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Tour and review our MICROCON® Hospital
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isolation room enclosure when treating suspected
or confirmed cases."
Administration of Aerosolized Medications
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is an all encompassing descriptive narrative
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Health Care Facilities when administering and
or treating patients with infectious respiratory
conditions such as TB." A
a printable version
of this article HERE!!
most work environments are at low risk for transmission
tuberculosis (TB),business managers, union leaders and
worksite health professionals should be aware that the
incidence of TB
is rising. Clearly,employers should be prepared to address
employee concerns. Accurate information should be provided
to dispel any apprehension that may arise from misinformation.
Tuberculosis is a contagious disease. There are, however,
of TB: latent infection and active. Only
an individual with active TB of the lungs or airways
can spread the disease by coughing and sneezing. This
is most likely to occur when individuals are in close
proximity for extended periods of time. Most office settings
worksites do not involve such sustained close contact.
Many of the current cases of TB are found in those workplaces
that bring people into close contact with others who
have active TB, such as health care facilities, correctional
institutions, and homeless shelters. Since the risk of
exposure to TB is very low in most worksites, TB is
rarely a problem in the general workplace.
Employees with suppressed
immune systems, such as those infected with the human
virus (HIV) and those undergoing chemotherapy, are at
higher risk for reactivating a latent TB infection or for
rapidly developing active TB after acquiring a new infection.
How employers handle a case of TB requires careful preparation.
concerns about TB as a workplace consideration parallels
and resembles dealing with HIV infection and AIDS in the
workplace. Specific issues that need to be addressed include
proper care of employees who are infected, protection of
confidentiality, assurance of non-discrimination, adequate
protection of non-infected employees, and employee education
The following questions and answers provide employers and
union leaders with clear guidance on how to deal with questions
and concerns about TB, HIV infection, and AIDS in the general
What is Tuberculosis (TB)?
Tuberculosis is an infectious
disease caused by the organism Mycobacterium tuberculosis, a
kind of bacterium. The infection is spread by airborne
droplets expelled when a person with active tuberculosis
coughs or sneezes. Individuals exposed to air contaminated
by a person
with active TB may breathe in TB bacteria. This is more
likely to occur in poorly ventilated, closely confined
though active TB is a communicable disease, it is usually
treatable when diagnosed promptly.
How do people find out if
they have latent TB infection or active TB ?
A tuberculin skin test will produce a
measurable reaction (bump at the test site) in most
people who have been infected with the TB bacteria.
Some immuno-suppressed persons will not have a reaction
to a tuberculin skin test; other diagnostic tests can
be used to help determine their TB status. Individuals
with positive tuberculin skin tests have TB infection
but do not necessarily have active TB. Active TB is
diagnosed with chest x-rays, sputum analysis, and sometimes
with other tests.
|What is latent TB infection!
individuals are infected with the Mycobacterium tuberculosis, they
generally remain infected for years but normally do not
develop active tuberculosis or show signs of illness. A
person with a healthy immune system is usually able to
contain the infection and not become ill with TB. This
condition is referred to as "latent tuberculosis infection." Only
about I in 10 persons with latent TB infection will ever
develop active TB, and this risk can be reduced even
further by taking preventive therapy. It is estimated
10 to 15 million people in this country have latent TB
infection. The U.S. Centers for Disease Control and Prevention
(CDC) has guidelines establishing who should receive
preventive treatment for latent TB infection. This treatment
decrease the chance of developing active TB later in
life. Persons with latent TB infection are not infectious,
they cannot transmit TB infection to others.What
is active TB?Active TB occurs
when an individual's immune system fails to contain the
TB organism, the organisms become reactivated, and the
person becomes ill. The disease can involve almost any
organ in the body, but most commonly involves the lungs
or airways. A person with active TB of the lungs or airways
is capable of spreading the disease to others by coughing
and sneezing. Most TB in this country is responsive to
anti-tuberculosis drugs and can be cured if diagnosed
and treated properly.
How is active TB treated?
