Page 56 - L:\GROUP\SDT\zip_disk\Book2.PDF

H. Inspection Scheduling and Scope

1. The evaluation of occupational exposure to TB shall be conducted in response to employee
complaints, related fatality/catastrophes, or as part of all industrial hygiene inspections
conducted in workplaces where the CDC has identified workers as having a greater
incidence of TB infection than in the general population. The degree of risk of
occupational exposure of a worker to TB will vary based on a number of factors discussed
in detail by the CDC (Appendix A, pg. 4-5). These workplaces have been the subject of
reports issued by the CDC which provide recommendations for the control of
tuberculosis. Specifically, these workplaces are as follows:

a. health care facilities
b. correctional institutions
c. long-term care facilities for the elderly
d. homeless shelters
e. drug treatment centers

Note: Health care facilities include hospitals where patients with confirmed or suspect TB are treated or to
which they are transported. Coverage of non-hospital health care settings (i.e., doctors’ offices, clinics, etc.)
includes only personnel present during the performance of high hazard procedures on suspect or active TB
patients. Dental health care personnel are covered by the directive only if they treat suspect or active
patients in a hospital or correctional facility.
1.
Homeless shelters - due to a variety of circumstances, the control of TB in homeless
shelters presents unique problems for the protection of workers. Shelters must establish
protocols that provide for rapid early identification followed by immediate transfer of
suspect cases if the shelters have elected not to treat these patients.

2. All inspections in these workplaces shall include a review of the employer’s plans for
employee TB protection, if any. Such plans may include the infection control program,
respiratory protection and skin testing. Employee interviews and site observations are an
integral part of the process evaluation.

3. Complaints received from state and local government employees who are outside federal
jurisdiction in federal enforcement states shall be referred to the appropriate agency by the
Area Office.

I. Inspection Procedures. The procedure given in the FIRM, Chapter II, shall be followed except as
modified in the following sections:

1. Health care facilities generally have internal infection control and employee health
programs. This function may be performed by a team or individual. Upon entry, the
CSHO shall request the presence of the infection control director and employee
occupational health professional responsible for occupational health hazard control.
Other individuals who will be responsible for providing records pertinent to the inspection
may include: training director, facilities engineer, director of nursing, etc.

2. The CSHO shall establish whether or not the facility has had a suspect or confirmed TB
case within the previous six (6) months from the opening conference to determine
coverage under the OSH Act. This determination may be based upon interviews and, in

48