OSHA proposes TB standard for 5.3 million workers
December 1, 1997 4 minutes read
OSHA proposes TB standard for 5.3 million workers
The long-awaited tuberculosis standard has been formally proposed, and it could mean occupational health programs have an opportunity to market a new service to employers of the 5.3 million workers covered by the new rule.
The proposed TB standard was released recently by the federal Occupational Safety and Health Administration (OSHA) in Washington, DC. It covers an estimated 5.3 million workers in more than 100,000 hospitals, homeless shelters, long-term care facilities, detention facilities, some laboratories, and other work settings with a high risk of TB infection. Many of those employers are health care providers themselves and so would not employ the services of an outside occupational health program, but for others such as detention facilities, the employer will need an occupational health provider to administer the required program.
They will need the service of an occupational health provider because the federal rule requires an extensive TB prevention and surveillance program. The standard comes on the heels of revised TB guidelines from the federal Centers for Disease Control and Prevention in Atlanta, which has expressed concern over the recent upsurge in TB cases and increasingly drug-resistant strains of the disease.
OSHA’s proposal incorporates the basic elements of the revised CDC recommendations, such as written exposure control plans, procedures for early identification of individuals with suspected or confirmed infectious TB, procedures for investigating employee skin test conversions and employee education and training. The major difference between the CDC guidelines and the proposed OSHA TB standard is that OSHA has the authority to enforce the standard.
The proposal incorporates basic infection control provisions designed to reduce occupational risks for exposed workers. Employers would be required to develop a written exposure control plan and identify and isolate anyone with suspected or confirmed infectious TB. The standard also would require the installation of engineering controls in some facilities, such as negative pressure isolation rooms or areas that would reduce or eliminate employee exposure. Other provisions call for tuberculin skin testing, hazard communication, training, and record keeping.
Under some specific conditions, the TB standard would require respiratory protection. That represents another opportunity for occupational health programs to manage the respirator program.
OSHA first began working on a TB standard in August 1993, after a resurgence in active TB cases nationwide and a call for action by labor unions. As an interim measure, OSHA issued nationwide enforcement procedures in October 1993 for certain work settings. The agency announced in January 1994 that it was working on a wide-ranging standard. The agency is now accepting comments on the proposed standard before making it final.
More than 5 million workers in about 100,000 establishments would be covered by the standard. OSHA estimates that the cost for implementing the standard in each establishment will average $2,400. The agency predicts that the standard would prevent at least 70% and up to 90% of work-related TB infections. More than 130 lives would be saved every year if the standard is implemented, OSHA says.
The number of infections would drop by about 25,000 infections per year and save employers between $89 million and $116 million in medical costs, lost production, and disability costs.
Kolavic SA, Kimura A, Simons SL, et al. An outbreak of Shigella dysenteriae type 2 among laboratory workers due to intentional food contamination. JAMA 1997; 278:396-398.
Outbreaks associated with Shigella dysenteriae type 2, also known as Schmitz bacillus, are uncommon in the United States. The last reported U.S. outbreak occurred among cafeteria workers in a Maryland medical center in 1983. The present report describes a maliciously perpetrated outbreak among 12 laboratory workers at a large Texas medical center from Oct. 29-Nov. 1, 1996.
The workers experienced severe gastrointestinal illness after eating commercially prepared muffins and doughnuts anonymously left in their break room. When stool cultures revealed S. dysenteriae, an investigation was launched.
Investigators interviewed 45 lab employees who recalled that during the night and morning shift change on Oct. 29, an unsigned e-mail from a supervisor's computer appeared on laboratory computer screens inviting workers to eat pastries in the break room. The break room cannot be accessed without entering a numerical security code.
Workers who ate the pastries reported diarrhea with fever, headache, or vomiting. Diarrhea began between 9 p.m., Oct. 29 and 4 a.m., Nov. 1. The mean incubation period until onset was 25 hours and was preceded by nausea, abdominal discomfort, and bloating. Five workers were treated in emergency departments; four others were hospitalized. Eight received intravenous fluids. Eleven were treated with ciprofloxacin, and one received a homeopathic medication. No deaths occurred. The attack rate was 100%. All 12 who ate pastries became ill. A family member of one worker also became ill after eating a muffin that was brought home. Investigation of the laboratory's storage freezer showed the reference culture of S. dysenteriae type 2 had been disturbed. The pathogen was isolated in virtually pure culture from Shigella broth enrichment cultures of the muffin specimen.
The researchers concluded that the organism's source was most likely the medical center's stock culture. No cases of S. dysenteriae type 2 had been diagnosed in the hospital lab for the past five years. A laboratory error therefore seemed unlikely as the cause of the outbreak.
Prompt contact with all area emergency departments and infectious disease physicians revealed no additional cases were reported; therefore, pastry contamination during commercial handling also was unlikely. No concurrent outbreaks were reported in Texas or any other state.
A criminal investigation is ongoing. Security measures have been implemented, including securing the laboratory freezer and replacing stock culture labels that identified microorganisms by name with a numerical identification system.
"To our knowledge, this is the first reported intentional contamination of food items with S. dysenteriae type 2," the authors state. "Bioterrorism through food contamination with microorganisms rarely is reported in the scientific literature. . . . The results of this investigation underscore the biological threat that accompanies malicious use of pathogenic microbiologic agents."
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