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occupational exposure to TB, the Area Office shall refer it to the state plan designee for
action.

2. When a complaint or inquiry regarding occupational exposure to TB in a state or local
government health care facility is received in a state without an OSHA-approved state
plan, the Regional Administrator shall refer it to the appropriate State public health
agency or local health agency.

P. Pre-citation Review. Citations proposed pursuant to this program shall be reviewed prior to
issuance, by the Regional Administrator and Regional Office Solicitor for consistency with these
procedures. The Directorate of Technical Support shall be contacted to establish expert witness
support. The Office of Health Compliance Assistance shall be provided with a copy of all
citations issued related to TB during the first 6 months of this directive.

Joseph A. Dear
Assistant Secretary
Distribution: National, Regional, and Area Offices
All Compliance Officers
State Designees
NIOSH Regional Program Directors
7(c)(1) Consultation Project Managers

Appendix A
“Guidelines for preventing the Transmission of Mycobacterium Tuberculosis in Health care Facilities, 1994”

Appendix B

Smoke-Trail Testing Method for Negative pressure Isolation Room

Test Method Description:
One of the purposes of a negative pressure TB isolation room is to prevent TB droplet nuclei from
escaping the isolation room and entering the corridor or other surrounding uncontaminated spaces. To
check for negative room pressure, use smoke-trails to demonstrate that the pressure differential is
inducing airflow from the corridor, through the crack at the bottom of the door (undercut) and into the
isolation room. When performing a smoke-trail test follow these recommendations where applicable:

1. Test only with the isolation room door shut. If not equipped with an anteroom, it is assumed that
there will be a loss of space pressure control when the isolation door is opened and closed. It is
not necessary to demonstrate direction of airflow when the door is open.

2. If there is an anteroom, release smoke at the inner door undercut, with both anteroom doors shut.

3. In addition to a pedestrian entry, some isolation rooms are also accessed through a wider
wheeled-bed stretcher door. Release smoke at all door entrances to isolation rooms.

4. So that the smoke is not blown into the isolation room, hold the smoke bottle/tube parallel to the
door so the smoke is released perpendicular to the direction of airflow through the door undercut.

5. Position the smoke bottle/tube tight to the floor, centered in the middle of the door jamb and
approximately two inches out in front of the door.

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