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OSHA Standards Interpretation and Compliance Letters
09/01/1995 - OSHA Tuberculosis Control Training and Resource Guide.

OSHA Standard Interpretation and Compliance Letters - Table of Contents OSHA Standard Interpretation and Compliance Letters - Table of Contents
  • Record Type: Interpretation
  • Standard Number:
  • Subject: OSHA Tuberculosis Control Training and Resource Guide.
  • Information Date: 09/01/1995

September 1, 1995

MEMORANDUM FOR:     NATIONAL OFFICE DIRECTORS
                   REGIONAL TB COORDINATORS

FROM:               STEPHEN MALLINGER
                   Acting Director
                   Directorate of Technical Support

SUBJECT:            OSHA Tuberculosis Control Training and Resource Guide
Attached for your use is an OSHA document entitled "OSHA Tuberculosis Control Training and Resource Guide". The document was developed by a Nurse Intern at the request of the Directorate of Health Standards.

The document is designed to assist field compliance safety and health officers (CSHOs) with the distribution of pertinent educational and informational materials on tuberculosis.

The document has been reviewed by the Office of Occupational Health Nursing staff and selected field representatives.

Since the intent of the document is to assist CSHOs with inspections, our plan at this time is only to provide copies of it internally to OSHA staff (National Office and Regional TB Coordinators). Wider distribution will be considered, if the need arises.

Additionally, this document is being made available through the DOL Electronic Bulletin Board System at (202) 219-4784. Specific instructions to assist users in accessing the document are also attached.

Attachment



To access the "TB Control and Resource Guide" document through the DOL
Bulletin Board, several steps are required as outlined below:

DOL BBS -      Dial into system (202-219-4784)
              Complete log-on
              Select M Main Library of Files 
              Select M Main Library of Files again
              Select S Select Library 
              Type OSHA 
              Select F Find files 
              Select K Keyword Search 
              Type any key word from title of document


                     ______________________________

                               OSHA

                       TUBERCULOSIS CONTROL

                     TRAINING AND RESOURCE GUIDE

                               - 1995 -
             _______________________________________________


                           INTRODUCTION

This document was produced by Mary Dirksen and edited by Robert Nester,
OSHA Nurse Interns, assigned to the Office of Occupational Health Nursing,
Directorate of Technical Support during the summer of 1995.  Project
assistance was provided by Carla Slaughter, Office of Occupational Health
Nursing.

The materials contained herein have been reviewed for their relevance.
Their inclusion has been based primarily upon the authority of the source
rather than an in-depth review of the reference.

OSHA does not endorse, certify, regulate, nor recommend any of these
programs or products in whole or in part.  The purpose is to provide OSHA
staff with viable resources related to the control and management of
tuberculosis (TB).

The information contained in this resource guide is not to be considered a
substitute for compliance, but rather may be useful in developing an
effective TB control program.


                      _______________________________

                                 OSHA

                          TUBERCULOSIS CONTROL

                      TRAINING AND RESOURCE GUIDE

                ______________________________________________

                            Table of Contents

I.   Program and Management Resources

    A.      General Management Assistance

    B.      Prevention / Control

    C.      Engineering Controls

    D.      Respiratory Protection

    E.      Population / Site Specific Assistance

            i.     Health care facilities

            ii.    Long-term care facilities

            iii.   Drug treatment facilities

            iv.    Correctional facilities

            v.     Homeless shelters and homeless care facilities

            vi.    Other high-risk populations

    Attachment A:  Smoke Trail Test for Negative Pressure Isolation Rooms

II.  Training Programs and Materials

III. Worker Education Materials/Resources

    A.      General Information

    B.      Screening

    C.      Medications/Treatment

    D.      Prevention/Control

    E.      TB/HIV

IV.  Non-English Language Resources

V.   Publications and Resources for Clinicians

VI.  State and Territorial Health Departments - Offices of TB Control

Appendices

A.   Addresses / Contact Information

B.   Centers for Disease Control and Prevention, Education and Training
    Materials Order Form (copy ready)



                                   I
_________________________________________________________________________

                                  PROGRAM AND

                             MANAGEMENT RESOURCES
                               _____________

The resources in Section I, Program and Management Resources, include
general assistance in the development, implementation and management of a
work place tuberculosis control program.
_________________________________________________________________________



                  ____________________________________

                   PROGRAM and MANAGEMENT RESOURCES
                  ____________________________________

A.   GENERAL MANAGEMENT ASSISTANCE

A Tool for Program Review Procedures in TB Control
1989
    A formal outline procedure to evaluate a program's effectiveness.
    Review process promotes quality assurance and allows for feedback
    and formal recommendations to flow in both directions.

    Mississippi State Department of Health.

__________________


Centers for Disease Control and Prevention (CDC) Tuberculosis
Guidelines (Condensed) Virginia Epidemiology Bulletin
1994

    Synopsis of the CDC 1994 Tuberculosis Guidelines; 3-pages.  Designed
    to assist employers to be in compliance with the CDC guidelines.

    Virginia Department of Health, Office of Epidemiology.

__________________


Enablers and Incentives
1989
    36-page booklet appropriate for health care workers working with
    high-risk populations.  Includes an article which describes the use
    of incentives and enablers, and a transcription of a recorded
    roundtable discussion by tuberculosis nurses in South Carolina who
    have first-hand experience in the use of incentives and enablers.

    American Lung Association of South Carolina.

__________________


Guide for Tuberculosis Programming in the 1990s
1991
    Organized outline of suggested program indicators used to gather
    information for use in evaluation of tuberculosis (TB) control
    programs.  17-page booklet aimed at TB control workers.

    American Lung Association, local chapter.

__________________


OSHA Enforcement Policy on Tuberculosis - Fact Sheet
1993
    Addendum to October, 1993 OSHA TB Compliance Directive.

__________________


OSHA Enforcement Policy and Procedures for Occupational Exposure to
Tuberculosis:  A Checklist

    American Federation of State, County and Municipal Employees,
    AFL-CIO.

__________________


Tuberculosis - Protection For Healthcare Workers
1995
    A comprehensive packet designed to assist the Infection Control
    Practitioner in implementing current CDC recommendations for the
    control of tuberculosis in health care facilities.  Complements a
    health care worker educational video [see Worker Education Materials
    and Resources - Association for Practitioners in Infection Control
    (APIC) for detail description of video].  Distributed by Lincoln
    Medical Education Foundation, Attn:  Tuberculosis Video, 4600 Valley
    Road, Lincoln, Nebraska  68510; (402) 483-4581; FAX (402) 483-4184.
    Packet + video:  $225.00 APIC members, $250.00 non-members; $35.00
    preview/rental applied toward purchase.

    Association for Practitioners in Infection Control and Epidemiology,
    Inc..

__________________


Tuberculosis Skin Testing Facility Record Card

    Card to record employee skin testing information.  For facilities
    with employee skin testing programs.

    Washington (State of) Department of Health, TB Control Program.

__________________


B.   PREVENTION / CONTROL

Infection Control Video

    Association for Practitioners in Infection Control and Epidemiology,
    Inc..

__________________


Controlling Occupational Exposure to Tuberculosis
1993
    Joint Commission on Accreditation of Healthcare Organizations.
    Monograph.  $40.00.

__________________


Industrial Hygiene Considerations in the Prevention of Tuberculosis
Transmission
1994
    A compilation of regulatory, research, and technical materials
    related to the environmental, occupational health, and industrial
    hygiene issues of workplace tuberculosis control.

    Hunter College School of Health Sciences, Center for Occupational &
    Environmental Health, (Daniel Kass, Director).  Permission to
    photo-copy granted by Hunter College.

__________________


Tuberculosis:  A Teacher's Resource Handbook

    For teachers and school workers involved in tuberculosis prevention
    and education programs.

    American Lung Association of Los Angeles County.

__________________


Tuberculosis (TB) Blueprint:  Goals and Objectives
1993
    Outlines the plan by the New York City Department of Health to
    control the spread of TB.  States three major goals:  1) increase
    treatment completion rate, 2) prevent the spread of TB in congregate
    settings, and 3) preventing future cases of active TB through
    screening and preventive treatment.  Includes objectives and
    implementation steps for each goal.

    New York City, Department of Health.

__________________


The following materials are available at no charge from the Centers
for Disease Control and Prevention (CDC), Information Services
(address in Appendix A).  A CDC Materials Order Form, suitable for
copying, is enclosed in Appendix B.

    Centers for Disease Control and Prevention.  (1994).  Guidelines
    for preventing the transmission of Mycobacterium tuberculosis
    in health-care facilities.  Morbidity and Mortality Weekly
    Report, 43(RR-13), October 28.


    Control of tuberculosis (TB) in correctional facilities. (1993).
    A 16-page booklet providing an overview of TB in correctional
    facilities and outlining a program of surveillance, containment, and
    prevention.  Includes screening guidelines for staff of correctional
    facilities.  Aimed at health care workers in corrections.


    Centers for Disease Control and Prevention.  (1993).  Tuberculosis
    control laws - United States, 1993:  Recommendations of the
    Advisory Council for the Elimination of Tuberculosis (ACET).
    Morbidity and Mortality Weekly Report, 42(No. RR-15).


    Centers for Disease Control and Prevention.  (1992).  Prevention
    and control of tuberculosis among homeless persons and prevention
    and control of tuberculosis in U.S. communities with at-risk
    minority populations.  Morbidity and Mortality Weekly Report,
    41(No. RR-5), April 17.


    Centers for Disease Control and Prevention. (1992).  Prevention
    and control of tuberculosis in migrant farm workers.  Morbidity
    and Mortality Weekly Report, 41(No.RR-10), June 5.


    TB in correctional facilities.  (1992).  A set of 67 slides on
    TB prevention and control; a 67-page booklet of slide facsimiles;
    and an 18-page narrative text designed to accompany the slide set.
    May be ordered separately.


    American Thoracic Society (ATS).  (1992).  Control of tuberculosis
    in the United States.  American Review of Respiratory Disease,
    146(6), 1623-1633.


    Centers for Disease Control and Prevention.  (1990).  Prevention
    and control of tuberculosis in facilities providing long-term
    care for the elderly.  Morbidity and Mortality Weekly Report,
    July 13, 1990.


    Centers for Disease Control and Prevention.  (1990).  Prevention
    and control of tuberculosis among foreign-born persons entering
    the United States.  Morbidity and Mortality Weekly Report,
    39(No. RR-18), December 28.


    What drug treatment centers can do to prevent tuberculosis.
    4-page guidelines with recommendations from the CDC.


    Centers for Disease Control and Prevention.  (1995).
    USPHS/IDSA guidelines for the prevention of opportunistic
    infections in persons infected with Human Immunodeficiency
    Virus:  A summary.  Morbidity and Mortality Weekly Report:
    Recommendations and Reports, 44(No. RR-8), July 14, 1995.


C.   ENGINEERING CONTROLS

Controlling Occupational Exposure to Tuberculosis
1993
    Joint Commission on Accreditation of Healthcare Organizations.
    Monograph.  $40.00.

__________________


Engineering Controls
1995
    A 20-minute video from the OSHA Office of Training and Education
    (OTI), Des Plaines, Illinois.  Includes a demonstration of smoke
    trail testing.

__________________


Centers for Disease Control and Prevention.  (1994).  Guidelines for
preventing the transmission of Mycobacterium tuberculosis in
health-care facilities.  Morbidity and Mortality Weekly Report, 43(No.
RR-13), October 28.

    Includes an engineering control section and other sections when
    considering the special needs of such diverse health care settings
    as dental clinics, long-term care facilities, and others.

    MMWR reprint available at no charge from the CDC, Information
    Services.

__________________


Reducing the Spread of Tuberculosis in Your Workplace
1995
    15-page guidebook designed to assist small organizations, agencies,
    and businesses which serve people at risk for tuberculosis to
    evaluate and maximize their indoor air quality.  Emphasis is on
    low-tech, low-cost administrative controls and the enhancement of
    natural ventilation systems.

    Contact Daniel Kass, Director, Hunter College School of Health
    Sciences, Center for Occupational & Environmental Health; $4.00/copy
    for less than 5, decreasing to $2.00/copy for 51 or more.  Permission
    to photo-copy granted by Hunter College.

__________________


Smoke-Trail Test for Negative Pressure Isolation Rooms

    Procedural guideline drafted by OSHA in January, 1994.  Copy
    enclosed at the end of Section I - Attachment A.

__________________


Using Ultraviolet Radiation and Ventilation to Control Tuberculosis (TB).
1990
    Booklet discusses the use, effectiveness, and technical
    installation details about UV radiation in the control of TB.
    Discusses technical details about both local exhaust and dilution
    ventilation.

    California Indoor Air Quality Program, California Department of
    Health Services.  Permission is granted to reproduce booklet,
    provided credit is given to the source.

__________________


D.   RESPIRATORY PROTECTION

Centers for Disease Control and Prevention.  (1994).  Guidelines for
preventing the transmission of Mycobacterium tuberculosis in
health-care facilities, Notice.  Morbidity and Mortality Weekly Report,
43(No. RR-13), October 28.

