Index

A

Accreditation and licensure, 6, 53, 58, 82, 117, 140, 141

Acquired immunodeficiency disease, see HIV

Active tuberculosis, 1, 8, 13, 23, 27–28, 88–92, 95–96, 100, 109, 132, 217

see also Drug resistance;

Mortality;

Outbreaks;

Symptoms;

Transmission of disease

compared to latent disease, 25

defined, 83

diagnosis, 25, 30, 32, 33, 37–40, 156;

see also Radiographs;

Sputum smears

general population, risk assessment data, 86–88

medical students, 85

nursing students, 84

OSHA estimates, 152–153

skin tests, 32, 33, 84(n.2)

Administrative controls, 8–9, 86, 98–99, 203

see also Isolation policies, rooms, and areas;

Record keeping;

Regulations and standards

CDC guidelines, 3, 8, 57, 63–74, 104–106, 143, 192, 230, 231, 232, 245–246, 293

CDC guidelines, implementation and effects, 108, 109–116, 120–124, 128, 129, 131, 133–134, 140, 234, 235, 238, 241, 246–250, 263–266, 301, 302

diagnosis, 8, 64, 103

inspection of facilities, 117–119

OSHA rule/standard, 10, 59–60, 63–72, 140, 142–144, 149

outbreaks, 8, 134, 135, 136, 145, 262–263, 300, 301

regulatory burden, 10, 138, 144

Administrative Procedure Act, 280

Adolescents, 27, 87, 196, 219, 220

African Americans, see Black persons

Age factors

see also Adolescents;

Children;

Elderly persons

active tuberculosis treatment, 40

CDC guidelines, implementation and

effects, 128, 130

correctional workers, 210

country comparisons, 27(n7), 92

historical perspectives, 27, 87

prevalence, 27, 87, 88, 92, 93, 98

risk assessment, 87, 88, 92, 93, 98, 192, 195, 202, 204, 213, 217, 219, 220, 223

skin tests, 30, 181



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Tuberculosis in the Workplace Index A Accreditation and licensure, 6, 53, 58, 82, 117, 140, 141 Acquired immunodeficiency disease, see HIV Active tuberculosis, 1, 8, 13, 23, 27–28, 88–92, 95–96, 100, 109, 132, 217 see also Drug resistance; Mortality; Outbreaks; Symptoms; Transmission of disease compared to latent disease, 25 defined, 83 diagnosis, 25, 30, 32, 33, 37–40, 156; see also Radiographs; Sputum smears general population, risk assessment data, 86–88 medical students, 85 nursing students, 84 OSHA estimates, 152–153 skin tests, 32, 33, 84(n.2) Administrative controls, 8–9, 86, 98–99, 203 see also Isolation policies, rooms, and areas; Record keeping; Regulations and standards CDC guidelines, 3, 8, 57, 63–74, 104–106, 143, 192, 230, 231, 232, 245–246, 293 CDC guidelines, implementation and effects, 108, 109–116, 120–124, 128, 129, 131, 133–134, 140, 234, 235, 238, 241, 246–250, 263–266, 301, 302 diagnosis, 8, 64, 103 inspection of facilities, 117–119 OSHA rule/standard, 10, 59–60, 63–72, 140, 142–144, 149 outbreaks, 8, 134, 135, 136, 145, 262–263, 300, 301 regulatory burden, 10, 138, 144 Administrative Procedure Act, 280 Adolescents, 27, 87, 196, 219, 220 African Americans, see Black persons Age factors see also Adolescents; Children; Elderly persons active tuberculosis treatment, 40 CDC guidelines, implementation and effects, 128, 130 correctional workers, 210 country comparisons, 27(n7), 92 historical perspectives, 27, 87 prevalence, 27, 87, 88, 92, 93, 98 risk assessment, 87, 88, 92, 93, 98, 192, 195, 202, 204, 213, 217, 219, 220, 223 skin tests, 30, 181

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Tuberculosis in the Workplace Agency for International Development, 312 AIDS, see HIV Airflow, see Ventilation Alcohol abuse, 35, 244 Ambulatory care facilities, 81, 95, 103, 121, 212 CDC guidelines, 58, 109, 129, 252 American Academy of Pediatrics, 175 American Association of Homes and Services for the Aged, 175 American Board of Emergency Medicine, 122 American College of Chest Physicians, 57 American College of Occupational Medicine, 176 American Federation of State, County and Municipal Employees, 115–116, 174 American Hospital Association, 63, 111, 175, 253 American Indians, 87, 197 American Nurses Association, 175 American Public Health Association, 175 American Society for Microbiology, 175 American Thoracic Society (ATS), 13(n.1), 35, 57, 58, 121, 153, 176 Annual risk of infection (ARI), 193–194, 195–201, 203–205, 210, 213, 215 Aplisol, 180 Arkansas, 102 Asians/Pacific Islanders, 87, 197, 214, 215 Association of Professionals in Infection Control and Epidemiology, 63, 242, 243, 257 Atlanta, Georgia, 99, 124–126, 197, 204, 205, 206, 236–237, 247–248, 300 Attitudes, 43 complacency, 137–138 isolation of patients, psychological factors, 39–40 patient treatment preferences, 35, 144 stigma, 32, 144 workers, 44 Attorneys, 208 Autopsies, 26, 85, 95, 98, 149, 212 see also Medical examiners B Barnhart, Scott, 293–308 Bass, John, 179–188 Bathrooms in isolation rooms, 251, 257 BCG vaccination, 33, 126, 128, 130, 183, 202, 219, 220 Black persons, 87, 196, 197, 204, 210, 215, 219, 220, 244 Blueprint for Tuberculosis Vaccine Development, 311 Body weight, see Weight factors Bone, 27, 28 Boostering phenomenon, 33, 185–187 Boston, Massachusetts, 211, 214 Bovine tuberculosis, 24 BCG vaccine, 33, 126, 128, 130, 183, 202, 219, 220 Brain, 27, 28 Britain, see United Kingdom Bronchoscopy, 94, 95, 106, 121, 130(n.6), 131, 145, 149, 190, 201, 215, 243, 263 Bureau of Mines, 45 Bureau of Prisons, 114 Burris, J.D., 271–292 Byssinosis, 285 C Cadavers, see Autopsies; Funeral homes; Medical examiners California, 6, 15, 20, 99–100, 118–119, 175, 201, 215, 256 Canada, 130(n.6) Cancer, 28, 39, 208, 299 Case law, see Litigation Case management, 11, 72–74, 154, 309, 310 see also Clinical practice guidelines directly observed therapy, 17, 22, 35, 41, 82, 119, 132, 139, 153 multidisciplinary, 41 Centers for Disease Control and Prevention (CDC), 309, 310, 311, 312 active tuberculosis defined, 83 control practices, surveys, 110–115 epidemiology, 6, 86–92, 311 hospital studies, 91–92, 96, 110–113, 114, 214 immigrant causing outbreak, 95–96 international collaboration, 312 latent tuberculosis defined, 13(n.1) mortality reports, 86–91, 92, 96, 153 outbreak reports, 8, 20, 37, 91, 95–96, 119–121, 123–131, 133–136, 141, 145, 230, 231–245, 261, 262, 302 prevalence reports, 86–92, 96, 152, 153

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Tuberculosis in the Workplace skin test demonstration project, 19, 91–92 surveys, 86–92, 110–115 Centers for Disease Control and Prevention (CDC) guidelines, 1, 2–4, 5–6, 8, 9, 11, 16, 43, 56–58, 72–74, 173, 177, 108–136, 293 administrative controls, 3, 8, 57, 63–74, 104–106, 143, 192, 230, 231, 232, 245–246, 293 ambulatory care, 58, 109, 129, 252 clinical practice, 18, 57, 59 community-level factors, 9, 64, 66, 67, 69 confidentiality, 64 contract employees, 236 correctional facilities, 2–3, 19, 57, 58 diagnosis, general, 109, 232; see also“skin tests” infra drug-resistant tuberculosis, 64, 66, 73 drug treatment, 35, 37, 73, 109, 234, 235, 241, 248, 302 emergency departments, 58, 73 enforcement powers lacking, 142 engineering controls, general, 3, 57, 63, 64, 65, 68, 74–76 friends of patients, 56–57 health care facilities and workers, 2–3, 4, 8, 18–21, 29, 30, 56–57, 61, 67, 69, 73, 138, 173, 190–191, 231, 232, 234; see also specific job categories infra and supra historical perspectives, 2–3, 4, 5–6, 8, 18–20, 43, 56, 57, 230, 231, 233–234 HIV, health care workers infected with, 28, 106 HIV patients, skin tests, 30 homeless shelters, 57, 58, 63 hospitals, 58, 73, 232 immigrants, 11, 57 isolation rooms, 73–74, 75, 76, 109, 111–112, 145, 245–246 laboratory personnel, 30, 58, 112, 118 latent tuberculosis, general, 121, 153 local governments, 66, 68, 232, 310, 312 long-term care facilities, 232, 246 masks, 76, 79, 145–146, 230; see also “respirators” infra nurses, 78 OSHA rule/standard compared to, 9, 43, 56–60, 62–80, 138–146 (passim), 152–155, 252, 290 outbreaks, 8, 20, 37, 141, 145 prevalence, 64, 66 public health, 56–57, 65, 71–72, 131, 133, 134, 310, 312 record keeping, 64, 65, 68, 72, 109 respirators, 3, 19, 20, 57, 63, 71, 76–80, 145–146, 230, 232, 293, 295, 300, 301; see also “masks” supra skin tests, 3, 29, 30, 33, 57(n.2), 58, 63, 64, 66, 67, 68, 69–70, 71, 142, 183, 232 surveillance, 64–65, 109 symptoms, 64, 246 transmission of disease, 64, 65, 244 worker job and financial protections, 70–71 Centers for Disease Control and Prevention (CDC) guidelines, implementation and effects, 108– 136, 138, 139, 141, 230–270 administrative controls, 108, 109–116, 120–124, 128, 129, 131, 133–134, 140, 234, 235, 238, 241, 246–250, 263–266, 301, 302 age factors, 128, 130 ambulatory care, 109, 129, 252 clinical practice, 247, 255, 309, 310 community-level factors, 135, 146, 232, 236 contract employees, 236 correctional facilities, 109, 113–115, 129, 130, 132, 133, 138, 246, 259 diagnosis, general, 58, 64–65, 72–74; see also “radiographs” and “skin tests” infra drug abusers, 244, 246, 252 drug-resistant tuberculosis, 109, 111, 112, 113, 115, 121, 126–127, 131, 234, 242, 250–251, 312 drug treatment, 109, 234, 235, 241, 248 emergency departments, 112, 129–130, 140, 231, 237, 250, 252, 256, 260, 262 engineering controls, general, 129–131, 134, 135, 136, 230, 232, 238–239, 245, 250–251, 257, 261, 293, 301, 302

