71–72, 131, 133, 134, 310, 312
record keeping, 64, 65, 68, 72, 109
respirators, 3, 19, 20, 57, 63, 71, 76–80, 145–146, 230, 232, 293, 295, 300, 301;
see also “masks” supra
skin tests, 3, 29, 30, 33, 57(n.2), 58, 63, 64, 66, 67, 68, 69–70, 71, 142, 183, 232
transmission of disease, 64, 65, 244
worker job and financial protections, 70–71
Centers for Disease Control and Prevention (CDC) guidelines,
implementation and effects, 108– 136, 138, 139, 141, 230–270
administrative controls, 108, 109–116, 120–124, 128, 129, 131, 133–134, 140, 234, 235, 238, 241, 246–250, 263–266, 301, 302
ambulatory care, 109, 129, 252
clinical practice, 247, 255, 309, 310
community-level factors, 135, 146, 232, 236
contract employees, 236
correctional facilities, 109, 113–115, 129, 130, 132, 133, 138, 246, 259
diagnosis, general, 58, 64–65, 72–74;
see also “radiographs” and “skin tests” infra
drug-resistant tuberculosis, 109, 111, 112, 113, 115, 121, 126–127, 131, 234, 242, 250–251, 312
drug treatment, 109, 234, 235, 241, 248
emergency departments, 112, 129–130, 140, 231, 237, 250, 252, 256, 260, 262
engineering controls, general, 129–131, 134, 135, 136, 230, 232, 238–239, 245, 250–251, 257, 261, 293, 301, 302
epidemiology, 131–132, 133, 231, 236, 247, 263, 310
health care facilities and workers, 109, 110–113, 115–136, 142, 174, 230–231, 234–266;
see also specific worker categories infra and supra
historical perspectives, 108, 124, 132, 133, 135–136, 231, 251, 254, 261–262
HIV patients, 120, 121, 126–127, 129, 231, 234–239 (passim), 244–245, 246, 247, 248, 265
homeless shelters, 117, 132, 237, 241, 246
hospitals, 110–113, 114, 116–120, 123, 124–136 (passim), 140, 174, 215, 231, 233, 234–259, 261–266, 301–302
isolation rooms, 111–112, 118–133
(passim), 136, 232–262 (passim), 302;
see also negative-pressure isolation rooms” and “ventilation” infra
laboratory personnel, 112, 118
latent tuberculosis, general, 121, 153
long-term care facilities, 232, 246
masks, 111, 112, 115, 116, 119, 120, 122, 125, 126, 127, 128, 131, 133, 234, 236, 238, 242, 244, 245, 250–258 (passim);
see also “respirators” infra
negative-pressure isolation rooms, 8, 109, 112, 118, 119, 125, 127, 128, 130(n.6), 234, 236, 238, 239, 242, 243, 252, 253, 254, 256–257, 302
nurses, 111, 122, 125, 236, 240, 254, 259, 261–262, 263, 264
outbreaks, 119–121, 123–131, 133–136, 230, 231–245, 261, 262, 302
physicians, 121, 125, 232, 236, 259, 264
radiographs, 115, 124–125, 130, 234, 246, 247, 248, 249, 263, 265
record keeping, 109
respirators, 109, 113, 121, 122, 125, 127–128, 129–131, 134, 136, 145– 146, 237, 243, 245, 252, 254, 256, 301–302, 306;
see also “masks” supra
skin tests, 109, 111, 113–117 (passim), 124–130 (passim), 144–145, 232–258
(passim)
surveillance, 129, 133, 153, 236
symptoms, 64
ventilation, 75, 76, 112, 130–131, 230, 234, 241, 250–258 (passim);
see also “negative-pressure isolation rooms” supra
Chest radiographs, see Radiographs
Chicago, Illinois, 115, 131, 196, 244, 302
Children, 87, 95–96, 196, 219, 220, 257, 262
adolescents, 27, 87, 196, 219, 220
skin tests, 30
Cities, see Urban areas
Clinical practice guidelines, CDC, 18, 57, 59, 247, 255, 309, 310
see also Case management;
“guidelines” under Centers for Disease Control and Prevention
Clinical trials, 130(n.7), 221–222
latent tuberculosis, treatment, 35, 220
Colorado, 215
Community-level factors, 12, 15, 17–18, 106, 124, 135, 138, 139, 156
see also Local governments;
Urban areas
CDC guidelines, 9, 64, 66, 67, 69, 135, 146, 232, 236
definitional issues, 83–85
elderly persons, 102
health care workers vs community at large, risk, 7, 10–11, 16, 81, 83–85, 88–89, 92, 98, 105, 135, 142, 189– 191, 192, 194–199, 201, 210, 213, 216, 232, 236
immigrants, 95–96
OSHA rule/standard, 9, 10, 52, 138, 139, 142
prevalence, 7, 9, 31, 52, 64, 67, 69, 132;
see also “health care workers…” supra
Computer databases, see Databases
Confidentiality, CDC guidelines/OSHA
rule/standard, 64
DNA fingerprinting, 38, 59(n.4), 84, 99, 101, 102, 104, 204, 244
Contract employees
OSHA rule/standard, 53–54, 60, 62, 141, 208, 288–289
Control measures, see Administrative
controls;
Engineering controls;
Hierarchy of controls;
Personal
respiratory protection
Correctional facilities, 2, 81, 104, 114, 116
age of workers, 210
CDC guidelines, 2–3, 19, 57, 58
CDC guidelines, implementation and
effects, 109, 113–115, 129, 130, 132, 133, 138, 246, 259
drug-resistant tuberculosis, 121
drug treatment, 114
employees, 6, 7, 15, 81, 89–90, 95, 99– 101, 106, 107, 114–115, 209–210, 259
historical perspectives, 5, 6, 14, 15–16, 18
immigrants, detainees, 101, 121, 208
inmates, 7, 14, 15–16, 62, 89–90, 99– 101, 114, 129, 130, 209–210, 220, 222, 311
inspections of, 117–118
isolation rooms, 118, 130, 133
local governments and, 101, 114, 115
National Commission on Correctional Health Care, 58
OSHA rule/standard, 3, 53, 60, 63, 89(n.5), 138, 152
outbreaks, 99–101, 114, 121, 129, 133, 209
public health measures, 311
radiographic screening, 130
risk assessment, 81, 89–90, 95, 104, 106, 208, 209–210, 213, 215, 220, 222
skin tests, 95, 99–101, 114, 115, 117, 215, 311
state regulations, 53
urban areas, 101, 115, 209–210
Costs and cost-effectiveness, 39, 261–266
administrative controls, regulatory
control measures, general, 23, 49, 50– 51, 53, 110, 137, 140, 231, 246, 261– 266
drug treatment, 265
education of workers, 266
enforcement of state and local
government worker safety, 53
fines and penalties, 20–21, 47, 55, 274, 275, 276, 290
homeless shelters, regulation, 63
injuries in the workplace, general, 271
inspection of facilities, 117
isolation, 263–266
mortality, 50–51
radiographs, 130
regulation, general, 2, 10, 45, 63, 137, 138, 140, 142, 144, 281, 282–283, 286, 290
respiratory protection, 71, 77, 118, 145, 146–147, 262, 296, 299
skin tests, 71, 142, 144, 261–262, 263, 264, 265
standards implementation, 2, 10, 49, 50–51, 261–266
surveys, 110
Coughing, 1, 13, 25, 26, 37, 103, 131, 190, 245, 246, 259
Court cases, see Litigation
Crabtree, Jamie, 271–292
D
Daniel, Thomas, 189–229
Databases, 85, 86–92, 111, 192, 214, 233, 247, 252, 253
Death rates, see Mortality
