Tuberculosis

Workers in a number of occupations are at risk of contracting the infectious disease tuberculosis. OHS reps need to ensure that employers minimise the risks to their members.

Tuberculosis or "TB" is an infectious disease caused by a germ called Mycobacterium Tuberculosis. TB used to be common in Australia up to the 1960's. It is fairly uncommon today - the incidence of TB in Australia averages around 1000 new cases per year (in Victoria, 250-320 per year). Approximately 85 per cent of TB notifications occur in people born overseas, with 50 per cent of these cases occurring in the first five years of residence in Australia. The disease is more common in Asia, Africa and South Central America. Workers can contract TB because of their work.

Notified cases of TB in Victoria dropped dramatically from 1,000 cases in 1954 to 292 in 2000, with the notification rate falling from 47 to 6 per 100,000. However, this was followed by a gradual increase in the number of notifications from 2003 to 2012, reaching its peak in 2010 with 435 cases.

Action Plan for Health and Safety Representatives

Identify the hazard and assess the risks

All work areas and tasks should be regularly assessed.

Determine whether tuberculosis is a risk in your occupation (see More information, below). Contact your union for advice if necessary.
Determine how many and which workers could be exposed.
Carry out inspections, observe, evaluate current existing precautions.
Talk to members of your work group - ask co-workers whether they are experiencing any health problems about which they are concerned.
Investigate any past illnesses or complaints, illness and workers compensation records kept by your employer.

Risk Prevention and Control

TB can be prevented through vaccination. In Australia, all children are offered TB vaccination (the BCG vaccine) usually at school around twelve or thirteen years of age. The vaccination does not give 100% protection, but it does protect against the more serious forms of the disease.

A skin test (Mantoux test) can show if TB bacteria are present in someone's body. A harmless substance is injected under the skin on the arm and a health care professional checks the skin two or three days later for any swelling. It is very important that the skin be checked at the right time. The worker is given the results of the test and advised if they need any further tests (for example a chest x-ray).

Measures to prevent and control the risk of TB:

Immunisation of staff at risk - workers, particularly newly appointed ones, should be tested for immunity to TB and given the BCG vaccination if they test negative or if their immunity is in doubt ;
Provision of health checks - in addition to an immunisation program, workers in high risk groups should be offered regular surveillance through TB testing.
Introduction of a safe system of work which minimises contact with potential sources of infection;
Information and training for all workers;
On-going evaluation of risk control measures.

Post - Exposure Procedure

TB disease and some cases of TB infection can be treated with medication. Modern medicines are very effective in treating TB. Treatment is important also to prevent the disease from being passed on. People with infectious TB disease in their lungs can pass the germ to other people until two weeks after they begin medical treatment.

It takes at least six months of medication to cure TB, however, some cases can take longer. If TB medication is not taken regularly, or the full course is not completed, then TB can return, develop into drug resistant TB and be more difficult to cure. Multiple drug resistant TB is a major concern in certain hospitals and has led to the death of a number of people.

If a person has TB, then all family members and close contacts will be tested to determine if they too have TB.

Can the infected worker continue to work?

If a worker has been diagnosed with an infectious form of TB (in the lungs) then it is possible to return to work 10 to 14 days after they commence treatment. If the worker has a non-infectious form of TB, it may be possible to return to work even the next day.

Summary

If tuberculosis is a risk for members of your designated work group, as the OHS representative, you should:

Carry out a risk assessment
Negotiate an Immunisation Policy
Negotiate a policy on Safe Systems of Work with your employer.
Ensure that the health status of at risk workers is monitored
Ensure that workers are provided with information and on-going training.

Legal Standards

The employer has a general duty of care (Section 21) of the Victorian Occupational Health and Safety Act, 2004 to provide and maintain a healthy and safe workplace. Under Section 22, the employer also the duty to monitor conditions at the workplace and to monitor the health and safety of employees.

Under the Health (Infectious Diseases) Regulations 2001 there is a requirement for medical practitioners and others to notify the government health authorities of a large number of infectious diseases, including tuberculosis. This is due to the high risks to public health in general. The purpose is to ensure that the department takes immediate steps to identify the sources of infection and implement necessary action.

More information on TB

What are the health effects of TB?

TB usually affects the lungs, but can affect other parts of the body such as the lymph glands, the bones, and occasionally, the brain. TB develops slowly in the body and it usually takes several months for symptoms to appear. The initial symptoms are usually fever, night sweats, chronic cough, weight loss, blood in saliva and a general feeling of ill health. The disease can shorten a person's life and can kill.

Who is at risk?

TB is usually passed on through the air. It can be transmitted from another person who has TB of the lungs. The germ gets into the air when that person coughs, sneezes, speaks or spits. TB can be associated with poor housing, inadequate ventilation and dusty rooms. Animals can also contract and therefore transmit TB. The TB bacteria cannot be spread to others by dishes, drinking glasses or other objects.

There is a greater chance of coming into contact with the TB if you are exposed to:

those in very close contact with infectious people,
children or elderly people,
people who have suppressed immune systems, including those who are HIV positive,
people on drugs affecting the body's defence system,
people on steroids,
people who are dependant on drugs or alcohol,
people in overcrowded or poor housing,
people with chronic poor health,
people who have not been vaccinated against TB, or
sick animals.

This means that a number of different groups of workers who come into close contact with infected people are at increased risk of contracting TB. These include:

healthcare workers, including nurses, doctors, ambulance officers
local government
community sector workers - those most at risk are staff of old peoples homes, refugee hostels, and hostels for the homeless
cleaners in hospitals, institutions, shelters
laundry workers who handle soiled linen
laboratory workers who handle infected laboratory specimens
housing workers
veterinary and other staff who handle animal specimens known to be susceptible to TB.

Generally people with confirmed TB are not considered infectious after the first two weeks of treatment, and may then be nursed in an open ward. Standard infection control procedures should be followed.

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