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Tuberculosis in the Workplace epidemiology, 131–132, 133, 231, 236, 247, 263, 310 health care facilities and workers, 109, 110–113, 115–136, 142, 174, 230–231, 234–266; see also specific worker categories infra and supra historical perspectives, 108, 124, 132, 133, 135–136, 231, 251, 254, 261–262 HIV patients, 120, 121, 126–127, 129, 231, 234–239 (passim), 244–245, 246, 247, 248, 265 homeless shelters, 117, 132, 237, 241, 246 hospitals, 110–113, 114, 116–120, 123, 124–136 (passim), 140, 174, 215, 231, 233, 234–259, 261–266, 301–302 immigrants, 11, 130, 246, 261 isolation rooms, 111–112, 118–133 (passim), 136, 232–262 (passim), 302; see also negative-pressure isolation rooms” and “ventilation” infra laboratory personnel, 112, 118 latent tuberculosis, general, 121, 153 local governments, 114, 115 long-term care facilities, 232, 246 masks, 111, 112, 115, 116, 119, 120, 122, 125, 126, 127, 128, 131, 133, 234, 236, 238, 242, 244, 245, 250–258 (passim); see also “respirators” infra negative-pressure isolation rooms, 8, 109, 112, 118, 119, 125, 127, 128, 130(n.6), 234, 236, 238, 239, 242, 243, 252, 253, 254, 256–257, 302 nurses, 111, 122, 125, 236, 240, 254, 259, 261–262, 263, 264 outbreaks, 119–121, 123–131, 133–136, 230, 231–245, 261, 262, 302 physicians, 121, 125, 232, 236, 259, 264 public health, 231, 232, 256 radiographs, 115, 124–125, 130, 234, 246, 247, 248, 249, 263, 265 record keeping, 109 respirators, 109, 113, 121, 122, 125, 127–128, 129–131, 134, 136, 145– 146, 237, 243, 245, 252, 254, 256, 301–302, 306; see also “masks” supra skin tests, 109, 111, 113–117 (passim), 124–130 (passim), 144–145, 232–258 (passim) surveillance, 129, 133, 153, 236 symptoms, 64 ventilation, 75, 76, 112, 130–131, 230, 234, 241, 250–258 (passim); see also “negative-pressure isolation rooms” supra Chest radiographs, see Radiographs Chicago, Illinois, 115, 131, 196, 244, 302 Children, 87, 95–96, 196, 219, 220, 257, 262 adolescents, 27, 87, 196, 219, 220 infection likelihood, 27, 28 skin tests, 30 Cities, see Urban areas Clinical practice guidelines, CDC, 18, 57, 59, 247, 255, 309, 310 see also Case management; “guidelines” under Centers for Disease Control and Prevention Clinical trials, 130(n.7), 221–222 BCG vaccination, 219, 220 latent tuberculosis, treatment, 35, 220 Colorado, 215 Community-level factors, 12, 15, 17–18, 106, 124, 135, 138, 139, 156 see also Local governments; Urban areas CDC guidelines, 9, 64, 66, 67, 69, 135, 146, 232, 236 definitional issues, 83–85 diagnosis, 29, 31, 38–39 elderly persons, 102 health care workers vs community at large, risk, 7, 10–11, 16, 81, 83–85, 88–89, 92, 98, 105, 135, 142, 189– 191, 192, 194–199, 201, 210, 213, 216, 232, 236 immigrants, 95–96 OSHA rule/standard, 9, 10, 52, 138, 139, 142 outbreaks, 84, 155 prevalence, 7, 9, 31, 52, 64, 67, 69, 132; see also “health care workers…” supra skin tests, 29, 31 Computer databases, see Databases Confidentiality, CDC guidelines/OSHA rule/standard, 64 Connecticut, 210, 278 Contact tracing, 11, 28, 70 DNA fingerprinting, 38, 59(n.4), 84, 99, 101, 102, 104, 204, 244 skin tests, 29, 30 time factors/costs, 263, 264

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Tuberculosis in the Workplace Contract employees OSHA rule/standard, 53–54, 60, 62, 141, 208, 288–289 Control measures, see Administrative controls; Engineering controls; Hierarchy of controls; Personal respiratory protection Correctional facilities, 2, 81, 104, 114, 116 age of workers, 210 CDC guidelines, 2–3, 19, 57, 58 CDC guidelines, implementation and effects, 109, 113–115, 129, 130, 132, 133, 138, 246, 259 drug-resistant tuberculosis, 121 drug treatment, 114 employees, 6, 7, 15, 81, 89–90, 95, 99– 101, 106, 107, 114–115, 209–210, 259 historical perspectives, 5, 6, 14, 15–16, 18 immigrants, detainees, 101, 121, 208 inmates, 7, 14, 15–16, 62, 89–90, 99– 101, 114, 129, 130, 209–210, 220, 222, 311 inspections of, 117–118 isolation rooms, 118, 130, 133 local governments and, 101, 114, 115 National Commission on Correctional Health Care, 58 OSHA rule/standard, 3, 53, 60, 63, 89(n.5), 138, 152 outbreaks, 99–101, 114, 121, 129, 133, 209 physicians, 95, 99–101 prevalence, 89–90, 152, 215 public health measures, 311 radiographic screening, 130 risk assessment, 81, 89–90, 95, 104, 106, 208, 209–210, 213, 215, 220, 222 skin tests, 95, 99–101, 114, 115, 117, 215, 311 state regulations, 53 urban areas, 101, 115, 209–210 Costs and cost-effectiveness, 39, 261–266 administrative controls, regulatory burden, 10, 138, 144 control measures, general, 23, 49, 50– 51, 53, 110, 137, 140, 231, 246, 261– 266 contact tracing, 263, 264 drug treatment, 265 education of workers, 266 enforcement of state and local government worker safety, 53 fines and penalties, 20–21, 47, 55, 274, 275, 276, 290 homeless shelters, regulation, 63 injuries in the workplace, general, 271 inspection of facilities, 117 isolation, 263–266 mortality, 50–51 radiographs, 130 regulation, general, 2, 10, 45, 63, 137, 138, 140, 142, 144, 281, 282–283, 286, 290 respiratory protection, 71, 77, 118, 145, 146–147, 262, 296, 299 skin tests, 71, 142, 144, 261–262, 263, 264, 265 standards implementation, 2, 10, 49, 50–51, 261–266 surveys, 110 Coughing, 1, 13, 25, 26, 37, 103, 131, 190, 245, 246, 259 Court cases, see Litigation Crabtree, Jamie, 271–292 D Daniel, Thomas, 189–229 Databases, 85, 86–92, 111, 192, 214, 233, 247, 252, 253 MedLine, 192, 233 Death rates, see Mortality Definitional issues, 82–85, 151 active tuberculosis, 83, 150 annual risk of infection (ARI), 193 community-level factors, 83–85 elimination of tuberculosis, 135(n.8) employers and employees, 286 engineering controls, 74 incidence and prevalence, 85(n.4) latent tuberculosis, 13(n.1), 150 material health impairment, 284 occupational exposure, 82, 83(n.1) occupationally acquired disease, 82 outbreak, 84 risk, 82–83, 193