    MMWR reprints available at no charge from the CDC, Information
    Services.

__________________


Exposure Control Manual
1995
    A manual of materials offering providers of long-term care facilities
    the necessary tools for implementing a tuberculosis (TB) control
    program.  Includes a sample risk assessment guide for use at the
    facility level, protocols for each of five categories of risk,
    NIOSH's technical guide to respiratory protection, and worksheets,
    checklists, and forms to help implement a facility-based TB infection
    control plan.  Includes engineering and administrative guidelines.
    Also includes copies of the OSHA TB guidelines, and the Guidelines
    for control of TB in long-term care facilities.

    American Health Care Association.  $15.00 for members; $25.00 for
    non-members.

__________________


Respiratory Protection Devices
1995
    National Institute for Occupational Safety and Health (NIOSH).
    Federal Register, June 8, 1995, 42 CFR Part 84, 60(110), 30336-30404.

__________________


Tuberculosis Control in Hospitals
1994
    A Tuberculosis (TB) resource packet providing materials to assist
    in tuberculosis control in hospital settings.  Includes the CDC
    guidelines (1994), OSHA's enforcement policy and procedures (issued
    10/93), OSHA's TB inspection survey checklist, guidelines on the
    elements of a respiratory protection program, and a resource list for
    training and education materials.

    American Hospital Association.  To order, call (800) AHA-2626,
    request order # 094692; $15.00 for members, $55.00 for non-members.

__________________


E.   POPULATION / SITE SPECIFIC ASSISTANCE


i.   Health Care Facilities

Centers for Disease Control and Prevention.  (1994).  Guidelines for
preventing the transmission of Mycobacterium tuberculosis in health
care facilities.  Morbidity and Mortality Weekly Reports, 43(No. RR-13),
October 28.

    MMWR reprints available at no charge from the CDC, Information
    Services.

__________________


Protection for Healthcare Workers
1995
    20-minute video addressing the following content areas:  increased
    incidence of tuberculosis, transmission, prevention, skin testing,
    environmental controls, treatment, personal protection, medical
    monitoring, and others.

    Association for Practitioners in Infection Control and Epidemiology,
    Inc.; order video from Lincoln Medical Education Foundation.

_________________


Tuberculosis Control in Hospitals
1994
    A Tuberculosis (TB) resource packet providing materials to assist in
    tuberculosis control in hospital settings.  Includes the CDC
    guidelines (1994), OSHA's enforcement policy and procedures (issued
    10/93), OSHA's TB inspection survey checklist, guidelines on the
    elements of a respiratory protection program, and a resource list for
    training and education materials.

    American Hospital Association.  To order, call (800) AHA-2626,
    request order # 094692; $15.00 for members, $55.00 for non-members.

__________________


ii.  Long-Term Care Facilities

Exposure Control Manual
1995
    A manual of materials offering providers of long-term care
    facilities the necessary tools for implementing a tuberculosis (TB)
    control program.  Includes a sample risk assessment guide for use
    at the facility level, protocols for each of five categories of
    risk, NIOSH's technical guide to respiratory protection, and
    worksheets, checklists, and forms to help implement a facility-based
    TB infection control plan.  Includes engineering and administrative
    guidelines.  Also includes copies of the OSHA TB guidelines, and the
    Guidelines for control of TB in long-term care facilities.

    American Health Care Association.  $15.00 for members; $25.00 for
    non-members.

__________________


Guidelines for Prevention of TB Transmission in Nursing Homes
1986
    Texas Department of Health.

__________________


Centers for Disease Control and Prevention.  (1990).  Prevention and
Control of Tuberculosis in Facilities Providing Long-Term Care for the
Elderly.  Morbidity and Mortality Weekly Report, 39(No. RR-10), July 13.

    Reprint available at no charge from the CDC, Information Services.

__________________


TB Control Screening Guidelines for Convalescent Homes
1988

    American Lung Association of Connecticut.

__________________


iii. Drug Treatment Facilities

What Drug Treatment Centers Can Do To Prevent Tuberculosis
1991
    Discusses tuberculosis transmission and infection rates, high risk
    persons, infection versus disease, symptoms, screening, and
    preventive therapy.

    Available at no charge from the CDC, Information Services.

__________________


iv.  Correctional Facilities

Clark, J.H.  (1993).  Strategies for guerrilla warfare.  American
Jails, January/February.

    Discusses controlling the spread of tuberculosis in correctional
    facilities.  Dr. Clark is the Chief Medical Officer at the Los
    Angeles County Sheriffs' Office.  (213) 974-0149.

__________________


Infectious Diseases:  A Management Issue

    Jail Managers Bulletin # III-2.  Teaches managers how to recognize
    infectious diseases and how to prevent the spread of infectious
    diseases in correctional facilities.

    American Jail Association.

__________________


Control of Tuberculosis in Correctional Facilities:  A Guide for
Health Care Workers
1993
    A 16-page booklet providing an overview of tuberculosis (TB) in
    correctional facilities and outlining a program of surveillance,
    containment, and prevention.  Includes information on HIV and TB.
    Also includes screening guidelines for staff of correctional
    facilities.  Aimed at health care workers in corrections.

    Available from the U.S. Government Printing Office, Publication
    No. 1993-533-001 (80540).

__________________


Communicable Diseases
1995
    6-page Jail Operations Bulletin (# VI-4) which covers tuberculosis.
    Contains a self test for learner evaluation.

    American Jail Association.

__________________


Guidelines for Prevention of TB Transmission in City and County Jails
1987
    Texas Department of Health.

__________________


TB in Correctional Facilities
1992
    A set of 67 slides on tuberculosis prevention and control in
    correctional settings; a 67-page booklet of slide facsimiles; and
    an 18-page narrative text designed to accompany the slide set.  May
    be ordered separately.

    Available at no charge from the CDC, Information Services.

__________________


v.   Homeless Shelters and Homeless Care Facilities

Health Care for the Homeless:  Annotated Bibliographies
1995
    Annotated Bibliography # 6:  Tuberculosis and homeless persons.
    9-pages of references for the period January 1987 - April 1995.

    Annotated Bibliography # 12:  Tuberculosis and HIV/AIDS.  45-pages
    of references for the period January 1987 - April 1995.

    Health Care for the Homeless Information Resource Center (HCHIRC).
    Questions to Yvonne Wallace, Librarian, HCHIRC.  Order from John
    Snow, Inc..

__________________


Centers for Disease Control and Prevention.  (1992).  Prevention and
control of tuberculosis among homeless persons and prevention and
control of tuberculosis in U.S. communities with at-risk minority
populations.  Morbidity and Mortality Weekly Report, 41(No. RR-5),
April 17.

    Reprint available at no charge from the CDC, Information Services.

__________________


TB Training for Shelter Workers

    Slide presentation for training homeless shelter workers to identify
    symptoms of tuberculosis.  Includes a skin testing protocol and a
    policy for tuberculin skin testing in homeless populations.

    Alma Illery Medical Center (Pittsburgh, Pennsylvania); contact Nurse
    Coordinator of Primary Health Care Services.

__________________


Wasatch Homeless Health Care Program

    This community based program has developed guidelines for PPD
    testing and follow-up of the staff at the homeless shelter.

    Contact:  Allan Ainsworth, Ph.D., Director, Fourth Street Clinic,
    404 South 400 West, Salt Lake City, Utah  84101; (801) 364-0058;
    FAX (801) 364-0161.

__________________


vi.  Other High Risk Populations

Centers for Disease Control and Prevention.  (1990).  Prevention and
control of tuberculosis among foreign-born persons entering the United
States.  Morbidity and Mortality Weekly Report, 39(No. RR-18).
December 28.

__________________


Centers for Disease Control and Prevention.  (1992).  Prevention and
control of tuberculosis among homeless persons and prevention and
control of tuberculosis in U.S. communities with at-risk minority
populations.  Morbidity and Mortality Weekly Report, 41(No. RR-5),
April 17.

    Reprint available at no charge from the CDC, Information Services.

__________________


Enablers and Incentives
1989
    36-page booklet appropriate for health care workers working with
    high risk populations.  Includes an article which describes the use
    of incentives and enablers, and a transcription of a recorded
    roundtable discussion by tuberculosis nurses in South Carolina who
    have first hand experience in the use of incentives and enablers.

    American Lung Association of South Carolina.

__________________


Guidelines for Prevention and Control of TB Among Individuals with HIV
Infection
1989
    Texas Department of Health, Tuberculosis Control Division

__________________


Centers for Disease Control and Prevention.  (1992).  National
action plan to combat multidrug-resistant tuberculosis:  Management
of persons exposed to multidrug-resistant tuberculosis.  Morbidity
and Mortality Weekly Report, 41(No. RR-11), June 19.

    Available at no charge from the CDC, Information Services.

__________________


Centers for Disease Control and Prevention.  (1992). Prevention and
control of tuberculosis in migrant farm workers.  Morbidity and
Mortality Weekly Report, 41(No. RR-10), June 5, 1992.

    Reprint available at no charge from the CDC, Information Services.

__________________


Managing Tuberculosis and HIV Infection in Today's General Workplace
1992
    National Leadership Coalition on AIDS; $5.00 for members, $10.00 for
    non-members.

__________________


Migrant Clinicians Network

    Publishes a newsletter with occasional information on tuberculosis
    issues among migrant workers.

    Migrant Clinicians Network, Michael Koroscik, Director of Education.

__________________


Office of Minority Health Resource Center (OMH-RC)

    Resource and referral service on minority health issues, including
    tuberculosis.  Offers database searches, information exchange,
    publications, mailing lists, technical assistance, data and
    statistics, and referrals.  Resource Person Network (volunteers)
    available to provide technical assistance, conduct professional and
    non-professional education training and workshops, and serve as
    reference specialists.  Brochures, articles, journals, and other
    literature accessible through the database search service.  English
    and Spanish speaking information specialists are available.  All
    resource center services are free of charge.

__________________


Tuberculosis and HIV/AIDS
1995
    Annotated bibliography # 12, 45-pages of references for the period
    January 1987 to April 1995.

    Health Care for the Homeless Information Resource Center (HCHIRC);
    Questions to Yvonne Wallace, Librarian, HCHIRC.  Order from John
    Snow, Inc..

__________________


Tuberculosis:  A Resource Kit

    This resource kit provides current materials on tuberculosis (TB)
    to clinicians and other staff caring for high risk populations.
    Document is divided into 11-sections:  using the kit, surveillance
    and epidemiology, diagnosis, patient management, infection control,
    screening and preventive therapy, treatment of susceptible TB,
    multidrug-resistant TB, HIV/AIDS and TB, health education materials
    and organizations.  Each section includes an annotated bibliography
    detailing current literature.  Additional materials include Fact
    Sheets summarizing key information from the literature and selected
    articles and publications.

    John Snow, Inc. (JSI) under contract to Health Resources & Services
    Administration (HRSA's) Bureau of Primary Health Care.  Order from
    JSI, note account # 1569 on check; $25.00.  Send to the attention
    of Yvonne Wallace - Library, JSI/HCHIRC.

_________________



                                 ATTACHMENT A:

             Smoke Trail Test for Negative Pressure Isolation Rooms.



January 14, 1994

MEMORANDUM FOR:     Regional Administrators

ATTENTION:          ARA/Technical Support

THROUGH:            Leo Carey
                   Director
                   Office of Field Programs

FROM:               Patricia K. Clark
                   Director
                   Directorate of Technical Support

SUBJECT:            Smoke-trail Test for Negative Pressure Isolation Rooms

The attached smoke-trail test procedure for negative pressure isolation
rooms was drafted to answer questions raised by the Tarrytown AO during a
recent inspection at a health-care facility.  This procedure may be useful
to other OSHA Compliance Officers performing inspections related to
occupational exposure to Tuberculosis.

This procedure will be discussed during the next teleconference on
January 27, 1993.


SMOKE-TRAIL TESTING METHOD FOR NEGATIVE PRESSURE ISOLATION ROOM

The OSHA TB Memorandum of October 8, 1993 provides clarification for
OSHA-wide enforcement policy and procedures for inspections concerning
occupational exposure to TB.  The OSHA TB Memorandum outlines OSHA's
expectations that employers follow the principles of TB control published
in the CDC document "Guidelines for Preventing the Transmission of
Tuberculosis in Health-care Settings, with Special Focus on HIV-Related
Issues (December 1990 MMWR)".

The CDC Guidelines recommend that the TB isolation room be under negative
pressure compared to surrounding spaces such that it induces airflow into
the room to prevent TB contaminant from escaping the room.  The CDC
publication also recommends employing smoke or flutter strips to prove
direction of airflow.  The CDC is recommending the use of qualitative
methods for demonstrating the performance of negative pressure isolation
rooms rather than quantitative methods such as measuring supply/exhaust
volumetric flow differentials, measuring space pressurization
differentials or measuring velocity of airflow at openings into the
isolation room.  The employer may choose to perform quantitative tests
in order to characterize and track the dynamic performance of these
negative pressure isolation rooms.  OSHA's expectations of conformance
to the CDC Guidelines can be adequately demonstrated by qualitative
testing such as smoke-trails without expending the employer's and OSHA's
resources on more complex quantitative testing.  The message here is to
"keep it simple".


