Tuberculosis exposure enforcement in health care

April 6, 1995
Gordon Moore, ARM
President
PIA III Associates, Inc.
[Recipient address omitted]
Dear Mr. Moore:
In response to your letter with questions on OSHA tuberculosis (TB) enforcement the following information is provided:
Question 1. Under what circumstances will OSHA issue a general duty clause citation for TB?
Answer: The Review commission has determined that for OSHA to issue a general duty clause violation, the compliance office must establish four factors. Once these factors have been determined then a citation under the OSHA general clause can be issued. The factors include:

a. The employer failed to keep the workplace free of a hazard to which employees were exposed.
b. The hazard was recognized by the employer or industry.
c. The hazard posed a serious injury or health risk.
d. A feasible abatement methods existed.

Citations under the general duty clause for TB exposure would be issued under the following circumstances once these four parameters were established:

1. Where the employer failed to implement a protocol for the early identification of individuals with active TB.
2. Where the employer failed to set up a medical surveillance program.
3. Where the employer failed to medically manage infected employees.
4. Where the employer failed to set up a worker education and training program.
5. Where the employer failed to institute appropriate engineering controls.

All of which is dependent upon there being employee exposure within the previous six months of an OSHA inspection. Please refer to the enclosed [OSHA Instruction CPL 02-00-106 (formerly CPL 2.106 ) Enforcement Procedures and Scheduling for Occupational Exposure to Tuberculosis] for more specific information.
Question 2. Must an employee be exposed to TB for a citation to be issued?
Answer: A facility must have had an active TB case within the previous six months for an OSHA citation to be issued. Exposure does not have to be direct. The potential for occupational exposure is enough to justify a citation.
Question 3. What protocols are required for a doctors office, nursing facility, hospital, clinic?
Answer: Please refer to the enclosed [OSHA Instruction CPL 02-00-106 (formerly CPL 2.106 ) Enforcement Procedures and Scheduling for Occupational Exposure to Tuberculosis]. Coverage of these facilities is addressed in the [directive]. If there is occupational exposure, OSHA would expect, at a minimum the facility to be incompliance with our [directive].
Question 4. Do the protocols need to be written?
Answer: Written protocols is preferred, but not required.
Question 5. Are any other written documents required for a TB program?
Answer: The compliance [directive] used by OSHA does not specifically require documentation. However, upon an OSHA inspection the employer may prefer to have written documentation of steps taken, training conducted, or medical treatment provided or offered to show compliance with the TB requirements.
Question 6. What test, if any, are required of employees?
Answer: If workers have occupational exposure to TB they would be required to have received the mantoux skin tests.
We hope that this information answers the questions that you posed. If you have further questions or need additional information please contact [the Office of Health Enforcement at (202) 693-2190].
Sincerely,
Ruth McCully, Director
[Office of Health Enforcement]
Enclosure
[This document was edited on 2/4/2004 to strike information that no longer reflects current OSHA policy. On 12/31/2003 29 CFR 1910.139 was revoked and the 1997 proposed standard on Occupational Exposure to Tuberculosis (TB) was withdrawn in the Federal Register.]

[Requester letter reproduced on OSHA page; omitted here.]