Definitional issues, 82–85, 151
annual risk of infection (ARI), 193
community-level factors, 83–85
elimination of tuberculosis, 135(n.8)
employers and employees, 286
engineering controls, 74
incidence and prevalence, 85(n.4)
latent tuberculosis, 13(n.1), 150
material health impairment, 284
occupational exposure, 82, 83(n.1)
occupationally acquired disease, 82
outbreak, 84
Demographic factors, 84, 94, 99, 107, 128, 135, 216, 219
see also Age factors;
Epidemiology;
Geographic factors;
Immigrants;
Race/ethnicity;
Socioeconomic
status;
Urban areas
gender factors, 84(n.3), 194, 202, 204, 211, 219, 220, 244
Dental clinics and schools, 113, 232, 260–261
Department of Health and Human Services, 46–47, 313
see also Centers for Disease Control and Prevention;
National Institute for Occupational Safety and Health;
National Institutes of Health
Food and Drug Administration, 180, 183
Health Care Financing
Public Health Service, 220
Department of Labor, 20, 47, 53, 273
see also Occupational Safety and Health Administration
Federal Advisory Council on Occupational Safety and Health, 47, 273
Developing countries, 1, 6, 15, 21, 107
Mexico, immigrants from, 6, 15, 87, 89, 195, 201
Philippines, immigrants from, 6, 15, 87, 89, 195
Vietnam, immigrants from, 6, 15, 87
Zimbabwe, 15
Diagnosis, 8, 9, 12, 15, 18, 22, 24, 28–34, 140, 156, 222, 223, 310–312
see also Contact tracing;
Latent
infection;
Skin testing;
Surveillance
active tuberculosis, 25, 30, 32, 33, 37– 40, 156;
see also Radiographs;
Sputum smears
administrative controls, 8, 64, 103
CDC guidelines, 58, 64–65, 72–74, 109, 232
community-level factors, 29, 31, 38–39
DNA fingerprinting, 38, 59(n.4), 84, 99, 101, 102, 104, 204, 244
HIV patients, tuberculosis diagnosis, 29, 38(n.13), 39, 127, 221, 311
immigrants, 22, 29, 33, 38, 311
OSHA rule/standard, 29, 64–65, 68, 72–74, 144–145, 151–152
physicians role in, 29, 36, 37, 39
private sector research, 312
record keeping, 37
state government role, active
tuberculosis, 37
time factors, diagnosis, 29, 30, 33, 34, 38–39, 58, 64, 70
time factors, transfer after diagnosis, 73–74
Diet, see Nutrition
Directly observed therapy, 17, 22, 35, 41, 82, 119, 132, 139, 153
Disabled persons, see Long-term care
facilities;
Mental retardation;
Nursing homes
DNA fingerprinting, 38, 59(n.4), 84, 99, 101, 102, 104, 204, 244
Drug abuse, 7, 14, 81, 103, 211, 220–221
see also Alcohol abuse
CDC guidelines, implementation and effects, 244, 246, 252
Drug resistance, 18, 120, 138, 309, 312
CDC guidelines, implementation and effects, 109, 111, 112, 113, 115, 121, 126–127, 131, 234, 242, 250–251, 312
CDC guidelines/OSHA rule/
correctional facilities, 121
health care workers infected, 7, 89, 91–92, 96, 98, 103, 115, 201
historical perspectives, 4, 5, 6, 11, 13– 14, 15, 19, 23, 154–155, 201, 231
immigrants, 121
mortality, 28, 96, 221, 222, 223
risk assessment, 89, 91–92, 96, 98, 103, 191, 201, 209, 222, 223
surgical treatment, 18
Drug treatment, 1, 12, 17–18, 22, 24, 82, 126, 155, 186–187, 221–223, 300, 309, 310, 311, 312
see also Case management;
Vaccines
active tuberculosis, 40–42;
see also Drug resistance
adherence, 36, 41, 155, 221, 222, 311
alcohol abuse and, 35
CDC guidelines, 35, 37, 73, 109, 234, 235, 241, 248, 302
correctional facilities, 114
costs, 265
directly observed therapy, 17, 22, 35, 41, 82, 119, 132, 139, 153
historical perspectives, 40, 41, 86, 154, 179–180, 182, 199
homeless shelter workers, 58
irritation medication, 190
isoniazid, 4, 13, 35, 40, 150, 216, 220, 221, 241, 248
latent tuberculosis, 24, 34–36, 42, 57(n.2), 121, 144, 150, 152–153, 156, 216, 220, 221, 223, 241
mortality, effectiveness in reducing, 28, 40
OSHA rule/standard, 58, 73, 109, 150, 153, 154
pentamidine, 103, 126, 127, 190, 234, 235, 238, 240
pregnant women, 35
private sector research, 312
risk levels and, 35–36
side effects, 35–36, 150, 179, 222
skin tests, false positives, 32, 33
time factors, 17–18, 22, 34, 35, 36, 40–41, 143(n.1), 155, 302
Dust-mist/dust-mist-fume respirators, 119, 126, 128, 239, 243, 252, 254, 256, 257, 295, 297, 301, 304
E
see also Cost factors;
Funding;
Socioeconomic status
fines and penalties, 20–21, 47, 55, 274, 275, 276, 290
unemployed persons, 7, 15, 43–44, 89, 153–154, 222
worker job and financial protection, 70–71
Education
see also Students
health care professionals, 37, 46, 57, 62, 106, 115, 119, 125, 133, 216, 231, 232, 236, 259, 262, 266
mentally retarded persons, 209–210
OSHA, 272
patients with latent tuberculosis, 35– 36, 65, 106
workers, general, 44, 46, 54–55, 65, 109, 115, 116, 232, 262, 266, 274, 294, 304–306, 310
Elderly persons, 101–102, 208, 222, 223
see also Nursing homes
infection likelihood, 27(n7), 28
infection rates, 87
OSHA rule/standard, 61
skin tests, 30
Embalming, 26, 61, 104, 116, 212–213
Emergency departments, 95, 118, 122, 135, 260
CDC guidelines, implementation and effects, 112, 129–130, 140, 231, 237, 250, 252, 256, 260, 262
OSHA rule/standard, 60, 62, 140, 208
Ending Neglect: The Elimination of Tuberculosis in the United States, 11, 12, 21, 41, 144, 154, 155, 309–313
Endotracheal suctioning, 190
Enforcement, 4, 5, 19, 20–21, 46, 56, 59, 133, 140, 234, 274–276, 278
see also Inspection of facilities;
Litigation
CDC powers lacking, 142
fines and penalties, 20–21, 47, 55, 274, 275, 276, 290
state and local government worker
safety, cost of, 53
Engineering controls, 8–9, 110, 120, 300, 301
see also Isolation policies, rooms, and areas;
Ventilation
CDC guidelines, 3, 57, 63, 64, 65, 68, 74–76
CDC guidelines, implementation and effects, 129–131, 134, 135, 136, 230, 232, 238–239, 245, 250–251, 257, 261, 293, 301, 302
defined, 74
inspection of facilities, 117
modeling exercises and studies, 8, 130, 134, 136
OSHA rule/standard, 63, 64, 74–76
ultraviolet germicidal irradiation (UVGI), 26, 59–60, 203, 230, 232, 238, 241, 245, 250–251, 253, 258, 302, 304
Epidemiology, 4–5, 6, 10–12, 86–98, 104
see also Prevalence;
Surveillance
annual risk of infection (ARI), 193– 194, 195–201, 203–205, 210, 213, 215
CDC guidelines, implementation and effects, 131–132, 133, 231, 236, 247, 263, 310
