[Federal Register Volume 64, Number 116 (Thursday, June 17, 1999)]
[Proposed Rules]
[Pages 32447-32449]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-15240]


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DEPARTMENT OF LABOR

Occupational Safety and Health Administration

29 CFR Part 1910

[Docket No. H-371]
RIN 1218-AB46


Occupational Exposure to Tuberculosis

AGENCY: Occupational Safety and Health Administration (OSHA), 
Department of Labor.

ACTION: Notice of limited reopening of rulemaking record.

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SUMMARY: On October 17, 1997, OSHA published its proposed standard to 
regulate occupational exposure to tuberculosis (TB). Public hearings on 
the proposal were held in Washington, DC, Los Angeles, CA, New York 
City, NY, and Chicago, IL between April 7 and June 4, 1998. The post-
hearing comment period closed on October 5, 1998. OSHA is now reopening 
the rulemaking record for 45 days to submit two reports to the docket: 
OSHA's report on TB control practices in homeless shelter settings (Ex. 
179-1); and the National Institute for Occupational Safety and Health's 
(NIOSH) Health Hazard Evaluation (HHE) of a medical waste treatment 
facility (Ex. 179-2). OSHA invites public comment on the findings of 
these reports and the underlying issues of the coverage of homeless 
shelters and medical waste treatment facilities within the scope of a 
final TB standard. OSHA also seeks comment on including TB and AIDS 
clinics and probation and parole officers within the scope of the 
standard as well as expanding the coverage of the standard to include 
all social service workers.
    In addition, OSHA is submitting to the docket four other documents, 
previously unavailable, that relate to issues addressed during the 
public hearings. These documents are: The American College of 
Occupational and Environmental Medicine's (ACOEM) ``Guidelines for 
Protecting Health Care Workers Against Tuberculosis'' (Ex. 179-3); 
``Laboratory Performance Evaluation of N95 Filtering Facepiece 
Respirators, 1996'' (Morbidity and Mortality Weekly Report, December 
11, 1998) (Ex. 179-4); ``The Costs of Healthcare Worker Respiratory 
Protection and Fit-Testing Programs'' by Scott E. Kellerman et al. 
(September 1998, Journal of Infection Control and Epidemiology) (Ex. 
179-5); and ``The Relative Efficacy of Respirators and Room Ventilation 
in Preventing Occupational Tuberculosis' by Kevin Fennelly and Edward 
Nardell (October 1998, Journal of Infection Control and 
Epidemiology)(Ex. 179-6). Public comment on these documents is also 
invited. Comments should be limited to the issues raised in these 
documents, and participants do not need to resubmit evidence or 
comments that are already in the record.

DATES: Comments must be postmarked no later than August 2, 1999.

ADDRESSES: Send two copies of your comments to: Docket Office, Docket 
H-371, Room N2625, Occupational Safety and Health Administration, U.S. 
Department of Labor, 200 Constitution Avenue, NW, Washington, DC 20210. 
Comments limited to 10 pages or fewer may also be transmitted by FAX 
to: 202-693-1648, provided that the original and one copy of the 
comment are sent to the Docket Office immediately thereafter.
    Comments may also be submitted electronically through OSHA's 
Internet site at URL, http://www/osha-slc.gov/e-comments/e-comments-
tb.html. Information such as studies and journal articles cannot be 
attached to electronic submissions and must be submitted in duplicate 
to the above address. Such attachments must clearly identify the 
respondent's electronic submission by name, date, and subject, so that 
they can be attached to the correct submission.
    The entire record for the TB rulemaking, including the new reports 
being submitted, is available for inspection and copying in the Docket 
Office, Docket H-371, telephone 202-693-2350.

FOR FURTHER INFORMATION CONTACT: Bonnie Friedman, Office of Information 
and Consumer Affairs, Occupational Safety and Health Administration, 
Room N-3647, U.S. Department of Labor, 200 Constitution Avenue, NW, 
Washington, DC 20210, Telephone (202) 693-1999, FAX (202) 693-1634.

