Tuberculosis exposure controls in a care facility

NOTICE: This is an OSHA Archive Document, and may no longer represent OSHA Policy. It is presented here as historical content, for research and review purposes only.

September 20, 1995
The Honorable Michael N. Castle
U.S. House of Representatives
[Recipient address omitted]
Dear Congressman Castle:
This letter is in response to your letter of August 7, on behalf of your constituent, Mr. E. Ray Quillen, regarding the implementation of the new Occupational Safety and Health Administration's (OSHA) tuberculosis (TB) regulations in October of 1995.
A proposed OSHA standard for Occupational Exposure to TB has been tentatively scheduled for publication in the federal register during the second quarter of fiscal year 1996. This is a proposed standard which, once published, will be open for a 90 day public comment period. There are no plans to release a final TB standard in October of 1995. ~~On October 8, 1993, OSHA issued a compliance memorandum for occupational exposure to TB (enclosed). This memorandum established agency wide policy for compliance and enforcement procedures for inspections involving occupational exposure to TB. This compliance memorandum is based on the 1990 Centers for Disease Control and Prevention (CDC) Guidelines for controlling TB exposure. OSHA is in the process of updating this memorandum with a compliance directive that is based upon the newer 1994 CDC Guidelines.~~
[This document was edited on 8/18/99 to strike information that no longer reflects current OSHA policy.]
The CDC and the CDC recommendations are the accepted authorities for infection control practices. The compliance procedures outlined in the October 8 memorandum emphasize CDC's specific recommendations including a hierarchy of controls (e.g., early identification, isolation, medical surveillance, personal protective equipment, and so forth). These compliance procedures are also consistent with the agency's traditional hierarchy of controls and "good industrial hygiene practice" which dictate that engineering controls be used whenever possible to eliminate and reduce the hazard at its source.
Mr. Quillen indicated in his letter that their normal procedure is to discharge a patient with TB to the hospital upon detection. This is an acceptable procedure. Under both the 1990 and 1994 CDC Guidelines the agency would expect that a facility that is not designed to treat TB patients (such as Mr. Quillen's) have procedures in place for the early evaluation and detection of patients with suspect TB. Once a suspect patient has been identified, procedures should be in place for the rapid transfer of the patient to a suitable facility designed to treat such patients. Mr. Quillen appears to be meeting these obligations.
Concerning respiratory protection, the compliance memorandum specifies that workers wear suitable approved particulate respirators under the circumstances listed below. Approved respirators include those respirators certified by the National Institute for Occupational Safety and Health (NIOSH), and include Types 100, 99, 95, and high efficiency particulate (HEPA) respirators.

1. When entering areas occupied by a confirmed or suspect TB patient.
2. When performing high risk procedures on an individual with suspect or confirmed TB,and
3. When emergency medical response personnel or others transport, in a closed vehicle, an individual with suspect or confirmed TB.

If, in Mr. Quillen's facility, staff members were to enter an area occupied by a suspect patient who was waiting for transport to another facility the agency would expect those employees to wear an approved particulate respirator for TB. Also if staff members were involved with transporting suspect TB patients, they would be expected to wear appropriate approved respiratory protection. The agency would not expect isolation rooms to be installed, nor would we expect everyone in the facility to wear HEPA respirators.
Concerning the penalty issue raised, a willful violation can have a maximum penalty of $70,000; however, these violations are only applied to those companies that display a blatant disregard for their responsibilities under the Occupational Safety and Health Act 1970 (OSH Act). Most violations related to TB have been classified as serious. The maximum penalty allowed for a serious violation currently is $7000. Realistically most serious violation penalties do not even approach that amount. During fiscal year 1994, the average assessed penalty for a serious violation throughout OSHA was approximately $780.00.
We have spoken with Mr. Randall Hair, the project director for OSHA's 7(c)(1) consultation program in Delaware, regarding Mr. Quillen's concerns. Mr. Hair has indicated that he will be trying to reach Mr. Quillen by telephone to further discuss the application of the OSHA guidelines to his workplace.
We hope that this information provides assistance to your constituent and clarifies his concerns about excess government regulations. Should you or Mr. Quillen require further information please contact Richard Fairfax in OSHA's Office of Health Compliance Assistance at (202) 219-8036. Thank you for your interest in worker health and safety.
Sincerely,
Joseph A. Dear
Assistant Secretary

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