TB of the lungs or airways is considered to be contagious
and requires immediate medical treatment. TB treatment
involves taking several drugs. After 2-4 weeks of treatment
with the appropriate drugs, most people are no longer
infectious and cannot transmit the disease to others. However,
cure of TB requires 6-12 months of continuous treatment,
or longer, in some cases. People must complete the entire
prescribed course of treatment to avoid relapse and/or
the risk of developing drug-resistant TB.
strains of rnycobacterium tuberculosis are
those strains which do not respond to treatment with
or all available anti-TB drugs. Most of these drug-resistant
strains result from incomplete or interrupted treatment
of TB in individuals who start out with drug-susceptible
TB. With only a portion of the bacteria destroyed,
surviving bacteria may develop resistance to standard
drugs and become more difficult to destroy. In some
organisms may become resistant to many drugs. Thus,
who do not complete their course of treatment risk
developing drug-resistant tuberculosis, which is
usually much more
difficult to treat effectively than drug-susceptible
TB. These individuals also may transmit drug-resistant
any connection between immune deficiency and TB?
For some people, yes. An individual
with a significantly
suppressed immune system (due to poor health, chronic abuse
of alcohol or drugs, old age, chemotherapy for cancer,
or HIV infection)
is more likely than a healthy person to develop active TB
disease if they already have latent TB infection or
if they are exposed to a new TB infection. The risk of developing
active TB in an individual who has latent TB infection but
has an intact immune system is very low (10 percent over a
However, the risk of developing active TB in an individual
with both HIV and latent TB infection is much greater (8 percent per
TB in the Workplace
is the risk of transmission
of TB in the workplace?
work environments are considered low risk for the transmission
of TB. The CDC has determined that there are only a few
settings where the incidence of active TB may be cause
for special concern.
Examples of such settings include health care facilities,
correctional institutions, homeless shelters, long-term
care facilities, and
drug treatment centers. Individuals employed in these settings,
therefore, have a potentially increased risk for exposure
to TB. The CDC has developed recommendations on how to
transmission in these potentially high-risk occupational
settings. Consultation on these issues can be obtained
and local TB control programs and through the CDC. The general
workplace is not a likely place for transmitting TB.
transmission a greater risk in the food/restaurant industry?
Since TB is not transmitted via food, the risk of TB
transmission in the food/restaurant industry is no
greater than in other
general work settings. If a worker in these industries
has active TB,
transmission may occur by the airborne route, as previously
described, and the health department should be notified
(as described below).
What should employers do when faced with
a case of active TB? Employers
and health care providers must immediately report
any case of active TB to the local or state
public health department. The health department will
case management, investigate the possibility that others
could be infected, and evaluate the risk of TB transmission
in that workplace. In some states, latent TB infection
must also be reported. Employers should contact their
local and state health authorities regarding laws and
regulations in their area. Employers may wish to obtain
written confirmation of specific recommendations received
from the health department.
can employees with active TB safely return to work?
employees are no longer infectious, and are able
to work, they may return to the workplace. In most
no longer contagious after 2-4 weeks of effective
drug therapy. However, return to work should be based
medical clearance by competent health care professionals.
Health care personnel or an employee's private physician
should ensure that employees returning to work adhere
treatment for TB.
offer mass TB screening to employees?
TB screening (skin tests) is not recommended
in most general workplace environments. According
CDC and TB medical experts, there is no indication
for mass TB screening of employees in low-risk
settings. In the event that an employee develops
active TB, local public health authorities should
so they can contact other people who may have been
exposed in the household or the workplace. In some
the risk of TB transmission may be higher than
in the general workplace (e.g., hospitals, correctional
facilities). An employer-organized TB skin testing
program should be available in those specific settings.
What should employees
know about TB?
An education program for employees
should include, at a minimum, the following:
of TB and how it is transmitted
between latent TB infection and active TB
and interpretation of TB skin testing
and symptoms of TB
When treatment of latent
TB infection is indicated
Purpose and importance
of adhering to and completing TB therapy
factors for latent TB infection progressing to active TB
active TB is treated and the importance of completing treatment
and prognosis of drug-resistant TB
of maintaining the confidentiality of a co-worker's medical condition
and medical records
Link between TB and HIV
and other immuno-suppressive conditions
policy on illness in the workplace
assistance and further information can be obtained A
TB education program, which may be part of a wellness program or other
worksite activity, will reduce employee apprehension and misinformation.
