Tuberculosis in the Workplace

335 Pages·2001·1.18 MB·English

by  Committee on Regulating Occupational Exposure to Tuberculosis, Division of Health Promotion and Dise

TUBERCULOSIS
IN THE
WORKPLACE
Marilyn J. Field, Editor
Committee on Regulating Occupational Exposure to Tuberculosis
Division of Health Promotion and Disease Prevention
INSTITUTE OF MEDICINE
NATIONAL ACADEMY PRESS
Washington, D.C.
NATIONAL ACADEMY PRESS • 2101 Constitution Avenue, NW • Washington, D.C. 20418
NOTICE: The project that is the subject of this report was approved by the Governing
Board of the National Research Council, whose members are drawn from the councils
of the National Academy of Sciences, the National Academy of Engineering, and the
Institute of Medicine. The members of the committee responsible for the report were
chosen for their special competences and with regard for appropriate balance.
Support for this project was provided by the U.S. Department of Health and Human
Services (Contract HHS-100-00-0008). The views presented are those of the Institute of
Medicine Committee on Regulating Occupational Exposure to Tuberculosis and are
not necessarily those of the funding organization.
Library of Congress Cataloging-in-Publication Data
Tuberculosis in the workplace / Marilyn J. Field, editor ; Committee on Regulating
Occupational Exposure to Tuberculosis, Division of Health Promotion and Disease
Prevention, Institute of Medicine.
p. cm.
Includes bibliographical references.
ISBN 0-309-07330-8
1. Tuberculosis—United States. 2. Medical personnel—Health risk assessment—United
States. 3. Tuberculosis—Prevention—Government policy—United States. I. Field,
Marilyn J, (Marilyn Jane) II. Institute of Medicine (U.S.). Committee on Regulating
Occupational Exposure to Tuberculosis.
RC313.A2 .T83 2001
614.5′42′0973—dc21
2001030369
Additional copies of this report are available from:
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Internet: www.nap.edu
Copyright 2001 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
Cover image: Mycobacterium tuberculosis. Copyright Dennis Kunkel Microscopy, Inc.
“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
—Goethe
INSTITUTE OF MEDICINE
Shaping the Future for Health
National Academy of Sciences
National Academy of Engineering
Institute of Medicine
National Research Council
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society of distinguished scholars engaged in scientific and engineering research,
dedicated to the furtherance of science and technology and to their use for
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Congress in 1863, the Academy has a mandate that requires it to advise the
federal government on scientific and technical matters. Dr. Bruce M. Alberts
is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the
charter of the National Academy of Sciences, as a parallel organization of
outstanding engineers. It is autonomous in its administration and in the selection
of its members, sharing with the National Academy of Sciences the responsibility
for advising the federal government. The National Academy of Engineering
also sponsors engineering programs aimed at meeting national needs, encourages
education and research, and recognizes the superior achievements of engineers.
Dr. William A. Wulf is president of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy
of Sciences to secure the services of eminent members of appropriate professions
in the examination of policy matters pertaining to the health of the public.
The Institute acts under the responsibility given to the National Academy of
Sciences by its congressional charter to be an adviser to the federal government
and, upon its own initiative, to identify issues of medical care, research, and
education. Dr. Kenneth I. Shine is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of
Sciences in 1916 to associate the broad community of science and technology
with the Academy’s purposes of furthering knowledge and advising the federal
government. Functioning in accordance with general policies determined by
the Academy, the Council has become the principal operating agency of both
the National Academy of Sciences and the National Academy of Engineering
in providing services to the government, the public, and the scientific and
engineering communities. The Council is administered jointly by both Academies
and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. William A. Wulf
are chairman and vice chairman, respectively, of the National Research Council.
iv
COMMITTEE ON REGULATING OCCUPATIONAL
EXPOSURE TO TUBERCULOSIS
Walter Hierholzer (Chair), Professor Emeritus of Internal Medicine, Infec-
tious Diseases and Epidemiology, Yale University
Scott Barnhart, Medical Director, Harborview Medical Center, and Asso-
ciate Dean, School of Medicine, University of Washington
Henry M. Blumberg, Associate Professor, Department of Medicine, Divi-
sion of Infectious Diseases, Emory University and Hospital Epidemi-
ologist, Grady Memorial Hospital
Scott Burris, Professor of Law, Temple University School of Law
Robyn Gershon, Assistant Professor, Division of Sociomedical Sciences,
Mailman School of Public Health at Columbia University
Douglas Hornick, Associate Professor, Division of Pulmonary Diseases
and Critical Care Medicine, Department of Internal Medicine, Uni-
versity of Iowa
Pamela Kellner, Director, Program Development Unit, Bureau of Tuber-
culosis Control, New York City Department of Health
James Melius, Executive Director, New York State Laborers’ Health and
Safety Trust Fund
Stephen G. Pauker, Sara Murray Jordan Professor of Medicine and Vice
Chair, Clinical Affairs, Department of Medicine, Tufts/New England
Medical Center
Robert C. Spear, Professor, Environmental Health Sciences, University of
California, Berkeley
Lester N. Wright, Deputy Commissioner and Chief Medical Officer, New
