![]() ![]() In circumstances in which a patient is able to produce a sputum sample through normal coughing, the patient could be instructed to wear a surgical mask while in public areas of the facility, enter a well-ventilated exam room alone, produce a sample, cease coughing, and redon the mask. "Do different requirements apply when a patient is requested to produce a sputum sample without cough-inducing clinical intervention, as opposed to a process of health-care-worker conducted cough-inducing procedures?" "May high risk procedures such as sputum induction be performed in non-negative pressure rooms so long as health care workers are protected with N-95 respirators and the procedure is carried out utilizing effective local exhaust?" It is my understanding that a negative pressure room would not be required so long as respiratory protection and local exhaust were utilized.Ģ. I have set forth the questions posed, along with my tentative conclusions, as follows:ġ. ![]() My client has asked me to seek guidance with respect to several issues arising under the tuberculosis enforcement guidelines issued by federal OSHA. I represent Kaiser Foundation Health Plan, Inc., Kaiser Foundation Hospitals, and the Permanente Medical Groups, known collectively as the Kaiser Permanente Medical Care Program. Re: Tuberculosis Enforcement Directive, Our File No. Occupational Safety and Health Administration Thank you for your interests in safety and health. If you have any further questions, you may contact. I hope this provides the information you needed and clarifies our position on the issues you mentioned. Some diagnostic procedures, such as those mentioned in the previous questions above, could still require either a negative pressure room or a local exhaust enclosure. Under OSHA's enforcement procedures, it would be permitted to instruct the patient in the proper procedures, to wear a surgical mask, and to wait in areas separate from the other patients. If suspect TB out-patients are seen infrequently, a negative pressure room would not be required for procedures like x-rays and other low-risk treatments. Your third question asks about the need for an acid-fast bacilli (AFB) isolation room in a facility that meets the "very low risk" or lower criteria, if suspect TB out-patients are present in the facility for diagnostic procedures. A "well-ventilated exam room," if under positive pressure, could push these air contaminants beyond the confines of the room and expose other workers. While a patient may be able to produce a sample without additional coughing, this may not always be the case. In response to your second question about the need for precautions when the patient is asked to self-induce a sputum specimen, the same precautions would apply as when a health care worker induces the sputum production. Health care workers would be required to wear respirators in either case. After completion of the procedure, the patient should remain in the enclosure until coughing subsides and the ventilation continued until airborne contaminates have been removed. The preferred method for cough-inducing procedures is the use of a local exhaust ventilation device such as a booth or special enclosure. A negative pressure room is an optional requirement for sputum induction procedures. Your first question inquired about the need for negative pressure rooms during high risk procedures, if local exhaust is provided and health care workers are protected with N-95 respirators. This is in response to your letter of April 25, requesting guidance for a client who had several issues relating to the Occupational Safety and Health Administration (OSHA) Tuberculosis (TB) Enforcement Procedures. ![]()
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