By Doug Parker, Executive Director
Tuberculosis is one of the deadliest infectious diseases in the world, causing an estimated 1.8 million deaths per year worldwide. The California Department of Public Health (CDPH) estimatesthat 2.3 million Californians are infected with latent tuberculosis infection (LTBI). Without diagnosis and treatment, 10% of LTBI cases can be expected to progress to active TB. California has the highest incidence rate of TB disease in the continental United States – 5.5 cases per year per 100,000 people, almost double the national rate.
On the front lines of treating patients and protecting the public are health care workers, who experience higher rates of active TB than the general population. Cal/OSHA appropriately recognizes that health care workers potentially exposed to patients with active TB are at elevated risk of infection and requires employers to offer these workers annual TB testing.
There is a proposal afoot to dismantle that safeguard. The California Conference of Local Health Officers (CCLHO) has petitioned the Occupational Safety and Health Standards Board to replace current rules with Centers for Disease Control guidelines issued in 2005 that would eliminate the requirement to offer annual TB testing to some health care workers at risk for exposure. Cal/OSHA considered these guidelines ten years ago and did not adopt them in drafting the current standard.
On its face, the proposal would only eliminate the availability of testing for workers at “low risk” of exposure. As in so much policy making, however, risk is a matter of perspective that can vary widely and tends to be better tolerated by the people who aren’t exposed to it. The proposal defines “low risk” as workers at hospitals with fewer than 6 active TB patients per year (or fewer than 3 per year at smaller facilities).
These assessments would rely on prompt and accurate diagnoses of TB. TB is a diagnosis that can be missed or delayed, and it is typical for patients to visit more than one emergency room or other care facility prior to seeing a doctor who makes the TB diagnosis.
The idea that health care facilities would be relieved of offering TB testing to potentially exposed workers in these settings is at odds with basic principles of occupational health. Our health care workers deserve better.