York Department of Correctional Services
Committee Consultants and Liaison
John J. Bass, Jr., Chair, Department of Medicine, University of South
Alabama
Thomas M. Daniel, Professor Emeritus of Medicine and International
Health, Case Western Reserve University
Lawrence Geiter, Director of Clinical Programs, Sequella Foundation,
Maryland
Phillip Harber, Professor of Family Medicine and Chief, Occupational
and Environmental Medicine, University of California, Los Angeles
Michael L. Tapper, Hospital Epidemiologist, Lennox Hill Hospital, New
York City
Keith F. Woeltje, Assistant Professor of Medicine, Section of Infectious
Diseases, Medical College of Georgia
M. Donald Whorton, Liaison, Board on Health Promotion and Disease
Prevention, Institute of Medicine
v
vi NOTE
Institute of Medicine Staff
Marilyn J. Field, Study Director
Elizabeth Epstein, Project Assistant (through July 2000)
Cara N. Christie, Project Assistant
Rose Marie Martinez, Director, Division of Health Promotion and Dis-
ease Prevention
vi
vii
Acknowledgments
In developing this report, the committee and staff benefited from the
expertise and experience of many individuals. In particular, we learned
much from the presenters and participants in the workshop and public
hearing held in August, 2000. At the committee’s request following the
workshop, Ronald Bayer further developed his presentation about ethical
issues, and Lisa Brousseau, Rachel Stricof, and Barry Farr also provided
additional information or other assistance. Appendix A lists the work-
shop participants, presenters, and agendas.
The authors of the commissioned background papers presented in
Appendixes B (John J. Bass, Jr.), C (Thomas M. Daniel), D (Keith F.
Woeltje), E (Scott Burris and Jamie Crabtree), and F (Phillip Harber, Scott
Barnhart, Douglas Hornick, and Robert Spear) made essential contribu-
tions to this report through their evidence reviews, and their extensive
discussions with committee members and staff. Their ability to develop
the evidence reviews on a tight schedule for discussion at the workshop
was especially appreciated. Dr. Daniel also patiently allowed us to draw
on his deep expertise and decades of experience in research on tuber-
culosis. Consultants Michael Tapper and Lawrence Geiter provided expert
advice and information about many issues. M. Donald Whorton, the
liaison to the committee from the IOM’s Board on Health Promotion and
Disease Prevention, likewise provided useful insights about the com-
mittee’s deliberations and analyses.
The project officer at the National Institute for Occupational Safety
and Health (NIOSH), Greg Wagner, always responded promptly to ques-
vii
viii ACKNOWLEDGMENTS
tions. Others at the agency who provided information and explanations
about NIOSH research and statements included Paul Jensen and Christo-
pher Coffey. At the Division of Tuberculosis Elimination (which is also
part of the Centers for Disease Control and Prevention [CDC]), Renee
Ridzon and Amy Curtis patiently answered many questions about CDC
data, guidelines, and procedures. The weekly summary of news about
tuberculosis developed by John Seggerson was an invaluable resource.
At the Occupational Safety and Health Administration (OSHA),
Amanda Edens was unfailingly helpful in answering questions about the
proposed rule. She and Claudia Thurber helped clarify aspects of OSHA’s
legislative, administrative, and judicial framework and differences be-
tween the language of the 1997 proposed rule and the 1994 CDC guide-
lines. Others at OSHA who provided useful information or explanations
included Susan Sherman for her review of legal matters, Steven Bayard,
Marthe Kent, and John Rainwater.
At the Institute of Medicine, study staff appreciate the assistance of
Sue Barron, Claudia Carl, Mike Edington, Pat Spaulding, Rita Gaskins,
Karen Autrey, and Melissa Goodwin among others. Michael Hayes helped
in copy editing the report.
ix
REVIEWERS
This report has been reviewed in draft form by individuals chosen for
their diverse perspectives and technical expertise, in accordance with pro-
cedures approved by the NRC’s Report Review Committee. The purpose
of this independent review is to provide candid and critical comments
that will assist the institution in making its published report as sound as
possible and to ensure that the report meets institutional standards for
objectivity, evidence, and responsiveness to the study charge. The review
comments and draft manuscript remain confidential to protect the integ-
rity of the deliberative process. We wish to thank the following individu-
als for their review of this report:
James August, American Federation of Labor and Congress of Industrial
Organizations
Alfred Franzblau, M.D., School of Public Health, University of Michigan
Victoria Fraser, M.D., Washington University School of Medicine
Alan Hinman, M.D., M.P.H., Task Force for Child Survival and Develop-
ment
Richard Menzies, M.D., Respiratory Epidemiology Unit, McGill Univer-
sity, Montreal Chest Institute
Mary L. Powell, Ph.D., University of Kentucky, Lexington
Although the reviewers listed above have provided many construc-
tive comments and suggestions, they were not asked to endorse the con-
clusions or recommendations nor did they see the final draft of the report
before its release. The review of this report was overseen by Robert
Lawrence, M.D., School of Hygiene and Public Health, Johns Hopkins
University, appointed by the Institute of Medicine and Elaine L. Larson,
R.N., Ph.D., Columbia University School of Nursing, appointed by the
NRC’s Report Review Committee, who were responsible for making cer-
tain that an independent examination of this report was carried out in
accordance with institutional procedures and that all review comments
were carefully considered. Responsibility for the final content of this re-
port rests entirely with the authoring committee and the institution.
ix