Tuberculosis
Tuberculosis (TB) is a serious infectious disease caused by a rod-shaped bacteria called mycobacterium tuberculosis.
How is TB Spread?
TB is spread through contact with an infected person. It is an airborne disease, which means that droplets from the infected person become suspended in the air. When you breathe in air containing TB bacteria, the bacteria may go into your lungs and grow there. It may also go to other parts of the body.
We know that TB affects the lungs, but there are other parts of the body that are affected too. TB can affect the kidneys, spine, and the brain, though it is not as infectious as the lung and throat.
Symptoms
TB bacteria can be in the body without making you sick. This is known as TB infection. Basically, the body has been able to contain the TB bacteria. However, the bacteria can cause TB disease if they break away. Symptoms of TB disease include fatigue, loss of appetite, weight loss, fevers and night sweats. When TB is in the lungs, the person may cough a lot, cough up mucus or phlegm, or blood.
TB INFECTION turns into TB DISEASE when something happens to weaken your natural defenses against disease. A person is also more likely to get TB disease from TB infection in the first two years following the time of infection. People who have had certain cancers or who are HIV-positive have a much higher chance of getting TB disease.
For every 100 people in the U.S. with TB infection, 90 will go through their whole lives without ever developing TB disease.
TB CAN ONLY BE SPREAD TO OTHERS WHEN THE TB DISEASE IS ACTIVE IN YOUR LUNGS.
Testing
The only way to know whether you are infected is to have a skin test. You can get one at your doctor's office or health department. A small amount of fluid (tuberculin) is injected just under the skin. After 2 - 3 days, the health care provider measures to see if the reaction is positive or negative. A bump about the size the a pencil eraser or larger means the test is positive and there is possible infection. The health care provider may do a chest x-ray or blood/urine test. If the exposure was recent, you may not show up positive yet. You may need another test later (10 - 12 weeks).
Treatment
TB infection is usually treated with isoniazid. It is taken for 6 months since TB bacteria die slowly. (HIV infected people take medication for a longer time.) Always take the full treatment.
There certain strains of TB bacteria that don't respond to the standard TB drugs. This drug-resistant TB is called multi-drug resistant tuberculosis, or MDR-TB. Often MDR-TB can be cured by another set of TB drugs, although these drugs are more dangerous to take and much more expensive.
Sometimes the MDR-TB doesn't respond to any of the available medications regularly. That's why completing a course of treatment is so important. Even though you feel better, you have to keep taking the drugs.
MDR-TB is most dangerous when the infected person has a weak immune system. Most of the health workers who have died from getting MDR-TB on the job were HIV+ individuals.
Occupational Exposure
Workers in a wide range of health care facilities, social services (e.g. Social Security Administration), long-term care facilities, laboratories and even workers in correctional and jail facilities are at risk. Since TB can float in the air, anyone who has close and prolonged contact with any individual with active TB disease is at risk.
Prevention
To keep the disease from spreading, diseased individuals are isolated. If you are infected and there are TB bacteria in your throat and lungs, you can infect others. Cover your mouth when coughing, sneezing, or laughing. Because TB is airborne, a good ventilation system is important. Disease spreads in small, closed spaces where air doesn't move well. Remember that you can't get infected from shaking hands or from sitting on toilet seats.
OSHA's Proposed Tuberculosis Standard
In October 1997 OSHA published its proposed Tuberculosis Standard. Starting in April 1998, OSHA held public hearings in Washington, D.C., Los Angeles, Chicago, and New York City. AFGE submitted comments in support of the standard on behalf of AFGE members. Howard Egerman, National Safety Representative for Social Security employees, represented AFGE at the hearing in Los Angeles.
Following the informal hearings, there is a post-hearing comment period. Then OSHA will evaluate the comments and data submitted, and then make the necessary changes to the proposed standard.
Summary of OSHA Proposal
The proposal covers hospitals, long-term care facilities for the elderly, corrections facilities, hospices, shelters for the homeless, drug abuse treatment facilities, labs that handle TB specimens, and emergency treatment during medical care, home health care, and home-based hospice care.
It does not cover social work, social welfare services, teachers, or law enforcement personnel unless they are providing services in one of the covered facilities (listed above).
OSHA proposes program that includes:
- An exposure control plan, including exposure determination, respiratory protection in certain situations, medical surveillance
- Baseline skin test and medical history
- Medical management and follow-up, including medical removal protection, if necessary
- Employee training
- Recordkeeping
The proposal is a good one. However, AFGE would like to see OSHA expand coverage provide adequate protection to social service employees, such as claims representatives. They would not be protected at their regular place of work in SSA office. Howard Egerman noted at the hearing that there have been several skin test conversions after what is a considered a short exposure that would not pose a hazard.
You can view a copy of the proposed standard in OSHA's web page at www.osha.gov.
OSHA's New Respiratory Protection Standard
Employers were required to implement OSHA's final respiratory protection standard (29 CFR 1910.134) by October 5, 1998. The new standard was published on January 8, 1998.
It provides guidance on selecting, using, and testing a respirator. The new standard requires fit testing to make sure the respirator fits the employee. The employer is required to offer a variety of respirators and to teach workers how to use them properly.
The standard also requires user seal checks every time the employee puts on a respirator. This is a negative-pressure check or a positive-pressure check to make sure the respirator is sealed closely to the worker's face. Workers must get training on these tasks.
The standard also gives firefighters better protection. When battling interior fires, firefighters are in "Immediately Dangerous to Life or Health" situations, which require use of a self-contained breathing apparatus. The standard also calls for at least two firefighters inside a building to be in visual and voice contact and two others posted outside, ready to assist inside firefighters. This is known as the "two-in/two-out" policy.
Respiratory protection against tuberculosis is covered under 29 CFR 1910.139.
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