TEST METHOD DESCRIPTION:

One of the purposes of a negative pressure TB isolation room is to prevent
TB contaminant from escaping the isolation room and entering the corridor
or other surrounding uncontaminated spaces.  To check for room negative
pressure, use smoke-trails to demonstrate that the pressure differential
is inducing airflow from the corridor, through the crack at the bottom of
the door (undercut) and into the isolation room.  When performing a
smoke-trail test follow these recommendations where applicable:

1.  Test only with the isolation room door shut.  If not equipped with
   an anteroom, it is assumed that there will be a loss of space
   pressure control when the isolation room door is opened and closed.
   It is not necessary to demonstrate direction of airflow when the
   door is open.

2.  If there is an anteroom, release smoke at the inner door undercut,
   with both anteroom doors shut.

3.  In addition to a pedestrian entry, some isolation rooms are also
   accessed through a wider wheeled-bed stretcher door.  Release smoke
   at all door entrances to isolation rooms.

4.  So that the smoke is not blown into the isolation room, hold the
   smoke bottle/tube parallel to the door so the smoke is released
   perpendicular to the direction of airflow through the door undercut.

5.  Position the smoke bottle/tube tight to the floor, centered in
   the middle of the door jamb and approximately two inches out in
   front of the door.

6.  Release a puff of smoke and observe the resulting direction of
   airflow.  Repeat the test at least once or until consistent results
   are obtained.

7.  Minimize momentum imparted to the smoke by squeezing the bulb or
   bottle slowly.  This will also help minimize the volume of smoke
   released.

8.  Depending on the velocity of the air through the door undercut, the
   smoke plume will either stay disorganized or it will form a distinct
   streamline.  In either case, the smoke will directionally behave
   in one of three ways.  It will:  (1) go through the door undercut
   into the isolation room, (2) remain motionless or (3) be blown back
   into the corridor.  Obviously, compliance with the intent of the CDC
   Guidelines for negative pressure requires that the smoke be drawn
   into the isolation room through the door undercut.

   Supply air diffusers in the ceiling or upper sidewall of the
   corridor may throw air directly at the isolation room door and
   disrupt the test.  If the room is unoccupied, proceed to step nine
   and release smoke on the inside of the door.

9.  Release smoke from the corridor side of the door only for occupied
   TB isolation rooms.  CSHOs should not enter occupied isolation
   rooms per the OSHA TB Memorandum of October 8, 1993.  If the room
   is unoccupied, also release smoke inside the isolation room (same
   position as step 5) to verify that released smoke remains contained
   in the isolation room (i.e. smoke as surrogate for TB contaminant).

10. If photography or videotaping is performed, it is recommended that
   a dark surface be placed on the floor to maximize contrast.  Be
   aware that most autofocusing cameras cannot focus on smoke.


TESTING "AS-USED" CONDITIONS:

Testing of negative pressure isolation rooms requires that the test
reflect "as-used" conditions.  Consider the following use variables which
may affect space pressurization and the performance of the negative
pressure isolation room:

1.  Patient toilet rooms (TR) are mechanically exhausted to control
   odors.  The position of the toilet room door may affect the
   pressure differential between the isolation room and the corridor.
   Smoke-trail tests should be performed with the TR door open and the
   TR door closed.  This will not be necessary if the TR door is
   normally closed and controlled to that position by a mechanical door
   closer.

2.  An open window will adversely affect the performance of a negative
   pressure isolation room.  If the isolation room is equipped with
   operable windows, perform smoke-trail tests with the window open and
   the window closed.

3.  There may be corridor doors that isolate the respiratory ward or
   wing from the rest of the facility.  These corridor doors are
   provided in the initial design to facilitate space pressurization
   schemes and/or building life-safety codes.  Direct communication
   with the rest of the facility may cause pressure transients in the
   corridor (e.g., proximity to elevator lobby) and affect the
   performance of the isolation room.  Perform isolation room
   smoke-trail testing with these corridor doors in their "as-used"
   position which is either normally open or normally closed.

4.  Isolation rooms may be equipped with auxiliary, fan-powered,
   recirculating, stand-alone HEPA filtration of UV units.  These units
   must be running when the smoke-trail test is performed.

5.  Do not restrict corridor foot traffic while performing smoke-trail
   tests.

6.  Negative pressure is accomplished by exhausting more air than is
   supplied to the isolation room.  Some HVAC systems employ variable
   air volume (VAV) supply air and sometimes VAV exhaust air.  By
   varying the supply air delivered to the space to satisfy thermal
   requirements, these VAV systems can adversely impact the performance
   of a negative pressure isolation room.  If the isolation room or the
   corridor is served by a VAV system you should perform the smoke test
   twice.  Perform the smoke test with the zone thermostat thermally
   satisfied and again with the zone thermostat thermally unsatisfied
   thus stimulating the full volumetric flowrate range of the VAV
   system serving the area being tested.


SMOKE:

Most smoke tubes, bottles and sticks use titanium chloride (TiCl(4)) to
produce visible fume.  There is no OSHA PEL or ACGIH TLV for this chemical
although it is a recognized inhalation irritant.  Health-care
professionals are concerned about releasing TiCl(4) around pulmonary
patients.  The smoke released at the door undercut makes only one pass
through the isolation room and is exhausted directly outside.  Isolation
room air is typically not recirculated.

As an alternative to TiCl(4), the literature suggests the use of "dry-ice"
in water.  Any product that is employed should be tested to insure
sufficient opacity for videotaping and photography.

Be prepared to present to the employer the Material Safety Data Sheet
(MSDS) for the smoke that you intend to release.


CSHO PROTECTION:

1.  The CSHO should be familiar with the MSDS for the smoke.  If TiCl(4)
   is used, the CSHO should avoid direct inhalation of the smoke or
   skin contact with the liquid.

2.  The CSHO should follow the recommendations in the OSHA TB Memorandum
   of October 8, 1993.

3.  If an isolation room is occupied by a patient infectious or suspect
   with TB, then the CSHO performing the smoke-trail test shall use a
   respirator.  You should assume that the isolation room is not
   under negative pressure.  Recent surveys (Infect Control Hosp
   Epidemiol 1993; 14:623-628) indicate that almost half of the
   isolation rooms tested were not under negative pressure.



                                   II

___________________________________________________________________________

                             TRAINING PROGRAMS

                               AND MATERIALS

                              ________________

Training Programs and Materials consist of those resources which can
assist in the successful development and implementation of a tuberculosis
(TB) control and prevention program.  Included are self-directed studies,
videos, slides, and lecture-format courses of varying duration.  These
resources are generally aimed at personnel who are responsible for the
health and safety program or the TB control program of an organization.
However, many are appropriate for workers who are, themselves, at risk.

___________________________________________________________________________



_____________________________________________________________________________

                    TRAINING PROGRAMS and MATERIALS
                   _________________________________

Core Curriculum on Tuberculosis, 3rd Edition
1994
    For providers of health care services providers.  A 95-page training
    guide on clinical and public health aspects of tuberculosis control.
    A set of 82 slides are available to accompany the training guide,
    or may be ordered separately.

    Available at no charge from the CDC, Information Services.

__________________


HHS-PHS-Federal Occupational Health - Tuberculosis Training Programs
1995

    A 2-volume tuberculosis (TB) education/training program marketed
    to federal agencies; available on an interagency agreement basis
    with Federal Occupational Health (FOH).  Program utilizes the CDC
    Core Curriculum and can be customized for the agency receiving the
    training.  Cost is negotiated on an interagency contract basis.

            Tuberculosis Orientation:  A Self-Study Guide for FOH
            Professionals

            >      Updates the latest information from the CDC
            >      Reviews importance of patient history
            >      Reviews rationale and procedure for 2-step testing

            FOH Presents Tuberculosis in the Workplace

            >      Orients participants to signs/symptoms of TB
            >      Reviews screening process
            >      Reviews importance of diagnostic follow-up
            >      Reviews CDC treatment guidelines

    Contact:  Peggy Coleman, RN, MS, Occupational Health Nurse Consultant
    to FOH, 4350 East-West Highway, Bethesda, Maryland; (301)594-0260.

__________________


Mantoux Tuberculin Skin Testing

    Video tape, wall chart.  Visual aids for training in the
    administration and interpretation of the Mantoux PPD Tuberculin Skin
    Test.

    Available at no charge from the CDC, Information Services.

__________________


Mantoux Skin Test Pretest/Posttest
1990
    12-questions relating to the Mantoux skin test.  Answer key and
    explanations on a separate sheet.  Designed to be used with the
    Mantoux Skin Test Instructional Video developed by the CDC; however,
    may be used without the video.

    New Hampshire Division of Public Health Services.

__________________


National Tuberculosis Model Centers

    3 national model center sites (San Francisco, New York City, and
    Newark, NJ) are funded by the Division of Tuberculosis (TB)
    Elimination, Centers for Disease Control and Prevention.  These
    centers provide training courses, offer clinical consultation for
    difficult cases, provide epidemiologic consultation, and have access
    to an extensive library of both written and video materials
    pertaining to TB, including translated materials.

    Training courses include:

    >    Preventing Tuberculosis in the Workplace - 8-hour
         course covering environmental and behavioral changes
         necessary to minimize potential for transmission of M.
         tuberculosis in clinical, institutional and workplace
         settings, including the implementation of OSHA
         regulations.

    >    Tuberculosis Update - 4 to 8-hour class.  Content
         may include epidemiology, diagnosis, management and
         treatment, multiple drug resistance, managing difficult
         cases, reporting, infection control, community control,
         TB and HIV.

    >    Tuberculosis 101 - 1 to 3-day course for non-medical
         health workers.  Content includes epidemiology,
         transmission, pathogenesis, screening, prevention,
         diagnosis, treatment, infection control.  Appropriate
         for health outreach workers, social service agency
         staff, drug treatment facility workers, HIV counseling
         center staff.

    >    Tuberculosis and the Law - 1 & 1/2-day course.
         Content includes transmission and pathogenesis, legal
         aspects of TB control, and infection control.

    >    Tuberculosis Program Manager's Course - 4-day
         intensive course for administrative and health care
         personnel involved in TB program administration.

         See address for the "National TB Model Centers", Appendix A.

__________________


Postgraduate Courses on Clinical Management and Control of Tuberculosis

    Intensive, 5-day courses aimed at health care professionals.  The
    purpose of these courses is to present current scientific knowledge
    about tuberculosis (TB), its prevention and control to health care
    professionals who are responsible for the management and control
    of TB.  Course content relevant to occupational management of TB
    includes factors influencing infectiousness of TB, advances in
    tuberculin testing, immunization, and planning TB control programs.

    National Jewish Center for Immunology and Respiratory Medicine.

__________________


Self-Study Modules on Tuberculosis
1995
    A set of 5 self-guided learning modules for health care staff and
    health and safety workers who are relatively new to tuberculosis
    (TB) control and with entry level knowledge of TB control issues.
    Aimed at staff/workers in high-risk facilities.

    Modules include:   1.  Transmission and Pathogenesis
                       2.  Epidemiology
                       3.  Diagnosis of TB Infection and Disease
                       4.  Treatment of TB Infection and Disease
                       5.  Infectiousness and Infection Control

    Centers for Disease Control and Prevention, Tuberculosis Division.


__________________


Tuberculosis:  Identification, Prevention and Control
1994
    Computer assisted instruction program aimed at licensed health
    care professionals.  Thoroughly covers CDC and OSHA guidelines.
    Includes learning objectives and a post-test.  Appropriate for
    facility awarded continuing education.  Program can be modified to
    include site-specific information.

    Developed and written by APIC.  Available from Healthsoft, Inc.,
    PO Box 3069, Orlando, Florida 32802-9773; (800) 235-0882.  Preview
    disk available at no charge.

__________________


Tuberculosis in the Workplace:  A Workbook for Working People
1994
    A self-guided workbook, 103-pages, $3.00.  A 24-minute video,
    entitled "Droplets of Death" ($15.00), is available to accompany
    the workbook.

    The Labor Institute.

__________________



                                   III

_____________________________________________________________________________

                         WORKER EDUCATION MATERIALS

                               AND RESOURCES
                                  ____________


The following agencies and organizations produce educational and
informational materials for distribution to workers in a variety of
occupational settings.  While all states provide tuberculosis educational
materials, those listed here may not be widely known or distributed, and
may be of additional value to a particular workplace or program.  The list
is not exhaustive.

A basic reading ability is required for the worker educational materials.
Materials focused toward health care professionals are more technically
challenging for the reader.  All materials are in English unless otherwise
noted.

Appendix A provides the contact information for the cited resources.

