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Archived News Release--Caution:
information may be out of date.
For more information call: (202) 219-8151
The Occupational Safety and Health Administration (OSHA)
today issued new enforcement guidance to protect workers against hazards posed
by tuberculosis (TB), including drug-resistant strains of the disease.
"OSHA has taken this action to control occupational
exposures to TB because the incidence of the disease has increased 14 percent
since 1985, reversing a 30-year downward trend," said Assistant Secretary of
Labor for OSHA, Joseph A. Dear. "Outbreaks have occurred in hospitals,
correctional institutions, nursing homes and residential care facilities for
AIDs patients. Drug-resistant strains pose an added threat.
"Twelve health care workers have died and several hundred
workers were infected and required medical treatment after workplace exposure
to TB," Dear said.
Specific control measures recommended by the Centers for
Disease Control and Prevention (CDC) and required by OSHA contributed to a drop
in the nation's TB cases in 1994 and 1995.
"But we still have to continue the fight," Dear said.
"This new compliance directive reflects the latest CDC guidelines and will help
us maintain effective control while we work toward proposing a TB standard
later this year."
The compliance directive (OSHA Instruction CPL 2.106)
supersedes a compliance memorandum issued Oct. 8, 1993. That memorandum had
been based principally on guidelines for preventing the transmission of TB in
health care settings issued by CDC in 1990. CDC revised the guidelines in
October, 1994, and the OSHA compliance directive reflects those revised
guidelines.
The directive and the CDC guidelines detail widely
recognized and accepted standards of protection employers should follow in
carrying out their responsibilities under the Occupational Safety and Health
Act.
OSHA will continue to inspect for occupational exposure to
TB in response to employee complaints, related fatalities or catastrophes, or
as part of all industrial hygiene inspections conducted in workplaces where the
CDC has identified workers as having a greater incidence of TB infection than
in the general population.
Those workplaces are as follows:
- health care facilities (Including hospitals where patients with
confirmed or suspected TB are treated or to which they have been transported.
Coverage of non-hospital health care facilities such as doctor's offices and
clinics includes only personnel present during performance of high hazard
procedures on suspect or active TB patients. Dental health care personnel are
covered by the directive only if they treat suspect or active patients in a
hospital or correctional facility.)
- correctional institutions
- long-term care facilities for the elderly
- homeless shelters (Homeless shelters must establish protocols that
provide for rapid early identification followed by immediate transfer of
suspect cases if the shelters have elected not to treat these patients.)
- drug treatment centers
The directive spells out inspection procedures as well as
steps to be taken to protect the inspecting compliance officers fr0om hazards
of exposure to TB.
It also says that employers can be cited for violations
of:
- The general duty clause of the Occupational Safety and Health Act
[Section (5)(a)(1)]. This requires the employer to furnish employment or a
place of employment free from recognized hazards likely to cause death or
serious physical harm to employees exposed to TB. (In the case of federal
facilities, Executive Order 12196, Section 1-201(a) would apply.)
- The respiratory protection standard (29 CFR 1910.134)
- The standard on accident prevention signs and tags (29 CFR 1910.145)
- The standard on access to employee exposure and medical records (29
CFR 1910.20)
- The standard on recording and reporting occupational injuries and
illnesses (29 CFR 1904)
The directive provides examples of feasible and useful
methods of abating the hazard if Section (5)(a)(1) is cited. These include
early identification of individuals with active TB, engineering controls,
medical surveillance of employees including initial examinations, periodic
evaluations and reassessments following exposures or changes in health, case
management of infected employees, and worker education and training.
The respiratory protection standard requires the employer
to provide respirators when such equipment is necessary to protect the health
of the employee.
The TB directive identifies certain circumstances where
respirators are required. Those circumstances are the same as those that were
specified in the October, 1993, compliance memorandum and that are specified in
the CDC guidelines. Respirators are required when:
- Workers enter rooms housing individuals with suspected or confirmed
infectious TB;
- Workers are present during the performance of high hazard procedures
on individuals who have suspected or confirmed infectious TB; or
- Emergency-medical-response personnel or others transport, in a closed
vehicle, an individual with suspected or confirmed TB.
The 1994 CDC guidelines specified standard performance
criteria for respiratory protection for TB. Subsequently the National Institute
for Occupational Safety and Health (NIOSH), partly in response to the CDC
criteria, issued revised certification requirements for particulate
respirators.
Based on these requirements, OSHA recognized in the
directive that the minimally acceptable level of respiratory protection is the
Type 95 respirator. The Type 95 respirator is considerably less expensive than
the high-efficiency particulate air (HEPA) respirator and is currently
available. If a facility chooses, they may continue to use HEPA respirators.
If a facility chooses to use disposable respirators, their
reuse is permitted as long as the respirator maintains its structural and
functional integrity and the filter material is not physically damaged or
soiled.
A single free copy of the directive may be obtained by
sending a self-addressed label to the U.S. Department of Labor, OSHA/OSHA
Publications, P.O. Box 37535 Washington, DC 20013-7535. Telephone (202)
219-4667, fax (202) 219-9266.
The directive is also available on the Internet World Wide
Web at http://www.osha.gov/ in the "Other Documents" section under
"Directives." It can be accessed by number (CPL 2.106) or by the date of
issuance, Feb. 9, 1996.
Archived News Release--Caution:
information may be out of date.
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