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OCR for page 173
Tuberculosis in the Workplace
A
Study Origins and Activities
In November 1999, the U.S. Congress directed the Secretary of Health and Human Services to contract with the National Academy of Sciences (NAS) for a study of the Occupational Safety and Health Administration’s (OSHA’s) rule making related to occupational exposure to tuberculosis (P.L. 106–113, Conference Report 196–749). The report was requested within 14 months of the legislation. The study was neither to delay issuing of the final rule nor to be delayed pending the rule’s publication. (OSHA released the standard after the committee completed its work.)
The agreement between the U.S. Department of Health and Human Services (DHHS) and the Institute of Medicine (IOM; the health policy arm of NAS) allowed the study to began officially on April 1, 2000. To undertake the requested study, the IOM appointed an 11-member committee of experts that met in April, August, and September 2000.
The legislative conference language listed three sets of questions. First, are health care workers at a greater risk of infection, disease, and mortality due to tuberculosis than individuals in the general community within which they reside? If so, what is the excess risk due to occupational exposure? Second, can the occupationally acquired risk be quantified for different work environments, different job classifications, etc., as a result of implementation of the 1994 guidelines of the Centers for Disease Control and Prevention (CDC) for the prevention of tuberculosis transmission at the work site or the implementation of specific parts of the CDC guidelines? Third, what effect will the implementation of OSHA’s proposed tuberculosis standard have on minimizing or eliminating the risk of infection, disease, and mortality due to tuberculosis?
OCR for page 174
Tuberculosis in the Workplace
For clarity in presenting its analysis, the committee slightly edited the questions as follows. (1) Are health care and selected other categories of workers at greater risk of infection, disease, and mortality due to tuberculosis than others in the community within which they reside? If so, what is the excess risk due to occupational exposure? Can the risk be quantified for different work environments and different job classifications? (2) What is known about the implementation and effects of CDC guidelines to control worker exposure to tuberculosis in hospitals, correctional facilities, and other work settings? (3) Given what is known about the CDC guidelines, what will be the likely effects on tuberculosis infection, disease, or mortality of an OSHA rule to protect workers from occupational exposure to tuberculosis?
Although the revised questions broadened the scope of the committee’s work beyond health care workers, most of the information identified by the committee focused on health care workers, mainly hospital employees. The committee arranged for five background papers that appear as Appendixes B, C, D, E, and G in this report. It also conducted a 1-day workshop and a half-day public meeting to solicit oral and written statements from interested organizations. Both these meetings were open to the public. The agendas are listed below.
INSTITUTE OF MEDICINE COMMITTEE ON REGULATING OCCUPATIONAL EXPOSURE TO TUBERCULOSIS
Public Meeting Lecture Room, National Academy of Sciences 2101 Constitution Avenue NW, Washington, DC. Monday, August 7, 2000
AGENDA
1:00 pm
Welcome and Overview of Meeting
Walter Hierholzer, M.D., Committee Chair
1:10
Panel 1
Service Employees International Union, AFL-CIO
William Borwegen, M.P.H.
Occupational Health and Safety Director
American Federation of State, County, and Municipal Employees
James August, M.P.H.
Assistant Director for Research and Health Services
OCR for page 175
Tuberculosis in the Workplace
American Nurses Association
Karen A.Worthington, M.S., R.N., COHN-S
Senior Occupational Safety and Health Nurse Specialist
New York State Public Employees Federation
Jonathan Rosen, M.S., C.I.H.
Director, Occupational Safety and Health Department
2:00
Panel 2
American Hospital Association
Roslyne D.W.Schulman, M.H.A., M.B.A.
Senior Associate Director, Policy Development
Gina Pugliese, R.N., M.S.
Director, Premier Safety Institute
American Association of Homes and Services for the Aged
Linda Bunning, R.N., N.H.A.
Director of Residential Services, Presbyterian Homes, Inc.
American Academy of Pediatrics
Jeffrey R.Starke, M.D.
Member, AAP Committee on Infectious Diseases
Baylor College of Medicine
American Public Health Association Occupational Health and Safety Section
Melissa A.Mc Diarmid, M.D., M.P.H.