SUPPLEMENTARY INFORMATION:

[[Page 32448]]

Background

    On August 25, 1993, the Labor Coalition to Fight TB in the 
Workplace petitioned OSHA to initiate rulemaking for a permanent 
standard issued under Section 6(b) of the Occupational Safety and 
Health (OSH) Act to protect workers from occupational exposure to TB. 
Citing the recent resurgence of TB and the emergence of new cases of 
multidrug-resistant TB (MDR-TB), the petitioners stressed the need for 
a substance-specific standard to address the particular hazards 
associated with occupational exposures to TB. The petitioners contended 
that the non-mandatory TB Guidelines published by the Centers for 
Disease Control and Prevention (CDC) do not provide adequate protection 
because they are not fully or rigorously implemented in most 
workplaces.
    On October 17, 1997, OSHA published its proposed standard for 
occupational exposure to TB (62 FR 54160). Based on a review of the 
data, OSHA made a preliminary determination that workers in hospitals, 
nursing homes, hospices, correctional facilities, homeless shelters, 
and certain other work settings are at significant risk of incurring TB 
infection while caring for their patients and clients or performing 
certain procedures. To reduce this occupational risk, OSHA proposed a 
standard that would require employers to protect TB-exposed workers by 
means of infection prevention and control measures that have been 
demonstrated to be highly effective in reducing or eliminating job-
related TB infections. These measures include procedures for the early 
identification of individuals with suspected or confirmed infectious 
TB, the isolation of such individuals in rooms designed to protect 
those in the vicinity of the room from contact with microorganisms 
causing TB, the use of respirators when performing certain high-hazard 
procedures, employee training, employee skin testing and, where 
appropriate, medical management and follow-up after an exposure 
incident or skin test conversion has occurred.

Homeless Shelters

    Throughout the development of the proposal, OSHA has been concerned 
about the feasibility of implementing a TB standard in homeless 
shelters because of the unique characteristics of the workforce in such 
shelters, the unique characteristics of the client population, and the 
non-profit nature of most homeless shelters. Prior to publication of 
the proposal, OSHA held stakeholder meetings with homeless shelter 
representatives and met with the Interagency Council on the Homeless to 
discuss issues related to the potential impact the standard might have 
on homeless shelters. In addition, during review under the Small 
Business Regulatory Enforcement Fairness Act (SBREFA), small business 
representatives from the homeless shelter sector raised specific 
concerns about many shelters' ability to implement certain provisions 
of OSHA's proposed standard. To address issues related to the 
feasibility of the proposed standard for homeless shelters, OSHA 
requested information in the proposal and held special sessions at each 
hearing site to receive testimony from employers, employees, clients 
and others representing homeless shelters. In addition, OSHA initiated 
a study to examine these issues further through an on-site survey of a 
number of homeless shelters. The results of this study (Ex. 179-1) did 
not become available to OSHA until after the close of the public 
comment period. This study has now been placed in the docket for this 
rulemaking and is available for public comment.

Waste Treatment Facilities

    During the development of the proposal, OSHA was also concerned 
about additional types of work settings that might need to be included 
within the scope of the TB standard because they pose a significant 
risk of occupational TB exposure to their employees. During the public 
hearings, testimony was submitted that addressed the potential for 
significant occupational exposure to TB at medical waste treatment 
facilities handling medical wastes that had not been decontaminated. 
Preliminary findings from investigations at a medical waste treatment 
facility where a TB outbreak had occurred were presented at the 
hearings and used as supplemental evidence to support the inclusion of 
medical waste treatment facilities within the scope of the standard. 
Other commenters suggested that instead of including the waste 
treatment facilities, laboratories covered under the TB standard should 
be required to decontaminate their TB wastes prior to sending them 
offsite for disposal. At the time of the public hearings on the TB 
rule, NIOSH was in the process of conducting a Health Hazard Evaluation 
(HHE) to evaluate the potential for occupational exposure to 
Mycobacterium tuberculosis during the processing the medical wastes. 
The final HHE (Ex. 179-2) was completed after the close of the public 
comment period, and has now been entered into the docket for public 
comment.

