OSHA looking to issue TB standard this fall

TB exposure control plans expected to be required

The Occupational Safety and Health Administration in Washington, DC, is nearing completion of its tuberculosis standard and expects to issue a proposed rule this fall after an extensive review process that will include cost estimates for hospital compliance, officials report.

"We are nearing the review process by the Department of Labor and then the Office of Management and Budget," says Susan Harwood, director of the office of risk assessment in the OSHA health standards program. "Since it has to do with health care, I'm sure they will want to look at it real carefully. I doubt it will be expedited."

The cost of compliance will likely remain an issue when the standard is open to public comment, as the economics of TB infection control have characterized the debate over measures such as respirators and isolation rooms. Under the edicts of the Occupational Safety and Health Act, the standard "has to be economically feasible," and thus the proposed rule will include an estimated cost of compliance for hospitals and other facilities that will be regulated.

Harwood would not comment specifically on the proposed requirements while the standard is under development, but noted, "There is no tremendous departure from the CDC [TB] guidelines -- they are really basic to it."1

A draft version of the standard under development obtained by Hospital Infection Control includes several requirements for identifying workers at risk and developing a TB exposure control plan in clinical settings. Though the standard remains under revision, a few key tenets of the draft are summarized here to give infection control professionals a preview of the standard that is expected to be issued this fall:

Exposure control plan: The employer must identify those employees who may have occupational exposure to TB at their work setting. The use of respiratory protection should not be considered when making this determination. In addition to making an exposure determination, the employer must also develop a written exposure control plan. This plan is to be made accessible to employees and is to be reviewed at least annually, or whenever necessary to reflect new or modified tasks, procedures, or engineering controls that affect occupational exposure. The exposure control plan shall contain at least the following elements:

* procedures and criteria for the prompt identification of individuals with suspected or confirmed infectious TB;

* procedures for informing employees about individuals who have been identified as having suspected or confirmed infectious TB;

* procedures for isolating and managing the care of individuals with suspected or confirmed infectious TB, or for referring those individuals to facilities with appropriate isolation facilities;

* procedures for reporting exposure incidents;

* a list of all high-hazard procedures performed in the workplace;

* a written schedule for the inspection, maintenance, and performance monitoring of engineering controls;

* a determination from the laboratory director as to whether the laboratory should operate at biosafety level 2 or 3 containment;

* policies and procedures to address delaying elective transport or relocation of individuals with suspected or confirmed infectious TB within the facility, masking individuals with suspected or confirmed infectious TB, minimizing employee traffic into isolation rooms or areas, minimizing the number of employees and the time spent in isolation rooms or areas, delaying elective high-hazard procedures until individuals with suspected or confirmed infectious TB are determined to be noninfectious, and minimizing the time individuals with suspected or confirmed infectious TB remain outside of an isolation room or area.

Reference

1. Centers for Disease Control and Prevention. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health care facilities, 1994. MMWR 1994; 43(No. RR-13): 1-133. *