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OSHA updates TB inspection procedures

July 17, 2015

By Craig Palmer

Washington – The Occupational Safety and Health Administration has updated instructions for conducting inspections and issuing citations related to employee exposures to tuberculosis in health care settings.

OSHA said the revised directive, effective June 30, 2015, does not create additional enforcement burdens for employers. "It simply updates the agency's inspection procedures with the most currently available public health guidance," the agency said.

The new instruction reflects guidance from the Centers for Disease Control and Prevention report "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health Care Settings, 2005". The CDC guidelines include recommendations to prevent the transmission of tuberculosis in dental care settings.

The CDC recommends that employers conduct evaluations of the risk for TB transmission regardless of whether patients with suspected or confirmed TB disease are expected to be encountered and classifies health care settings as low risk, medium risk or potential ongoing transmission.

The OSHA instruction establishes inspection procedures related to occupational exposure to TB in health care settings in the following circumstances:

  • In response to any valid employee complaint regarding TB exposure or in response to any valid referral regarding TB exposure from a government agency or safety and health professional.
  • In response to TB-related employee fatalities or catastrophes.
  • As part of all health inspections in facilities where the incidence of TB infection among patients/clients in the relevant facility or health care setting is greater than the incidence of TB among individuals in the most local general population for which the health department has information.

Various types of health care settings might be present in a single facility. A health care setting is defined as "any setting in which health care is delivered and workers might share air space with persons with TB disease or come in contact with clinical TB specimens. This term is broader than the term 'facility,' which refers to a building or set of buildings. Examples of health care settings are inpatient settings (e.g. patient rooms), outpatient settings (e.g. TB treatment facilities and dental clinics) and non-traditional facility-based settings (e.g. medical settings in correctional facilities)."

Four percent of the 9,582 TB cases reported in the United States in 2013 were among health care workers, the CDC said. TB case rates have been declining since 1992.

"Despite the decreasing TB case rate, however, greater progress should be made," OSHA said. "Additionally, multi-drug resistant (MDR) tuberculosis and extremely drug-resistant (XDR) tuberculosis continue to pose serious threats to workers in health care settings. OSHA will continue to enforce employers' obligations to protect affected employees against the hazards associated with TB."