Prisons Overlook TB Infection

Most of the hoopla and controversy surrounding OSHA's late-term abortion of the tuberculosis standard focuses on the hazards facing health care workers. But in many ways, hazards facing other workers -- like corrections officers, for example -- are much worse. In fact, it was the tuberculosis-related death of a New York corrections officer and the hospitalization of another (along with his young son whom he had unknowingly infected) that helped stimulate labor's petition of OSHA in 1995 for a tuberculosis standard. OSHA's withdrawal of the proposed standard was based largely on the assumption that everyone was already following voluntary CDC guidelines and doing what they were supposed to do to protect their employees.

But CDC's August 20 Morbidity and Mortality Weekly Report (MMWR) paints a far different -- and more troubling -- picture, at least in correctional institutions. A CDC investigation found that a clearly symptomatic inmate with an active TB infection "had resided in three different jails and a state prison, placing hundreds of employees and other inmates at risk for TB infection."

More than 5% of prison employees who had a previously negative TB test, and almost 13% of employees who had not received a previous TB test received diagnoses of latent TB infection. (Latent infections are not "active" or infectious, but can become active and infectious at a later date if not treated.) More upsetting is the suspicion that undiagnosed prison-related TB infections can contribute to rises in TB infection rates among the general outside population:

During 1992--2002, the TB rate in Kansas increased from 2.2 per 100,000 population to 3.3, the largest increase among all 50 states and the District of Columbia; in the majority of states, the TB rate declined. Although the contribution of correctional facilities to the TB burden in Kansas is unknown, a study in Tennessee reported that 43% of persons identified with TB in the city of Memphis had previous contact with a single urban jail and no other identified common exposure.

The CDC calls for correctional institutions to implement formal Tuberculosis Infection Control Plans (TBICPs), educate employees, continuously monitor the effectiveness of the TBICP, maintain a tracking system for inmate TB screening and treatment and to establish a mechanism for sharing this information with local and state health departments and other correctional facilities.

Of course, had the tuberculosis standard been in effect now, all of this (and more) may have been required and the exposures and infections might not have happened. On the other hand, this incident occurred in Kansas, a state that does not provide federally approved OSHA coverage for its public employees (although it does have a non-federally approved program). But that's another story.