Other Work Settings

    In addition to homeless shelters and medical waste treatment 
facilities, other work settings were also recommended by various 
commenters for possible inclusion in the final standard. Several 
commenters urged OSHA to cover TB and AIDS clinics based on the fact 
that these types of clinics are likely to have a high percentage of 
clients at risk for having infectious TB. OSHA is considering including 
these ambulatory clinics within the scope of the final standard and 
seeks additional information on whether such inclusion is warranted. In 
particular, OSHA solicits information on the number of such clinics, 
the number of employees typically employed by these clinics, and data 
on the risk of TB to employees of these facilities.
    Commenters also urged the Agency to include parole and probation 
officers within the scope of the final standard. These commenters 
testified during the public hearings that parole and probation officers 
must often interact with the same type of high-risk populations as 
employees in correctional facilities and therefore, they should be 
included within the scope of the final standard. Therefore, OSHA also 
solicits additional information on whether the inclusion of parole and 
probation officers under the final standard is warranted.
    Finally, commenters urged the Agency to expand the standard's 
coverage of social service workers to include all social service 
workers and not just social service workers providing services to 
individuals who are in TB isolation or who are otherwise segregated or 
isolated due to having infectious TB. OSHA solicits information on 
whether expanding coverage to all social service workers is warranted. 
In particular, OSHA is concerned about the feasibility of including 
such a broad spectrum of workers in the final standard. Thus, the 
Agency is interested in ways to determine the type(s) of social service 
workers who may reasonably be anticipated to incur occupational 
exposure to TB and types of provisions that would be most effective to 
reduce TB risks of such employees.

Additional Submissions to the Record

    In addition, four other documents pertinent to issues raised during 
the rulemaking became available after the close of the rulemaking 
record. These documents are: (1) the American College of Occupational 
and Environmental

[[Page 32449]]

Medicine's (ACOEM) ``Guidelines for Protecting Health Care Workers 
Against Tuberculosis'' (Ex. 179-3); (2) ``Laboratory Performance 
Evaluation of N95 Filtering Facepiece Respirators, 1996'' (Morbidity 
and Mortality Weekly Report, December 11, 1998) (Ex. 179-4); (3) ``The 
Costs of Healthcare Worker Respiratory Protection and Fit-Testing 
Programs'' by Scott E. Kellerman et al. (September 1998, Journal of 
Infection Control and Epidemiology) (Ex. 179-5) and (4) ``The Relative 
Efficacy of Respirators and Room Ventilation in Preventing Occupational 
Tuberculosis'' by Kevin Fennelly and Edward Nardell (October 1998, 
Journal of Infection Control and Epidemiology) (Ex. 179-6).

Reopening of the Record and Request for Comments

    In order to complete the rulemaking record on issues related to the 
feasibility of the proposed standard for homeless shelters and medical 
waste treatment facilities, OSHA is now reopening the rulemaking record 
and placing in the record the final homeless shelter study, ``Final 
Report on Site Visits to Nine Homeless Shelters'', (Ex. 179-1) and the 
NIOSH medical waste facility HHE(Ex. 179-2). OSHA is also submitting 
four additional documents, listed above, which include three articles 
related to respiratory protection issues discussed during the hearings 
and one article by the ACOEM outlining recommendations for controlling 
the transmission of TB. These exhibits are available in the Docket 
Office at the address listed above.
    OSHA seeks public comment on (1) the homeless shelter report, (2) 
the NIOSH HHE, and (3) the underlying issues related to the feasibility 
of the proposed standard for homeless shelters, and whether the 
standard should cover medical waste treatment facilities, to help OSHA 
determine whether and, if so, how homeless shelters and medical waste 
treatment facilities should be regulated under the final TB standard. 
Comments are also requested on whether OSHA should require laboratories 
to decontaminate medical wastes containing Mycobacterium tuberculosis 
before these wastes are sent offsite for disposal. In addition, new 
information on including TB and AIDS clinics as well as social service 
workers and parole and probation officers within the scope of a final 
standard is sought.
    OSHA also requests comment on four additional documents: the ACOEM 
TB guidelines and three articles addressing respiratory protection 
against TB, which are listed above. In particular, the Agency is 
interested in comments regarding the adequacy of qualitative fit-
testing for N95 respirators for determining a face-seal leakage of no 
greater than 10 percent.
    This document was prepared under the direction of Charles N. 
Jeffress, Assistant Secretary of Labor for Occupational Safety and 
Health, U.S. Department of Labor, 200 Constitution Avenue, NW, 
Washington, DC 20210.
    It is issued under section 6(b) of the Occupational Safety and 
Health Act of 1970 (29 U.S.C. 655), Secretary of Labor's Order No. 1-90 
(55 FR 9033) and 29 CFR part 1911.

    Signed at Washington, DC, this 9th day of June, 1999.
Charles N. Jeffress,
Assistant Secretary of Labor.
[FR Doc. 99-15240 Filed 6-16-99; 8:45 am]
BILLING CODE 4510-26-P