The reader will note in the cited resources that several sources do not
have documents listed.  The available documents were too extensive to be
listed in-total in this publication.  It is recommended the user of this
guide contact the source for a complete listing of the available
documents.

___________________________________________________________________________



                   _______________________________________

                   WORKER EDUCATION MATERIALS / RESOURCES
                   _______________________________________


A.     GENERAL INFORMATION

[Includes materials aimed at worker populations identified as high risk
for tuberculosis (TB) exposure.]

    American Federation of State, County and Municipal Employees (AFSCME)

            *    Tuberculosis.  Fact sheet.

            *    TB in Correctional Institutions.  Fact sheet.

            *    Tuberculosis Questions and Answers.  Fact sheet.

            *    Multidrug-Resistant TB (MDR TB).  Fact sheet.

            *    OSHA Enforcement Policy & Procedures for
                 Occupational Exposure to Tuberculosis.  Checklist.


    American Federation of Teachers (AFT)

            *    Tuberculosis - The "New" Epidemic.  Fact sheet.


    American Jail Association

            *    Jail Operations Training Bulletin on Tuberculosis.


    American Lung Association (ALA)

            *    Tuberculosis Education Resource Guide.  (1993).
                 An extensive listing of patient/public educational
                 materials, many of which are appropriate for worker
                 education and training, both written and audio-visual.
                 Each citation notes the intended audience, the
                 languages the materials are available in, and the cost.
                 Contact local chapters by calling (800) LUNG-USA
                 (800-586-4872).


    American Nurses Association (ANA)

            *    Tuberculosis:  A Deadly Disease Makes a Comeback.
                 (1993).  Pamphlet.


    Association for Practitioners in Infection Control and Epidemiology,
    Inc. (APIC)

            *    Tuberculosis:  Identification, Prevention and
                 Control.  (1994).  Computer assisted instruction
                 (CAI) program aimed at licensed health care
                 professionals.  Thoroughly covers CDC and OSHA
                 guidelines.  Includes learning objectives and a
                 post-test.  Appropriate for facility awarded
                 continuing education.  Program can be modified to
                 include site-specific information.  Available from
                 Healthsoft, Inc., PO Box 3069, Orlando, Florida,
                 32802-9773; (800) 235-0882. Preview disk available
                 at no charge.

            *    TB:  What You Need To Know.  (1994).  Computer
                 assisted instruction (CAI) program for non-clinical
                 workers.  Program can be modified to include
                 site-specific information.  Available at a basic
                 reading level in English and Spanish.  30-minutes or
                 less to complete the post test.  Available from
                 Healthsoft, Inc., PO Box 3069, Orlando, Florida,
                 32802-9773; (800) 235-0992.  Preview disk available
                 at no charge.

            *    Tuberculosis:  Protection For Healthcare
                 Workers. (1995).  Videotape.  Approximately
                 20-minutes.  Addresses the following:  increased
                 incidence of tuberculosis, current crisis, disease
                 process, transmission, prevention, skin testing,
                 laboratory identification, environmental controls,
                 treatment, personal protection, medical monitoring.
                 Accompanied by a comprehensive packet designed to
                 assist in the implementation of current CDC
                 recommendations.

                 Distributed by Lincoln Medical Education Foundation,
                 Attn:  Tuberculosis Video, 4600 Valley Road, Lincoln,
                 Nebraska, 68510; (402) 483-4581; FAX (402) 483-4184.
                 $225.00 APIC members, $250.00 non-members; $35.00
                 preview/rental applied toward purchase.


    Centers for Disease Control and Prevention (CDC); Information Services

            *    TB Facts for Health Care Workers.  (1993).
                 7-page booklet.

            *    Think TB!  (1992).  Poster listing symptoms of
                 tuberculosis (TB); also available in Spanish.

            *    Exposure to TB.  (1991).  Pad of tear-off
                 sheets designed for correctional facility inmates;
                 also available in Spanish.

            *    Tuberculosis - Get the Facts.  (1990).  1-page
                 pamphlet on basic facts about transmission, infection,
                 and testing; also available in Spanish.

            *    Stop TB!  (1994).  Poster describing transmission
                 & TB pathogenesis.

            *    Stop TB!  (1994).  Pad of tear-off sheets
                 duplicating the Stop TB! poster.

            *    Questions and Answers About TB.  (1994).  16-page
                 booklet about transmission, skin test, and treatment.


    Indiana State Board of Health


    The Labor Institute

            *    Tuberculosis in the Workplace:  A Workbook for
                 Working People (1994).  A worker-oriented
                 training workbook (103-pages).  $3.00 each;
                 discounted prices for large orders of workbooks
                 - contact distributor, The Apex Press, at
                 (914) 271-6500.

            *    Droplets of Death:  TB in the Workplace.
                 Videotape, 24-minutes; $15.00.


    Mississippi State Department of Health, Tuberculosis Control Branch

            *    Homeless Person Poster.  (1992).  Poster,
                 $2.00 each for 1-100.


    Missouri Department of Health, Bureau of Tuberculosis Control

            *    Facts About TB as it Occurs Among Inmates in
                 Correctional Facilities.  Videotape, 2 parts, 14
                 minutes and 31 minutes.

            *    Facts About TB.  Videotape, 14 minutes.

            *    Guidelines for Education of Staff/Clients of
                 Homeless Shelters.


    National Institutes of Health, National Institute of Allergy
    and Infectious Diseases (NIH, NIAID)

            *    Tuberculosis.  (1995).  Fact sheet, 8-pages.

            *    Tuberculosis:  What Health Care Workers Should
                 Know.  (1993).  Pamphlet; includes graphic
                 flow-chart to determine high-risk persons.


    New York Academy of Medicine

            *    Tuberculosis, poster, several languages available.


    New York State, Department of Health

            *    Pamphlets for health care workers, criminal justice
                 workers.

            *    Fact sheets in English and Spanish.

            *    Question & answer sheets about tuberculosis.

            *    Tuberculosis, poster.

            *    When a Co-Worker Has TB:  What You Need to Know
                 About Tuberculosis in the Workplace.  (1994).
                 Video.


    Service Employees International Union (SEIU)

            *    TB:  The Real Deal.  (1995).  Fact sheet.

            *    No One is Immune to TB:  Important Facts For All
                 Workers.  (1995).  Fact sheet.

            *    Your Right to Workers' Compensation.  (1995).
                 Fact sheet.


    University of California, San Diego, Preventive Pulmonary Medicine

            *    The Many Faces of TB.  (1992).  15-minute
                 video; $100.00.


The U.S. Public Health Service has a tuberculosis (TB) control
office in every state and can provide general information on TB.  The
contact information for each state's TB control office is located in
Section VI - State and Territorial Health Departments, Offices of TB
Control.


B.   SCREENING / TESTING

    American Federation of State, County and Municipal Employees
    (AFSCME)

            *    Screening and Skin Testing.  Fact sheet.


    American Federation of Teachers (AFT)

            *    Tuberculosis and the Health Care Worker
                 - Surveillance and Preventive Therapy.  Fact sheet.


    American Lung Association of Hawaii

            *      Fact sheet (basic).

    Centers for Disease Control and Prevention (CDC), Information Services

            *    Mantoux Tuberculin Skin Testing.  (1991).
                 Videotape training aid on the administration and
                 interpretation of the Mantoux skin test.

            *    Mantoux Tuberculin Skin Testing.  (1990).
                 Wall chart visual aid for interpreting the results
                 of the skin test.

            *    The TB Skin Test.  (1991).  Pad of tear-off
                 sheets designed for correctional facility inmates;
                 also available in Spanish.


    Florida Department of Health and Rehabilitation Services


    Kentucky Department for Health Services, Tuberculosis Control Program


    Massachusetts Department of Health, Tuberculosis Control Program


    Maryland Department of Health and Mental Hygiene, Tuberculosis Control


    New York State Department of Health, Tuberculosis Control Program

            *    Fact About the TB Skin Test.  (1992).  In
                 English and Spanish.

            *    Skin Testing and Classification of Tuberculosis.
                 Fact sheet.


    Oakland County Health Division (Michigan)


    Service Employees International Union (SEIU)

            *    TB Skin Test:  What You Need to Know About Your
                 Health.  (1995).  Fact sheet.


    Texas Department of Health


    Washington (State of) Department of Health, TB Control Program


C.   MEDICATIONS / TREATMENT


    American Federation of Teachers (AFT)

            *      Multiple-Drug Resistant TB.  Fact sheet.


    Centers for Disease Control and Prevention (CDC), Information Services

            *    TB Can Be Cured.  (1991).  Pad of tear-off
                 sheets designed for correctional facility inmates;
                 also available in Spanish.


    County of Sonoma Public Health Department (California)


    Florida Department of Health and Rehabilitative Services,
    Tuberculosis Control Program


    Hawaii Department of Health, Tuberculosis Branch

            *      Individual medication instruction sheets.


    Massachusetts Department of Public Health, Tuberculosis
    Control Program

            *    Pamphlets on isoniazid, ethambutol, pyrazinamide,
                 rifampin, streptomycin.


    Montgomery County Health Department (Maryland)


    New York State Department of Health, Tuberculosis Control Program


    North Carolina Department of Environment, Health, and Natural Resources


    Oakland County Health Division (Michigan)

            *    Pamphlet on positive reactors who may or may not
                 need INH.


    Pennsylvania Department of Health, Tuberculosis Control Program

            *    Pamphlets on streptomycin, rifampin, pyrazinamide,
                 isoniazid, and ethambutol.


    South Dakota Lung Association


    Spokane County Health District (Washington state)


    Washington (State of), Department of Health

            *    Pills Prevent TB.  (1994).  Pamphlet; available
                 in several languages.


    Whatcom County Health Department (Washington state)


    Wisconsin Department of Health and Human Services, Tuberculosis
    Control Program

            *    Pamphlets and drug information sheets on rifampin,
                 pyrazinamide, isoniazid, and ethambutol.


D.     PREVENTION / CONTROL

    American Federation of State, County and Municipal Employees
    (AFSCME)

            *    Controlling Transmission in High Risk Settings.
                 Fact sheet.

            *    Respiratory Protection.  Fact sheet.


    American Federation of Teachers (AFT)

            *    TB:  Steps for Protecting Staff and Students.
                 Fact sheet.

            *    Tuberculosis and the Health Care Worker
                 - Surveillance and Preventive Therapy.  Fact sheet.

            *    Tuberculosis and the Health Care Worker
                 - Control Measures Against Exposure.  Fact sheet.

            *    TB:  Steps for Protecting Workers from Workplace
                 Exposure.  Fact sheet.


    American Journal of Nursing (AJN)

            *    TB or Not TB:  New Guidelines for Prevention and
                 Treatment.  (1995).  19-minute video aimed at
                 health care workers; $285.00 to purchase; $70.00
                 rental.  Approved for CE credit.


    Centers for Disease Control and Prevention (CDC), Information Services

            *    TB in Correctional Facilities.  (1992).  Set
                 of 67 slides on prevention and control of
                 tuberculosis in correctional settings; 67-page
                 booklet of slide facsimiles based on slide set;
                 18-page narrative text designed to accompany slide set.

            *    You Can Prevent TB.  (1991).  Pad of tear-off
                 sheets designed for correctional facility inmates;
                 also available in Spanish.


    New York State Department of Health, Tuberculosis Control Program

            *    Preventive Therapy for Tuberculosis.  Fact Sheet.


    Service Employees International Union (SEIU)

            *    A Workplace TB Plan:  Putting the Pieces
                 Together. (1995).  Fact sheet.

            *    Union Tools that Work.  (1995).  Fact sheet.


E.   TB / HIV


    American Federation of State, County and Municipal Employees
    (AFSCME)

            *    The TB/HIV Connection.  Fact sheet.


    American Lung Association (ALA)


    Centers for Disease Control and Prevention (CDC); Information Services

            *    TB and HIV (The AIDS Virus).  (1991).  Pad of
                 tear-off sheets designed for correctional facility
                 inmates; also available in Spanish.

            *    TB/HIV Double Trouble.  (1992).  Poster.

            *    TB/HIV - The Connection:  What Health Care
                 Workers Should Know.  (1993).  16-page booklet.

            *    Tuberculosis - The Connection Between TB and HIV
                 (the AIDS Virus).  (1990).  1-page pamphlet on
                 the risk of HIV-related TB, testing, and therapy;
                 also available in Spanish.


    CDC National AIDS Clearinghouse


    Hawaii (State of), Department of Health, AIDS/STD Project


    Maryland Department of Health and Mental Hygiene


    National Institutes of Health, National Institute of Allergy
    and Infectious Diseases (NIH, NIAID)

            *    HIV-Related TB:  How to Help Yourself.
                 (1993).  8-page booklet.


    National Leadership Coalition on AIDS


    New York State Department of Health, Tuberculosis Control Program


    North Carolina Department of Environment, Health and Natural
    Resources



                                   IV

_________________________________________________________________________

                           NON-ENGLISH LANGUAGE

                               RESOURCES
                               _________

Tuberculosis (TB) educational and informational materials are available
for workers whose primary language is not English.  These materials
include general information on TB, its prevention, and treatment
medications.  The addresses or other contact information for the
organizations cited are located in Appendix A.