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Tuberculosis in the Workplace Demographic factors, 84, 94, 99, 107, 128, 135, 216, 219 see also Age factors; Epidemiology; Geographic factors; Immigrants; Race/ethnicity; Socioeconomic status; Urban areas gender factors, 84(n.3), 194, 202, 204, 211, 219, 220, 244 Dental clinics and schools, 113, 232, 260–261 Department of Health and Human Services, 46–47, 313 see also Centers for Disease Control and Prevention; National Institute for Occupational Safety and Health; National Institutes of Health Food and Drug Administration, 180, 183 Health Care Financing Administration, 51, 118 Public Health Service, 220 Department of Labor, 20, 47, 53, 273 see also Occupational Safety and Health Administration Federal Advisory Council on Occupational Safety and Health, 47, 273 Developing countries, 1, 6, 15, 21, 107 Mexico, immigrants from, 6, 15, 87, 89, 195, 201 Philippines, immigrants from, 6, 15, 87, 89, 195 Vietnam, immigrants from, 6, 15, 87 Zimbabwe, 15 Diabetes, 28, 30 Diagnosis, 8, 9, 12, 15, 18, 22, 24, 28–34, 140, 156, 222, 223, 310–312 see also Contact tracing; Latent infection; Skin testing; Surveillance active tuberculosis, 25, 30, 32, 33, 37– 40, 156; see also Radiographs; Sputum smears administrative controls, 8, 64, 103 CDC guidelines, 58, 64–65, 72–74, 109, 232 community-level factors, 29, 31, 38–39 DNA fingerprinting, 38, 59(n.4), 84, 99, 101, 102, 104, 204, 244 HIV patients, tuberculosis diagnosis, 29, 38(n.13), 39, 127, 221, 311 immigrants, 22, 29, 33, 38, 311 OSHA rule/standard, 29, 64–65, 68, 72–74, 144–145, 151–152 physicians role in, 29, 36, 37, 39 private sector research, 312 record keeping, 37 state government role, active tuberculosis, 37 time factors, diagnosis, 29, 30, 33, 34, 38–39, 58, 64, 70 time factors, transfer after diagnosis, 73–74 Diet, see Nutrition Directly observed therapy, 17, 22, 35, 41, 82, 119, 132, 139, 153 Disabled persons, see Long-term care facilities; Mental retardation; Nursing homes DNA fingerprinting, 38, 59(n.4), 84, 99, 101, 102, 104, 204, 244 Drug abuse, 7, 14, 81, 103, 211, 220–221 see also Alcohol abuse CDC guidelines, implementation and effects, 244, 246, 252 injection abusers, 30, 246 OSHA rule/standard, 60, 208 Drug resistance, 18, 120, 138, 309, 312 CDC guidelines, implementation and effects, 109, 111, 112, 113, 115, 121, 126–127, 131, 234, 242, 250–251, 312 CDC guidelines/OSHA rule/ standard, 64, 66, 73 correctional facilities, 121 health care workers infected, 7, 89, 91–92, 96, 98, 103, 115, 201 historical perspectives, 4, 5, 6, 11, 13– 14, 15, 19, 23, 154–155, 201, 231 immigrants, 121 mortality, 28, 96, 221, 222, 223 risk assessment, 89, 91–92, 96, 98, 103, 191, 201, 209, 222, 223 surgical treatment, 18 treatment, 40, 41 Drug treatment, 1, 12, 17–18, 22, 24, 82, 126, 155, 186–187, 221–223, 300, 309, 310, 311, 312 see also Case management; Vaccines active tuberculosis, 40–42; see also Drug resistance adherence, 36, 41, 155, 221, 222, 311 alcohol abuse and, 35 attitudes of patients, 35, 144

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Tuberculosis in the Workplace CDC guidelines, 35, 37, 73, 109, 234, 235, 241, 248, 302 correctional facilities, 114 costs, 265 directly observed therapy, 17, 22, 35, 41, 82, 119, 132, 139, 153 historical perspectives, 40, 41, 86, 154, 179–180, 182, 199 homeless shelter workers, 58 irritation medication, 190 isoniazid, 4, 13, 35, 40, 150, 216, 220, 221, 241, 248 latent tuberculosis, 24, 34–36, 42, 57(n.2), 121, 144, 150, 152–153, 156, 216, 220, 221, 223, 241 liver damage, 35, 150 mortality, effectiveness in reducing, 28, 40 OSHA rule/standard, 58, 73, 109, 150, 153, 154 pentamidine, 103, 126, 127, 190, 234, 235, 238, 240 physicians, 17, 41 pregnant women, 35 private sector research, 312 pyrazinamide, 35, 40 rifampin, 4, 13, 35, 40, 104 risk levels and, 35–36 side effects, 35–36, 150, 179, 222 skin tests, false positives, 32, 33 time factors, 17–18, 22, 34, 35, 36, 40–41, 143(n.1), 155, 302 Dust-mist/dust-mist-fume respirators, 119, 126, 128, 239, 243, 252, 254, 256, 257, 295, 297, 301, 304 E Economic factors, 43, 287 see also Cost factors; Funding; Socioeconomic status fines and penalties, 20–21, 47, 55, 274, 275, 276, 290 OSHA rule/standard, 49, 54–55 unemployed persons, 7, 15, 43–44, 89, 153–154, 222 worker job and financial protection, 70–71 Education see also Students dental schools, 113, 260–261 health care professionals, 37, 46, 57, 62, 106, 115, 119, 125, 133, 216, 231, 232, 236, 259, 262, 266 mentally retarded persons, 209–210 OSHA, 272 patients with latent tuberculosis, 35– 36, 65, 106 public, 45, 312 workers, general, 44, 46, 54–55, 65, 109, 115, 116, 232, 262, 266, 274, 294, 304–306, 310 Elderly persons, 101–102, 208, 222, 223 see also Nursing homes infection likelihood, 27(n7), 28 infection rates, 87 OSHA rule/standard, 61 skin tests, 30 Embalming, 26, 61, 104, 116, 212–213 Emergency departments, 95, 118, 122, 135, 260 CDC guidelines, 58, 73 CDC guidelines, implementation and effects, 112, 129–130, 140, 231, 237, 250, 252, 256, 260, 262 OSHA rule/standard, 60, 62, 140, 208 skin tests, 130, 260 Ending Neglect: The Elimination of Tuberculosis in the United States, 11, 12, 21, 41, 144, 154, 155, 309–313 Endotracheal suctioning, 190 Enforcement, 4, 5, 19, 20–21, 46, 56, 59, 133, 140, 234, 274–276, 278 see also Inspection of facilities; Litigation CDC powers lacking, 142 fines and penalties, 20–21, 47, 55, 274, 275, 276, 290 state and local government worker safety, cost of, 53 Engineering controls, 8–9, 110, 120, 300, 301 see also Isolation policies, rooms, and areas; Ventilation CDC guidelines, 3, 57, 63, 64, 65, 68, 74–76 CDC guidelines, implementation and effects, 129–131, 134, 135, 136, 230, 232, 238–239, 245, 250–251, 257, 261, 293, 301, 302 defined, 74

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Tuberculosis in the Workplace inspection of facilities, 117 modeling exercises and studies, 8, 130, 134, 136 OSHA rule/standard, 63, 64, 74–76 ultraviolet germicidal irradiation (UVGI), 26, 59–60, 203, 230, 232, 238, 241, 245, 250–251, 253, 258, 302, 304 Epidemiology, 4–5, 6, 10–12, 86–98, 104 see also Prevalence; Surveillance annual risk of infection (ARI), 193– 194, 195–201, 203–205, 210, 213, 215 CDC guidelines, implementation and effects, 131–132, 133, 231, 236, 247, 263, 310 historical perspectives, 4–5, 6, 10, 11, 12, 13, 14, 82, 87–88, 90, 131–132, 133, 138, 231 HIV and tuberculosis, 25(n.4) OSHA estimates, 10, 88 respirators, 148 U.S. government surveys and databases, 86–92 worldwide, 22 Ethnicity, see Immigrants; Race/ethnicity Europe, 199 BCG vaccination, 33 United Kingdom, 217 Executive Order 11612, 47 Executive Order 12196, 288 Executive Order 12866, 47, 50–51, 281, 283 Executive orders, other, 48, 53, 281 F Family members, 91, 95–96 CDC guidelines, 56–57, 153 isolation of patients from, 39–40 OSHA mortality estimates, 153 outbreak defined, 84 skin tests, 29 visits to patients, 23, 40, 56–57, 62, 79, 208, 245, 257 Federal Advisory Council on Occupational Safety and Health, 47, 273 Federal Coal Mine Health and Safety Act, 46 Federal government, 1, 5, 12, 16–17, 18, 45, 310 see also Centers for Disease Control and Prevention; Legislation; National Institute for Occupational Safety and Health; Occupational Safety and Health Administration; Office of Technology Assessment; Regulations and standards; terms beginning “Executive…” Agency for International Development, 312 Bureau of Mines, 45 Bureau of Prisons, 114 Department of Labor, 20 employees of, 52–53, 54–55, 58, 61, 288 Immigration and Naturalization Service, 21, 101, 121 Mine Safety and Health Administration, 60 OSHRC, 277 surveys and databases, 86–92, 110–115 Veterans Administration, 101, 102, 176, 246–247 Filters, see High-efficiency particulate air filters; Masks; Personal respiratory protection Fines and penalties, 20–21, 47, 55, 274, 275, 276, 290 see also Litigation Fit testing and fit, respirators, 77–79, 146– 148, 149, 293, 296, 297–299, 304–306 Florida, 6, 201, 205, 212, 215 Food and Drug Administration, 180, 183 Foreign countries, see International perspectives Foreign origin, see Immigrants Friends CDC guidelines, 56–57 skin tests, 29 visits to patients, 23, 40, 56–57, 62, 79, 208, 245, 257 Funding, 5, 17, 18, 54–55, 310 community programs, 138 risk defined, 83 urban hospitals, 82 Funeral homes, 90–91, 104, 121, 212 embalming, 26, 61, 104, 116, 212–213 OSHA rule, 61 skin testing, 61, 116

