Nosocomial TB control guidelines debated; will OSHA's proposed regulations prevail? Occupational Safety and Health Administration.

Abstract

WASHINGTON—Although the frightening resurgence of tuberculosis (TB) in the United States a decade ago has been followed by a welcome decline in incidence of infection, a debate continues about the need for regulatory measures to control the disease in hospitals and other health care facilities. While some experts see the decline as evidence that regulation is unnecessary, others say there is a need for an enforceable standard to protect health care workers and others from infection and prevent resurgence of the disease. The ongoing debate was heightened this summer with two public hearings—in April and August—held by an ad hoc committee of the Institute of Medicine (IOM), chaired by Walter Hierholzer, MD, professor emeritus of internal medicine at Yale University. The hearings were a response by the IOM to a congressional request to study to what extent health care workers are at greater risk from exposure to TB than others in the community. Congress was responding to complaints from health care institutions about proposed regulations by the Occupational Safety and Health Administration (OSHA) aimed at protecting health care workers who may be exposed to the disease. Some have described the measures as burdensome and, in light of the US decline in TB incidence, unnecessary. In the late 1980s and early 1990s, considerable alarm over the increase in nosocomial TB prompted the Centers for Disease Control and Prevention (CDC) to issue two sets of guidelines for TB control in health care facilities. The first was published in 1990, followed by an expanded and revised version in 1994 (MMWR Morb Mortal Wkly Rep. 1994;43:1-132). In 1997, in response to requests by organizations representing health care workers, OSHA issued proposed regulations that in essence would codify the CDC guidelines. The comment period has closed and OSHA is expected to issue the final notice before the end of the year.