____________________________________________________________________________



                       ______________________________

                       NON-ENGLISH LANGUAGE RESOURCES
                       ______________________________


OFFICE OF MINORITY HEALTH RESOURCE CENTER (OMH-RC)

    Assists in locating educational and other literature and
    publications in languages other than English through
    computerized database searches.  A group of publications is
    also available from OMH-RC which lists organizations and
    programs that provide minority health materials.  OMH-RC
    services are free.


AMHERIC

    Fairfax County (Virginia) Health Department


ARABIC

    Francis J. Curry, National Tuberculosis Model Center


ASIAN LANGUAGE LIST OF RECOMMENDED TUBERCULOSIS HEALTH EDUCATION
MATERIALS

    Association of Asian Pacific Community Health Organization (AAPCHO)
    provides a list of tuberculosis educational materials and their
    sources which have been evaluated and approved for linguistic accuracy,
    cultural appropriateness, and clinical accuracy in Chinese, Korean,
    Tagalog, and Vietnamese.  The 3-page list is in English and is
    continually being updated.  No charge.


CAMBODIAN

    American Lung Association of Maryland

    American Lung Association of San Diego and Imperial Counties
    (California)

    American Lung Association of Virginia

    Fairfax County (Virginia) Health Department

    Francis J. Curry, National Tuberculosis Model Center

    Hawaii State Department of Health

    Maryland Department of Health and Mental Hygiene, Tuberculosis Control

    Massachusetts Department of Public Health, TB Control Program

    Massachusetts Refugee Health Program

    Seattle-King County Department of Public Health (Washington state)

    Sonoma County TB Control Chest Clinic (California)

    State of Hawaii, AIDS/STD Project

    Washington (state) Department of Health, Tuberculosis Control


CAPE VERDEAN

    Massachusetts Department of Public Health, Tuberculosis Control Program


CHINESE

    American Lung Association of Alameda County (California)

    American Lung Association of Hawaii

    American Lung Association of Los Angeles County (California)

    American Lung Association of Maryland

    American Lung Association of San Francisco

    American Lung Association of Virginia

    Asian Health Services

    Association of Asian Pacific Community Health Organizations

    California Department of Health Services

    Francis J. Curry, National Tuberculosis Model Center

    Massachusetts Department of Public Health, Tuberculosis Control Program

    North East Medical Services (NEMS)

    San Francisco Department of Public Health, Division of TB Control

    Seattle-King County Department of Public Health, Tuberculosis Division
    (Washington state)

    Sonoma County TB Control Chest Clinic (California)

    State of Hawaii, AIDS/STD Project

    The New York Academy of Medicine


CANTONESE CHINESE

    American Lung Association of San Francisco

    San Francisco Department of Public Health, Division of TB Control


CREOLE (HAITIAN)

    American Lung Association of Virginia

    Dade County Public Health Unit, Tuberculosis Control Program (Florida)

    Massachusetts Department of Public Health, Tuberculosis Control Program

    The New York Academy of Medicine


DARI

    American Lung Association of Virginia


ETHIOPIAN (Tigrinia)

    American Lung Association of Virginia

    Fairfax County Health Department (Virginia)

    Francis J. Curry, National Tuberculosis Model Center

    Sonoma County TB Control Chest Clinic (California)


FARSI

    American Lung Association of Virginia

    Fairfax County Health Department (Virginia)


FILIPINO (TAGALOG)

    American Lung Association of Hawaii

    American Lung Association of Virginia

    Asian Health Services

    Association of Asian Pacific Community Health Organizations

    California Department of Health Services

    Francis J. Curry, National Tuberculosis Model Center

    State of Hawaii, AIDS/STD Project


FRENCH

    American Public Health Association

    Massachusetts Department of Public Health, Tuberculosis Control Program

    New York City Health Department, Bureau of Tuberculosis


GREEK

    Massachusetts Department of Public Health, Tuberculosis Control Program


HMONG

    American Lung Association of Hawaii


ILOCANO

    American Lung Association of Hawaii

    Association of Asian Pacific Community Health Organizations

    Hawaii State Department of Health

    State of Hawaii, AIDS/STD Project


ITALIAN

    American Public Health Association

    Massachusetts Department of Public Health, Tuberculosis Control Program


JAPANESE

    American Lung Association of Hawaii

    Spokane County Health District (Washington state)

    State of Hawaii, AIDS/STD Project

    Washington (state) Department of Health, Tuberculosis Control Program


KOREAN

    American Lung Association of Hawaii

    American Lung Association of Los Angeles County

    American Lung Association of Virginia

    Asian Health Services

    Association of Asian Pacific Community Health Organizations

    California Department of Health Services

    Fairfax County Health Department (Virginia)

    Francis J. Curry, National Tuberculosis Model Center

    Hawaii State Department of Health

    Los Angeles County Health Department

    Louisville and Jefferson County Board of Health (Kentucky)

    Madigan Army Hospital Medical Center (Washington state)

    Seattle-King County Department of Public Health, Tuberculosis
    Division (Washington state)

    State of Hawaii, AIDS/STD Project

    Washington (state) Department of Health, Tuberculosis Control Program


LAOTIAN

    American Lung Association of Hawaii

    American Lung Association of Los Angeles

    American Lung Association of Maryland

    American Lung Association of San Diego and Imperial Counties (California)

    American Lung Association of Virginia

    Fairfax County Health District (Virginia)

    Francis J. Curry, National Tuberculosis Model Center

    Hawaii State Department of Health

    Louisville and Jefferson County Board of Health (Kentucky)

    Maryland Department of Health and Mental Hygiene, Tuberculosis Control

    Massachusetts Department of Public Health, TB Control Program

    Massachusetts Refugee Health Program

    Seattle-King County Department of Public Health, Tuberculosis
    Division (Washington state)

    Sonoma County TB Control Chest Clinic (California)

    Spokane County Health District (Washington state)

    State of Hawaii, AIDS/STD Project

    Washington (state) Department of Health, Tuberculosis Control Program


POLISH

    Washington (state) Department of Health, Tuberculosis Control Program


PORTUGUESE

    Massachusetts Department of Public Health, Tuberculosis Control Program


ROMANIAN

    Sonoma County TB Control Chest Clinic (California)


RUSSIAN

    American Lung Association

    American Lung Association of Massachusetts

    Dupage County Health Department, Tuberculosis Clinic (Illinois)

    Francis J. Curry, National Tuberculosis Model Center

    Massachusetts Department of Public Health

    Washington (state) Department of Health, Tuberculosis Control Program


SAMOAN

    American Lung Association of Hawaii

    Hawaii State Department of Health

    State of Hawaii, AIDS/STD Project


SAUDI

    Spokane County Health District (Washington state)


SPANISH

    American Academy of Pediatrics-Committee on Infectious Diseases

    American Lung Association

    American Lung Association of Brooklyn (New York)

    American Lung Association of Los Angeles County

    American Lung Association of Massachusetts

    American Lung Association of San Francisco

    American Public Health Association

    Centers for Disease Control and Prevention, Division of Tuberculosis
    Elimination

    Chelan-Douglas Health District (Washington state)

    County of Los Angeles Department of Health Services, Tuberculosis
    Control (California)

    County of Los Angeles, Health Education Unit (California)

    Dade County Public Health Unit, Tuberculosis Control Program (Florida)

    Fairfax County Health Department (Virginia)

    Florida Department of Health and Rehabilitative Services, Tuberculosis
    Control Program

    Francis J. Curry, National Tuberculosis Model Center

    Louisville and Jefferson County Board of Health (Kentucky)

    Madigan Army Hospital Medical Center (Washington state)

    Malheur County Health Department (Oregon)

    Massachusetts Department of Public Health, Tuberculosis Control Program

    Montgomery County Health Department (Maryland)

    New Hampshire Division of Public Health Services

    New Mexico, Health and Environment Department, TB Control Program

    New York City Health Department, Bureau of Tuberculosis

    Orange County Health Care Agency (California)

    Prince George's County TB Control Division (Maryland)

    San Francisco Department of Public Health, Division of TB Control

    Seattle-King County Department of Public Health, Tuberculosis
    Division (Washington state)

    Skagit County Health Department (Washington state)

    Sonoma County TB Control Chest Clinic (California)

    Spokane County Health District (Washington state)

    Texas Department of Health, Tuberculosis Control Division

    The New York Academy of Medicine

    US-Mexico Border Health Association (JUNTOS Project)

    Wake County Department of Health (North Carolina)

    Washington (state) Department of Health, Tuberculosis Control Program


THAI

    State of Hawaii, AIDS/STD Project


TONGAN

    Hawaii State Department of Health, Tuberculosis Branch

    State of Hawaii, AIDS/STD Project


VIETNAMESE

    American Lung Association of Hawaii

    American Lung Association of San Diego and Imperial Counties
    (California)

    American Lung Association of Virginia

    Asian Health Services

    Association of Asian Pacific Community Health Organizations

    California Department of Health Services

    Fairfax County Health Department (Virginia)

    Francis J. Curry, National Tuberculosis Model Center

    Louisville and Jefferson County Board of Health (Kentucky)

    Maryland Department of Health and Mental Hygiene, Tuberculosis Control

    Massachusetts Department of Public Health, TB Control Program

    Massachusetts Refugee Health Program

    Montgomery County Health Department (Maryland)

    Orange County Health Care Agency (California)

    Prince George's County TB Control Division (Maryland)

    Seattle-King County Department of Public Health, Tuberculosis
    Division (Washington state)

    Sonoma County TB Control Chest Clinic (California)

    Spokane County Health District (Washington state)

    State of Hawaii, AIDS/STD Project

    Washington (state) Department of Health, Tuberculosis Control Program


VISAYAN

    State of Hawaii, AIDS/STD Project



                                    V

__________________________________________________________________________

                        PUBLICATIONS AND RESOURCES

                            FOR CLINICIANS

                            _____________

This section, Publications and Resources for Clinicians, contains
resources for health care providers who are delivering care to persons
with tuberculosis.  The materials are highly technical and
clinically-oriented.  The addresses and other contact information for
the organizations cited are located in Appendix A.

____________________________________________________________________________


                  _________________________________________

                  PUBLICATIONS and RESOURCES for Clinicians
                  _________________________________________


American Association of Occupational Health Nurses. (1994).  AAOHN
    advisory:  Tuberculosis.  AAOHN Journal, 42(10).  Reprints from
    AAOHN: $5.00 members; $8.00 non-members.


American Thoracic Society.  (1990).  Diagnostic standards and
    classification of tuberculosis.  American Review of
    Respiratory Disease, 142, 725-735.


Association of Asian Pacific Community Health Organizations.  (1994).
    Clinical TB protocol.  Available at no charge from AAPCHO.


Association of State & Territorial Public Health Laboratory Directors;
    and, Public Health Practice Program Office, Division of Laboratory
    Systems (CDC).  (1995).  Mycobacterium tuberculosis:  Assessing
    your laboratory, (ASTPHLD #U60-CCU303019).  Atlanta, GA:  CDC


Carmon, M.  (1993).  Legal challenges of tuberculosis in the workplace.
    AAOHN Journal, 41(2), 96-100.


Centers for Disease Control and Prevention.  (1994).  Expanded
    tuberculosis surveillance and tuberculosis morbidity - United
    States, 1993.  Morbidity and Mortality Weekly Report, 43(20),
    361-366.


Centers for Disease Control and Prevention.  (1993).  Initial therapy
    for tuberculosis in the era of multi-drug resistance:
    Recommendations of the advisory council for the elimination of
    tuberculosis (ACET).  Morbidity and Mortality Weekly Report,
    42(No. RR-7).


Centers for Disease Control and Prevention.  (1991).  Purified protein
    derivative (PPD)-tuberculin anergy and HIV infection:  Guidelines
    for anergy testing and management of anergic persons at risk of
    tuberculosis.  Morbidity and Mortality Weekly Report, 40(No. RR-5).


Centers for Disease Control and Prevention.  (1993).  Technical
    guidance on HIV counseling.  Morbidity and Mortality Weekly
    Report, 42(No. RR-2).


Colditz, G.A., Brewer, T.F., Berkey, C.S., Wilson, M.E. Burdick, E.,
    Fineberg, H.V., & Mosteller, F. (1994).  Efficacy of BCG vaccine
    in the prevention of tuberculosis:  Meta-analysis of the published
    literature.  JAMA, 271(9), 698-702.


Daugherty, J.S., Hutton, M.D., & Simone, P.M.  (1993).  Prevention and
    control of tuberculosis in the 1990s.  Nursing Clinics of North
    America, 28(3), 599-611.


Directly observed therapy (DOT):  It can help you cure TB.
    Informational brochure for physicians to introduce them to the benefits
    of DOT.  Available from New York State Department of Health.