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Tuberculosis in the Workplace G Gender factors, 84(n.3), 194, 202, 204, 211, 219, 220, 244 pregnant women, 35 General-duty clause, OSHA, 47, 53, 59, 108, 117, 140, 141, 252, 273, 276, 279, 280, 288 Geographic factors, 6, 14–15, 97, 99, 104– 105, 128, 135, 136, 139, 142, 183, 190, 195, 201, 202, 206–207, 310 see also Community-level factors; Immigrants; International perspectives; State-level factors; Urban areas; specific states and countries mail surveys, 110 rural areas, 190, 192, 195, 198, 219, 243 Government Organization and Employees Act, 290 Government role, 44, 45, 82 see also Enforcement; Federal government; Local governments; Public health; Regulations and standards; State governments Granulomas, see Tubercules Gynecology, see Obstetrics and gynecology H Handicapped persons, see Long-term care facilities; Mental retardation; Nursing homes Harber, Philip, 293–308 Hawaii, 87, 100 Health care facilities and workers, 1, 2, 36, 39 see also Administrative controls; Ambulatory care facilities; Contract workers; Emergency departments; Engineering controls; Home care; Hospices; Hospitals; Isolation rooms and areas; Laboratory personnel; Long-term care facilities; Medical examiners; Nursing homes; Nursing personnel; Personal respiratory protection; Risk levels and assessment; Physicians bronchoscopy, 94, 95, 106, 121, 130(n.6), 131, 145, 149, 190, 201, 215, 243, 263 CDC guidelines, 2–3, 4, 8, 18–21, 29, 30, 56–57, 61, 67, 69, 73, 138, 173, 190–191, 231, 232, 234 CDC guidelines, implementation and effects, 109, 110–113, 115–136, 121, 122, 125, 127–131, 142, 174, 230– 231, 234–266 committee study at hand, goals and methodology, 7, 16, 92–93, 173–174 community at large vs health care workers, risk, 7, 10–11, 16, 81, 83– 85, 88–89, 92, 98, 105, 135, 142, 189–191, 192, 194–199, 201, 210, 213, 216, 232, 236 dental clinics and schools, 113, 232, 260–261 drug-resistant tuberculosis, 7, 89, 91– 92, 96, 98, 103, 115, 201 education, general, 44, 46, 54–55, 65, 109, 115, 116, 232, 262, 266, 274, 294, 304–306, 310 education, professionals, 37, 46, 57, 62, 106, 115, 119, 125, 133, 216, 231, 232, 236, 259, 262, 266; see also “students” infra historical perspectives, 2–3, 5, 7, 15, 18–20, 86, 199–200 HIV infected workers, 28, 106, 204 housekeeping staff, 98, 200, 202, 205, 206, 259 infected with tuberculosis, 1, 2, 6, 88– 91 isolation of patients; see Isolation rooms and areas obstetrics and gynecology, 99, 204 occupational exposure defined, 82 OSHA rule/standard, 4, 29, 59, 60, 61, 62, 69, 73, 138, 142–144, 152, 154, 173, 208, 287 outreach workers, 41, 91, 215 psychiatric facilities, 61, 101, 220 respiratory therapists, 94, 206, 215, 259 risk assessment, 85–86, 88–99, 102, 103, 104, 105–106, 107, 142–144, 189–229 see also “community…” supra

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Tuberculosis in the Workplace skin tests, facilities, 30, 62, 93, 94, 102, 117, 120, 124, 125–126, 128, 129, 151–152, 186, 212, 234 skin tests, workers, 19, 29, 30, 32, 36, 91, 93, 94, 103, 115, 124–128 (passim), 192, 215, 216–218, 232– 262 (passim), 300, 301, 302, 304 students, medical, 62, 85, 99, 100, 196, 287, 216–217, 259, 287 WHO guidelines, 23 Health Care Financing Administration, 51, 118 Medicaid, 53 Medicare, 51, 53, 118 HEPA, see High-efficiency particulate air filters Hepatic system, see Liver damage Hierarchy of controls, 57, 58, 76, 129, 134, 136, 145, 148, 230, 293, 300, 302 see also Administrative controls; Engineering controls; Personal respiratory protection High-efficiency particulate air filters (HEPA), 59–60, 148, 230, 236, 242, 254, 256, 257, 258, 261, 297, 301, 302, 304, 305, 306 Hispanics, 87, 196, 197, 215 Mexico, immigrants from, 6, 15, 87, 89, 195, 201 Puerto Ricans, 196, 197, 219, 252 Historical perspectives, 1, 4–6, 15–16, 17, 19, 23, 25, 43, 45–46, 87, 116, 120– 121, 124, 154–155 age factors in prevalence, 27, 87 CDC guidelines, 2–3, 4, 5–6, 8, 18–20, 43, 56, 57, 230, 231, 233–234 CDC guidelines, implementation and effects, 108, 124, 132, 133, 135–136, 231, 251, 254, 261–262 CDC reports of active tuberculosis, 86–87 complacency, 137–138 correctional facilities, 5, 6, 14, 15–16, 18 country comparison studies, 92 drug-resistant tuberculosis, 4, 5, 6, 11, 13–14, 15, 19, 23, 154–155, 201, 231 epidemiology of tuberculosis, 4–5, 6, 10, 11, 12, 13, 14, 82, 87–88, 90, 131–132, 133, 138, 231 funding, 17, 18 health care facilities and workers, 2–3, 5, 7, 15, 18–20, 86, 199–200 hospitals, 5, 199 inspection of facilities, 117 mortality, 4, 14, 15, 19, 106, 221–223 OSHA rule/standard, 3–4, 5–6, 7, 19, 45–47, 56, 57, 108–109, 150–151, 278 outbreaks, 1, 11, 15, 16, 82, 108, 133, 139, 141, 155, 194, 199, 202, 230, 295, 300 public health efforts, 11, 17, 23, 43, 155, 201–202, 231 prevalence, 27, 86–93, 131–132, 133, 138, 150–151 risk assessment, 82, 86–93, 105–106, 189–190, 194–200, 216–217, 219 skin tests, 179–180, 181 state government role, 5, 6, 8, 17, 18 treatment regimens, 40, 41, 86, 154, 179–180, 182, 199 HIV, 5, 6, 7, 14, 15–16, 25(n.4), 28, 40, 51, 71, 139, 154–155, 156 CDC guidelines, 18, 30, 106 CDC guidelines, implementation and effects, 120, 121, 126–127, 129, 231, 234–239 (passim), 244–245, 246, 247, 248, 265 diagnosis of tuberculosis, 29, 38(n.l3), 39, 127, 221, 311; see also “skin tests” infra health care workers infected, 28, 106, 204 latent tuberculosis treatment, 34, 35 OSHA rule/standard, 61 risk assessment, 81, 82, 88, 95, 97–98, 104, 106, 191, 201, 202, 203, 204, 207, 211, 220–221, 222 skin tests, 29, 30, 38(n.l3), 127, 311 time factors, tuberculosis infection, 239 Home care OSHA rule/standard, 60, 62, 289 risk assessment, 81, 103 Homeless persons and shelters, 7, 14, 15, 156 CDC guidelines, 57, 58, 63, 117, 132, 237, 241, 246 cost of regulation of, 63 drug treatment of workers, 58 inspections of, 117–118

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Tuberculosis in the Workplace OSHA rule/standard, 3, 21, 60, 63, 117, 208 outbreaks, 82, 95, 103, 211 risk assessment, 81, 82, 103, 208, 210– 211, 222, 223 skin tests, 58, 103, 117, 211, 241 WHO guidelines, 23 Hospices OSHA rule/standard, 60, 62, 208 risk assessment, 95, 103, 211 Hospital Infection Program (CDC), 253, 254 Hospitals, 1, 2, 5, 8, 15, 39, 81, 82, 104, 116, 121 see also Emergency departments; Isolation rooms and areas CDC guidelines, 58, 73, 232 CDC guidelines, implementation and effects, 110–113, 114, 116–120, 123, 124–136 (passim), 140, 174, 215, 231, 233, 234–259, 261–266, 301–302 CDC studies, 91–92, 96, 110–113, 114, 214 contract employees, 53–54, 62, 141, 208, 288–289 employees infected, 5, 30, 91–92, 199– 207, 215, 234 employment duration, 126 historical perspectives, 5, 199 inspections of, 117–119, 133–134, 252 intensive care units, 95, 256 isolation of patients; see Isolation rooms and areas OSHA rule/standard, 53–54, 60, 73, 94–95, 138, 139, 140–156, 252, 287 outbreaks, 7, 8, 82, 91, 95, 97, 98–100, 106, 120, 123, 124–129, 131, 133, 203, 204–205, 212, 221, 234–245, 261, 301, 302 risk assessment, 52, 81, 82, 86, 93, 94– 95, 97–100, 102, 103, 104–105, 106, 199–207, 215, 222, 243 skin tests, 30, 62, 93, 94, 102, 117, 120, 124, 125–126, 128, 129, 151–152, 199–207, 215, 231–266 (passim), 300, 301, 302 socioeconomic status of employees, 126, 200, 204 state regulation, 53 Veterans Administration, 101, 102, 176 Housekeeping staff, 98, 200, 202, 205, 206, 259 Human immunodeficiency virus, see HIV I Illinois, 6, 115, 131, 196, 244, 302 Immigrants, 7, 11, 14, 15, 22, 121, 135, 155, 156, 311, 312 see also Developing countries; specific groups BCG vaccination, 33, 126, 128, 130, 183, 202, 219, 220 CDC guidelines, 11, 57, 130, 246, 261 community-level factors, 95–96 detainees, 101, 121, 208 diagnosis, 22, 29, 33, 38, 311 European, 33, 199 Filipino, 6, 15, 87, 89, 195 geographic factors, 6 Hispanics, 87, 196, 197, 215 Mexican, 6, 15, 87, 89, 195, 201 medical school graduates, 99 OSHA rule/standard, 60 outbreak caused by family member, 95–96 prevalence, 22, 30, 192, 195, 199, 201 public health measures, 12, 22–23, 156 risk assessment, 81, 82, 87, 89, 91, 95– 96, 99, 107, 192, 195, 199, 201, 202, 204, 214, 215 skin tests, 29, 33, 311 Vietnamese, 6, 15, 87 Immigration and Naturalization Service, 21, 101, 121 Immune system, 26–27, 28, 40, 41, 106, 120, 191, 199, 216–220, 223, 244 see also HIV macrophages, 26–27 skin tests and, 33, 180–183, 185 time factors, 30, 215 tubercules, 27 Implementation of controls, see Administrative controls; Engineering controls; Hierarchy of controls; Personal respiratory protection Injection drug abusers, see Drug abuse