historical perspectives, 4–5, 6, 10, 11, 12, 13, 14, 82, 87–88, 90, 131–132, 133, 138, 231
HIV and tuberculosis, 25(n.4)
respirators, 148
U.S. government surveys and
databases, 86–92
worldwide, 22
Ethnicity, see Immigrants;
Race/ethnicity
Europe, 199
BCG vaccination, 33
United Kingdom, 217
Executive Order 12866, 47, 50–51, 281, 283
Executive orders, other, 48, 53, 281
F
isolation of patients from, 39–40
OSHA mortality estimates, 153
outbreak defined, 84
skin tests, 29
visits to patients, 23, 40, 56–57, 62, 79, 208, 245, 257
Federal Advisory Council on Occupational Safety and Health, 47, 273
Federal Coal Mine Health and Safety Act, 46
Federal government, 1, 5, 12, 16–17, 18, 45, 310
see also Centers for Disease Control and Prevention;
Legislation;
National Institute for Occupational Safety and Health;
Occupational Safety and Health Administration;
Office of Technology Assessment;
Regulations and standards;
terms beginning “Executive…”
Agency for International Development, 312
Bureau of Mines, 45
Bureau of Prisons, 114
Department of Labor, 20
employees of, 52–53, 54–55, 58, 61, 288
Immigration and Naturalization Service, 21, 101, 121
Mine Safety and Health Administration, 60
OSHRC, 277
surveys and databases, 86–92, 110–115
Veterans Administration, 101, 102, 176, 246–247
Filters, see High-efficiency particulate air filters;
Masks;
Personal respiratory protection
Fines and penalties, 20–21, 47, 55, 274, 275, 276, 290
see also Litigation
Fit testing and fit, respirators, 77–79, 146– 148, 149, 293, 296, 297–299, 304–306
Florida, 6, 201, 205, 212, 215
Food and Drug Administration, 180, 183
Foreign countries, see International perspectives
Foreign origin, see Immigrants
Friends
CDC guidelines, 56–57
skin tests, 29
visits to patients, 23, 40, 56–57, 62, 79, 208, 245, 257
Funding, 5, 17, 18, 54–55, 310
community programs, 138
risk defined, 83
urban hospitals, 82
Funeral homes, 90–91, 104, 121, 212
embalming, 26, 61, 104, 116, 212–213
OSHA rule, 61
G
Gender factors, 84(n.3), 194, 202, 204, 211, 219, 220, 244
pregnant women, 35
General-duty clause, OSHA, 47, 53, 59, 108, 117, 140, 141, 252, 273, 276, 279, 280, 288
Geographic factors, 6, 14–15, 97, 99, 104– 105, 128, 135, 136, 139, 142, 183, 190, 195, 201, 202, 206–207, 310
see also Community-level factors;
Immigrants;
International perspectives;
State-level factors;
Urban areas;
specific states and countries
mail surveys, 110
rural areas, 190, 192, 195, 198, 219, 243
Government Organization and Employees
Act, 290
see also Enforcement;
Federal government;
Local governments;
Public health;
Regulations and standards;
State governments
Granulomas, see Tubercules
Gynecology, see Obstetrics and gynecology
H
Handicapped persons, see Long-term care
facilities;
Mental retardation;
Nursing homes
Harber, Philip, 293–308
Health care facilities and workers, 1, 2, 36, 39
see also Administrative controls;
Ambulatory care facilities;
Contract workers;
Emergency departments;
Engineering controls;
Home care;
Hospices;
Hospitals;
Isolation rooms and areas;
Laboratory personnel;
Long-term care facilities;
Medical
examiners;
Nursing homes;
Nursing personnel;
Personal
respiratory protection;
Risk levels and assessment;
Physicians
bronchoscopy, 94, 95, 106, 121, 130(n.6), 131, 145, 149, 190, 201, 215, 243, 263
CDC guidelines, 2–3, 4, 8, 18–21, 29, 30, 56–57, 61, 67, 69, 73, 138, 173, 190–191, 231, 232, 234
CDC guidelines, implementation and effects, 109, 110–113, 115–136, 121, 122, 125, 127–131, 142, 174, 230– 231, 234–266
committee study at hand, goals and methodology, 7, 16, 92–93, 173–174
community at large vs health care
workers, risk, 7, 10–11, 16, 81, 83– 85, 88–89, 92, 98, 105, 135, 142, 189–191, 192, 194–199, 201, 210, 213, 216, 232, 236
dental clinics and schools, 113, 232, 260–261
drug-resistant tuberculosis, 7, 89, 91– 92, 96, 98, 103, 115, 201
education, general, 44, 46, 54–55, 65, 109, 115, 116, 232, 262, 266, 274, 294, 304–306, 310
education, professionals, 37, 46, 57, 62, 106, 115, 119, 125, 133, 216, 231, 232, 236, 259, 262, 266;
see also “students” infra
historical perspectives, 2–3, 5, 7, 15, 18–20, 86, 199–200
HIV infected workers, 28, 106, 204
housekeeping staff, 98, 200, 202, 205, 206, 259
infected with tuberculosis, 1, 2, 6, 88– 91
isolation of patients;
see Isolation rooms and areas
obstetrics and gynecology, 99, 204
occupational exposure defined, 82
OSHA rule/standard, 4, 29, 59, 60, 61, 62, 69, 73, 138, 142–144, 152, 154, 173, 208, 287
psychiatric facilities, 61, 101, 220
respiratory therapists, 94, 206, 215, 259
risk assessment, 85–86, 88–99, 102, 103, 104, 105–106, 107, 142–144, 189–229
see also “community…” supra
skin tests, facilities, 30, 62, 93, 94, 102, 117, 120, 124, 125–126, 128, 129, 151–152, 186, 212, 234
skin tests, workers, 19, 29, 30, 32, 36, 91, 93, 94, 103, 115, 124–128 (passim), 192, 215, 216–218, 232– 262 (passim), 300, 301, 302, 304
students, medical, 62, 85, 99, 100, 196, 287, 216–217, 259, 287
WHO guidelines, 23
Health Care Financing Administration, 51, 118
Medicaid, 53
HEPA, see High-efficiency particulate air filters
Hepatic system, see Liver damage
Hierarchy of controls, 57, 58, 76, 129, 134, 136, 145, 148, 230, 293, 300, 302
see also Administrative controls;
Engineering controls;
Personal respiratory protection
High-efficiency particulate air filters (HEPA), 59–60, 148, 230, 236, 242, 254, 256, 257, 258, 261, 297, 301, 302, 304, 305, 306
Mexico, immigrants from, 6, 15, 87, 89, 195, 201
Puerto Ricans, 196, 197, 219, 252
Historical perspectives, 1, 4–6, 15–16, 17, 19, 23, 25, 43, 45–46, 87, 116, 120– 121, 124, 154–155
age factors in prevalence, 27, 87
CDC guidelines, 2–3, 4, 5–6, 8, 18–20, 43, 56, 57, 230, 231, 233–234
CDC guidelines, implementation and effects, 108, 124, 132, 133, 135–136, 231, 251, 254, 261–262
CDC reports of active tuberculosis, 86–87
complacency, 137–138
correctional facilities, 5, 6, 14, 15–16, 18
country comparison studies, 92
drug-resistant tuberculosis, 4, 5, 6, 11, 13–14, 15, 19, 23, 154–155, 201, 231
epidemiology of tuberculosis, 4–5, 6, 10, 11, 12, 13, 14, 82, 87–88, 90, 131–132, 133, 138, 231
health care facilities and workers, 2–3, 5, 7, 15, 18–20, 86, 199–200
