OSHA Issues Revised Instruction for Inspectors Related to TB Exposures
July 17, 2015 02:49 PM
The Occupation Safety and Health Administration (OSHA) has issued Instructions for general enforcement policies and procedures to be followed when conducting inspections and issuing citations related to occupational exposure to tuberculosis (TB). The Instruction reflects guidance from the updated Centers for Disease Control and Prevention (CDC) report: “Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005.
In the document, OSHA reviews the background and current state of TB surveillance and control in the United States:
“Since 1953, with the cooperation of state and local health departments, the CDC has collected information on newly-reported cases of TB in the United States. According to the CDC, a resurgence of TB in the mid-1980s was marked by several years of increasing case counts. The number of reported TB cases peaked in 1992. Case counts began decreasing again in 1993, and 2013 marked the twenty-first year of decline in the total number of TB cases reported in the United States since the peak of the resurgence. In total, 9,582 TB cases were reported in the United States in 2013, and approximately 4% of those cases were among healthcare workers (CDC Fact Sheet, Trends in Tuberculosis, 2013). This represents a rate of 3.0 cases per 100,000 persons, the lowest recorded rate since national reporting began in 1953.”
Despite the decreasing TB case rate, however, greater progress should be made. Additionally, multi-drug-resistant (MDR) tuberculosis and extremely drug resistant (XDR) tuberculosis continue to pose serious threats to workers in healthcare settings. OSHA will continue to enforce employers’ obligations to protect affected employees against the hazards associated with TB.”
OSHA defines a “healthcare setting” as any setting in which healthcare is delivered and workers might share air space with persons with the TB disease or come in contact with clinical TB specimens.
The Instructions provide guidelines as to when the OSHA inspector are to conduct inspections of health care settings related to occupational exposure to TB. Inspections are to occur 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 healthcare setting is greater than the incidence of TB among individuals in the most local general population for which the health department has information.
Hospice facilities are grouped as long term care within in the “nontraditional facility-based settings” and would be subject to the same inspection protocols as a long-term care facility.
Home health care, which would include home hospice, is recognized as a type of health care setting subject to OSHA inspection for occupational TB exposures. However, the document separates this setting from inpatient and outpatient settings and limits inspections to an evaluation of the employer’s TB Control program and employee interviews.
Agencies may want to review the CDC’s Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005 to ensure they have an effective TB control program in place.
To view the OSHA Instructions click here.