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Tuberculosis in the Workplace Inspection of facilities, 8, 20, 53, 55, 72, 109, 116–119, 133–134, 136, 252, 259, 288, 294 hospitals, 117–119, 133–134, 252 Intensive care units, 95, 256 International perspectives, 15, 22–23, 92, 156, 312 see also Developing countries; Immigrants age factors in prevalence, 27(n.7), 92 BCG vaccination, 33, 126, 128, 130, 183, 202, 219, 220 Canada, 130(n.6) control efforts, 12 Europe, 33, 188 funding, 310 Italy, 221 Puerto Ricans, 196, 197, 219, 252 United Kingdom, 217 World Health Organization (WHO), 22–23, 41, 195 Intubation, 190 Isolation policies, rooms, and areas, 39–40, 54, 140, 230 bathrooms in, 251, 257 CDC guidelines, 73–74, 75, 76, 109, 111–112, 145, 245–246 CDC guidelines, implementation and effects, 111–112, 118–133 (passim), 136, 232–262 (passim), 302 correctional facilities, 118, 130, 133 cost factors, 263–266 nursing homes, 118 OSHA rule/standard, 73–74, 75, 76, 109, 111–112, 145, 282 psychological factors, 39–40 time factors, 73–74, 75, 76, 130(n.6), 237, 238, 246, 254 ultraviolet germicidal irradiation (UVGI), 26, 59–60, 203, 230, 232, 238, 241, 245, 250–251, 253, 258, 302, 304 ventilation, 11, 60, 75, 76, 121, 130– 131, 199, 230, 232, 238, 250, 251, 254, 256–257; se also Negative-pressure isolation rooms visits to patients, 23, 40, 56–57, 62, 79, 208, 245, 257 Isoniazid, 35, 40, 150, 216, 220, 221, 241, 248 resistance to, 4, 13 Italy, 221 J Jails, see Correctional facilities Joint Commission on the Accreditation of Healthcare Organizations, 58, 117 K Kidneys, 27, 28, 95, 246 Koch, Robert, 179 L Laboratory personnel, 95, 98, 206 see also Sputum smears CDC guidelines, 30, 58, 112, 118 OSHA rule/standard, 60, 62, 208 Labor Coalition to Fight TB in the Workplace, 19, 20 Labor unions, 44, 45, 117, 133, 174, 252 Larynx, 1, 28 Latent infection, 1, 13, 22, 23, 24, 27, 42, 156, 216–218, 311 see also Skin testing American Thoracic Society, 57(n.2), 121 CDC guidelines, 13(n.1), 57(n.2), 121, 153 clinical trials, 35, 220 compared to active disease, 25 defined, 13(n.1), 150 education of patients, 35–36, 65, 106 HIV patients, treatment of latent tuberculosis, 34, 35 OSHA rule/standard, 88, 121, 152–153 pregnant patients, treatment of, 35 prevalence, 88, 152–153, 216–218, 220, 221 public health measures, 34, 35 risk assessment, 35–36 treatment, 24, 34–36, 42, 57(n.2), 121, 144, 150, 152–153, 156, 216, 220, 221, 223, 241 Legislation, 20, 69(n.7), 71–72, 281 see also Regulations and standards Administrative Procedure Act, 280 Federal Coal Mine Health and Safety Act, 46 Government Organization and Employees Act, 290

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Tuberculosis in the Workplace National Environmental Policy Act, 281 Occupational Safety and Health Act, 45–48, 54, 271–292; see also Occupational Safety and Health Administration Public Law 106–113, 173 Regulatory Flexibility Act, 281 state, 45–46, 69(n.7), 71–72 Unfunded Mandates Reform Act, 50, 281, 290 Local factors, see Community-level factors; Urban areas Local governments, 5 CDC guidelines, 66, 68, 232, 310, 312 CDC guidelines, implementation and effects, 114, 115 correctional facilities, 101, 114, 115 employees of, OSHA rule/standard, 52, 53, 61, 141, 287 Long-term care facilities see also Nursing homes CDC guidelines, 116, 232, 246 OSHA rule/standard, 60, 61 outbreaks, 95, 101–103, 208 risk assessment, 81, 101–103, 222 skin tests, 30 Litigation, 44–52 (passim), 82, 264, 271, 276, 277–278, 280, 282, 283–286, 288, 289 see also Enforcement attorneys, 208 OSHRC, 277 Liver damage, 35, 150 Lungs, 1 see also Radiographs infection processes, 26–27, 28 silicosis, 28 Lymphatic system, 27, 28 M Macrophages, 26–27 Mantoux method, 181, 182, 258 Maryland, 113, 255 Masks, 40, 298 see also Personal respiratory protection CDC guidelines, 76, 79, 145–146, 230, 236 CDC guidelines, implementation and effects, 111, 112, 115, 116, 119, 120, 122, 125, 126, 127, 128, 131, 133, 234, 236, 238, 242, 244, 245, 250–258 (passim) high-efficiency particulate air filters (HEPA), 59–60, 148, 230, 236, 242, 254, 256, 257, 258, 261, 297, 301, 302, 304, 305, 306 N95 respirators, 8, 77, 111, 118, 119, 125, 133, 145, 147, 148, 149, 254, 255, 295, 296, 297, 300, 301, 304, 305, 306 OSHA rule, 73, 74, 76, 78, 79, 145–146, 147, 148, 149, 282 surgical, 111, 112, 115, 120, 122, 126, 127, 128, 133, 234, 235, 238, 240, 242, 243, 245, 251–256 (passim), 296, 300, 301, 302, 304 Material impairment of health, 48–49, 50 Medicaid, 53 Medical examiners, 53, 60, 61, 208 autopsies, 26, 85, 95, 98, 149, 212 Medicare, 51, 53, 118 Medication, see Drug resistance; Drug treatment MedLine, 192, 233 Mental health facilities, see Psychiatric facilities Mental retardation, 209–210 Methodology, see Research methodology Metropolitan areas, see Urban areas Mexico, immigrants from, 6, 15, 87, 89, 195, 201 Miami, Florida, 126, 150, 198, 205, 214, 234, 261, 300 Michigan, 103, 211 Migrant workers, CDC guidelines, 57 Military personnel, 88, 94, 95, 194, 196, 197, 205, 206, 217, 220 Veterans Administration, 101, 102, 176, 246–247 Milk, ovine tuberculosis, 24 Mine Safety and Health Administration, 60 Mine workers, 45, 46, 60 Minnesota, 100, 207, 252 Minority groups, see Immigrants; Race/ethnicity

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Tuberculosis in the Workplace Modeling exercises and studies, 88, 123, 131, 132, 136, 151, 214, 248, 249–250 engineering controls, general, 8, 130, 134, 136 respiratory protection, 9, 145, 147, 148, 303–304 Molecular analysis, see DNA fingerprinting Morgues, see Medical examiners Mortality, 90, 191, 216, 221–223 CDC reports, 86–91, 92, 96, 153 cost-effectiveness of regulation, 50–51 drug-resistant tuberculosis, 28, 96, 221, 222, 223 historical perspectives, 4, 14, 15, 19, 106, 221–223 OSHA estimates, 10, 153–154 OSHA rule/standard, 48, 284 treatment absent, 28 treatment effective, 40 Multidrug-resistance, see Drug resistance Multiple-employer workplaces, see Contract employees N National Advisory Committee on Occupational Safety and Health, 46, 273 National Coalition for the Elimination of Tuberculosis, 312 National Commission on Correctional Health Care, 58 National Environmental Policy Act, 281 National Health Survey, 88, 195 National Institute for Occupational Safety and Health (NIOSH) inspection of facilities, 118–119 research, 272–273 respirators, certification, 8, 19, 20, 46, 77, 79, 118, 119, 122, 145, 254, 295, 296–298, 298, 301, 306 National Institutes of Health, 311, 312 National Tuberculosis Controllers Association, 175 Native Americans, see American Indians Negative-pressure isolation rooms, 8, 40(n.14), 203, 302 CDC guidelines, 8, 109, 112, 118, 119, 125, 127, 128, 130(n.6), 234, 236, 238, 239, 242, 243, 252, 253, 254, 256–257, 302 WHO guidelines, 23 Netherlands, 220 New Jersey, 6, 113, 117, 252, 255 New York City, 6, 15, 87, 91, 122, 127–128, 192, 196, 202–203, 204, 205, 206, 209, 210–211, 213, 214, 215, 220– 221, 222, 235, 237–240, 248, 250, 255–256, 260–261, 262, 301 New York State, 6, 15, 117, 118, 209, 252, 278 New York State Public Employees Federation, 175 N95 respirators, 8, 77, 111, 118, 119, 125, 133, 145, 147, 148, 149, 254, 255, 295, 296, 297, 300, 301, 304, 305, 306 NIOSH, see National Institute for Occupational Safety and Health North Carolina, 151, 208–209, 214 Nursing homes inspections of, 117–118 isolation rooms, 118 risk assessment, 15, 101–102, 104, 208–209, 213 skin tests, 30, 117, 208–209 Nursing personnel, 23, 37, 41, 175, 303 CDC guidelines, 78 CDC guidelines, implementation and effects, 111, 122, 125, 236, 240, 254, 259, 261–262, 263, 264 OSHA regulation, 53, 54, 62 risk assessment, 85, 91, 93, 98, 99, 102, 103, 104, 105, 196, 199–206 (passim), 215, 217, 218 Nutrition, 223 skin test results, 33 O Obstetrics and gynecology, 99, 204 Occupational Safety and Health Act, 45–48, 54, 271–292