inspection of facilities, 117
mortality, 4, 14, 15, 19, 106, 221–223
OSHA rule/standard, 3–4, 5–6, 7, 19, 45–47, 56, 57, 108–109, 150–151, 278
outbreaks, 1, 11, 15, 16, 82, 108, 133, 139, 141, 155, 194, 199, 202, 230, 295, 300
public health efforts, 11, 17, 23, 43, 155, 201–202, 231
prevalence, 27, 86–93, 131–132, 133, 138, 150–151
risk assessment, 82, 86–93, 105–106, 189–190, 194–200, 216–217, 219
state government role, 5, 6, 8, 17, 18
treatment regimens, 40, 41, 86, 154, 179–180, 182, 199
HIV, 5, 6, 7, 14, 15–16, 25(n.4), 28, 40, 51, 71, 139, 154–155, 156
CDC guidelines, implementation and effects, 120, 121, 126–127, 129, 231, 234–239 (passim), 244–245, 246, 247, 248, 265
diagnosis of tuberculosis, 29, 38(n.l3), 39, 127, 221, 311;
see also “skin tests” infra
health care workers infected, 28, 106, 204
latent tuberculosis treatment, 34, 35
OSHA rule/standard, 61
risk assessment, 81, 82, 88, 95, 97–98, 104, 106, 191, 201, 202, 203, 204, 207, 211, 220–221, 222
skin tests, 29, 30, 38(n.l3), 127, 311
time factors, tuberculosis infection, 239
Home care
OSHA rule/standard, 60, 62, 289
Homeless persons and shelters, 7, 14, 15, 156
CDC guidelines, 57, 58, 63, 117, 132, 237, 241, 246
cost of regulation of, 63
drug treatment of workers, 58
inspections of, 117–118
OSHA rule/standard, 3, 21, 60, 63, 117, 208
risk assessment, 81, 82, 103, 208, 210– 211, 222, 223
skin tests, 58, 103, 117, 211, 241
WHO guidelines, 23
Hospices
OSHA rule/standard, 60, 62, 208
Hospital Infection Program (CDC), 253, 254
Hospitals, 1, 2, 5, 8, 15, 39, 81, 82, 104, 116, 121
see also Emergency departments;
Isolation rooms and areas
CDC guidelines, implementation and
effects, 110–113, 114, 116–120, 123, 124–136 (passim), 140, 174, 215, 231, 233, 234–259, 261–266, 301–302
CDC studies, 91–92, 96, 110–113, 114, 214
contract employees, 53–54, 62, 141, 208, 288–289
employees infected, 5, 30, 91–92, 199– 207, 215, 234
employment duration, 126
historical perspectives, 5, 199
inspections of, 117–119, 133–134, 252
isolation of patients;
see Isolation rooms and areas
OSHA rule/standard, 53–54, 60, 73, 94–95, 138, 139, 140–156, 252, 287
outbreaks, 7, 8, 82, 91, 95, 97, 98–100, 106, 120, 123, 124–129, 131, 133, 203, 204–205, 212, 221, 234–245, 261, 301, 302
risk assessment, 52, 81, 82, 86, 93, 94– 95, 97–100, 102, 103, 104–105, 106, 199–207, 215, 222, 243
skin tests, 30, 62, 93, 94, 102, 117, 120, 124, 125–126, 128, 129, 151–152, 199–207, 215, 231–266 (passim), 300, 301, 302
socioeconomic status of employees, 126, 200, 204
state regulation, 53
Veterans Administration, 101, 102, 176
Housekeeping staff, 98, 200, 202, 205, 206, 259
Human immunodeficiency virus, see HIV
I
Illinois, 6, 115, 131, 196, 244, 302
Immigrants, 7, 11, 14, 15, 22, 121, 135, 155, 156, 311, 312
see also Developing countries;
specific groups
BCG vaccination, 33, 126, 128, 130, 183, 202, 219, 220
CDC guidelines, 11, 57, 130, 246, 261
community-level factors, 95–96
diagnosis, 22, 29, 33, 38, 311
geographic factors, 6
Mexican, 6, 15, 87, 89, 195, 201
medical school graduates, 99
OSHA rule/standard, 60
outbreak caused by family member, 95–96
prevalence, 22, 30, 192, 195, 199, 201
public health measures, 12, 22–23, 156
risk assessment, 81, 82, 87, 89, 91, 95– 96, 99, 107, 192, 195, 199, 201, 202, 204, 214, 215
Immigration and Naturalization Service, 21, 101, 121
Immune system, 26–27, 28, 40, 41, 106, 120, 191, 199, 216–220, 223, 244
see also HIV
macrophages, 26–27
skin tests and, 33, 180–183, 185
tubercules, 27
Implementation of controls, see
Administrative controls;
Engineering controls;
Hierarchy of controls;
Personal respiratory protection
Injection drug abusers, see Drug abuse
Inspection of facilities, 8, 20, 53, 55, 72, 109, 116–119, 133–134, 136, 252, 259, 288, 294
hospitals, 117–119, 133–134, 252
International perspectives, 15, 22–23, 92, 156, 312
see also Developing countries;
Immigrants
age factors in prevalence, 27(n.7), 92
BCG vaccination, 33, 126, 128, 130, 183, 202, 219, 220
Canada, 130(n.6)
control efforts, 12
funding, 310
Italy, 221
Puerto Ricans, 196, 197, 219, 252
United Kingdom, 217
World Health Organization (WHO), 22–23, 41, 195
Intubation, 190
Isolation policies, rooms, and areas, 39–40, 54, 140, 230
CDC guidelines, 73–74, 75, 76, 109, 111–112, 145, 245–246
CDC guidelines, implementation and effects, 111–112, 118–133 (passim), 136, 232–262 (passim), 302
correctional facilities, 118, 130, 133
cost factors, 263–266
nursing homes, 118
OSHA rule/standard, 73–74, 75, 76, 109, 111–112, 145, 282
psychological factors, 39–40
time factors, 73–74, 75, 76, 130(n.6), 237, 238, 246, 254
ultraviolet germicidal irradiation
(UVGI), 26, 59–60, 203, 230, 232, 238, 241, 245, 250–251, 253, 258, 302, 304
ventilation, 11, 60, 75, 76, 121, 130– 131, 199, 230, 232, 238, 250, 251, 254, 256–257;
se also Negative-pressure isolation rooms visits to patients, 23, 40, 56–57, 62, 79, 208, 245, 257
Isoniazid, 35, 40, 150, 216, 220, 221, 241, 248
Italy, 221
J
Jails, see Correctional facilities
Joint Commission on the Accreditation of Healthcare Organizations, 58, 117
K
Koch, Robert, 179
L
Laboratory personnel, 95, 98, 206
see also Sputum smears
CDC guidelines, 30, 58, 112, 118
OSHA rule/standard, 60, 62, 208
Labor Coalition to Fight TB in the Workplace, 19, 20
Labor unions, 44, 45, 117, 133, 174, 252
Latent infection, 1, 13, 22, 23, 24, 27, 42, 156, 216–218, 311
see also Skin testing
American Thoracic Society, 57(n.2), 121
CDC guidelines, 13(n.1), 57(n.2), 121, 153
compared to active disease, 25
education of patients, 35–36, 65, 106
HIV patients, treatment of latent
OSHA rule/standard, 88, 121, 152–153
pregnant patients, treatment of, 35
prevalence, 88, 152–153, 216–218, 220, 221
public health measures, 34, 35
risk assessment, 35–36
treatment, 24, 34–36, 42, 57(n.2), 121, 144, 150, 152–153, 156, 216, 220, 221, 223, 241
Legislation, 20, 69(n.7), 71–72, 281
see also Regulations and standards
Administrative Procedure Act, 280
Federal Coal Mine Health and Safety Act, 46
Government Organization and Employees Act, 290
National Environmental Policy Act, 281
Occupational Safety and Health Act, 45–48, 54, 271–292;
