TRANSMISIONES POR CAUSA DE MUERTE (MORTIS CAUSA)

REGULATION: Section 1904.11

Subpart C – Recordkeeping forms and recording criteria

(66 FR 6123, Jan. 19, 2001)

Note to Subpart C: This Subpart describes the work-related injuries and illnesses that an employer must enter into the OSHA records and explains the OSHA forms that employers must use to record work-related fatali- ties, injuries, and illnesses.

Section 1904.11 Recording criteria for work-related tuberculosis cases (a) Basic requirement.

If any of your employees has been occupationally exposed to anyone with a known case of active tuberculosis (TB), and that employee subsequently develops a tuberculosis infection, as evidenced by a positive skin test or diagnosis by a physician or other licensed health care professional, you must record the case on the OSHA 300 Log by checking the “res- piratory condition” column.

(b) Implementation.

(1) Do I have to record, on the Log, a positive TB skin test result obtained at a pre-employment physi- cal?

No, you do not have to record it because the employee was not occupationally exposed to a

known case of active tuberculosis in your workplace. (2) May I line-out or erase a recorded TB case if I obtain evidence that the case was not caused by occupational exposure?

Yes, you may line-out or erase the case from the Log under the following circumstances:

(i) The worker is living in a household with a per- son who has been diagnosed with active TB; (ii) The Public Health Department has identified the worker as a contact of an individual with a case of active TB unrelated to the workplace; or (iii) A medical investigation shows that the employee’s infection was caused by exposure to TB away from work, or proves that the case was not related to the workplace TB exposure.

PREAMBLE DISCUSSION: Section 1904.11

(66 FR 6013-6017, Jan. 19, 2001)

The following are selected excerpts from the preamble to the Occupational Injury and Illness Recording and Reporting Requirements, the Recordkeeping rule (66 FR 5916, 29 CFR Parts 1904 and 1952). These excerpts represent some of the key discussions related to the final rule (66 FR 6122, 29 CFR Parts 1904 and 1952).

Section 1904.11 Recording criteria for work-related tuberculosis cases

Section 1904.11 of the final rule being published today addresses the recording of tuberculosis (TB) infections that may occur to workers occupationally exposed to TB.... There are two general stages of TB, tuberculosis infection and active tuberculosis dis- ease.

Individuals with tuberculosis infection and no active disease are not infectious; tuberculosis infec- tions are asymptomatic and are only detected by a positive response to a tuberculin skin test....

The text of Section 1904.11 of the final rule states:

(a) Basic requirement.

If any of your employees has been occupationally

exposed to anyone with a known case of active tuberculosis (TB), and that employee subsequently develops a tuberculosis infection, as evidenced by a positive skin test or diagnosis by a physician or other licensed health care professional, you must record the case on the OSHA 300 Log by checking the “res- piratory condition” column.

(b) Implementation.

(1) Do I have to record, on the Log, a positive TB skin test result obtained at a pre-employment physi- cal?

No, because the employee was not occupationally exposed to a known case of active tuberculosis in your workplace.

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(2) May I line-out or erase a recorded TB case if I obtain evidence that the case was not caused by occupational exposure?

Yes. You may line-out or erase the case from the Log under the following circumstances:

(i) The worker is living in a household with a per- son who has been diagnosed with active TB; (ii) The Public Health Department has identified the worker as a contact of an individual with a case of active TB unrelated to the workplace; or (iii) A medical investigation shows that the employee’s infection was caused by exposure to TB away from work, or proves that the case was not related to the workplace TB exposure.

Positive Skin Tests

...A positive tuberculin skin test indicates that the employee has been exposed to Mycobacterium tuberculosis and has been infected with the bacteri- um. Although the worker may or may not have active tuberculosis disease, the worker has become infect- ed. Otherwise, his or her body would not have formed antibodies against these pathogens. (OSHA is aware that, in rare situations, a positive skin test result may indicate a prior inoculation against TB rather than an infection.)

OSHA believes that TB infection is a significant change in the health status of an individual, and, if occupational in origin, is precisely the type of illness Congress envisioned including in the OSHA injury and illness statistics. Contracting a TB infection from a patient, client, detainee, or other person in the workplace would cause serious concern, in OSHA’s view, in any reasonable person. Once a worker has contracted the TB infection, he or she will harbor the infection for life. At some time in the future, the infection can progress to become active disease, with pulmonary infiltration, cavitation, and fibrosis, and may lead to permanent lung damage and death. An employee harboring TB infection is particularly likely to develop the full-blown disease if he or she must undergo chemotherapy, contracts another disease, or experiences poor health....