Contact the American Lung Association or other organizations listed on
page 6 for educational resources.
AIDS & TB
What are HIV infection and
The human immunodeficiency virus (HIV)
is the cause of acquired immunodeficiency syndrome (AIDS). HIV
infection weakens the body's natural ability to fight diseases.
As the immune system
fails, a person infected with HIV may develop a variety of life-threatening
illnesses such as pneumonia, cancer extensive damage to the nervous
system, or have other evidence of a severe deficiency of the immune
person would then be diagnosed as having AIDS. However, HIV-infected
individuals may not show signs of illness for many years and should
be productive members of the workforce.
How is HIV infection transmitted?
is transmitted when blood or body fluids from someone who
is HIV-positive enters someone else's blood stream. HIV
is most commonly transmitted in four body fluids: blood,
semen, vaginal secretions, and, in rare instances, breast
milk. Activities that are known to transmit HIV include
having unprotected sex or sharing needles or syringes with
someone infected with HIV HIV is not spread through casual
contact and is not transmitted through air, food, or water.
employees with HIV infection or AIDS at greater risk if
TB is present in the workplace?
Yes. While employees with
HIV infection or AIDS are just as susceptible as other
employees to developing
infection after exposure to TB, they are at much greater
risk of developing active TB if they become infected with
the TB bacteria. These
primary progressive TB infections (when initial infection
goes directly into active disease) may develop very rapidly
and can be life threatening for the HIV-infected employee.
Therefore, employers should encourage employees with HIV
infection to be
evaluated for latent TB infection. Employees
with HIV infection or AIDS carry latent TB infection at the
as other HIV-negative employees from similar backgrounds
(country of origin, socio-economic status, etc.) However,
individuals who are infected with the TB organism develop
active TB at a higher rate than HIV-negative employees because
of their suppressed immune systems. These conditions do
not justify treating persons with HIV infection differently
from other job
applicants or employees. Fear of TB contagion should
not be used to discriminate against HIV-positive employees.
precautions have to be taken if it is known that employees with
HIV infection or AIDS are in the general workplace?
Good workplace practices and standard first aid procedures
that promote a healthy workplace will protect HIV-positive
and HIV-negative employees alike.
The Americans with Disabilities Act
How does the ADA
ADA, enacted in 1990, an employer cannot discriminate
against a qualified individual 1) who has a disability,
2) who had a disability, or 3) who is perceived
to have a disability on the basis of that disability.
protects both applicants and employees with disabilities
against discrimination in such areas as hiring,
firing, discipline, assignments, compensation and
benefits. A "qualified
individual with a disability" is a person who
1) meets the job requirements (e.g., skills, education,
work experience) and 2) can perform the essential
of the job. "Essential functions" are
the primary tasks critical to successful performance
of a job. An employer does not have to hire or retain
individuals whose disabilities prevent them from
performing the essential job functions.
Does the ADA apply to TB,
HIV or AIDS?
with HIV infection, AIDS, and active TB have disabilities covered by
the ADA. Individuals with latent TB infection would be protected by
if an employer discriminates against them on the basis of their TB
status. Limiting the job responsibilities of an employee with latent
will violate the ADA, since this employee does not pose a significant
risk of transmission to anyone else. Individuals
with active TB do pose a "direct threat" of transmission
to others. This
fact, however, does not entitle employers to refuse to hire or to fire
such individuals. Rather, employers have an obligation under the
ADA to provide reasonable accommodation) that removes the direct threat.
For example employers should consider as reasonable accommodation
permitting employees with active TB sufficient leave from work to undergo
thereby removing the risk of infection. Under appropriate circumstances,
employers should consider permitting employees to continue to work
at home while undergoing treatment. Employers do not have to provide
a specific accomodation if it imposes an "undue hardship" (significant
difficulty or expense) on the employer.