see also
Occupational Safety and Health Administration
Regulatory Flexibility Act, 281
Unfunded Mandates Reform Act, 50, 281, 290
Local factors, see Community-level factors;
Urban areas
Local governments, 5
CDC guidelines, 66, 68, 232, 310, 312
CDC guidelines, implementation and effects, 114, 115
correctional facilities, 101, 114, 115
employees of, OSHA rule/standard, 52, 53, 61, 141, 287
Long-term care facilities
see also Nursing homes
risk assessment, 81, 101–103, 222
skin tests, 30
Litigation, 44–52 (passim), 82, 264, 271, 276, 277–278, 280, 282, 283–286, 288, 289
see also Enforcement attorneys, 208
OSHRC, 277
Lungs, 1
see also Radiographs
infection processes, 26–27, 28
silicosis, 28
M
Macrophages, 26–27
see also Personal respiratory protection
CDC guidelines, 76, 79, 145–146, 230, 236
CDC guidelines, implementation and effects, 111, 112, 115, 116, 119, 120, 122, 125, 126, 127, 128, 131, 133, 234, 236, 238, 242, 244, 245, 250–258 (passim)
high-efficiency particulate air filters (HEPA), 59–60, 148, 230, 236, 242, 254, 256, 257, 258, 261, 297, 301, 302, 304, 305, 306
N95 respirators, 8, 77, 111, 118, 119, 125, 133, 145, 147, 148, 149, 254, 255, 295, 296, 297, 300, 301, 304, 305, 306
OSHA rule, 73, 74, 76, 78, 79, 145–146, 147, 148, 149, 282
surgical, 111, 112, 115, 120, 122, 126, 127, 128, 133, 234, 235, 238, 240, 242, 243, 245, 251–256 (passim), 296, 300, 301, 302, 304
Material impairment of health, 48–49, 50
Medicaid, 53
Medical examiners, 53, 60, 61, 208
autopsies, 26, 85, 95, 98, 149, 212
Medication, see Drug resistance;
Drug treatment
Mental health facilities, see Psychiatric facilities
Mental retardation, 209–210
Methodology, see Research methodology
Metropolitan areas, see Urban areas
Mexico, immigrants from, 6, 15, 87, 89, 195, 201
Miami, Florida, 126, 150, 198, 205, 214, 234, 261, 300
Migrant workers, CDC guidelines, 57
Military personnel, 88, 94, 95, 194, 196, 197, 205, 206, 217, 220
Veterans Administration, 101, 102, 176, 246–247
Milk, ovine tuberculosis, 24
Mine Safety and Health Administration, 60
Minority groups, see Immigrants;
Race/ethnicity
Modeling exercises and studies, 88, 123, 131, 132, 136, 151, 214, 248, 249–250
engineering controls, general, 8, 130, 134, 136
respiratory protection, 9, 145, 147, 148, 303–304
Molecular analysis, see DNA fingerprinting
Morgues, see Medical examiners
Mortality, 90, 191, 216, 221–223
CDC reports, 86–91, 92, 96, 153
cost-effectiveness of regulation, 50–51
drug-resistant tuberculosis, 28, 96, 221, 222, 223
historical perspectives, 4, 14, 15, 19, 106, 221–223
treatment absent, 28
treatment effective, 40
Multidrug-resistance, see Drug resistance
Multiple-employer workplaces, see
Contract employees
N
National Advisory Committee on Occupational Safety and Health, 46, 273
National Coalition for the Elimination of Tuberculosis, 312
National Commission on Correctional Health Care, 58
National Environmental Policy Act, 281
National Health Survey, 88, 195
National Institute for Occupational Safety and Health (NIOSH)
inspection of facilities, 118–119
research, 272–273
respirators, certification, 8, 19, 20, 46, 77, 79, 118, 119, 122, 145, 254, 295, 296–298, 298, 301, 306
National Institutes of Health, 311, 312
National Tuberculosis Controllers Association, 175
Native Americans, see American Indians
Negative-pressure isolation rooms, 8, 40(n.14), 203, 302
CDC guidelines, 8, 109, 112, 118, 119, 125, 127, 128, 130(n.6), 234, 236, 238, 239, 242, 243, 252, 253, 254, 256–257, 302
WHO guidelines, 23
Netherlands, 220
New Jersey, 6, 113, 117, 252, 255
New York City, 6, 15, 87, 91, 122, 127–128, 192, 196, 202–203, 204, 205, 206, 209, 210–211, 213, 214, 215, 220– 221, 222, 235, 237–240, 248, 250, 255–256, 260–261, 262, 301
New York State, 6, 15, 117, 118, 209, 252, 278
New York State Public Employees Federation, 175
N95 respirators, 8, 77, 111, 118, 119, 125, 133, 145, 147, 148, 149, 254, 255, 295, 296, 297, 300, 301, 304, 305, 306
NIOSH, see National Institute for Occupational Safety and Health
North Carolina, 151, 208–209, 214
Nursing homes inspections of, 117–118
isolation rooms, 118
risk assessment, 15, 101–102, 104, 208–209, 213
Nursing personnel, 23, 37, 41, 175, 303
CDC guidelines, 78
CDC guidelines, implementation and effects, 111, 122, 125, 236, 240, 254, 259, 261–262, 263, 264
risk assessment, 85, 91, 93, 98, 99, 102, 103, 104, 105, 196, 199–206
Nutrition, 223
skin test results, 33
O
Occupational Safety and Health
Administration, 1, 2, 3–4, 5, 7, 9–10, 16, 19, 20, 21, 23, 43–57, 108. 123, 133, 134, 137–154, 173, 189, 271–292
administrative controls, 10, 59–60, 63–72, 140, 142–144, 149
CDC guidelines compared to rule, 9, 43, 56–60, 62–80, 138–146 (passim), 152–155, 252, 290
community-level factors, 9, 10, 52, 138, 139, 142
confidentiality, 64
contract employees, 53–54, 60, 62, 141, 208, 288–289
correctional facilities, 3, 53, 60, 63, 89(n.5), 138, 152
see also “skin tests” infra
drug treatment, 58, 73, 109, 150, 153, 154
emergency departments, 60, 62, 140, 208
enforcement, 19, 20–21, 46, 47, 59, 116–118, 133, 140, 141, 234, 271, 272, 274–276, 280
epidemiological estimates, 10, 88
fines and penalties, 20–21, 47, 55, 274, 275, 276, 290
funeral homes, 61
general-duty clause, 47, 53, 59, 108, 117, 140, 141, 252, 273, 276, 279, 280, 288
health care workers and facilities, 4, 29, 59, 60, 61, 62, 69, 73, 138, 142–144, 152, 154, 173, 208, 287;
see also specific job categories infra and supra
historical perspectives on rule/standard, 3–4, 5–6, 7, 19, 45–47, 56, 57, 108–109, 150–151, 278
HIV patients, 61
homeless shelters, 3, 21, 60, 63, 117, 208
hospitals, 53–54, 60, 73, 94–95, 138, 139, 140–156, 252, 287
immigrants, 60
inspection of facilities, 53, 55, 72, 116–118, 252–253, 274–276, 288
isolation rooms, 73–74, 75, 76, 130(n.6), 237, 238, 246, 254;
see also “ventilation” infra
laboratory personnel, 60, 62, 208
local government employees, 52, 53, 61, 141, 287
long-term care facilities, 60, 61
masks, 73, 74, 76, 78, 79, 145–146, 147, 148, 149, 282;
see also “respirators” infra
mortality, 10, 48, 153–154, 284
outbreaks, 37, 140, 141, 151–152, 154, 208
