Tuberculosis testing policy for home healthcare workers

OSHA archive notice: "This is an OSHA Archive Document, and may no longer represent OSHA Policy. It is presented here as historical content, for research and review purposes only."

June 3, 2002

Mr. John M. Herringer

Associate Director, Standards Interpretation

Joint Commission on Accreditation

of Healthcare Organizations

[Recipient address omitted]

Dear Mr. Herringer:

Thank you for your November 13, 2001 letter regarding two-step purified protein derivative (PPD) testing for Tuberculosis and its implementation by the home-health care industry. In particular you asked whether the two-step TB testing for new potentially exposed employees, explained in the Occupational Safety and Health Administration's (OSHA's) compliance directive, CPL 2.106, Enforcement Procedures and Scheduling for Occupational Exposure to Tuberculosis, is mandated for the home healthcare industry.

OSHA's compliance directive, CPL 2.106, Enforcement Procedures and Scheduling for Occupational Exposure to Tuberculosis focuses on the workplaces identified by the Centers for Disease Control and Prevention (CDC) as those where the risk was considered the highest. This instruction is not a "mandate," nor is it a final OSHA standard applicable to any particular segment of the health care industry. Rather, it was written as a directive to our field offices to clarify the application of the General Duty Clause when inspecting facilities identified as belonging in these high hazard groups.

The General Duty Clause is paragraph 5(a)(1) of the Occupational Safety and Health (OSH) Act of 1970. It requires each employer to, "furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious harm...."

In paragraph L.1. the directive sets forth General Duty Clause policy in regard to TB exposure, including feasible abatement methods, such as TB skin testing. (See paragraph L.1.e.2.) However, section 5(a)(1) citations are issued only, "...to employers with employees working in one of the workplaces where the CDC has identified workers as having a higher incidence of TB infection than the general population...." (See paragraph L.1.c.) Paragraph H.1. of the directive lists those workplaces as follows:

1. Health care facilities,

2. Correctional institutions,

3. Long-term care facilities for the elderly,

4. Homeless shelters, and

5. Drug treatment centers.

Home health care clearly does not fall into categories b through e. It also does not take place in "health care facilities" (category a). A "facility" is "something created to serve a particular function," e.g., "a new mental health facility" (Webster's II New College Dictionary, 1995, p.401). Thus OSHA would not cite home health care employers for not conducting TB testing.

However, the CDC's Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health Care Facilities, 1994, upon which the OSHA directive was largely based, does recommend several measures for healthcare workers who perform home health care to patients who have suspected or confirmed infectious TB.

Thank you for your interest in occupational safety and health. We hope you find this information helpful. OSHA requirements are set by statute, standards, and regulations. Our interpretation letters explain these requirements and how they apply to particular circumstances, but they cannot create additional employer obligations. This letter constitutes OSHA's interpretation of the requirements discussed. Note that our enforcement guidance may be affected by changes to OSHA rules. Also, from time to time we update our guidance in response to new information. To keep apprised of such developments, you can consult OSHA's website at http://www.osha.gov. If you have any further questions, please feel free to contact the [Office of Health Enforcement] at (202) 693-2190.

Sincerely,

Richard E. Fairfax, Director

[Directorate of Enforcement Programs]