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Tuberculosis in the Workplace Occupational Safety and Health Administration, 1, 2, 3–4, 5, 7, 9–10, 16, 19, 20, 21, 23, 43–57, 108. 123, 133, 134, 137–154, 173, 189, 271–292 administrative controls, 10, 59–60, 63–72, 140, 142–144, 149 CDC guidelines compared to rule, 9, 43, 56–60, 62–80, 138–146 (passim), 152–155, 252, 290 community-level factors, 9, 10, 52, 138, 139, 142 confidentiality, 64 contract employees, 53–54, 60, 62, 141, 208, 288–289 correctional facilities, 3, 53, 60, 63, 89(n.5), 138, 152 diagnosis, 37, 64–65, 72–74; see also “skin tests” infra drug abusers, 60, 208 drug treatment, 58, 73, 109, 150, 153, 154 emergency departments, 60, 62, 140, 208 enforcement, 19, 20–21, 46, 47, 59, 116–118, 133, 140, 141, 234, 271, 272, 274–276, 280 epidemiological estimates, 10, 88 fines and penalties, 20–21, 47, 55, 274, 275, 276, 290 funeral homes, 61 general-duty clause, 47, 53, 59, 108, 117, 140, 141, 252, 273, 276, 279, 280, 288 health care workers and facilities, 4, 29, 59, 60, 61, 62, 69, 73, 138, 142–144, 152, 154, 173, 208, 287; see also specific job categories infra and supra historical perspectives on rule/standard, 3–4, 5–6, 7, 19, 45–47, 56, 57, 108–109, 150–151, 278 HIV patients, 61 home care, 60, 62, 289 homeless shelters, 3, 21, 60, 63, 117, 208 hospices, 60, 62, 208 hospitals, 53–54, 60, 73, 94–95, 138, 139, 140–156, 252, 287 immigrants, 60 inspection of facilities, 53, 55, 72, 116–118, 252–253, 274–276, 288 isolation rooms, 73–74, 75, 76, 130(n.6), 237, 238, 246, 254; see also “ventilation” infra laboratory personnel, 60, 62, 208 local government employees, 52, 53, 61, 141, 287 long-term care facilities, 60, 61 masks, 73, 74, 76, 78, 79, 145–146, 147, 148, 149, 282; see also “respirators” infra mortality, 10, 48, 153–154, 284 nurses, 53, 54, 62 outbreaks, 37, 140, 141, 151–152, 154, 208 patient management, 72–74 physicians, 61, 62, 289 prevalence estimates, 27, 88, 94–95, 150–154 prevalence, OSHA rule/standard, 64, 88, 138 private sector role in rulemaking, 52, 272, 278 procedural requirements, 280–281 psychiatric facilities, 61 public health measures, 65, 71–72, 79, 138, 271, 290 record keeping, 64, 65, 68, 72, 109, 274, 276 respirators, 48, 63, 71, 76–80, 108, 117, 140, 141, 145–149, 232, 282, 293, 300–301, 306; see also “masks” supra skin tests, 29, 64, 68, 71, 142, 144–145, 151–152 state governments and, 52, 53, 61, 71–72, 141, 274, 278 state-level prevalence, 88, 150–151 surveillance rule/standard, 64–65, 109, 274 symptoms, 64 time factors for rule, 142, 276, 280, 281 toxic substances, 271, 274, 282, 283, 284–285 ventilation, 60, 75, 76 worker job and financial protections, 70–71, 138 Occupational Safety and Health Review Commission, 47 Office of Technology Assessment, 20 Oklahoma, 100 Omaha, Nebraska, 6, 87

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Tuberculosis in the Workplace Oregon, 215 Organ transplants renal, 95 skin tests, 30 OSHA, see Occupational Safety and Health Act; Occupational Safety and Health Administration OSHRC, 277 Outbreaks, 7, 9, 23, 68, 84, 95–104, 105, 123–131, 190, 192 administrative controls, 8, 134, 135, 136, 145, 262–263, 300, 301 CDC guidelines and, 8, 20, 37, 91, 119–121, 123–131, 133–136, 141, 145, 230, 231–245, 261, 262, 302 community-related exposure, 84, 155 correctional facilities, 99–101, 121, 129, 133, 209 defined, 84 DNA fingerprinting, 84, 204 engineering controls, 8–9, 134, 136, 145, 300 historical perspectives, 1, 11, 15, 16, 82, 108, 133, 139, 141, 155, 194, 199, 202, 230, 295, 300 homeless shelters, 82, 95, 103, 211 hospitals, 7, 8, 82, 91, 95, 97, 98–100, 106, 120, 123, 124–129, 131, 133, 203, 204–205, 212, 221, 234–245, 261, 301, 302 immigrant causing, 95–96 long-term care settings, 95, 101–103, 208 OSHA actions, 37, 140, 141, 151–152, 154, 208 research methodology, 96–97, 105, 119–120 shipboard, 221 Outpatient treatment, see Ambulatory care Outreach workers, 41, 91, 215 Outsourcing, see Contract employees P Pacific Islanders, see Asians/Pacific Islanders Patient education, see Education Penalties, see Fines and penalties Pennsylvania, 101, 121, 196 Pentamidine, 103, 126, 127, 190, 234, 235, 238, 240 Personal respiratory protection, 8, 9, 177, 293–308 see also Masks American Thoracic Society, 57 CDC guidelines, 3, 19, 20, 57, 63, 71, 76–80, 145–146, 230, 232, 293, 295, 300, 301 CDC guidelines, implementation and effects, 109, 113, 121, 122, 125, 127–128, 129–131, 134, 136, 145–146, 237, 243, 245, 252, 254, 256, 301–302, 306 cost factors, 71, 77, 118, 145, 146–147, 262, 296, 299 disposable, 131, 295, 299, 301, 304; see also “N95 respirators” infra dust-mist/dust-mist-fume respirators, 119, 126, 128, 239, 243, 252, 254, 256, 257, 295, 297, 301, 304 epidemiology and, 148 fit testing and fit, 77–79, 146–148, 149, 293, 296, 297–299, 304–306 high-efficiency particulate air filters, 59–60, 148, 230, 236, 242, 254, 256, 257, 258, 261, 297, 301, 302, 304, 305, 306 inspection of facilities, 117–118, 119 modeling exercises and studies, 9, 145, 147, 148, 303–304 NIOSH certification, 8, 19, 20, 46, 77, 79, 118, 119, 122, 145, 254, 295, 296–298, 298, 301, 306 N95 respirators, 8, 77, 111, 118, 119, 125, 133, 145, 147, 148, 149, 254, 255, 295, 296, 297, 300, 301, 304, 305, 306 OSHA rule/standard, 48, 63, 71, 76– 80, 108, 117, 140, 141, 145–149, 232, 282, 293, 300–301, 306 positive-pressure supplied air respirators, 295, 296, 304, 305 powered air-purifying respirators (PAPR), 76, 145, 295, 296, 304, 305 risk assessment, 294, 300, 304 time factors, 124, 146–147, 304 Pharmaceuticals, see Drug resistance; Drug treatment Philippines, immigrants from, 6, 15, 87, 89, 195