Medical authorities agree that in
most cases individuals with active TB require 2-4 weeks
from the workplace to undergo treatment and eliminate
the risk of transmission. Once treatment has begun,
employee has been determined to be non infectious
by a competent medical expert, and provided the individual
continues with the course of treatment, most individuals will no
longer pose a "direct threat" to others and
can return to the workplace. An
employer who treats a person with HIV infection or
AIDS differently because of concerns that the individual may have
TB and may infect others will violate the ADA
because there is no evidence of direct threat. In addition
ADA, other federal and state anti-discrimination laws
offer protection to persons with active or latent TB
employees be notified if a co-worker has latent TB?
In the case of employees with latent TB infection,
they do not present a significant risk to others on
of their latent infection. Moreover, the ADA has strict
confidentiality requirements, including keeping medical
records separate from all other personnel records and
limiting access to medical records. Supervisors and
managers may be informed about an individual's TB status
if, as a result of the disability, the individual presents
a significant risk to others or requires reasonable accommodation.
employees be notified if a co-worker has active TB?
a general rule, based on both legal and practical concerns,
employers and supervisors should not reveal an employees
medical condition to others. Once an employee is diagnosed
with active TB, it is the employer's obligation, as stated
above, to notify the local health department. Health officials
are responsible for investigating reports and notifying
other employees who may have been exposed. Counseling about
potential risk for TB infection should be done by trained
medical or public health officers. Throughout this process,
the confidentiality of the employee with active TB must
Guidelines for Tuberculosis and
in the General Workplace
|General workplace environments pose low
risk for the transmission of TB and virtually no risk for
the transmission of HIV There are, however, a number of
measures that can be taken to keep TB risks low and to
reassure the workforce. The following guidelines apply
to the general workplace, not settings that the
Centers for Disease Control and Prevention (CDC) or state
or local health authorities have determined may have
a higher risk for the transmission of TB (e.g., health
facilities, correctional institutions, long-term care
facilities, drug treatment centers, and homeless shelters.)
highest levels of management and union leadership should
actively support appropriate education programs about both
TB and HIV and provide these programs to all employees.
Providing sound information is essential in overcoming
policy should be based on scientific and epidemiological
evidence, e.g., that most workplaces pose low risk for
TB transmission, and that people with latent TB infection
pose no risk of transmission as long as the bacterium remains
Employees with active
TB should immediately seek medical treatment and
should not return to the workplace until they have been
cleared to do so by their health care provider.
is no medical indication for mass skin testing to detect
latent TB infection or HIV screening in the general workforce,
according to the CDC and other TB experts. Under the
Americans with Disabilities Act (ADA), there are strict
on the timing and use of medical screening including
HIV and skin testing for TB.
active TB is a communicable disease, employers should verify
that employees with active TB have undergone and completed
appropriate treatment. Employers may determine this through
certification from the employee's health care provider.
|• Workplace policy should always
encourage employees to seek medical treatment when they
are ill and get advice from competent health care professionals
when they have questions concerning their health.
the local or state public health department for assistance
in the event of a possible or confirmed case of active
TB in the workforce. No special workplace action is necessary
for employees with latent TB infection, although such
persons may benefit from preventive therapy.
policy regarding return to work for employees with active
TB should be based on individual medical clearance by competent
health professionals. Employees with active TB should be
allowed to come back to work once they present evidence
of adherence to ongoing drug therapy and when judged to
be non-infectious by competent medical personnel.
with active TB and/or HIV infection are protected under
the ADA, and may not be discriminated against because
of their disabilities. Persons with latent TB infection
will be protected if an employer discriminates against
such individuals on the basis of having latent TB. It
is not illegal, however, for employers to remove employees
with active TB from the workplace until they are no longer
and practices must protect the confidentiality of employees" medical
and health insurance information.
For Additional Information Contact:
phone book for local
or state office.
" American Lung
1740 Broadway New
York, NY 10019-4374 212 315-8700 Check
your phone book for local chapter.
Check your phone book for local chapter.
for Disease Control and Prevention
Tuberculosis Elimination National Center for Prevention Services 1600 Clifton
Road, NE, Mail Stop E-10 Atlanta, GA 30333 404 639-2503
Occupational Safety and Health Administration
your phone book for regional office.
International or National Union
Health and Safety Division Check your phone book for number.
