Tuberculosis enforcement policy in health care

NOTICE: This is an OSHA Archive Document, and may no longer represent OSHA Policy. It is presented here as historical content, for research and review purposes only.

March 23, 1995

The Honorable Jesse Helms
United States Senate
[Recipient address omitted]
Dear Senator Helms:

Thank you for your letter of February 9, on behalf of your constituent, Dr. James A. McQueen, MD. Dr. McQueen wrote to you in regards to Occupational Safety and Health Administration (OSHA) Tuberculosis (TB) regulations he believed were effective January 1.

In Dr. McQueen's letter he provided copies of several documents related to tuberculosis. These documents were not prepared nor issued by OSHA. OSHA has not promulgated regulations pertaining to tuberculosis. The material supplied by Dr. McQueen apparently was written by two physicians from Duke University and covers TB control in healthcare settings. The questionnaire and the drug treatment regime mentioned in Dr. Purcell's letter and provided in his enclosure are not OSHA requirements. OSHA's current inspection procedures are based on a compliance memorandum issued October 8, 1993 (enclosure). The enforcement guidelines from that memorandum follow the 1990 Centers for Disease Control and Prevention (CDC) Guidelines for TB. The provisions of the compliance memorandum would not become effective until there was an actual exposure case at a facility.

On October 28, 1994, the CDC issued their revised guidelines for Tuberculosis. Under these guidelines the recommendations apply primarily to inpatient health care facilities including hospitals, medical wards in correctional facilities, nursing homes, and hospices. The guidelines also include recommendations that apply to ambulatory care facilities, emergency departments, home health care settings, emergency medical services, medical offices, and dental settings. These guidelines are currently being reviewed by OSHA for the development of a compliance directive to replace the October 8 compliance memorandum.

Although the compliance memorandum is an enforcement policy, and not a regulation, OSHA has been petitioned by five different unions to develop a standard. OSHA is proceeding with rulemaking. When a proposed regulation is published in the Federal Register comments from the public will be solicited. Docket #H-371 has been opened for this purpose.

We hope that this letter addresses your concerns, if you have any further questions please do not hesitate to contact Richard Fairfax in the Office of Health Compliance Assistance at (202) 219-8036.

Sincerely,
Joseph A. Dear
Assistant Secretary

Enclosure

[Congressional and constituent correspondence reproduced on OSHA page; omitted here.]