patient management, 72–74
prevalence estimates, 27, 88, 94–95, 150–154
prevalence, OSHA rule/standard, 64, 88, 138
private sector role in rulemaking, 52, 272, 278
procedural requirements, 280–281
psychiatric facilities, 61
public health measures, 65, 71–72, 79, 138, 271, 290
record keeping, 64, 65, 68, 72, 109, 274, 276
respirators, 48, 63, 71, 76–80, 108, 117, 140, 141, 145–149, 232, 282, 293, 300–301, 306;
see also “masks” supra
skin tests, 29, 64, 68, 71, 142, 144–145, 151–152
state governments and, 52, 53, 61, 71–72, 141, 274, 278
state-level prevalence, 88, 150–151
surveillance rule/standard, 64–65, 109, 274
symptoms, 64
time factors for rule, 142, 276, 280, 281
toxic substances, 271, 274, 282, 283, 284–285
worker job and financial protections, 70–71, 138
Occupational Safety and Health Review Commission, 47
Office of Technology Assessment, 20
Oklahoma, 100
Oregon, 215
Organ transplants renal, 95
skin tests, 30
OSHA, see Occupational Safety and Health Act;
Occupational Safety and Health Administration
OSHRC, 277
Outbreaks, 7, 9, 23, 68, 84, 95–104, 105, 123–131, 190, 192
administrative controls, 8, 134, 135, 136, 145, 262–263, 300, 301
CDC guidelines and, 8, 20, 37, 91, 119–121, 123–131, 133–136, 141, 145, 230, 231–245, 261, 262, 302
community-related exposure, 84, 155
correctional facilities, 99–101, 121, 129, 133, 209
defined, 84
engineering controls, 8–9, 134, 136, 145, 300
historical perspectives, 1, 11, 15, 16, 82, 108, 133, 139, 141, 155, 194, 199, 202, 230, 295, 300
homeless shelters, 82, 95, 103, 211
hospitals, 7, 8, 82, 91, 95, 97, 98–100, 106, 120, 123, 124–129, 131, 133, 203, 204–205, 212, 221, 234–245, 261, 301, 302
immigrant causing, 95–96
long-term care settings, 95, 101–103, 208
OSHA actions, 37, 140, 141, 151–152, 154, 208
research methodology, 96–97, 105, 119–120
shipboard, 221
Outpatient treatment, see Ambulatory care
Outsourcing, see Contract employees
P
Pacific Islanders, see Asians/Pacific Islanders
Patient education, see Education Penalties, see Fines and penalties
Pentamidine, 103, 126, 127, 190, 234, 235, 238, 240
Personal respiratory protection, 8, 9, 177, 293–308
see also Masks
American Thoracic Society, 57
CDC guidelines, 3, 19, 20, 57, 63, 71, 76–80, 145–146, 230, 232, 293, 295, 300, 301
CDC guidelines, implementation and effects, 109, 113, 121, 122, 125, 127–128, 129–131, 134, 136, 145–146, 237, 243, 245, 252, 254, 256, 301–302, 306
cost factors, 71, 77, 118, 145, 146–147, 262, 296, 299
disposable, 131, 295, 299, 301, 304;
see also “N95 respirators” infra
dust-mist/dust-mist-fume respirators, 119, 126, 128, 239, 243, 252, 254, 256, 257, 295, 297, 301, 304
epidemiology and, 148
fit testing and fit, 77–79, 146–148, 149, 293, 296, 297–299, 304–306
high-efficiency particulate air filters, 59–60, 148, 230, 236, 242, 254, 256, 257, 258, 261, 297, 301, 302, 304, 305, 306
inspection of facilities, 117–118, 119
modeling exercises and studies, 9, 145, 147, 148, 303–304
NIOSH certification, 8, 19, 20, 46, 77, 79, 118, 119, 122, 145, 254, 295, 296–298, 298, 301, 306
N95 respirators, 8, 77, 111, 118, 119, 125, 133, 145, 147, 148, 149, 254, 255, 295, 296, 297, 300, 301, 304, 305, 306
OSHA rule/standard, 48, 63, 71, 76– 80, 108, 117, 140, 141, 145–149, 232, 282, 293, 300–301, 306
positive-pressure supplied air
respirators, 295, 296, 304, 305
powered air-purifying respirators (PAPR), 76, 145, 295, 296, 304, 305
risk assessment, 294, 300, 304
time factors, 124, 146–147, 304
Pharmaceuticals, see Drug resistance;
Drug treatment
Physicians
CDC guidelines, implementation and effects, 121, 125, 232, 236, 259, 264
correctional facilities, 95, 99–101
hospital, rule protecting physicians in, 54
OSHA rule/standard, 61, 62, 289
risk assessment, 95, 98, 99–101, 105, 204, 206, 215, 217
Political factors, 21, 123(n.4)
Positive-pressure supplied air respirators, 295, 296, 304, 305
Poverty, see Socioeconomic status
Powered air-purifying respirators (PAPR), 76, 145, 295, 296, 304, 305
Pregnancy latent tuberculosis treatment, 35
Prevalence, 7, 9, 27(n.7), 107, 131–132, 138, 140, 191, 192, 194–223 (passim)
see also Risk levels and assessment;
Surveillance
age factors, 27, 87, 88, 92, 93, 98
annual risk of infection (ARI), 193–194, 195–201, 203–205, 210, 213, 215
CDC reports, 86–92, 96, 152, 153
community-level factors, 7, 9, 31, 52, 64, 67, 69, 132
correctional facilities, 89–90, 152, 215
defined, 85(n.4)
elimination of tuberculosis, defined, 135(n.8)
historical perspectives, 27, 86–93, 131–132, 133, 138, 150–151
immigrants, 22, 30, 192, 195, 199, 201
latent tuberculosis, 88, 152–153, 216–218, 220, 221
OSHA estimates, 27, 88, 94–95, 150–154
OSHA rule/standard, 64, 88, 138
skin tests and, 30, 31, 144, 183, 184–185, 199–207
state-level, OSHA estimates, 88, 150–151
Prisons, see Correctional facilities
Privacy, see Confidentiality
Private sector, 6, 44, 54–55, 108
diagnosis and treatment research, 312
OSHA rule/standard, 52, 272, 278
Professional education, see Education
Psychiatric facilities, 101, 220
OSHA rule/standard, 61
Psychological factors, see Attitudes
Public health, 1, 12, 21–23, 24, 45, 82, 83, 86, 154, 309, 310
see also Case management;
Community-level factors;
Contact
tracing;
Outbreak investigations;
Surveillance
CDC guidelines, 56–57, 65, 71–72, 131, 133, 134, 310, 312
CDC guidelines, implementation and effects, 231, 232, 256
correctional inmates, 311
historical perspectives, 11, 17, 23, 43, 155, 201–202, 231
latent tuberculosis treatment, 34, 35
milk, 25
OSHA rule/standard, 65, 71–72, 79, 138, 271, 290
skin tests, 32
Public Health Service, 220
Public Law 91–596, see Occupational Health and Safety Act
Puerto Ricans, 196, 197, 219, 252
Q
Quarantine, see Isolation policies, rooms, and areas
R
Race/ethnicity, 87, 88, 90–91, 93, 99, 107, 128, 130, 192, 194, 196–198, 200, 204, 206–207, 214, 220, 244
see also Immigrants
black persons, 87, 196, 197, 204, 210, 215, 219, 220, 244
Puerto Ricans, 196, 197, 219, 252
white persons, 87, 88, 91, 194, 196–197, 198, 200, 215, 219, 220
Radiographs, 25, 30, 37, 38, 39, 83, 86, 95, 98, 102, 311
CDC guidelines, implementation and effects, 115, 124–125, 130, 234, 246, 247, 248, 249, 263, 265
