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These OSHA regulations do not require that all employees use all possible barrier
precautions. Rather, the employer must make the determination as to which employees need to
wear gloves, which require face protection, which need impermeable gowns, etc. This is to be
done on a job-by-job or task-by-task basis. Guidelines promulgated by the CDC are similar and
also discuss or reference disposal methods for contaminated waste.[160]
Prevention of transmission of Mycobacterium tuberculosis (MTB) in health care settings
is important, particularly in view of increasing numbers of MTB cases and also increasing
incidence of multiple drug resistant MTB strains, OSHA have promulgated inspection and
enforcement criteria which are based upon Centers for Disease Control (CDC) recommendations.
First, the CDC supports use of administrative measures to reduce risk of exposure to persons
with infectious MTB through policies that insure rapid detection, isolation, evaluation, and
treatment of persons likely to have MTB. Second, the CDC recommends engineering controls in
the workplace to reduce the concentration of infective droplet nuclei. This can be achieved
through proper ventilation. Use of ultraviolet light can also aid in disinfection. Third, the CDC
supports use of personal respiratory protective equipment by health care workers when
engineering controls alone will not provide adequate protection. Such a respirator must filter
particles 1 micron in size with 95% efficiency and have a face-seal leakage of no more than 10%.
A NIOSH-certified respirator with a HEPA filter meets the CDC criteria.[1076]

High-risk settings for exposure to MTB may include:

1. Entering a room occupied by a known or suspected infectious tuberculosis patient;

2. Performing certain high hazard medical procedures such as aerosol administration of
medication, bronchoscopy, and sputum induction; and

3. Transporting patients with tuberculosis.

Institutions utilizing respirators must implement a comprehensive respiratory protection
program with written standard operating procedures, medical screening of health care workers
who will use the respirators, employee training, and equipment inspection, cleaning,
maintenance, and storage checks. Each institution must have a tuberculosis infection control
program, assign supervisory responsibility to persons with expertise in infection control, and
evaluate the risk for transmission of tuberculosis in the workplace. The risk for transmission in a
work area is assessed as low, intermediate, or high based upon the number of patients with MTB
admitted to the work area along with the number of health care workers who become PPD
positive.[1076]
Develop and display leadership in implementing infection control practices. Review
routine tasks and procedures to determine the potential risks for exposure to infectious agents. A
reasonable approach should be taken, recognizing that risks cannot be completely eliminated and
that unwieldy, complicated measures to prevent exposure are unlikely to add any additional
measure of safety. In fact, institution of additional complex procedures or use of cumbersome
equipment may increase the potential for accidents. Develop and practice the skills necessary to
safely perform tasks as a routine that never varies. The true meaning of "universal precautions"
is the safety afforded by the most minimal level of infection control in routine procedures.