Georgia Workers Compensation News

Health Care Workers In Atlanta Where Worker Compensation System Do Not Consider Occupational Tb A Compensable Disease

Most of the decreases in reported cases of TB since 1992 have occurred in areas such as New York City, where resources have been invested to improve or initiate TB control provisions, such as those outlined in OSHA's proposed standard. However, the 1995 statistics show that over the course of four years there is substantial variability in the increases and decreases of cases reported by each state for any given year (Ex. 6-34). In 1995, 15 states reported an increase in the number of TB cases compared with 1994. In addition, a recent study has shown that MDR-TB has spread to patients in Florida and Nevada, and to health care workers in Atlanta, Georgia and Miami, Florida. Moreover, one individual with MDR-TB infected or caused disease in at least 12 people in a nursing home in Denver, Colorado (Ex. 7-259). This study shows very clearly the ability of TB to be spread to different areas of the country. This is to be expected given the mobile nature of today's society and the frequency with which people travel. Immigration also contributes to the incidence of the disease. For example, while the number of active TB cases has decreased among U.S. born persons, the number of foreign born persons reported with TB has increased 63 % since 1986, with a 5.4 % increase in 1995 (i.e., from 7,627 cases in 1994 to 8,042 cases in 1995). Thirty to fifty percent of these cases were diagnosed 1 to 5 years after the individual enters the U.S. (Ex. 6-34). Thus, tuberculosis continues to be a public health problem throughout the United States.

1. OSHA is requiring employees who are transporting an unmasked individual with suspected or confirmed infectious TB within a facility to wear a respirator. Is this appropriate? How often would an individual with suspected or confirmed infectious TB be transported unmasked through a facility? Under what circumstances would it be infeasible to mask such an individual? What other precautions should be taken when transporting such an individual who is not masked?

2. OSHA is requiring that maintenance personnel use respiratory protection during maintenance of air systems or equipment that may reasonably be anticipated to contain aerosolized M. tuberculosis. When would it be necessary to access such an air system at the time it was carrying air that may contain aerosolized M. tuberculosis? Should OSHA require that such air systems be purged and shut down whenever these systems are accessed for maintenance or other procedures?

3. OSHA has received information that the use of certain kinds of respirators in helicopters providing emergency medical services may hamper pilot communication. Have other air ambulance services encountered this problem? Does this problem exist when the employee is using a type N95 respirator or other types of respiratory protection such as powered air purifying respirators? What other infection control or industrial hygiene practices could be implemented to minimize employee exposure in these circumstances?

4. The CDC states that there may be selected settings and circumstances (e.g., bronchoscopy on an individual with suspected or confirmed infectious TB or an autopsy on a deceased individual suspected of having had active TB at the time of death) where the risk of transmission may be such that increased respiratory protection such as that provided by a more protective negative-pressure respirator or a powered air purifying respirator may be necessary. Are there circumstances where OSHA should require use of a respirator that is more protective than a type N95 respirator? If so, what are the circumstances and what type of respiratory protection should be required?

5. OSHA is proposing that respirators be fit-tested annually, which is consistent with general industrial hygiene practice, or, in lieu of an annual fit test, that employees have their need to receive the annual fit test be evaluated by the physician or other licensed health care professional, as appropriate. For the circumstances and conditions regulated by this standard, will the evaluation provide enough ongoing information about the fit of a respirator to be an adequate substitute for fit testing? Should OSHA require that an actual fit test be performed periodically? If so, at what frequency?

6. OSHA has not included any provisions regarding the use of supplied air respirators. Are there circumstances in which supplied air respirators would be used to protect against M. tuberculosis? Should OSHA include provisions addressing supplied air respirators in the standard?

7. OSHA is permitting the reuse of disposable respirators provided the respirator does not exhibit excessive resistance, physical damage, or any other condition that renders it unsuitable for use. Will the respirators continue to protect employees throughout the reuse period?

8. In the proposed standard for TB, OSHA has included separate provisions for all aspects of a respiratory protection program for tuberculosis. What other elements might need to be included? Which respiratory protection provisions, if any, are not appropriate for protection against TB? Please provide reasons and data to support inclusion or exclusion of particular provisions.

1. Should any provisions be added to the Medical Surveillance program?

2. OSHA has not required that physical exams be included as part of the baseline evaluation. Is there information that is essential to medical surveillance for TB that can only be learned from a baseline physical exam?

3. OSHA is specifying tuberculin skin testing frequencies for employees with negative skin tests. Should tuberculin skin testing be administered more or less frequently? Are there other ways to determine the frequency of tuberculin skin testing?

4. OSHA is proposing that employees entering AFB isolation rooms or areas be skin tested every 6 months. However, employees providing home health care, home care, and home-based hospice care are to be skin tested annually. Employees entering the home of an individual who has suspected or confirmed infectious TB may have the same potential for exposure to aerosolized M. tuberculosis as employees who enter an isolation room. In light of this, should employees providing care to individuals with suspected or confirmed infectious TB in private homes be skin tested every 6 months?

5. OSHA is requiring that all tuberculin skin testing be administered, read, and interpreted by or under the supervision of a physician or other licensed health care professional, as appropriate, according to current CDC recommendations. Should OSHA require specific training for individuals who are administering, reading, and interpreting tuberculin skin tests? If so, what type of training should be required?

6. Should OSHA require a declination form for employees who do not wish to undergo tuberculin skin testing?

7. OSHA is including Medical Removal Protection (MRP) provisions for employees who are unable to wear respiratory protection or who contract infectious tuberculosis. Are there additional provisions that need to be included? What remedies are available to employees in states where worker compensation system do not consider occupational TB a compensable disease? What benefits are provided to workers who are unable to wear a respirator?

8. In the proposed standard for TB, OSHA has included separate provisions for all aspects of a respiratory protection program for tuberculosis. What other elements might need to be included? Which respiratory protection provisions, if any, are not appropriate for protection against TB? Please provide reasons and data to support inclusion or exclusion of particular provisions.

Contact Georgia Workers Compensation Attorneys

Learn more about your legal rights, contact a Worker's Compensation Lawyer in the following cities in Georgia now.