Huebner, R.E., Schein, M.F., & Bass, J.B., Jr.  (1993).  The
    tuberculin skin test.  Clinical Infectious Diseases, 17, 968-975.


National AIDS Clearinghouse (CDC).  (1995).  HIV/AIDS and tuberculosis.
    A database search drawn from the CDC National Clearinghouse's
    Educational Materials Database.  The database is updated twice yearly.


National Institutes of Health, National Institute of Allergy and
    Infectious Diseases.  (1993).  Tuberculosis:  Resurgence of an
    old problem.


Office of Minority Health Resource Center (OMH-RC)
    Resource and referral service.  Offers database searches, information
    exchange, publications, mailing lists, technical assistance, data and
    statistics, and referrals.  Resource Person Network (volunteers)
    available to provide technical assistance, conduct professional level
    education training and workshops, and serve as reference specialists.
    Database searches to locate brochures, articles, bibliographies,
    journals, and other literature.  All resource center services are free
    of charge.


The following resources are available at no charge from the Centers
for Disease Control & Prevention (CDC), Information Services (IS).  The
address for IS, National Center for Prevention Services, at the CDC is
listed in Appendix A.  In addition, a reproducible order form for CDC
material is located in Appendix B.

    American Thoracic Society.  (1992).  Control of
    tuberculosis in the United States.  American Review of
    Respiratory Disease, 146(6), 1623-1633.

    American Thoracic Society.  (1994).  Treatment of
    tuberculosis and tuberculosis infection in adults and
    children.  American Journal of Respiratory and Critical
    Care Medicine, 149(5), 1359-1374.

    Centers for Disease Control and Prevention.  (1990).
    Screening for tuberculosis and tuberculosis infection in
    high-risk populations and use of preventive therapy for
    tuberculosis infection in the US.  Morbidity and Mortality
    Weekly Report, March 18.

    Centers for Disease Control and Prevention.  (1993).
    Tuberculosis control laws - United States, 1993: 
    Recommendations of the advisory council for the elimination
    of tuberculosis (ACET).  Morbidity and Mortality Weekly
    Report, 42,(No. RR-15), November 12.

    Centers for Disease Control and Prevention.  (1992).
    Management of persons exposed to multidrug-resistant
    tuberculosis.  Morbidity and Mortality Weekly Report,
    41(No. RR-11), June 19.

    Core curriculum on tuberculosis, 3rd Edition.  (1994).
    For providers of health care services.  A 95-page training
    guide on clinical and public health aspects of tuberculosis
    control.  A set of 82 slides to accompany the training
    booklet is also available.

    Reported tuberculosis in the United States, 1993.
    Statistics on tuberculosis cases and case rates reported for
    1993.

    TB care guide:  Highlights from core curriculum on
    tuberculosis.  (1994).  A 57-page booklet for clinicians
    on care of TB patients, with a tear-off card for dosage
    calculation and reference.

    Treating tuberculosis:  A clinical guide.  (1994).  A
    fold-out chart with 8 panels with tables on TB treatment and
    medications for clinicians' reference.



                                 VI

__________________________________________________________________________

                        STATE AND TERRITORIAL

                    OFFICES OF TUBERCULOSIS CONTROL

                             __________

Each state and territory of the United States has an Office of
Tuberculosis Control.  The point of contact for each office listed
is current as of May 1995.  Your local telephone directory should be
consulted for any number or personnel changes.
____________________________________________________________________________



