OSHA Inspection: U.S. VETERANS ADMINISTRATION HOSPITAL

Issued

Jul 2, 1993

Abate by

Sep 30, 1993

General-duty citation text

Section 5(a)(1) of the Occupational Safety and Health Act of 1970:  The
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employer did not furnish employment and a place of employment which
were free from recognized hazards that were causing or likely to cause
death or serious physical harm to employees in that employees were
exposed to the hazard of being infected with Mycobacterium tuberculosis
through contact with patients determined by the Centers for Disease
Control (CDC) to be at high risk for tuberculosis:
Mantoux skin testing was not provided at intervals
as recommended by the most current Centers for
Disease Control (CDC) guidelines.
-The hospital did not ensure that employees received
pre-employment ppd skin tests.
-The hospital did not ensure that annual skin testing
was done for general health care workers.
Among other methods, the feasible and acceptable method to correct
this hazard, as recommended by the CDC guidelines, is to perform
Mantoux tuberculin skin tests on ppd negative healthcare workers to
identify persons whose skin tests convert to positive. The frequency
of the tests must be in accordance with current CDC guidelines.
The Centers for Disease Control have determined that an effective
tuberculosis control program contains, as a minimum, the following
elements.
1. Early identification and preventative treatment of persons who
have tuberculosis infection and are at high risk for active
tuberculosis.
2. Early identification and treatment of persons with active
tuberculosis.
3. Preventive of the spread of infectious droplet nuclei using
source-control methods such as local exhaust ventilation.
4. Reduction of microbial contamination in the air using methods
such as general ventilation, taking into consideration recommended
dilution factors, air mixing, HEPA filtration, and direction of
air flow.
Rooms occupied by TB or suspected TB patients must be under
negative pressure exhausted to the outside and away from intake
vents.
5. Provision of particulate respirators to healthcare workers
exposed to tuberculosis because of contact with patients at risk
for tuberculosis. The particulate respirator must be designed to
filter out particles 1-5 microns in diameter. As a minimum, a
NIOSH approved dust, mist and fume respirator must be used.
6. Provision of training to employees on the hazard and control
of tuberculosis. The training must include the epidemiology,
transmission and pathogenesis of tuberculosis.
Reference: CDC MMWR December 7, 1990/Vol. 39. Guidelines for
Preventing the Transmission of Tuberculosis in Health Care Settings,
with Special Focus on HIV Related Issues.

Issued

Jul 2, 1993

Abate by

Jul 8, 1993