Professor of Medicine
Director, Occupational Health Project, University of Maryland
3:00
Break
3:20
Panel 3
National Tuberculosis Controllers Association
Betty L.Gore, R.N., M.S.N., C.I.C.
Nurse Consultant, Tuberculosis Control Program
South Carolina Department of Health and Environment
California Department of Health
Robert Harrison, M.D.
California Department of Health Services
Chief, Occupational Health Surveillance and Evaluation Program
American Society for Microbiology
Mary Gilchrist, Ph.D.
Director, University Hygienic Laboratory, University of Iowa
Cook County Department of Corrections
James McAuley, M.D.
Medical Director, Cermak Health Services
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Tuberculosis in the Workplace
4:10
Panel 4
Veterans Administration
Gary Roselle, M.D.
National Program Director for Infectious Diseases
Chief, Medical Services, Cincinnati VA Medical Center
American College of Occupational Medicine
John Balbus, M.D.
Center for Risk Science and Public Health, George Washington
University Medical Center
American Thoracic Society
Edward Nardell, M.D.
Associate Professor of Medicine, Harvard Medical School
Tuberculosis Control Officer, Massachusetts Department of
Health
Society for Healthcare Epidemiology of America
Patrick Brennan, M.D.
Hospital Epidemiologist, University of Pennsylvania
Association for Professionals in Infection Control
Rachel Stricof, M.T., M.P.H.
Epidemiologist, New York State Department of Health
5:10
Public Comment Period
Adjourn
INSTITUTE OF MEDICINE WORKSHOP ON REGULATING OCCUPATIONAL EXPOSURE TO TUBERCULOSIS
Lecture Room, National Academy of Sciences 2101 Constitution Avenue NW, Washington, DC. Tuesday, August 8, 2000
AGENDA
8:30 am
Welcome, Workshop Objectives
Walter Hierholzer, M.D., Committee Chair
Professor Emeritus of Internal Medicine, Infectious Diseases
and Epidemiology, Yale University
8:40–9:40
Occupational Exposure to Tuberculosis: Evidence Review
Thomas Daniel, M.D.
Professor Emeritus of Medicine and International Health
Case Western Reserve University
Discussant:
George Comstock, M.D., Dr. P.H.
Professor of Epidemiology
Johns Hopkins University
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Tuberculosis in the Workplace
9:40–10:40
Strengths and Limitations of Tuberculin Skin Testing:
Evidence Review
John Bass, Jr., M.D.
Chair, Department of Medicine
University of South Alabama
Discussant:
C.Fordham von Reyn
Professor of Medicine
Section Chief, Infectious Disease Section
Dartmouth, Hitchcock Medical Center
10:40–11:00
Break
11:00–12:15
Personal Respirators and Tuberculosis Control: Evidence
Review
Phillip Harber, M.D.
Professor, Department of Family Medicine
Chief, Occupational and Environmental Medicine
University of California, Los Angeles
Discussants:
Lisa Brosseau, Ph.D.
Associate Professor, Division of Environmental &
Occupational Health, University of Minnesota
Barry Farr, M.D.
Professor of Internal Medicine, University of Virginia
12:15pm
Lunch in Refectory (tickets in meeting folder)
1:30–3:30
1994 CDC Guidelines: Preventing Transmission of
Tuberculosis in Health-Care Facilities
Effects of the CDC Guidelines: Evidence Review
Keith Woeltje, M.D., Ph.D.
Assistant Professor, Section of Infectious Diseases,
Department of Medicine, Medical College of Georgia
Lessons Learned at the CDC
Amy Curtis, Ph.D.
Epidemiologist, CDC Division of TB Elimination
and
Lisa Panlilio, M.D.
Medical Epidemiologist, CDC Hospital Infections Program
Discussants:
Gina Pugliese, R.N.
Director, Premier Safety Institute, Premier Health System
James August, M.P.H.
Assistant Director for Research and Health
American Federation of State, County, and Municipal
Employees
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Tuberculosis in the Workplace
3:30–3:50
Break
3:50–4:30
Ethical Issues in Regulating Workplace Exposure to TB
Ronald Bayer, Ph.D.
Professor of Public Health, Columbia University
4:30
Public Comment and Continued Discussion
5:00
Adjourn
Representative terms from entire chapter:
occupational health