                 STATE AND TERRITORIAL HEALTH DEPARTMENTS
                         Tuberculosis Control Offices
____________________________________________________________________________
                                  |
Frank K. Bruce                     | William W. Stead, MD
Director                           | Director
Tuberculosis Control Branch        | Tuberculosis Control Division
Alabama Department of Public Health| Arkansas Department of Health
434 Monroe Street                  | 4815 West Markham Street
Montgomery, ALABAMA  36130-3017    |  - Mailstop 45
                                  | Little Rock, ARKANSAS  72205
                                  |
Consultant:  N/A                   | Consultant:  Dory Moers, RN
                                  |
Phone:  (334) 613-5330             | Phone:  (501) 661-2398
Fax:    (334) 288-5021             | Fax:    (501) 661-2759
___________________________________|________________________________________
                                  |
Elizabeth Funk, MD                 | Sarah Royce, MD, MPH
Epidemiologist                     | Chief
Infectious Disease Group           | TB Control Branch
Alaska Health Department and       | California Department of
Social Services                   |  Health Services
Section of Epidemiology            | 2151 Berkeley Way, Room 715
P.O. Box 240249                    | Berkeley, CALIFORNIA  94704-1101
Anchorage, ALASKA  99524           |
                                  |
Consultant:  Suzanne Banda, RN     | Consultant:  N/A
                                  |
Phone:  (907) 561-4406             | Phone:  (510) 540-2973
Fax:    (907) 562-7802             | Fax:    (510) 849-5269
___________________________________|________________________________________
                                  |
Edgar Reed, MD                     | Richard E. Hoffman, MD, MPH
Department of Health               | Tuberculosis Control Officer
Government of American Samoa       | Colorado Department of Health
LBJ Tropical Medical Center        | 4300 Cherry Creek Drive South
Pago Pago, AMERICAN SAMOA  96799   | DCEED-A3
                                  | Denver, COLORADO  80222-1530
                                  |
Consultant:  N/A                   | Consultant:  N/A
                                  |
Phone:  9-011-684-633-2243         | Phone:  (303) 692-2676
Fax:    9-011-684-633-5379         | Fax:    (303) 782-0904
___________________________________|________________________________________
                                  |
Norman J. Petersen, FM             | Joseph Marino
Acting Assistant Director          | Program Director
Disease Prevention Services        | TB Control Program
Arizona Department of Health       | Connecticut Department of Public
Services                          |  Health Services
3815 North Black Canyon Highway    | 150 Washington Street
Phoenix, ARIZONA  85015            | Hartford, CONNECTICUT  06106
                                  |
Consultant:  Caroline Nejedlo, RN  | Consultant:  Patricia Kucharski, RN
                                  |
Phone:  (602) 230-5808             | Phone:  (203) 566-3099
Fax:    (602) 230-5959             | Fax:    (203) 566-5823
___________________________________|________________________________________
                                  |
Kathleen E. Russell, MPH           | Beverly Devoe, MHS
Coordinator                        | Program Manager
Tuberculosis Elimination Program   | Tuberculosis Control Program
Delaware Dept. of Health and       | Georgia Department of
Social Services                   |  Human Resources
Jessie Cooper Building             | 1305 Redmond Circle, Building 512
P.O. Box 637                       | Rome, GEORGIA  30161-1393
Dover, DELAWARE  19903             |
                                  |
Consultant:  N/A                   | Consultant:  N/A
                                  |
Phone:  (302) 739-6620             | Phone:  (706) 295-6292
Fax:    (302) 739-6617             | Fax:    (706) 295-6747
___________________________________|________________________________________
                                  |
VACANT                             | Cecilia T. Arciaga
Chief                              | Tuberculosis Program Coordinator
Bureau of Tuberculosis Control     | Department of Public Health
Department of Health and           |  and Social Services
Human Services                    | Government of Guam
DCGH - Building 15                 | P.O. Box 2816
1905 E Street, SE                  | Agana, GUAM  96910
Washington, DISTRICT OF COLUMBIA   |
20003                             |
                                  |
Consultant:  Jean Mainer, RN       | Consultant:  N/A
                                  |
Phone:  (202) 724-2195             | Phone:  9-001-671-734-7145
Fax:    (202) 724-2363             | Fax:    9-001-671-734-5910
___________________________________|________________________________________
                                  |
Lerina Nena, RN                    | Azucena Ignacio, MD
TB Program Manager                 | Chief
Dept. of Health Services           | Tuberculosis Branch
P.O. Box PS70, Palikir Station     | Hawaii Department of Health
Palikir                            | 1700 Lanakila Avenue
Pohnpei, FEDERATED STATES OF       | Honolulu, HAWAII  96817-2199
MICRONESIA  96941                 |
                                  |
Consultant:  N/A                   | Consultant:  N/A
                                  |
Phone:  9-011-691-320-2619         | Phone:  (808) 832-5731
Fax:    9-011-670-233-0214         | Fax:    (808) 832-5846
___________________________________|________________________________________
                                  |
James Jackson                      | Jesse Greenblatt, MD, MPH
Director, HIV/STD/TB Prevention    | State Epidemiologist
Florida Department of Health &     | Idaho Department of Health
Rehab. Services                   |  and Welfare
1317 Winewood Blvd., Building E    | 450 West State Street
4th Floor, Room 416                | Boise, IDAHO  83720
Tallahassee, FLORIDA  32399-0700   |
                                  |
Consultant:  N/A                   | Consultant:  N/A
                                  |
Phone:  (904) 487-3684             | Phone:  (208) 334-5941
Fax:    (904) 487-1521             | Fax:    (208) 334-6581
___________________________________|________________________________________
                                  |
Ben Atkinson, MPH                  | Gene D. Simmons, MPH
Chief                              | Program Manager
TB Control Program                 | Tuberculosis Control Program
Illinois Department of             | Kentucky Department for
Public Health                     |  Health Services
525 West Jefferson Street          | 275 East Main Street
- 1st Floor                       | Frankfort, KENTUCKY  40621-001
Springfield, ILLINOIS  62761       |
                                  |
Consultant:  N/A                   | Consultant:  Donna Perkins,
                                  |                   RN, BSN
                                  |
Phone:  (217) 785-5371             | Phone:  (502) 564-4276
Fax:    (217) 524-4515             | Fax:    (502) 564-4553
___________________________________|________________________________________
                                  |
VACANT                             | Vic Tomlinson
Director                           | Tuberculosis Control Section
Division of Communicable Disease   | Louisiana Department of Health
Indiana State Department of Health |  and Hospitals
P.O. Box 1964                      | 325 Loyola, Room 617
1330 West Michigan Street          | New Orleans, LOUISIANA  70112
Indianapolis, INDIANA  46206-1964  |
                                  |
Consultant:  N/A                   | Consultant:  N/A
                                  |
Phone:  (317) 383-6458             | Phone:  (504) 568-5015
Fax:    (317) 383-6747             | Fax:    (504) 568-5016
___________________________________|________________________________________
                                  |
Patricia Quinlisk, MD              | Kathy Gensheimer, MD
Iowa Department of Public Health   | Director, TB Control and
Lucas State Office Building        |  Refugee Program
321 East 12th Street               | Bureau of Health
Des Moines, IOWA  50319-0075       | Department of Human Services
                                  | 157 Capitol - State House,
                                  |  Station #11
                                  | Augusta, MAINE  04333
                                  |
Consultant:  N/A                   | Consultant:  Joan Blossom, RN
                                  |
Phone:  (515) 281-4941             | Phone:  (207) 287-3748
Fax:    (515) 242-4958             | Fax:    (207) 287-6865
___________________________________|________________________________________
                                  |
Harold H. Geer                     | Sarah Bur, RN, MPH
Director, TB Control Section       | Chief
Bureau of Disease Control          | Division of Tuberculosis Control
Kansas Department of Health        | Maryland Dept. of Health and
and Environment                   |  Mental Hygiene
109 Southwest Ninth Street         | 201 West Preston Street
Mills Building, Suite 605          | O'Connor Building - 3rd Floor,
Topeka, KANSAS  66612-1271         |  Rm 307A
                                  | Baltimore, MARYLAND  21201-2399
                                  |
Consultant:  Angela Akerstron, RN  | Consultant:  N/A
                                  |
Phone:  (913) 296-5589             | Phone:  (410) 225-6692
Fax:    (913) 296-4197             | Fax:    (410) 669-4215
___________________________________|________________________________________
                                  |
Sue C. Etkind, RN, MS              | Mahree Skalar
Director                           | Deputy Director
Tuberculosis Control Program       | Division of Environmental Health
Massachusetts Department of        |  and Epidemiology
Public Health                     | Missouri Department of Health
305 South Street                   | 1730 East Elm Street
Jamaica Plain, MASSACHUSETTS  02130| P.O. Box 570
                                  | Jefferson City, MISSOURI
                                  |  65102-0570
                                  |
Consultant:  Janice Boutotte, RN   | Consultant:  Marty Huber, RN
                                  |
Phone:  (617) 983-6970             | Phone:  (314) 751-6080
Fax:    (617) 983-8735             | Fax:    (314) 526-6892
___________________________________|________________________________________
                                  |
Dennis Minnice                     | Denise Ingman
Chief                              | TB Program Coordinator
Division of Tuberculosis Control   | Preventive Health Services
Michigan Department of             | Montana State Department of
Public Health                     |  Health and Environmental Science.
P.O. Box 30035                     | 1400 Broadway - Cogsweil Building
3500 N. Martin Luther King Blvd.   | Helena, MONTANA  59620-0901
Lansing, MICHIGAN  48909           |
                                  |
Consultant:  N/A                   | Consultant:  N/A
                                  |
Phone:  (517) 335-8063             | Phone:  (406) 444-0275
Fax:    (517) 335-8121             | Fax:    (406) 444-2606
___________________________________|________________________________________
                                  |
Kristine MacDonald, MD, MPH        | Roger Murray
Director, TB Control Program       | Coordinator
Minnesota Department of Health     | Tuberculosis Control Program
P.O. Box 9441                      | Nebraska Department of Health
717 Delaware Street SE             | 301 Centennial Mall South
Minneapolis, MINNESOTA  55440      | P.O. Box 95007
                                  | Lincoln, NEBRASKA  68509-5007
                                  |
Consultant:  Claudia Miller        | Consultant:  N/A
                                  |
Phone:  (612) 623-5526             | Phone:  (402) 471-2937
Fax:    (612) 623-5743             | Fax:    (402) 471-6426
___________________________________|________________________________________
                                  |
James M. Holcombe, MPA             | Sandra Henneke, RN
Director                           | Program Manager
Tuberculosis Control Branch        | Tuberculosis Control Program
Mississippi State Department       | Nevada State Department of
of Health                         |  Human Resources
2423 North State Street            | 505 East King Street, Room 304
Jackson, MISSISSIPPI  39216        | Carson City, NEVADA
 89710
                                  |
Consultant:  Paulette W. Smith, RN | Consultant:  N/A
                                  |
Phone:  (601) 960-7700             | Phone:  (702) 687-4800
Fax:    (601) 354-0661             | Fax:    (702) 687-4988
___________________________________|________________________________________
                                  |
Richard DiPentima, RN, MPH         | James Jones, MPH
TB Program Chief                   | Chief, Tuberculosis Control
Bureau                             |  Section
Bureau Disease Control             | Dept. of Environment, Health, &
New Hampshire Division of Public   |  Natural Resources
Health Services                   | P.O. Box 27687
6 Hazen Drive                      | Raleigh, NORTH CAROLINA
Concord, NEW HAMPSHIRE  03301-6527 |  27611-7687
                                  |
Consultant:  Janice Oberacker      | Consultant:  Dee Foster, RN
                                  |
Phone:  (603) 271-4496             | Phone:  (919) 733-7286
Fax:    (603) 271-4933             | Fax:    (919) 715-4699
___________________________________|________________________________________
                                  |
Clifford G. Freund                 | Larry Shireley, MPH
Director                           | TB Control Program
Communicable Disease Services      | Division of Disease Control
New Jersey State Department        | North Dakota Department of
of Health                         |  Health
University Office Plaza - CN 369   | 600 East Boulevard Avenue
Trenton, NEW JERSEY  08625-0369    | Bismarck, NORTH DAKOTA
                                  |  58505-0200
                                  |
Consultant:  Doris Lewis,          | Consultant:  N/A
                 RN, MA, MPA      |
                                  |
Phone:  (609) 588-7539             | Phone:  (701) 328-2378
Fax:    (609) 588-7431             | Fax:    (701) 328-4727
___________________________________|________________________________________
                                  |
Doris Fields                       | Isamu J. Abraham, MO
Director, Tuberculosis Control     | Secretary of Health
Program                           | Commonwealth of the Northern
Bureau of Infectious Disease       |  Mariana Islands
Prevention & Control              | Department of Health
Public Health Division             | P.O. Box 409 CK
Health and Environment Department  | Saipan, MARIANA ISLANDS
P.O. Box 26110                     |
1990 St. Francis Drive             |
Santa Fe, NEW MEXICO  87502        |
                                  |
Consultant:  Jean Smithpeter,      | Consultant:  Lupe Hofschnieder
                 RN, MSN          |
                                  |
Phone:  (505) 827-0156             | Phone:  9-011-670-234-8950
Fax:    (505) 827-0163             | Fax:    9-011-670-234-8930
___________________________________|________________________________________
                                  |
George DiFerdinando, MD, MPH       | Thomas J. Halpin, MD
Director                           | Director
Bureau TB Control                  | Division of Prevention Medicine
New York State Department of Health| Ohio Department of Health
Corning Tower, Room 840/859        | P.O. Box 118
Empire State Plaza                 | 246 North High Street
Albany, NEW YORK  12237            | Columbus, OHIO  43266-0118
                                  |
Consultant:  Elizabeth Foster, RN  | Consultant:  Shirley Dobbins, RN
                                  |
Phone:  (518) 474-7000             | Phone:  (614) 466-0304
Fax:    (518) 473-6164             | Fax:    (614) 644-8526
___________________________________|________________________________________
                                  |
Jon Tillinghast, MD, MPH           | Mildred Soto, MPH
TB Control Officer                 | Director
Communicable Disease Division      | Tuberculosis Control Program
Oklahoma State Department of Health| Department of Health
1000 NE Tenth Street               | P.O. Box 71423, Correo General
Oklahoma City, OKLAHOMA  73117-1299| San Juan, PUERTO RICO  00936-1423
                                  |
Consultant:  Helen Gretz, RN       | Consultant:  Millie Rodriquez,
                                  |                   RN, MSN
                                  |
Phone:  (405) 271-4063             | Phone:  (809) 721-2000, x 205
Fax:    (405) 271-5149             | Fax:    (809) 723-3565
___________________________________|________________________________________
                                  |
Elizabeth Brown, MS, RN            | Janet O'Connel, MPH
TB Program Director                | Program Administrator for
Oregon Health Division             |  TB Control
800 NE Oregon, Suite 772           | Office of Disease Control
Portland, OREGON  97232            | Rhode Island Department of Health
                                  | 3 Capitol Hill
                                  | Providence, RHODE ISLAND  02908-5097
                                  |
Consultant:  Liz Binam, RN         | Consultant:  Jean Mainer
                                  |
Phone:  (503) 731-4024             | Phone:  (401) 277-2577
Fax:    (503) 731-4798             | Fax:    (401) 272-3771
___________________________________|________________________________________
                                  |
Anthony Polloi, MD                 | Donald F. Capella
Director                           | Secretary of Health and Environment
ATTN:  Jill McCready               | P.O. Box 16
Bureau of Health Services          | Majuro Hospital
Republic of Palau                  | Majuro, REPUBLIC OF MARSHALL
P.O. Box 6027                      |  ISLANDS  96960
Koror, PALAU - W.C. Is.  96940     |
                                  |
Consultant:  N/A                   | Consultant:  Justina R. Langidrik, MPH
                                  |
                                  |
Phone:  9-011-680-488-2813         | Phone:  9-011-692-625-7246
Fax:    9-011-680-488-1211         | Fax:    9-011-692-625-3432
___________________________________|________________________________________
                                  |
VACANT                             | Carol J. Pozsik, RN, MPH
Tuberculosis Control Program       | Director
Pennsylvania Department of Health  | Division of Tuberculosis Control
P.O. Box 90                        | S. Carolina Department of Health &
Health and Welfare Building        |   Environmental Control
- 10th Floor West                 | 2600 Bull Street
Commonwealth and Forster Street    | Columbia, SOUTH CAROLINA  29201
Harrisburg, PENNSYLVANIA           |
17108-0090                        |
                                  |
Consultant:  N/A                   | Consultant:  Betty Gore, RN,
                                  |                   MSN, CIC
                                  |
Phone:  (717) 787-6267             | Phone:  (803) 737-4150
Fax:    (717) 783-3794             | Fax:    (803) 737-6531
___________________________________|________________________________________
                                  |
Kristin Schweigert                 | William Graham, MD
TB Project Coordinator             | Medical Director
Office of Communicable Disease     | Tuberculosis Control Program
Prevention and Control             | Vermont Department of Health
South Dakota State Department      | P.O. Box 70
of Health                         | 109 Cherry Street
445 East Capitol Avenue            | Burlington, VERMONT  05402
Pierre, SOUTH DAKOTA  57501-3182   |
                                  |
Consultant:  N/A                   | Consultant:  N/A
                                  |
Phone:  (605) 773-3364             | Phone:  (802) 863-7245
Fax:    (605) 773-6623             | Fax:    (802) 865-7701
___________________________________|________________________________________
                                  |
H. David Crowder                   | VACANT
Division of Tuberculosis Control   | Bureau of Tuberculosis Control
Tennessee Department of Health     | Virginia State Department of Health
and Environment                   | 1500 East Main Street, Rm. 119
Tennessee Tower Building           | Richmond, VIRGINIA  23218
- 13th Floor                      |
Nashville, TENNESSEE  37247-4911   |
                                  |
Consultant:  Pat Johnson, RN       | Consultant:  N/A
                                  |
Phone:  (615) 532-2691             | Phone:  (804) 786-6251
Fax:    (615) 532-8478             | Fax:    (804) 371-0248
___________________________________|________________________________________
                                  |
Michael F. Kelley, MD, MPH         | Sylvia Buntin-Simmons, PhD
Bureau Chief                       | Project Director
Bureau of Communicable Disease     | TB Control Program
Control                           | Virgin Islands Department of Health
Texas Department of Health         | Community Health Services
1100 West 49th Street              | 48 Sugar Estate
Austin, TEXAS  78756-3199          | St Thomas Hospital
                                  | St Thomas, VIRGIN ISLANDS  00802
                                  |
Consultant:  Isabel Vitek,         | Consultant:  N/A
                 RN, BSN          |
                                  |
Phone:  (512) 458-7455             | Phone:  (809) 774-3168
Fax:    (512) 458-7787             | Fax:    (809) 771-4001
___________________________________|________________________________________
                                  |
Lillian Tom-Orme, RN, PhD          | Kay Anderson, RN
Director, Community Health         | TB Controller
Services                          | Washington Department of Health
Refugee and Pulmonary Program      | 1511 Third Avenue, Suite 201
Utah Department of Health          | Seattle, WASHINGTON  98101
P.O. Box 142868                    |
288 North, 1460 West               |
Salt Lake City, UTAH  84114-2868   |
                                  |
Consultant:  Margaret Chamberlin,  | Consultant:  Sheryl Palaniuk, RN
                 RN, BSN          |
                                  |
Phone:  (801) 538-6141             | Phone:  (206) 464-5327
Fax:    (801) 538-6694             | Fax:    (206) 464-6123
___________________________________|________________________________________
                                  |
James H. Walker, MD                | Dawn Tuckey
Director                           | Director
Tuberculosis Control Program       | Tuberculosis Control Program
West Virginia Department of Health | Wisconsin Department of Health
1422 East Washington Street        |  & Social Services
Charleston, WEST VIRGINIA  25301   | 1414 East Washington Avenue
                                  | Madison, WISCONSIN  53703
                                  |
Consultant:  Carolyn Winkler, RN   | Consultant:  N/A
                                  |
Phone:  (304) 558-2669             | Phone:  (608) 266-9452
Fax:    (304) 558-6335             | Fax:    (608) 266-3696
___________________________________|________________________________________
                                  |
Alex Bowler                        |
Coordinator                        |
Wyoming Department of Health       |
and Social Services               |
Hathaway Building, 4th Floor,      |
Room 419                          |
Cheyenne, WYOMING  82002           |
                                  |
Consultant:  N/A                   |
                                  |
Phone:  (307) 777-5658             |
Fax:    (307) 777-5402             |
___________________________________|________________________________________



                             APPENDIX A

                   Addresses / Contact Information


                        Addresses & Contacts
                          for TB Resources

AIDS Action Council
    1875 Connecticut Ave., NW, Suite 700
    Washington, DC  20009

    (202) 986-1300 - FAX: (202) 986-1345

AIDS Coalition to Unleash Power ("Act-Up")
    135 W. 29th Street, #10
    New York, New York  10001

    (212) 564-2437 - FAX (212) 594-5441

Alma Illery Medical Center
    7227 Hamilton Avenue
    Pittsburgh, Pennsylvania  15208

    (412) 244-4775

American Academy of Family Physicians
    8880 Ward Parkway
    Kansas City, Missouri  64114

    (816) 333-9700 or (800) 274-2237 (toll free)

American Academy of Pediatrics
    141 Northwest Point Boulevard
    Elk Grove Village, Illinois  60007-0927

    (708) 228-5005 - FAX (708) 228-5097

American Ambulance Association
    50 Monroe, NW
    Suite 420
    Grand Rapids, MI  49503-6201

    (616) 454-0775

American Association for Continuity of Care
    1730 N. Lynn Street, Suite 502
    Arlington, Virginia  22209

    (703) 525-1191 - FAX (703) 276-8196

American Association for Respiratory Care
    11030 Ables Lane
    Dallas, Texas  75229

    (214) 243-2272 - FAX (214) 484-2720

American Association for World Health
    1129 20th Street, NW, Suite 400
    Washington, DC  20036

    (202) 466-5883 - FAX (202) 466-5896

American Association of Occupational Health Nurses (AAOHN)
    50 Lenox Pointe
    Atlanta, GA  30324-3176

    (800) 241-8014 / (404) 262-1162 / FAX (404) 262-1165

American College of Chest Physicians
    3300 Dundee Road
    Northbrook, Illinois  60062-2348