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Tuberculosis in the Workplace Physicians CDC guidelines, implementation and effects, 121, 125, 232, 236, 259, 264 correctional facilities, 95, 99–101 diagnosis, 29, 36, 37, 39 drug treatment, 17, 41 hospital, rule protecting physicians in, 54 OSHA rule/standard, 61, 62, 289 risk assessment, 95, 98, 99–101, 105, 204, 206, 215, 217 skin tests, 95, 98, 217 Pneumonia, 207, 237 Political factors, 21, 123(n.4) Positive-pressure supplied air respirators, 295, 296, 304, 305 Poverty, see Socioeconomic status Powered air-purifying respirators (PAPR), 76, 145, 295, 296, 304, 305 Pregnancy latent tuberculosis treatment, 35 Prevalence, 7, 9, 27(n.7), 107, 131–132, 138, 140, 191, 192, 194–223 (passim) see also Risk levels and assessment; Surveillance age factors, 27, 87, 88, 92, 93, 98 annual risk of infection (ARI), 193–194, 195–201, 203–205, 210, 213, 215 CDC guidelines, 64, 66 CDC reports, 86–92, 96, 152, 153 community-level factors, 7, 9, 31, 52, 64, 67, 69, 132 correctional facilities, 89–90, 152, 215 defined, 85(n.4) elimination of tuberculosis, defined, 135(n.8) historical perspectives, 27, 86–93, 131–132, 133, 138, 150–151 immigrants, 22, 30, 192, 195, 199, 201 latent tuberculosis, 88, 152–153, 216–218, 220, 221 OSHA estimates, 27, 88, 94–95, 150–154 OSHA rule/standard, 64, 88, 138 skin tests and, 30, 31, 144, 183, 184–185, 199–207 state-level, OSHA estimates, 88, 150–151 Prisons, see Correctional facilities Privacy, see Confidentiality Private sector, 6, 44, 54–55, 108 diagnosis and treatment research, 312 OSHA rule/standard, 52, 272, 278 state rule, 53, 278 Professional education, see Education Psychiatric facilities, 101, 220 OSHA rule/standard, 61 Psychological factors, see Attitudes Public health, 1, 12, 21–23, 24, 45, 82, 83, 86, 154, 309, 310 see also Case management; Community-level factors; Contact tracing; Outbreak investigations; Surveillance CDC guidelines, 56–57, 65, 71–72, 131, 133, 134, 310, 312 CDC guidelines, implementation and effects, 231, 232, 256 correctional inmates, 311 educational efforts, 45, 312 historical perspectives, 11, 17, 23, 43, 155, 201–202, 231 immigrants, 12, 22–23, 156 latent tuberculosis treatment, 34, 35 milk, 25 OSHA rule/standard, 65, 71–72, 79, 138, 271, 290 outreach workers, 41, 91, 215 skin tests, 32 Public Health Service, 220 Public Law 91–596, see Occupational Health and Safety Act Public Law 106–113, 173 PubMed (MedLine), 192, 233 Puerto Ricans, 196, 197, 219, 252 Pyrazinamide, 35, 40 Q Quarantine, see Isolation policies, rooms, and areas R Race/ethnicity, 87, 88, 90–91, 93, 99, 107, 128, 130, 192, 194, 196–198, 200, 204, 206–207, 214, 220, 244 see also Immigrants Asians/Pacific Islanders, 87, 197, 214, 215

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Tuberculosis in the Workplace black persons, 87, 196, 197, 204, 210, 215, 219, 220, 244 Hispanics, 87, 196, 197, 215 Puerto Ricans, 196, 197, 219, 252 white persons, 87, 88, 91, 194, 196–197, 198, 200, 215, 219, 220 Radiographs, 25, 30, 37, 38, 39, 83, 86, 95, 98, 102, 311 CDC guidelines, implementation and effects, 115, 124–125, 130, 234, 246, 247, 248, 249, 263, 265 correctional facilities, 130 cost factors, 130 Record keeping, 37 see also Surveillance CDC guidelines, 64, 65, 68, 72, 109 OSHA rule/standard, 64, 65, 68, 72, 109, 274, 276 skin test results, 29 Regulations and standards, 1, 2, 3–4, 5–6, 7, 9, 16, 43–55, 108, 109, 118, 137–156, 309–310 see also Centers for Disease Control and Prevention (CDC) guidelines; Centers for Disease Control and Prevention (CDC) guidelines, implementation and effects; Definitional issues; Enforcement; Inspection of facilities; Occupational Safety and Health Administration; State governments accreditation and licensure, 6, 53, 58, 82, 117, 140, 141 American College of Chest Physicians, 57 American Thoracic Society (ATS), 57, 58, 121, 153, 176 cost and cost-effectiveness, regulations, 2, 10, 45, 63, 137, 138, 140, 142, 144, 281, 282–283, 286, 290 cost and cost-effectiveness, standards, 2, 10, 49, 50–51, 261–266 Executive Order 11612, 47 Executive Order 12196, 288 Executive Order 12866, 47, 50–51, 281, 283 Executive orders, other, 48, 53, 281 exemptions, 4, 53, 64, 287, 289 litigation, 44–52 (passim), 82, 264, 271, 276, 277–278, 280, 282, 283–286, 288, 289 mine workers, 45, 46, 60 National Advisory Committee on Occupational Safety and Health, 46, 273 National Commission on Correctional Health Care, 58 NIOSH certification of respirators, 8, 19, 20, 46, 77, 79, 118, 119, 122, 145, 254, 295, 296–298, 301, 306 respirators, general, 294 skin tests, 29, 180, 195 treatment, directly observed therapy, 17, 22, 35, 41, 82, 119, 132, 139, 153 treatment observation, state requirements, 41 tuberculin as cure, 180 voluntary standards, 9–10, 54–55, 57, 58, 108, 121, 138, 276 WHO guidelines, 23 Regulatory Flexibility Act, 281 Renal system, see Kidneys Research methodology, 7, 46, 92–93, 248 see also Epidemiology; Risk levels and assessment annual risk of infection (ARI), 193–194 committee study at hand, goals and methodology, 2, 7–9, 16–17, 173–178, 189, 191 controlled studies, 6–7, 20, 122–124 databases, 85, 86–92, 111, 192, 214, 233, 247, 252, 253 literature review, 192–194, 233 mail surveys, 110 OSHA, 272–273 outbreak reports, 96–97, 105, 119–120 time factors, 7, 137, 192 Resistance, see Drug resistance Respirators, see Personal respiratory protection Respiratory isolation, see Administrative controls; Centers for Disease Control and Prevention (CDC) guidelines; Isolation policies, rooms, and areas Respiratory therapists, 94, 206, 215, 259 Rifampin, 35, 40 resistance to, 4, 13, 104 Risk factors, see Risk levels and assessment

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Tuberculosis in the Workplace Risk levels and assessment, 2, 81–107, 189–229 see also Demographic factors; Inspection of facilities; Prevalence; Surveillance age factors, 87, 88, 92, 93, 98, 192, 195, 202, 204, 213, 217, 219, 220, 223 annual risk of infection (ARI), 193–194, 195–201, 203–205, 210, 213, 215 CDC guidelines, 2, 64, 66–69, 143, 190–191, 192, 232, 244, 246, 261 CDC studies, 196, 214–216 community at large vs health care workers, risk, 7, 10–11, 16, 81, 83–85, 88–89, 92, 98, 105, 135, 142, 189–191, 192, 194–199, 201, 210, 213, 216, 232, 236 correctional facilities, 81, 89–90, 95, 104, 106, 208, 209–210, 213, 215, 220, 222 definition of risk, 82–83, 193 drug-resistant tuberculosis, 89, 91–92, 96, 98, 103, 191, 201, 209, 222, 223 embalmers, 104, 116 health care workers, 85–86, 88–99, 102, 103, 104, 105–106, 107, 142–144, 189–229 see also “community..." supra HIV patients, 81, 82, 88, 95, 97–98, 104, 106, 191, 201, 202, 203, 204, 207, 211, 220–221, 222 home care, 81, 103 homeless shelters, 81, 82, 103, 208, 210–211, 222, 223 hospices, 95, 103, 211 hospitals, 52, 81, 82, 86, 93, 94–95, 97–100, 102, 103, 104–105, 106, 199–207, 215, 222, 243 immigrants, 81, 82, 87, 89, 91, 95–96, 99, 107, 192, 195, 199, 201, 202, 204, 214, 215 latent tuberculosis treatment, 35–36 long-term care facilities, 81, 101–103, 222 nurses, 85, 91, 93, 98, 99, 102, 103, 104, 105, 196, 199–206 (passim), 215, 217, 218 nursing homes, 15, 101–102, 104, 208– 209, 213 OSHA rule/standard, 2, 48–50, 52, 64, 66, 68–69, 88, 94–95, 139, 142–144, 148–154, 189, 208, 213–214, 275, 284–286 physicians, 95, 98, 99–101, 105, 204, 206, 215, 217 respirators, 294, 300, 304 respiratory therapists, 94, 206, 215, 259 time factors, 68, 151(n.5), 192, 203, 216, 219, 220, 221, 254 urban areas, 82, 106, 195, 196, 197, 199–200, 201, 202–207, 213, 214, 219 ventilation, 190, 199, 212, 213, 221 Rural areas, 190, 192, 195, 198, 219, 243 S San Francisco, California, 6, 15, 87, 198, 215, 221 Seattle, Washington, 35, 198, 211, 241, 293 Side effects, drug treatment, 35–36, 150, 179, 222 Silicosis, 28, 91 Skin testing, 22, 23, 25, 28–34, 36, 38(n.13), 93, 156, 180, 186–187, 195, 218–219, 311 accuracy, 30–34, 39, 83, 94, 144, 182– 187, 221 active tuberculosis, 32, 33, 84(n.2) age factors, 30, 181 American Thoracic Society, 57(n.2) boostering phenomenon, 33, 185–187 CDC demonstration project, 19, 91–92 CDC guidelines, 3, 29, 30, 33, 57(n.2), 58, 63, 64, 66, 67, 68, 69–70, 71, 142, 183, 232 CDC guidelines, implementation and effects, 109, 111, 113–117 (passim), 124–130 (passim), 144–145, 232–258 (passim) children, 30 community-level factors, 29, 31 contact tracing and, 29, 30 correctional facilities, 95, 99–101, 114, 115, 117, 215, 311 cost factors, 71, 142, 144, 261–262, 263, 264, 265 dental schools, 113 elderly persons, 30 emergency departments, 130, 260

