Tuberculosis: is a serious bacterial disease that most often affects the lungs and can be fatal.

How TB is spread: Tuberculosis is transmitted through the air (airborne) by microscopic droplets of saliva or sputum containing the TB bacteria. TB can only be spread by individuals with active tuberculosis disease!

Who is a risk at work: AFSCME members who work in hospitals and other health care facilities, prisons, homeless shelters, mental health institutions, social services are most likely to come into contact with people that are contagious.

Prevention: An exposure control plan to promptly identify and isolate individuals that are or might be contagious in an area with special ventilation. Signs must be posted to entrances to isolation areas and workers who enter must follow airborne isolation precautions, and wear respiratory protection. Worker training should include signs and symptoms of TB, how TB is spread, prevention measures, and treatment.

WHAT IS TUBERCULOSIS?

Tuberculosis (TB) is a bacterial disease that can affect several parts of the body. The most common form of TB disease is pulmonary (lung) tuberculosis, which can cause severe damage to the lungs, disability, and death. The symptoms include fever, fatigue, night sweats and dramatic weight loss. Coughing up blood, severe chest pain and hoarseness appear in the later stages of the disease.

Most people have mild symptoms or none at all when they are infected. Tuberculosis bacteria can lie "dormant" (without symptoms) for many years after the original infection. Unless the infection is treated, about 10% of the people who become infected with tuberculosis will develop active tuberculosis disease at some point in their lives.

Tuberculosis is transmitted through the air (airborne) by microscopic droplets of saliva or sputum containing the TB bacteria. Individuals with active TB disease spread infectious droplets by coughing, sneezing, singing or just talking. These droplets can be inhaled by anyone in the area. The bacteria can survive in moist or dried sputum for up to six weeks, but TB is killed by sunlight or ultraviolet light (UV) in a few hours.

WHAT IS DRUG-RESISTANT TUBERCULOSIS?

Multi-drug resistant tuberculosis (MDR-TB) refers to TB cases that are difficult to treat with available drugs. MDR-TB has developed as the result of TB patients that did not complete their treatment with TB medications. The bacteria that survived developed a resistance to the drugs. MDR-TB poses a serious threat, particularly to people that have weakened immune systems, such as persons with AIDS or patients taking drugs to treat cancer.

WHO IS AT RISK?

TB poses a risk to workers that are exposed to patient, inmates, clients and others with active disease. The disease spreads more easily in crowded living settings, and is made worse by poor ventilation. AFSCME members who work in hospitals, long term care facilities for the elderly and other health care facilities, prisons, homeless shelters, mental health institutions, social services are most likely to come into contact with people who have an infectious case of TB. Workers that are present during autopsies also face an increased risk of exposure.

WHAT TEST IS USED TO IDENTIFY TB INFECTION?

The tuberculin skin test (TST) is used to identify individuals that have been infected with tuberculosis. The test is performed by injecting a small amount of purified protein derivative (PPD) under the skin, and must be read between 48 and 72 hours after the injection. Infected individuals will have a "positive" test, which means they will develop a small swollen area where the injection was given. A positive skin test by itself does not mean that a person has tuberculosis disease. Additional tests performed as part of a medical examination must be performed to make a diagnosis for TB disease.

WHAT CAN BE DONE TO PREVENT THE SPREAD OF TUBERCULOSIS?

The following steps to prevent worker exposure to tuberculosis are based on the Occupational Safety and Health Administration's (OSHA) proposed standard on TB and guidelines from the Centers for Disease Control and Prevention (CDC) for the prevention of tuberculosis in hospitals, prisons, and other settings.

• Exposure Control Plan: Identifies workers that are exposed to TB and which tasks or procedures can cause exposure. The risk assessment includes finding out the number of TB cases that are in the community being served, or are likely to enter a facility from other jurisdictions. Health departments keep track of TB case rates.
• Prompt Identification of Confirmed and Suspected Cases: Screening programs to identify contagious individuals in hospitals, long-term care facilities, prisons, and other institutions. Identification of TB cases is made through medical examinations, skin tests, and laboratory tests.
• Prompt Isolation of Confirmed and Suspected Cases: Move patients, inmates or others that have a known case of active TB or have symptoms that might be caused by TB to an isolation room.
• Engineering Controls: Removing or decreasing the number of infectious bacteria in the air reduces the spread of TB. The most important method is ventilation. Isolation rooms must be under "negative pressure" to prevent contaminated air from leaving the room. The airflow in the isolation room should be able to fill the room with clean air at least six times per hour.

• Warning signs: Posting a sign reading "AFB Isolation Precautions" at the entrance to a room or area where there is TB patient.
• Restricting Access to Isolation Rooms: Limiting the number of staff allowed to enter isolation rooms. For example, staff that must be in the isolation room to provide care can also bring in food trays, rather than exposing dietary staff. All staff that may have to enter the patient's room including housekeeping staff must be trained on and follow airborne isolation precautions.
• Performing "High Hazard" Procedures in Isolation: Engineering controls are used to capture infectious droplets that are released by patients during "high hazard" medical procedures. High hazard procedures include bronchoscopy, sputum induction, and endotracheal intubation or suctioning. An autopsy is another example of a high hazard procedure that requires precautions to prevent exposure.
• Treating TB Cases: Medication usually reduces the amount of infectious bacteria in the sputum within a few weeks, unless the type of TB is a drug-resistant strain.
• Respiratory Protection: Wearing a respirator that is certified by the National Institute for Occupational Safety and Health (NIOSH) to prevent breathing in TB bacteria when staff enter a TB isolation room or have contact with a patient. At a minimum, workers should be fit tested and wear an N-95 disposable respirator when entering an isolation room. Workers who are present for high hazard procedures such as bronchoscopy or autopsy need a more protective respirator, such as a half or full-face respirator with disposable particulate filter cartridges, or a powered air-purifying respirator (PAPR).

WHAT LAWS ARE THERE TO PROTECT WORKERS?

The Occupational Safety and Health Administration is working on, but has yet to issue a regulation to protect workers from occupational exposure to tuberculosis. OSHA has the authority to require employers to implement steps to protect workers from TB under the "General Duty" Clause of the Occupational Safety and Health Act. The General Duty requires that "...every employer covered under the Act must furnish to his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees."

February 2001