correctional facilities, 130
cost factors, 130
Record keeping, 37
see also Surveillance
CDC guidelines, 64, 65, 68, 72, 109
OSHA rule/standard, 64, 65, 68, 72, 109, 274, 276
skin test results, 29
Regulations and standards, 1, 2, 3–4, 5–6, 7, 9, 16, 43–55, 108, 109, 118, 137–156, 309–310
see also Centers for Disease Control and Prevention (CDC) guidelines;
Centers for Disease Control and
Prevention (CDC) guidelines,
implementation and effects;
Definitional issues;
Enforcement;
Inspection of facilities;
Occupational Safety and Health
Administration;
State governments
accreditation and licensure, 6, 53, 58, 82, 117, 140, 141
American College of Chest Physicians, 57
American Thoracic Society (ATS), 57, 58, 121, 153, 176
cost and cost-effectiveness,
regulations, 2, 10, 45, 63, 137, 138, 140, 142, 144, 281, 282–283, 286, 290
cost and cost-effectiveness,
standards, 2, 10, 49, 50–51, 261–266
Executive Order 12866, 47, 50–51, 281, 283
Executive orders, other, 48, 53, 281
exemptions, 4, 53, 64, 287, 289
litigation, 44–52 (passim), 82, 264, 271, 276, 277–278, 280, 282, 283–286, 288, 289
National Advisory Committee on Occupational Safety and Health, 46, 273
National Commission on Correctional Health Care, 58
NIOSH certification of respirators, 8, 19, 20, 46, 77, 79, 118, 119, 122, 145, 254, 295, 296–298, 301, 306
respirators, general, 294
treatment, directly observed therapy, 17, 22, 35, 41, 82, 119, 132, 139, 153
treatment observation, state requirements, 41
tuberculin as cure, 180
voluntary standards, 9–10, 54–55, 57, 58, 108, 121, 138, 276
WHO guidelines, 23
Regulatory Flexibility Act, 281
Renal system, see Kidneys
Research methodology, 7, 46, 92–93, 248
see also Epidemiology;
Risk levels and assessment
annual risk of infection (ARI), 193–194
committee study at hand, goals and methodology, 2, 7–9, 16–17, 173–178, 189, 191
controlled studies, 6–7, 20, 122–124
databases, 85, 86–92, 111, 192, 214, 233, 247, 252, 253
literature review, 192–194, 233
mail surveys, 110
OSHA, 272–273
outbreak reports, 96–97, 105, 119–120
Resistance, see Drug resistance
Respirators, see Personal respiratory protection
Respiratory isolation, see Administrative controls;
Centers for Disease
Control and Prevention (CDC) guidelines;
Isolation policies, rooms, and areas
Respiratory therapists, 94, 206, 215, 259
Risk factors, see Risk levels and assessment
Risk levels and assessment, 2, 81–107, 189–229
see also Demographic factors;
Inspection of facilities;
Prevalence;
Surveillance
age factors, 87, 88, 92, 93, 98, 192, 195, 202, 204, 213, 217, 219, 220, 223
annual risk of infection (ARI), 193–194, 195–201, 203–205, 210, 213, 215
CDC guidelines, 2, 64, 66–69, 143, 190–191, 192, 232, 244, 246, 261
community at large vs health care workers, risk, 7, 10–11, 16, 81, 83–85, 88–89, 92, 98, 105, 135, 142, 189–191, 192, 194–199, 201, 210, 213, 216, 232, 236
correctional facilities, 81, 89–90, 95, 104, 106, 208, 209–210, 213, 215, 220, 222
definition of risk, 82–83, 193
drug-resistant tuberculosis, 89, 91–92, 96, 98, 103, 191, 201, 209, 222, 223
health care workers, 85–86, 88–99, 102, 103, 104, 105–106, 107, 142–144, 189–229
see also “community..." supra
HIV patients, 81, 82, 88, 95, 97–98, 104, 106, 191, 201, 202, 203, 204, 207, 211, 220–221, 222
homeless shelters, 81, 82, 103, 208, 210–211, 222, 223
hospitals, 52, 81, 82, 86, 93, 94–95, 97–100, 102, 103, 104–105, 106, 199–207, 215, 222, 243
immigrants, 81, 82, 87, 89, 91, 95–96, 99, 107, 192, 195, 199, 201, 202, 204, 214, 215
latent tuberculosis treatment, 35–36
long-term care facilities, 81, 101–103, 222
nurses, 85, 91, 93, 98, 99, 102, 103, 104, 105, 196, 199–206 (passim), 215, 217, 218
nursing homes, 15, 101–102, 104, 208– 209, 213
OSHA rule/standard, 2, 48–50, 52, 64, 66, 68–69, 88, 94–95, 139, 142–144, 148–154, 189, 208, 213–214, 275, 284–286
physicians, 95, 98, 99–101, 105, 204, 206, 215, 217
respiratory therapists, 94, 206, 215, 259
time factors, 68, 151(n.5), 192, 203, 216, 219, 220, 221, 254
urban areas, 82, 106, 195, 196, 197, 199–200, 201, 202–207, 213, 214, 219
ventilation, 190, 199, 212, 213, 221
Rural areas, 190, 192, 195, 198, 219, 243
S
San Francisco, California, 6, 15, 87, 198, 215, 221
Seattle, Washington, 35, 198, 211, 241, 293
Side effects, drug treatment, 35–36, 150, 179, 222
Skin testing, 22, 23, 25, 28–34, 36, 38(n.13), 93, 156, 180, 186–187, 195, 218–219, 311
accuracy, 30–34, 39, 83, 94, 144, 182– 187, 221
active tuberculosis, 32, 33, 84(n.2)
American Thoracic Society, 57(n.2)
boostering phenomenon, 33, 185–187
CDC demonstration project, 19, 91–92
CDC guidelines, 3, 29, 30, 33, 57(n.2), 58, 63, 64, 66, 67, 68, 69–70, 71, 142, 183, 232
CDC guidelines, implementation and effects, 109, 111, 113–117 (passim), 124–130 (passim), 144–145, 232–258
(passim)
children, 30
community-level factors, 29, 31
correctional facilities, 95, 99–101, 114, 115, 117, 215, 311
cost factors, 71, 142, 144, 261–262, 263, 264, 265
dental schools, 113
elderly persons, 30
Food and Drug Administration, 180, 183
friends of patients, 29
funeral home employees, 61, 116
health care facilities, implementation, 30, 62, 93, 94, 102, 117, 120, 124, 125–126, 128, 129, 151–152, 186, 212, 234
health care workers, 19, 29, 30, 32, 36, 91, 93, 94, 103, 115, 124–128
(passim), 192, 215, 216–218, 232–262
historical perspectives, 179–180, 181
HIV patients, 29, 30, 38(n.13), 127, 311
homeless shelters, 58, 103, 117, 211, 241
hospitals, 30, 62, 93, 94, 102, 117, 120, 124, 125–126, 128, 129, 151–152, 199–207, 215, 231–266 (passim), 300, 301, 302
immune response and, 33, 180–183, 185;
see also “HIV patients” supra
infection with tuberculosis defined, 83
long-term care facilities, 30
National Health Survey, 88, 195
nursing homes, 30, 117, 208–209
nutritional factors, 33
organ transplants and, 30
OSHA rule/standard, 29, 64, 68, 71, 142, 144–145, 151–152
prevalence and, 30, 31, 144, 183, 184– 185, 199–207
public health measures, 32
reading outcomes, 181–182
record keeping, 29
risk assessment, 83, 84(n.2), 88, 91–92, 93–94, 98–99, 102, 107, 194–196, 199–201, 202–207, 209, 211, 212–221