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Tuberculosis in the Workplace Food and Drug Administration, 180, 183 friends of patients, 29 funeral home employees, 61, 116 health care facilities, implementation, 30, 62, 93, 94, 102, 117, 120, 124, 125–126, 128, 129, 151–152, 186, 212, 234 health care workers, 19, 29, 30, 32, 36, 91, 93, 94, 103, 115, 124–128 (passim), 192, 215, 216–218, 232–262 (passim), 300, 301, 302, 304 historical perspectives, 179–180, 181 HIV patients, 29, 30, 38(n.13), 127, 311 homeless shelters, 58, 103, 117, 211, 241 hospitals, 30, 62, 93, 94, 102, 117, 120, 124, 125–126, 128, 129, 151–152, 199–207, 215, 231–266 (passim), 300, 301, 302 immigrants, 29, 33, 311 immune response and, 33, 180–183, 185; see also “HIV patients” supra infection with tuberculosis defined, 83 long-term care facilities, 30 National Health Survey, 88, 195 nursing homes, 30, 117, 208–209 nutritional factors, 33 organ transplants and, 30 OSHA rule/standard, 29, 64, 68, 71, 142, 144–145, 151–152 overview of, 177, 179–188 physicians, 95, 98, 217 prevalence and, 30, 31, 144, 183, 184– 185, 199–207 public health measures, 32 reading outcomes, 181–182 record keeping, 29 risk assessment, 83, 84(n.2), 88, 91–92, 93–94, 98–99, 102, 107, 194–196, 199–201, 202–207, 209, 211, 212–221 social stigma due to positive, 32, 144 state-level factors, general, 93, 113 students, 62 surveillance and, 29, 33, 34, 83, 144 time factors, 29, 30, 33, 34, 38(n.13), 58, 64, 70, 115, 126, 181, 185–186, 203, 235, 236, 255, 258, 304 vaccines, effects on, 33 Sneezing, 1, 13, 25, 259 Social factors, 43, 104, 311 see also Community-level factors; Contact tracing; Family members; Friends positive skin tests causing stigma, 32, 144 Social service workers, 115–116 OSHA rule/standard, 60, 61, 208 risk assessment, 98 Society for Healthcare Epidemiology of America, 112, 176, 242, 243, 253, 302 Society for Occupational and Environmental Health, 239 Socioeconomic status, 81, 85, 91, 93, 107 see also Homeless persons and shelters hospital personnel, 126, 200, 204 unemployed persons, 7, 15, 43–44, 89, 153–154, 222 South Carolina, 129 Spear, Robert, 293–308 Sputum smears, 25, 37, 38, 41, 72, 73, 112, 124, 125, 126, 234–240 (passim), 246, 247, 248–249, 256, 258, 263, 264, 265 risk assessment, 83, 98, 103, 190, 194, 195, 201, 210 time factors, 256, 264 Standards, see Regulations and standards State governments, 20, 45–46, 117, 140, 309, 310, 312 accreditation and licensure, 6, 53, 82, 140, 141 control programs, general, 8, 17, 18, 69(n.7), 109 correctional facilities, 53 diagnosis of active tuberculosis, 37 employees of, OSHA rule/standard, 52, 53, 61, 141, 274, 278, 287 funding, 55 historical perspectives, 5, 6, 8, 17, 18 hospitals, regulation of, 53 inspection of facilities, 118–119, 274 legislation, 45–46, 69(n.7), 71–72 OSHA, 52, 53, 61, 71–72, 141, 274, 278 private sector role in rulemaking, 53, 278 public health authorities, CDC guidelines/OSHA rule/standard, 71–72

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Tuberculosis in the Workplace treatment observation, 41 worker training, 274 State-level factors, 6, 14–15, 99(n.7), 132, 155, 215 see also specific states CDC reports of active disease, 86–87 correctional facilities, 100–101, 114, 209 OSHA estimates of prevalence, 88, 150–151 skin tests, 93, 113 St. Louis, Missouri, 198, 205, 206, 250, 266 Stop TB Initiative, 312 Strategic Plan for Tuberculosis Training and Education, 310 Streptomycin, 40 Students dental, 113, 260–261 medical, 62, 85, 99, 100, 196, 287, 216–217, 259, 287 other, 95–96, 196 Substance abuse, see Drug abuse Surgical masks, 111, 112, 115, 120, 122, 126, 127, 128, 133, 234, 235, 238, 240, 242, 243, 245, 251–256 (passim), 296, 300, 301, 302, 304 Surgical treatment, 18, 79–80, 95 organ transplants, 30, 95 Surveillance, 11, 81, 86–93, 107, 110–116, 216–219 see also Diagnosis; Mortality; Prevalence; Record keeping CDC guidelines, 64–65, 109 CDC guidelines, implementation and effects, 129, 133, 153, 236 correctional facilities, 114 federal government surveys and databases, 86–92, 110–115 nursing homes, 102 OSHA rule/standard, 64–65, 109, 274 skin tests, 29, 33, 34, 83, 144 Symptoms, 37–39, 118, 135, 136, 155, 221, 245 CDC definition of active tuberculosis, 83 CDC guidelines, 64, 246 coughing, 1, 13, 25, 26, 37, 103, 131, 190, 245, 246, 259 OSHA rule/standard, 64 sneezing, 1, 13, 25, 259 T Tennessee, 100 Testing, see Diagnosis; Skin testing; Sputum smears Texas, 6, 113, 209–210 Time factors autopsies, 98 committee study at hand, 137, 173 contact tracing, 263, 264 correctional facility, length of stay, 115 diagnosed patients, transfer from health care facilities, 73–74 diagnosis, 29, 30, 33, 34, 38–39, 58, 64, 70 drug treatment, 17–18, 22, 34, 35, 36, 40–41, 143(n.l), 155, 302 elimination of tuberculosis, defined, 135(n.8) emergency department stays, 118 exposure and infection, 26, 98 health care facilities, admission standards, 4 HIV patients, infection with tuberculosis, 239 hospital employment duration, 126 immigrants, 30, 215 isolation and isolation rooms, 73–74, 75, 76, 130(n.6), 237, 238, 246, 254 OSHA rule/standard, 142, 276, 280, 281 research methodology, 7, 137, 192 respiratory protection, 124, 146–147, 304 risk assessment, 68, 151 (n.5), 192, 203, 216, 219, 220, 221, 254 skin tests, 29, 30, 33, 34, 38(n.13), 58, 64, 70, 115, 126, 181, 185–186, 203, 235, 236, 255, 258, 304 sputum smears, 256, 264 worker benefits following severance, 71 Toilet facilities, see Bathrooms in isolation rooms Toxic substances, 57(n.2) drug toxicity, 222 OSHA, 271, 274, 282, 283, 284–285 Transmission of disease, 25–26, 103, 177, 259 see also Risk levels and assessment CDC guidelines, 64, 65, 244

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Tuberculosis in the Workplace coughing, 1, 13, 25, 26, 37, 103, 131, 190, 245, 246, 259 embalming, 26, 61, 104 health care worker knowledge of, 112 milk, 24 OSHA rule/standard, 64, 65 skin test conversion rates and, 186–187 sneezing, 1, 13, 25, 259 Transplants, organs, see Organ transplants Treatment, see Drug treatment; Surgical treatment Tubercules, 27 Tuberculin skin test, see Skin testing Tubersol, 180 U Ultraviolet germicidal irradiation (UVGI), 26, 59–60, 203, 230, 232, 238, 241, 245, 250–251, 253, 258, 302, 304 Unemployed persons, 7, 15, 43–44, 89, 153–154, 222 see also Homeless persons and shelters worker job and financial protections, 70–71 Unfunded Mandates Reform Act, 50, 281, 290 Unions, see Labor unions United Kingdom, 217 Urban areas, 5, 6, 15, 17, 82, 106, 119, 234, 243, 248 see also Homeless persons and shelters; specific cities CDC reports of active disease, 86–87 correctional facilities, 101, 115, 209–210 risk assessment, 82, 106, 195, 196, 197, 199–200, 201, 202–207, 213, 214, 219 UVGI, see Ultraviolet germicidal irradiation V Vaccines, 12, 22, 155, 311, 312 BCG, 33, 126, 128, 130, 183, 202, 219, 220 skin tests and, 33 Ventilation, 11, 23, 26, 103, 125, 304 CDC guidelines, 75, 76, 112, 130–131, 230, 234, 241, 250–258 (passim) isolation rooms, 11, 60, 75, 76, 121, 130–131, 199, 230, 232, 238, 250, 251, 254, 256–257; see also Negative-pressure isolation rooms nursing homes, 208 OSHA rule/standard, 60, 75, 76 risk assessment, 190, 199, 212, 213, 221 Vermont, 15, 87 Veterans Administration, 101, 102, 176, 246–247 Vietnam, immigrants from, 6, 15, 87 Virgin Islands, 252 Visitors of patients, 23, 40, 56–57, 62, 79, 208, 245, 257 Voluntary standards, 9–10, 54–55, 57, 58, 108, 121, 138, 276 see also Centers for Disease Control and Prevention (CDC) guidelines; Centers for Disease Control and Prevention (CDC) guidelines, implementation and effects WHO guidelines, 23 Volunteers, 54, 62, 278, 287 W Washington State, 151, 200–201, 208, 214 Weight factors, 28, 37, 245, 265 fit testing, respirators, 298 White persons, 87, 88, 91, 194, 196–197, 198, 200, 215, 219, 220 Woeltje, Keith, 230–270 Workplace hazards, strategies for reducing, 43–45 World Health Organization (WHO), 22–23, 41, 195 Wyoming, 15 X X-ray detection, see Radiographs Z Zimbabwe, 15