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Gary Evans writes Hospital Infection Control & Prevention (HIC), Hospital Employee Health (HEH) and contributes to IRB Advisor (IRB). As senior writer at AHC, Evans has written numerous articles on infectious disease threats to both patients and health care workers, including pandemic influenza, MERS and Ebola. He has been honored for excellence in analytical reporting five times by the National Press Club in Washington, DC.
The Occupational Safety and Health Administration – which lost an epic battle with the infection control community to adopt a separate tuberculosis standard more than a decade ago – has decided to put TB back on its radar and update compliance requirements for healthcare settings.
An OSHA directive issued July 13 essentially incorporates the Centers for Disease Control and Prevention’s 2005 TB guidelines,1 replacing the 1994 CDC version the agency had heretofore been using. As part of this, OSHA adopts the CDC’s TB risk classifications for healthcare settings: low, medium, and potential ongoing transmission.
“The employer’s decisions concerning medical surveillance should be based on up-to-date risk assessments,” the OSHA directive states. “In low risk settings, annual screening is not necessary; however, if an exposure to a person with, or specimen containing, TB occurs, the employer should provide screening and update the risk assessment in accord with the 2005 CDC Guidelines. In medium risk settings, screening should be provided at least every year. In settings where there is the potential for ongoing transmission, workers should be tested every 8–10 weeks until a determination is made that there is no more ongoing transmission. At that point, the setting should be reclassified as medium risk, and should remain at that classification (at a minimum) for at least one year.”
Other changes in the new directive include inspecting additional healthcare settings, which run the gamut from emergency medical services to dental offices. Most hospital infection preventionists should already have their programs in line with the 2005 CDC guidelines, says Patti Grant, RN, BSN, MS, CIC, Director of Infection Prevention/Quality at Methodist Hospital for Surgery in Addison, TX.
“IP’s traditionally are solid when it comes to treating a CDC/HICPAC guidance as a roadmap for patient, employee, and visitor protection,” she says. “Although OSHA is strictly employee safety driven, most IP’s will take any CDC/HICPAC peer-reviewed, full-publication referenced document, and give it the respect and implementation it deserves.”
That said, Grant raises the “worrisome” question of whether OSHA has essentially established a TB standard without the requisite public comment period on a draft version published in the Federal Register.
Indeed, one could take the view that OSHA is adding compliance demands in the absence of evidence of increased risk of occupational transmission of TB in healthcare settings.
“I am dismayed with this and feel it is another round of unnecessary new compliance expectations,” says Ruth Carrico, PhD, FSHEA, RN, CIC, a former IP who is now an infectious disease professor at the University of Louisville. “There are so many ways to better use the limited resources we have in our efforts to prevent transmission of infection.”
Even in issuing the rule, OSHA conceded that 2013 saw the lowest recorded TB rate (3 cases per 100,000 people) since national reporting began in 1953.
“In 2013, 9,582 TB cases were reported in the United States, and approximately 383 of those cases were among healthcare workers,” OSHA states. “Multi-drug-resistant and extremely drug-resistant TB continue to pose serious threats to workers in healthcare settings. [TB] is the second most common cause of death from infectious disease in the world after HIV/AIDS.”
1. Centers for Disease Control and Prevention. Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Health-Care Settings, 2005 MMWR 2005;54:No. RR-17:http://www.cdc.gov/mmwr/pdf/rr/rr5417.pdf