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Appendix A, pgs. 36-37) Training should be repeated as needed.

Workers shall be trained to recognize, and report to a designated person,
any patients or clients with symptoms suggestive of infectious TB and
instructed on the post exposure protocols to be followed in the event of an
exposure incident. (see Appendix A, pg. 23)

5. Engineering Controls. The use of each control measure must be based on
its ability to abate the hazard.

a. Individuals with suspected or confirmed infectious TB disease must
be placed in a respiratory acid-fast bacilli (AFB) isolation room.
High hazard procedures on individuals with suspected or
confirmed infectious TB disease must be performed in AFB
treatment rooms, AFB isolation rooms, booths, and/or hoods. AFB
isolation refers to a negative pressure room or an area that exhausts
room air directly outside or through HEPA filters if recirculation is
unavoidable.
b. Isolation and treatment rooms in use by individuals with suspected
or confirmed infectious TB disease shall be kept under negative
pressure to induce airflow into the room from all surrounding
areas (e.g., corridors, ceiling plenums, plumbing chases, etc.). (See
Appendix A, Supplement No. 3, page 76)

Note: The employer must assure that AFB isolation rooms are
maintained under negative pressure. At a minimum, the employer
must use nonirritating smoke trails or some other indicator to
demonstrate that direction of airflow is from the corridor into the
isolation/treatment room with the door closed. If an anteroom
exists, direction of airflow must be demonstrated at the inner door
between the isolation/treatment room and the anteroom. (See
Appendix B)

c. Air exhausted from AFB isolation or treatment rooms must be
safely exhausted directly outside and not recirculated into the
general ventilation system. (See Appendix A, Supplement No. 3,
page 87).

In circumstances where recirculation is unavoidable, HEPA filters
must be installed in the duct system from the room to the general
ventilation system. (See Appendix A, Supplement No. 3, page 82).
For these HEPA filters, a regularly scheduled monitoring program
to demonstrate as-installed effectiveness should include; 1)
recognized field test method, 2) acceptance criteria, and 3) testing
frequencies (see Appendix A, Supplement No. 3, page 85). The air
handling system should be appropriately marked with a TB
warning where maintenance personnel would have access to the
duct work, fans, or filters for maintenance or repair activities.

d. In order to avoid leakage, all potentially contaminated air which is

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