TB in the Workplace: The Threat Remains

If you think of tuberculosis (TB) as a disease of your parent’s or grandparent’s generations, or as a present-day threat only in third-world countries, perhaps you should think again. Consider this:

• More than 2 billion people—roughly one-third of the world’s population—are infected with TB bacilli, the microbes that cause TB, according to the World Health Organization (WHO).


• One in 10 people infected with TB bacilli will become sick with active TB in their lifetime (people with HIV are at much greater risk).


• There were 9.2 million new TB cases in 2006, according to WHO, and 1.7 million people died from TB that year.


• TB is now the second most common cause of death from infectious disease in the world after human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), according to OSHA.


• In 2007, 13,293 new TB cases were reported in the U.S.

It is true that the incidence of TB in the U.S. is lower than in many other countries, but a resurgence of TB in this country in the 1980s and the recent emergence of multi-drug-resistant strains of the disease are cause for concern.

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Healthcare workers and employees in correctional facilities face a significantly higher risk of TB infection. But employees in other industries—including nursing homes, social services offices, homeless shelters, bars, and adult entertainment centers, to name a few—also are at higher risk.

TB Infection
Caused by bacteria, TB is a contagious disease that primarily affects the lungs. The Cal/OSHA Compliance Advisor newsletter states that transmission is generally through droplets transported through air when an infected person coughs, speaks, or sneezes. Not everyone who becomes infected with TB gets sick (however, a person will still test positive on a TB skin test). Some people will become sick immediately after becoming infected; in others, the disease will lay dormant for an indefinite period of time and cause disease later, and a minority of people will not manifest active disease.

When a TB infection develops into the active disease, it is generally contagious and has symptoms that include cough, fever, chills, and weight loss. Once infected, regardless of disease state, people are treated with drugs to prevent active disease. It generally takes 6 months to a year of treatment to rid the body of TB.

Who Is at Risk?
The occupational risk of TB infection is highest for workers who have more frequent contact with people who are most likely to manifest active TB, such as:

• People with HIV infection


• People who have been recently infected with TB (in the last two years)


• People who inject illegal drugs


• Babies and young children


• The elderly


• People who were not treated correctly for TB in the past


• People with certain medical conditions such as diabetes, certain types of cancer, and those who are underweight

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Workplace Prevention

You can implement administrative, environmental, and respiratory protection controls to protect workers where there is a risk of TB infection in occupational settings, according to the Cal/OSHA Compliance Advisor. These include:

Administrative Controls

• Conduct an assessment to determine whether workers risk coming into contact with TB-infected individuals.


• If there is a risk, develop a written TB infection control plan that includes airborne precautions, methods of identifying infected persons, and handling infected workers (e.g., subsequent testing and the how and when of returning to work).


• Implement effective work practices to manage people with suspected or confirmed TB disease.


• Ensure proper cleaning and sterilization or disinfection of potentially contaminated equipment.


• Train and educate workers regarding TB, with specific focus on prevention, transmission, and symptoms.


• Screen and evaluate workers who are at risk for TB disease or who might be exposed.


• Use workplace signage advising of respiratory hygiene and cough etiquette.

Environmental Controls

If you know that people with active TB will be regularly present in a facility, environmental controls may be appropriate, including:

• Controlling the infection source by using local exhaust ventilation (e.g., hoods, tents, or booths) and by diluting and removing contaminated air by using general ventilation.


• Controlling the airflow to prevent contamination of air in areas adjacent to the source, and clean the air by using high efficiency particulate air (HEPA), filtration, or ultraviolet germicidal irradiation (UVGI).

Respiratory Protection Controls

The use of respiratory protection can further reduce workers’ risk of exposure to potential TB infection. You can:

• Implement a respiratory protection program.


• Train workers on respiratory protection, including proper respirator selection (for example, surgical masks are not sufficiently protective against TB).

In tomorrow’s Advisor, we’ll look at steps you can take—including a detailed, prewritten policy—to help prevent the spread of TB and other communicable diseases in your workplace.