Risk of infection, death from TB in health care
The Occupational Safety and Health Administration (OSHA) recently reopened the docket on its proposed tuberculosis rule to allow comment on its draft final risk assessment for occupational TB. The revised draft risk assessment includes the following key elements:
OSHA divided the data into four exposure scenarios (low, intermediate, high, and very high) to describe the potential range of risk that might be experienced by workers exposed to TB. The degree to which enhanced TB control measures reduced the risk of infection was considered as the data allowed.
The weighted average estimates of lifetime occupational risk of TB infection in hospitals are presented in chart form (See chart.) The lifetime risk of TB infection ranged from 17.5 per 1,000 workers to 431.7 per 1,000 workers, depending on the scenario for the amount of TB exposure and the TB controls in hospitals. Based on studies done at the very-high exposure hospitals — both before and after installation of enhanced TB controls — OSHA estimates that these controls can reduce the lifetime risk of infection by 46% to 92%.
The lifetime risk of developing active TB once infected is estimated at 10% with no treatment and 6.5% if a prophylactic treatment is given. (Practical difficulties with completing the six to nine month treatment course reduces its clinical effectiveness.) The case death rate from TB for health care workers is estimated at 7.8%. These percentages were applied to the lifetime infection risk estimates to derive health care worker active TB and death risks. Weighted average estimates of risk of death caused by occupationally acquired TB range from 0.1 per 1,000 for hospital workers in low-risk communities to 3.4 per 1,000 for workers in hospitals lacking enhanced controls and treating more than 100 TB patients per year.
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