social stigma due to positive, 32, 144
state-level factors, general, 93, 113
students, 62
surveillance and, 29, 33, 34, 83, 144
time factors, 29, 30, 33, 34, 38(n.13), 58, 64, 70, 115, 126, 181, 185–186, 203, 235, 236, 255, 258, 304
vaccines, effects on, 33
see also Community-level factors;
Contact tracing;
Family members;
Friends
positive skin tests causing stigma, 32, 144
Social service workers, 115–116
OSHA rule/standard, 60, 61, 208
risk assessment, 98
Society for Healthcare Epidemiology of
America, 112, 176, 242, 243, 253, 302
Society for Occupational and Environmental Health, 239
Socioeconomic status, 81, 85, 91, 93, 107
see also Homeless persons and shelters
hospital personnel, 126, 200, 204
unemployed persons, 7, 15, 43–44, 89, 153–154, 222
South Carolina, 129
Spear, Robert, 293–308
Sputum smears, 25, 37, 38, 41, 72, 73, 112, 124, 125, 126, 234–240 (passim), 246, 247, 248–249, 256, 258, 263, 264, 265
risk assessment, 83, 98, 103, 190, 194, 195, 201, 210
Standards, see Regulations and standards
State governments, 20, 45–46, 117, 140, 309, 310, 312
accreditation and licensure, 6, 53, 82, 140, 141
control programs, general, 8, 17, 18, 69(n.7), 109
correctional facilities, 53
diagnosis of active tuberculosis, 37
employees of, OSHA rule/standard, 52, 53, 61, 141, 274, 278, 287
funding, 55
historical perspectives, 5, 6, 8, 17, 18
hospitals, regulation of, 53
inspection of facilities, 118–119, 274
legislation, 45–46, 69(n.7), 71–72
OSHA, 52, 53, 61, 71–72, 141, 274, 278
private sector role in rulemaking, 53, 278
public health authorities, CDC
guidelines/OSHA rule/standard, 71–72
treatment observation, 41
worker training, 274
State-level factors, 6, 14–15, 99(n.7), 132, 155, 215
see also specific states
CDC reports of active disease, 86–87
correctional facilities, 100–101, 114, 209
OSHA estimates of prevalence, 88, 150–151
St. Louis, Missouri, 198, 205, 206, 250, 266
Stop TB Initiative, 312
Strategic Plan for Tuberculosis Training and Education, 310
Streptomycin, 40
Students
medical, 62, 85, 99, 100, 196, 287, 216–217, 259, 287
Substance abuse, see Drug abuse
Surgical masks, 111, 112, 115, 120, 122, 126, 127, 128, 133, 234, 235, 238, 240, 242, 243, 245, 251–256
(passim), 296, 300, 301, 302, 304
Surgical treatment, 18, 79–80, 95
Surveillance, 11, 81, 86–93, 107, 110–116, 216–219
see also Diagnosis;
Mortality;
Prevalence;
Record keeping
CDC guidelines, implementation and effects, 129, 133, 153, 236
correctional facilities, 114
federal government surveys and databases, 86–92, 110–115
nursing homes, 102
OSHA rule/standard, 64–65, 109, 274
skin tests, 29, 33, 34, 83, 144
Symptoms, 37–39, 118, 135, 136, 155, 221, 245
CDC definition of active tuberculosis, 83
coughing, 1, 13, 25, 26, 37, 103, 131, 190, 245, 246, 259
OSHA rule/standard, 64
T
Tennessee, 100
Testing, see Diagnosis;
Skin testing;
Sputum smears
Time factors
autopsies, 98
committee study at hand, 137, 173
correctional facility, length of stay, 115
diagnosed patients, transfer from health care facilities, 73–74
diagnosis, 29, 30, 33, 34, 38–39, 58, 64, 70
drug treatment, 17–18, 22, 34, 35, 36, 40–41, 143(n.l), 155, 302
elimination of tuberculosis, defined, 135(n.8)
emergency department stays, 118
exposure and infection, 26, 98
health care facilities, admission
standards, 4
HIV patients, infection with tuberculosis, 239
hospital employment duration, 126
isolation and isolation rooms, 73–74, 75, 76, 130(n.6), 237, 238, 246, 254
OSHA rule/standard, 142, 276, 280, 281
research methodology, 7, 137, 192
respiratory protection, 124, 146–147, 304
risk assessment, 68, 151 (n.5), 192, 203, 216, 219, 220, 221, 254
skin tests, 29, 30, 33, 34, 38(n.13), 58, 64, 70, 115, 126, 181, 185–186, 203, 235, 236, 255, 258, 304
worker benefits following severance, 71
Toilet facilities, see Bathrooms in isolation
rooms
Toxic substances, 57(n.2)
drug toxicity, 222
OSHA, 271, 274, 282, 283, 284–285
Transmission of disease, 25–26, 103, 177, 259
see also Risk levels and assessment
coughing, 1, 13, 25, 26, 37, 103, 131, 190, 245, 246, 259
health care worker knowledge of, 112
milk, 24
skin test conversion rates and, 186–187
Transplants, organs, see Organ transplants
Treatment, see Drug treatment;
Surgical treatment
Tubercules, 27
Tuberculin skin test, see Skin testing
Tubersol, 180
U
Ultraviolet germicidal irradiation (UVGI), 26, 59–60, 203, 230, 232, 238, 241, 245, 250–251, 253, 258, 302, 304
Unemployed persons, 7, 15, 43–44, 89, 153–154, 222
see also Homeless persons and shelters
worker job and financial protections, 70–71
Unfunded Mandates Reform Act, 50, 281, 290
Unions, see Labor unions
United Kingdom, 217
Urban areas, 5, 6, 15, 17, 82, 106, 119, 234, 243, 248
see also Homeless persons and shelters;
specific cities
CDC reports of active disease, 86–87
correctional facilities, 101, 115, 209–210
risk assessment, 82, 106, 195, 196, 197, 199–200, 201, 202–207, 213, 214, 219
UVGI, see Ultraviolet germicidal
irradiation
V
Vaccines, 12, 22, 155, 311, 312
BCG, 33, 126, 128, 130, 183, 202, 219, 220
skin tests and, 33
Ventilation, 11, 23, 26, 103, 125, 304
CDC guidelines, 75, 76, 112, 130–131, 230, 234, 241, 250–258 (passim)
isolation rooms, 11, 60, 75, 76, 121, 130–131, 199, 230, 232, 238, 250, 251, 254, 256–257;
see also
Negative-pressure isolation rooms
nursing homes, 208
OSHA rule/standard, 60, 75, 76
risk assessment, 190, 199, 212, 213, 221
Veterans Administration, 101, 102, 176, 246–247
Vietnam, immigrants from, 6, 15, 87
Virgin Islands, 252
Visitors of patients, 23, 40, 56–57, 62, 79, 208, 245, 257
Voluntary standards, 9–10, 54–55, 57, 58, 108, 121, 138, 276
see also Centers for Disease Control and Prevention (CDC) guidelines;
Centers for Disease Control and Prevention (CDC) guidelines,
implementation and effects
WHO guidelines, 23
W
Washington State, 151, 200–201, 208, 214
Weight factors, 28, 37, 245, 265
fit testing, respirators, 298
White persons, 87, 88, 91, 194, 196–197, 198, 200, 215, 219, 220
Woeltje, Keith, 230–270
Workplace hazards, strategies for
reducing, 43–45
World Health Organization (WHO), 22–23, 41, 195
Wyoming, 15
X
X-ray detection, see Radiographs
Z
Zimbabwe, 15