Before the advent of modern medications, tuberculosis (TB) was a much-feared disease. After the discovery of tests to detect TB and drugs to treat it, TB largely became a disease of poor, third-world countries. According to the World Health Organization, there were 1.7 million deaths from TB and 9.2 million new cases diagnosed in 2006—the vast majority of which were in developing countries. However, in the 1980s in the United States, TB began a resurgence that continues with the emergence of multi-drug-resistant strains. While the incident rate in the United States is still far lower than that in most countries, TB is a real occupational health risk in healthcare facilities and correctional institutions—more than 13,000 cases of TB were diagnosed in 2006, including 408 healthcare workers and 17 correctional workers that contracted TB in an occupational setting, according to the Centers for Disease Control.

TB Infection

Caused by bacteria, TB is a contagious disease that primarily affects the lungs. Transmission is generally through droplets transported through air when an infected person coughs, speaks, or sneezes. Not everyone who becomes infected with TB gets sick (however, a person will still test positive on a TB skin test). Some people will become sick immediately after becoming infected; in others, the disease will lay dormant for an indefinite period of time and cause disease later, and a minority of people will not manifest active disease. For those whose infections lead to active disease, it is generally contagious and has symptoms that include cough, fever, chills, and weight loss. Once infected, regardless of disease state, people are treated with drugs to prevent active disease. It generally takes six months to a year of treatment to rid the body of TB.

Who Is at Risk?

Occupational risk of TB is highest for healthcare and correctional workers due to their contact with those who are most likely to manifest active TB. These include:

• people with HIV infection


• people who have been recently infected with TB (in the last two years)


• people who inject illegal drugs


• babies and young children


• the elderly


• people who were not treated correctly for TB in the past


• people with certain medical conditions such as diabetes, certain types of cancer, and those who are underweight

---

Use our sample communicable diseases policy as part of your preparedness efforts for contagious illnesses.

---

Workplace Prevention

Administrative, environmental, and respiratory protection controls can be implemented to protect workers where there is a risk of TB infection in occupational settings.

Administrative Controls

• Conduct an assessment to determine whether workers risk coming into contact with TB-infected individuals.


• If there is a risk, develop a written TB infection control plan that includes airborne precautions, methods of identifying infected persons, and handling infected workers (e.g., subsequent testing and the how and when of returning to work).


• Implement effective work practices to manage people with suspected or confirmed TB disease.


• Ensure proper cleaning and sterilization or disinfection of potentially contaminated equipment.


• Train and educate workers regarding TB, with specific focus on prevention, transmission, and symptoms.


• Screen and evaluate workers who are at risk for TB disease or who might be exposed.


• Use workplace signage advising of respiratory hygiene and cough etiquette.

Environmental Controls

When people with active TB will be regularly or constantly present in a facility, environmental controls may be appropriate. Consider taking these steps:

• Control the infection source by using local exhaust ventilation (e.g., hoods, tents, or booths) and by diluting and removing contaminated air by using general ventilation.


• Control the airflow to prevent contamination of air in areas adjacent to the source, and clean the air by using high efficiency particulate air (HEPA), filtration, or UVGI (ultraviolet germicidal irradiation).

Respiratory Protection Controls

Use of respiratory protection can further reduce workers' risk of exposure to potential TB infection. You can:

• Implement a respiratory protection program.


• Train workers on respiratory protection, including proper respirator selection (for example, surgical masks are not sufficiently protective against TB).

Conclusion

While in the United States TB is no longer the scourge it was in the past, it is a risk to workers who regularly come in contact with populations that have a higher than normal incidence of the disease, such as persons who are HIV positive, intravenous drug users, the elderly, and those who are ill with other diseases. In these settings, just as with bloodborne pathogens, employers should take steps to help protect workers from TB exposure and infection.

Laughter Isn't the Only Thing That's Contagious

Communicable diseases, whether they are contracted inside or outside the workplace, can affect your company—and few employers consider in advance what decisions will need to be made when presented with an employee (or employees) with a communicable disease. COCA's sample communicable diseases policy, which can be tailored to fit your organization's needs, will help you prepare for a flu epidemic or other outbreaks of communicable diseases that could affect your workplace.