AT MINIMUM, ANY EXPOSURE INCIDENT INVOLVING TUBERCULOSIS, MUST CONTAIN ALL OF THE FOLLOWING ELEMENTS
Management must identify each employee involved in an exposure incident. The employee should receive a tuberculin skin test as soon as possible with a retest at 12 weeks. The employee must also undergo an evaluation by a physician and a medical questionnaire. Upon completion of a three month follow-up, those employees who remain to be tuberculin non-reactors will have completed the process and should return to their normally scheduled TB screening. In most cases the normal schedule for TB screening, is once yearly, or upon a visit from the FO H personnel that administer this type of testing.
The physician’s written opinion must be limited to: The employee’s TB skin test status (e. g., Positive or negative): The employee’s in affectivity status (e.g. noninfectious or infectious): A statement that the employee has been informed of the results of the medical evaluation; A statement that the employee has been told about any medical conditions resulting from exposure to TB that require further evaluation or treatment; Recommendations for work restrictions; and, The employee’s ability to wear a respirator, (if applicable). All medical findings or diagnoses not directly related to TB infectious status, ability to wear a respirator, or work restrictions must be kept confidential and not included in any report.
For the Collateral Duty Safety Officer working on this case, the following must be performed as well.
DECONTAMINATION OF SPACES
Tuberculosis is transmitted by small airborne droplets or droplet nuclei from person-to-person in close contact or possibly through ventilation systems. Other dried secretions in and of themselves do not pose a significant hazard. Therefore when a case of active pulmonary tuberculosis disease is discovered, the following steps should be taken: The filters in the ventilation system exhausting the areas where the source case worked must be cleaned as per the usual HVAC procedures. If possible, increased circulation of fresh air and exposure of the working spaces to natural light (sunlight) will rapidly clear any infectious, airborne droplet nuclei from the spaces. In the case of the Calexico Station where the exposure to sunlight is impractical if not impossible, at the very least the filters in the ventilation system should be thoroughly cleaned if not replaced, and the personnel assigned to this task should be notified of the reason for the cleaning or replacement.
REFERENCES CONCERNING TUBERCULOSIS EXPOSURE CONTROL INCLUDE THE FOLLOWING DOCUMENTS:
The United States Land Ports of Entry Design Guide, Prevention and Control of Tuberculosis in Correctional Facilities, Recommendations of the Advisory Council for the Elimination of Tuberculosis, issued by the Center for Disease Control and the Proposed Rule for the Occupational Exposure to TB (§ 1910.1035) issued by OSHA. On the OWCP or Office of Worker’s Compensation side of the issue the employee, supervisor and all other personnel involved should follow the established protocols:
ESTABLISHED PROTOCOLS: Occupational diseases are defined as being produced by systemic infections, continued or repeated stress or strain, exposure to toxins, poisonous fumes, noise, etc., in the work environment longer than (1) one workday or shift. In order to qualify as a disease, injury must be caused by exposure or activities on at least (2) two days. Example: Employee, whose job is moving equipment every day, develops back strain. If back strain came from continued lifting rather than lifting a specific piece of furniture, case would be classified as occupational disease. The same rule applies to an employee who was exposed to toxic fumes over a long period of time and contracts respiratory disease, then that employee would be classified as having sustained a disease. In cases identified by this example, A CA-2 would be filed by the employee to OWCP.
NOTE: Employees should be aware that it is extremely difficult to prove these conditions were caused by person’s job activities or environment and take longer to adjudicate than traumatic injuries. If as I suspect, is the case in this matter, the employee was exposed for the 8 hours or less, then the CA- 1 is the correct course of action and if as I have been informed the employees are made to attend appointments with physicians and/or medical facilities, on their day(s) off, then this is not the correct course of action because under the CA-1 the employee should be employing Continuation of Pay (COP) during subsequent appointments. In order to meet the threshold of an injury in a single event that occurs within eight hours, (CA-1), the injury must meet five requirements: The CA-1 must be timely filed. The employee must be a civil employee. The fact of the injury must be met. (The fact in this place was any documentation from a third party agency, as in this case, the agency was notified by ICE that the individuals were positive TB Carriers/Infected ) The employee must be injured while performance duty, and The casual relationship between condition and injury must be met in the sequence. (In this case) While in the performance of their duties which require that the employees work in close proximity of any individual processed, (fingerprinting) an individual infected with Tuberculosis, as was identified by a subsequent agency (ICE), in an enclosed environment (with-out direct sunlight), the employees came into contact with the individual that was infected with Tuberculosis.
Please be advised that should the level of exposure rise to the level of an Occupational Disease/Exposure to the same individual beyond the 8 hours and therefore require a CA-2 the following applies: (A good example of this type of exposure would be an employee exposed to Scabies where an employee may have one of Texas families for a significant period of time. The employee is informed that the individual in custody is positive for Scabies and at a later time the employee develops a rash, and also the employee was exposed for over 8 hours) No COP is authorized for Occupational Disease. If the employee is entitled to Leave, Compensation for Leave Without Pay; Leave Buyback; or any other Wage Loss, such as a Downgrade/Reduction in Pay, Loss of Night Pay Differential, etc., or Scheduled Award, file a CA-7, “Claim for Compensation”, Sections 1 – 7, and submit to agency for completion and submission to OWCP. Supervisor Should: Assist employee in filing CA-2, Notice of Occupational Disease and Claim for Compensation, immediately in CBP e-comp electronic system. Challenge claim, if appropriate at the time of submission. Give employee the signed receipt of Report of Notice of Occupational Disease or Illness. Give employees two copies of appropriate CA – 35 a – h checklist. (These list are essential in describing the information needed from both the employee and the Agency in order to have the appropriate OWCP District Office adjudicate the claim. One checklist is for the employee to gather the necessary evidence to support the claim and the second checklist employee to take to the attending physician. Complete CA-2, 19-35 along with appropriate CA-35 a-h, Agency portion of the checklist and submit to OWCP, within 10 working days of receipt from the employee. Not give CA-16, Authorization for Examination and/or Treatment, unless OWCP has approved. Explain to employee: The right to elect Sick or Annual Leave or Leave With-Out Pay, pending adjudication of the claim. If the employee sustains any out-of-pocket medical expenses to include pharmacy, submit CA-915, Claim for Reimbursement. For Mileage Reimbursement submit OWCP-957 Medical Travel Refund Request. Provide employee with OWCP-1500, Federal Employees Compensation Program Medical Providers Claim Form. Give employee Affiliated Computer System (ACS) address information card to be given to treating physician/medical facility for handling bill submissions and medical procedures authorizations. Inform employee if claim is being challenged? Give employee CA-7 Claim for Compensation, with instructions to complete the front and return the form to the agency for agency completion of sections 8-15 for submission to OWCP. If Leave Buy Back is authorized, complete CA-7, Claim for Compensation, Sections 8-15, along with the CA-7B, Leave Buy Back, (LBB) Worksheet Certification and Election, and submit to OWCP.