Employment Opportunity Commission
L Street, NW Washington, DC 20507 800 669-EEOC
to AIDS Service 800 458-5231
Leadership Coalition on AIDS
M Street, NW, Suite 905 Washington, DC 20036 202
|These guidelines are the product of the
contributions, comments, and deliberations of the following
individuals who participated in a symposium in New York
City on September 16, 1992. Affiliations are listed solely
for purposes of identification. Colin
Baigel, M.D., Director of Employee Health Services, Bristol-Myers
Squibb Mark Barnes, Esq., Associate
Health Commissioner, City of New York Ronald
Bayer, Ph.D., Professor, Columbia University School of
Public Health Rosalind Brannigan,
M.PH., Director, Workplace Resource Center, National Leadership
Coalition on AIDS Katherine Cox,
M.PH., M.Ed., Health and Safety Specialist, Department
of Research, American Federation of State, County & Municipal
Employees James Craig, M.D., M.PH.,
Vice President & Director, Health and Safety Services,
General Mills, Inc. Robert J. Darga,
M.D., Director of Programs, National Association of People
with AIDS Samuel W Dooley, Jr.,
M.D., Assistant Director for Science, Division of Tuberculosis
Elimination, National Center for Prevention Services, the
Centers for Disease Control and Prevention (Consultant) Katy
Lind Evelyn, R.N., M.S., N.P, Manager, Occupational Health
Services, Syntex (USA) Inc.
||Glenn Haughie, M.D., M.PH., IBM Director
of Health, IBM Corporation Donald
J. Kennedy, M.D., Associate Professor of Internal Medicine,
Division of Infectious Diseases and Center for Vaccine
Development, St. Louis University School of Medicine Sheldon
Landesman, M.D., Professor of Medicine, SUNY Health Science
Center at Brooklyn. Consultant for Tuberculosis, New York
City Department of Health Carol
Levine, M.A., Executive Director, The Orphan Project, Fund
for the City of New York David C
Logan, M.D., M.PH., Clinical Toxicologist, Mobil Oil Corporation Maria
Lyzen, R.N., M.S. COHN, Co-Director, AIDS Education, UAW-GM
Center for Health and Safety Jeff
T. Monford, Manager, Workplace Resource Center, National
Leadership Coalition on AIDS Robert
Refowitz, M.D., Ph.D., Regional Head, Preventive Medicine,
Kaiser-Permanente, Ohio Region Robert
S. Rhodes, M.D., M.PH., FACOEM, Regional Medical Director,
General Motors LeonJ. Warshaw, M.D.,
F.A.C.R, Executive Director, New York Business Group on
Health, Inc. Karen Widhelm, Director,
Health Care Consulting, Southwestern Bell
Appreciation is extended to the following
Special appreciation to:
Roy L. DeHart, M.D., M.PH., FACOEM, President,
American College of Occupational and Environmental Medicine
B. Reichman, M.D., M.PH., President (1992-93), American
Deputy Director, National Programs, American Lung Association
Clay, Associate, Infectious Lung Disease, American Lung
Mitcheal A. Metzner,
Workplace HIV/AIDS Program, Office of HIV/AIDS Program,
American Red Cross
Jerald A. Breitman,
Director, Professional Relations, Burroughs Wellcome Co.
Castro, M.D., Assistant Director for TB and HIV Office
of the Associate Director (HIV/AIDS), the Centers for Disease
Control and Prevention
M.S., Coordinator, Professional Education Program, Gay
Men's Health Crisis
Jon T. O'Neal,
M.D., M.PH., Occupational Medicine Resident, Harvard University
Christen, Executive Director, San Francisco AIDS Foundation
Akin, Ph.D., Vice President for Public Policy, Syntex (USA)
Michael R. Lauber, President,
Tusco Manufacturing, Inc.
DiStasio, Senior Policy Analyst, U.S. Department of Labor
Singer, J.D., Office of Advocacy, U.S. Small Business Administration
Barbara Darraugh, Editor John Rodgers, Graphic
Designer Callie Norton, Production Coordinator Lettercomm,
Reprints of this
brochure obtainable through: National
Leadership Coalition on AIDS 1730
M Street, NW Suite 905 Washington,
DC 20036 202/429-0930 FAX:
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