As discussed elsewhere in this document (see the Legal Authority section above), Congress did not intend OSHA’s recordkeeping system only to capture conditions over which the employer has complete control or the ability to prevent the condition. The Act thus supports a presumption of work-relatedness for illnesses resulting from exposure in the workplace, and the OSHA recordkeeping system has always reflected this position (although a few specific excep- tions to that presumption are permitted, including an

exception for common colds and flu). In accordance with that presumption, when an employee is

exposed to an infectious agent in the workplace, such as TB, chicken pox, etc., either by a co-worker, client, patient, or any other person, and the employee becomes ill, workplace conditions have either caused or contributed to the illness and it is therefore work- related. Since, as discussed above, TB infection is clearly a serious condition, it is non-minor and must be recorded.

Employee-to-Employee Transmission

...OSHA believes, under the positional theory of causality, that non-minor illnesses resulting from an exposure in the work environment are work-related and therefore recordable unless a specific exemption to the presumption applies. Infection from exposure to another employee at work is no different, in terms of the geographic presumption, from infection result- ing from exposure to a client, patient, or any other person who is present in the workplace. The trans- mission of TB infection from one employee to anoth- er person at work, including a co-worker, clearly is non-minor and is squarely within the presumption.

...[I]n the final rule being published today, TB cases are recordable without regard to the relative risk present in a given industry, providing only that the employee with the infection has been occupa- tionally exposed to someone with a known case of active tuberculosis. Employers may rebut the pre- sumption only if a medical investigation or other spe- cial circumstances reveal that the case is not work- related.

In the final rule, OSHA has not adopted the “spe- cial industries” presumption, for several reasons. First, doing so would be inconsistent with the approach taken by the Agency in other parts of the rule, i.e., specific industries have not been singled out for special treatment elsewhere. Second, a “spe- cial industries” presumption is not needed because the approach OSHA has taken in this section will pro- vide employers with better ways of rebutting work- relatedness when that is appropriate. Finally, the spe- cial industries approach is not sufficiently accurate or well enough targeted to achieve the intended goal. Many cases of occupationally transmitted TB occur among employees in industries other than the “spe- cial industries,” and evidence shows that the risk of TB infection varies greatly among facilities in the spe- cial industries.

...OSHA agrees that a case of TB should be recorded only when an employee has been exposed to TB in the workplace (i.e., that the positional theory

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of causation applies to these cases just as it does to all others). OSHA has added an additional recording criterion in this case: for a TB case occurring in an employee to be recordable, that employee must have been exposed at work to someone with a known case of active tuberculosis.

...Under the final rule, if a worker reports a case of TB but the worker has not been exposed to an active case of the disease at work, the case is not record- able. However, OSHA sees no need for the employer to document such workplace exposure, or for the Agency to require a higher level of proof that work- place exposure has occurred in these compared with other cases. Further, OSHA knows of no justification for excluding cases simply because they are the first or only case discovered in the workplace. If a worker contracted the disease from contact with a co-worker, patient, client, customer or other work contact, the case would be work-related, even though it was the first case detected. Many work- related injury and ill- ness cases would be excluded from the recordkeep- ing system if cases were only considered to be work- related when they occurred in clusters or epidemics. This was clearly not Congress’s intent.

The final rule’s criteria for recording TB cases include three provisions designed to help employers rule out cases where occupational exposure is not the cause of the infection in the employee (i.e., where the infection was caused by exposure outside the work environment). An employer is not required to record a case involving an employee who has a posi-

tive skin test and who is exposed at work if (1) the worker is living in a household with a person who has been diagnosed with active TB, (2) the Public Health Department has identified the worker as a contact of a case of active TB unrelated to the work- place, or (3) a medical investigation shows that the employee’s infection was caused by exposure to TB away from work or proves that the case was not related to the workplace TB exposure.

...OSHA has added an implementation question to the final rule to make sure that employers under- stand that pre-employment skin test results for TB are not work-related and do not have to be recorded. These results are not considered work-related for the purposes of the current employer’s Log because the test result cannot be the result of an event or expo- sure in the current employer’s work environment.

...[T]he final rule allows employers to rebut the presumption of work-relatedness if a medical evalua- tion concludes that the TB infection did not arise as a result of occupational exposure, a physician or other licensed health care professional could use the CDC Guidelines or another method to investigate the ori- gin of the case. If such an investigation resulted in information that demonstrates that the case is not related to a workplace exposure, the employer need not record the case. For example, such an investiga- tion might reveal that the employee had been vacci- nated in childhood with the BCG vaccine. The em- ployer may wish, in such cases, to keep records of the investigation and determination.