    (708) 498-1400 - FAX (708) 498-5460

American College of Internal Physicians
    711 Second Street, NE, Suite 200
    Washington, DC  20002

    (202) 544-7498 - FAX (202) 546-7105

American College of Physicians
    Independence Mall West, Sixth Street at Race
    Philadelphia, Pennsylvania  19106-1572

    (215) 351-2829 - FAX (215) 351-2829

American College of Preventive Medicine
    1015 15th Street, NW, Suite 403
    Washington, DC  20005

    (202) 789-0003 - FAX (202) 289-8274

American Correctional Health Services Association
    11 West Monument Ave., Suite 510
    P.O. Box 2307
    Dayton, Ohio  45401-2307

    (513) 223-9630 - FAX (513) 223-6307

American Federation of State, County and Municipal Employees, AFL-CIO
(AFSCME)
    1625 L Street, NW
    Washington, DC  20036-5687

    (202) 429-1000 - FAX (202) 429-1293

American Federation of Teachers, AFL-CIO (AFT)
    555 New Jersey Avenue, NW
    Washington, DC  20001-2079

    (202) 393-5674 - FAX (202) 879-4597

American Geriatrics Society
    770 Lexington Avenue, Suite 400
    New York, New York  10021

    (212) 308-1414

American Health Care Association (AHCA)
    1201 L Street, NW
    Washington, DC  20005

    (202) 898-2850 - FAX (202) 842-3860

American Hospital Association
    1 North Franklin Street
    Chicago, Illinois  60606

    (312) 422-3000

American Jail Association
    2053 Day Road, Suite 100
    Hagerstown, Maryland  21740-9795
    ATTN:  Training Coordinator

    (301) 790-3930 - FAX (301) 790-2941

American Journal of Nursing Company (AJN)
    Educational Services Division
    555 West 57th Street
    New York, New York  10019-2961

    (800) CALL-AJN [(800) 225-5256] - FAX (212) 944-9055

American Lung Association
    1740 Broadway
    New York, New York  10019-4374

    (212) 315-8700 - FAX (212) 265-5642

    (800) LUNG-USA [(800) 586-4872] to contact local chapters or
     request information.

American Medical Association
    515 North State Street
    Chicago, Illinois  60610

    (312) 464-5000 - FAX (312) 464-4184

American Nurses Association
    600 Maryland Avenue, SW, Suite 100W
    Washington, DC  20024-2571

    (202) 651-7126 - (800) 637-0323

American Public Health Association
    1015 15th Street NW
    Washington, DC  20005

    (202) 789-5600 - FAX (202) 789-5681

American Society for Microbiology
    1325 Massachusetts Avenue, NW
    Washington, DC  20005

    (202) 737-3600

American Thoracic Society
    1740 Broadway
    New York, New York  10019-4374

    (212) 315-8778 - FAX (212) 265-5642

Asian Health Services
    310 Eighth Street
    Suite 200
    Oakland, California  94607

    (510) 465-3374

Association for Practitioners in Infection Control and Epidemiology, Inc.
(APIC)
    1016 16th Street, NW, 6th Floor
    Washington, DC  20036

    (202) 296-2742 - FAX (202) 296-5645

    Exec. Director:  Rick Dorman

Association of Asian Pacific Community Health Organizations
(AAPCHO)
    1212 Broadway, Suite 730
    Oakland, California  94612-1825

    (510) 272-9536 - FAX (510) 272-0817

    Program Coordinator:  Jeff Caballero

Association of Community Health Nursing Educators
    President
    Bianca M. Chambers, RN, D.N.Sc.
    Indiana University School of Nursing
    Department of Community Health Nursing
    1111 Middle Drive
    Indianapolis, Indiana  46202-5107

    (317) 274-2129 - FAX (317) 278-1378

Association of State and Territorial Directors of Nursing
    Elfrida Nord, RN, MPH
    Chief, Section of Nursing
    Department of Health and Social Services
    P.O. Box 110611
    Juneau, Alaska  99811-0611

    (907) 465-3150 - FAX (907) 465-3913

Association for Professionals in Infection Control and Epidemiology, Inc.
    1016 16th Street, NW - Sixth Floor
    Washington, DC  20036

    (202) 296-2742 - FAX (202) 296-5645

Association of State and Territorial Health Officials
    415 Second Street, NW, Suite 200
    Washington, DC  20002

    (202) 546-5400

California Department of Health Services
    California Indoor Air Quality Program
    Dr. Janet Macher
    Dr. Kenneth W. Kizer, ME, MPH, Director of CA Dept Health
    Services
    2151 Berkeley Way
    Berkeley, California

    (510) 540-2469

Centers for Disease Control and Prevention (CDC)
    Division of Tuberculosis Elimination and Control
    1600 Clifton Road, NE, Mailstop E-10
    Atlanta, Georgia  30333

    (404) 639-8120; (404) 639-1819 (voice activated, for ordering
    specific materials)

    FAX (404) 639-8628

    RN Consultant: Susan Dougharty Gibson: (404) 639-8135

Centers for Disease Control and Prevention (CDC)
    Information Services
    National Center for Prevention Services
    1600 Clifton Road, NE, Mailstop E-06
    Atlanta, Georgia  30333

    (404) 639-1819 (voice activated, for ordering
    materials/publications)

    FAX (404) 639-8628

Centers for Disease Control and Prevention (CDC)
    National AIDS Clearinghouse
    P.O. Box 6003
    Rockville, Maryland  20849-6003

    (800) 458-5231 - (301) 217-5343 - FAX - (301) 251-5343

Centers for Disease Control and Prevention (CDC)
    Office of Safety & Health
    1600 Clifton Road
    Atlanta, Georgia  30333

    (404) 639-3235 (copy of Biosafety in Microbiological &
    Biomedical Laboratories, 3rd Ed.)

College of American Pathologists
    325 Waukegan Road
    Northfield, Illinois  50093-2750

    (708) 446-8800

Congress of National Black Churches
    1225 I Street, NW, Suite 750
    Washington, DC  20005

    (202) 371-1091 - FAX (202) 371-0908

Department of Defense
    Office of the Assistant Secretary of Defense (Clinical Services)
    1200 Defense Pentagon - Health Affairs
    Washington, DC  20301-1200

    (703) 695-7116

Department of Veterans Affairs
    Office of Geriatrics and Extended Care (114)
    810 Vermont Avenue, NW
    Washington, DC  20420

    (202) 535-7165 - FAX (202) 535-7006

Drug Strategies
    2445 M Street, NW, Suite 480
    Washington, DC  20037

    (202) 663-6090 - FAX (202) 663-6110

1199 National Health and Human Service Employee Union
    330 West 42nd Street, 15th Floor
    New York, New York  10036

    (212) 631-4580 - FAX (212) 695-0538

Food and Drug Administration
    5600 Fishers Lane
    HFD (NLRC)
    Rockville, Maryland  20857

    (301) 443-2410 - FAX (301) 443-9292

Hawaii (State of), Department of Health
    AIDS/STD Project
    1250 Punchbowl Street
    Honolulu, Hawaii  96813

Health Care Finance Administration
    Hubert Humphrey Building, Room 314G
    200 Independence Avenue, SW
    Washington, DC  20201

    (202) 690-5727 - FAX (202) 690-6262

Health Care for the Homeless Information Resource Center
    John Snow, Inc.
    210 Lincoln Street
    Boston, Massachusetts  02111

    (617) 482-9485 - FAX (617) 482-0617

Health Resources & Services Administration
    5600 Fishers Lane, Rm 7-05
    Rockville, Maryland  20857

    (301) 443-1993 - FAX (301) 443-9645

Home Health Services and Staffing Association (HHSSA)
    115 D South
    Saint Asaph Street
    Alexandria, Virginia  23314

    Mark Ranslem (703) 836-9863

Hunter College School of Health Sciences
    The Center for Occupational & Environmental Health
    425 East 25th Street
    New York, New York  10010

    (212) 481-8790 - FAX (212) 481-8795

    Director:  Daniel Kass (212) 481-4361

Indian Health Service
    5600 Fishers Lane, Room 6-05
    Rockville, Maryland  20857

    (301) 443-1083

Infectious Diseases Society of America
    Yale University School of Medicine
    333 Cedar Street, 201 LCI
    New Haven, Connecticut  06510-8056

    (203) 785-4141 - FAX (203) 785-6179

Joint Commission on Accreditation of Healthcare Organizations
(JCAHO)
    One Renaissance Boulevard
    Oakbrook Terrace, Illinois  60181

    (708) 916-5600

Labor Institute, The
    853 Broadway, Room 2014
    New York, New York  10003

    (212) 674-3322 - FAX (212) 353-1203

Lincoln Medical Education Foundation
    Attn:  Tuberculosis Video
    4600 Valley Road
    Lincoln, Nebraska  68510

    (402) 483-4581 - FAX (402) 483-4184

Madigan Army Health Social Service Department
    Medical Center
    Tacoma, Washington  98431

    (206) 968-2302

Massachusetts Refugee Health Program
    305 South Street
    Jamaica Plains, Massachusetts  02130

    (617) 522-3700

Migrant Clinicians Network
    5524 Bee Caves Road, Building I, Suite 1
    Austin, Texas  78746

    (512) 327-2017 - (512) 327-0719

National Association of Community Health Centers, Inc.
    1330 New Hampshire Avenue, Suite 122
    Washington, DC  20036

    (202) 659-8008 - FAX (202) 659-8519

National Association of County Health Officials
    440 First Street, NW, Suite 500
    Washington, DC  20001

    (202) 783-5550

National Black Nurses Association
    1511 K Street, NW, Suite 415
    Washington, DC  20006

    (202) 393-6870 - FAX (202) 347-3808

National Coalition for the Homeless
    1612 K Street, NW, Suite 1004
    Washington, DC  20006

    (202) 775-1322 - FAX (202) 775-1316

National Commission for Clinical Laboratory Standards (NCCLS)
    771 East Lancaster Avenue
    Villanova, Pennsylvania  19085

    (215) 525-2435

National Commission on Correctional Health Care
    2105 North Southport, Suite 200
    Chicago, Illinois  60614-4017

    (312) 528-0818

National Council of La Raza
    810 First Street, NE, Suite 300
    Washington, DC  20002

    (202) 289-1380 - FAX (202) 289-8173

National Foundation for Infectious Diseases
    4733 Bethesda Avenue, Suite 750
    Bethesda, Maryland  20814-5228

    (301) 656-0003 - FAX (301) 907-0878

National Health Care for the Homeless Council
    P.O. Box 68019
    Nashville, Tennessee  37206-8019

    (615) 226-2292 - FAX (615) 226-1656

National Heart, Lung and Blood Institute
    National Institutes of Health
    9000 Rockville Pike
    Building 31, Room 5A52
    Bethesda, Maryland  20892

    (301) 496-5166 - FAX (301) 496-7408

National Institute of Allergy and Infectious Diseases (NIAID)
    National Institutes of Health
    9000 Rockville Pike
    Building 31, Room 7A03
    Bethesda, Maryland  20892

    (301) 496-2263 - FAX (301) 496-4409

National Institute of Nursing Research
    National Institutes of Health
    Building 45, Room 3AN-12
    MSC 6300
    Bethesda, Maryland  20892-6300

    (301) 594-6908 - FAX (301) 480-8260

National Jewish Center for Immunology and Respiratory Medicare
    TB Office K624
    1400 Jackson Street
    Denver, Colorado  80206

    (303) 398-1700 - (800) 423-8891, extension: 1700

National Leadership Coalition on AIDS
    1730 M Street, NW, Suite 905
    Washington, DC  20036

    (202) 429-0930 - FAX (202) 872-1977

National Minority AIDS Council
    300 I Street, NW, Suite 400
    Washington, DC  20002

    (202) 544-1076 - FAX (202) 544-0378

National Public Health Information Coalition
    P.O. Box 941804
    Atlanta, Georgia  30341-0804

National Rural Health Association
    1 West Armour, Suite 301
    Kansas City, Missouri  64111

    (816) 756-3140 - FAX (816) 756-3144

National Technical Information Service
    U.S. Department of Commerce
    5285 Port Royal Road
    Springfield, Virginia  22161

    (800) 553-6847

National Tuberculosis Model Centers
    Francis J. Curry, National Tuberculosis Center
    3180 18th Street, Suite 101
    San Francisco, California  94110

    (415) 502-4600 - FAX (415) 502-4620

           Director:  Gisela Schecter, MD, MPH
           Education Director:  Wesley S. Wong

National Tuberculosis Model Centers (continued)
    National Tuberculosis Center, UMDNJ
    University of Medicine and Dentistry of New Jersey
    65 Bergen Street, Suite GB-1
    Newark, New Jersey  07107-3001

    (201) 982-3270 - FAX (201) 982-3268

           Education Director:  Debra Bottinick

New Hampshire Division of Public Health Services
    6 Hazen Drive
    Concord, New Hampshire  03301

    (603) 271-4661

New York Academy of Medicine
    1216 Fifth Avenue
    New York, New York  10029

New York City Department of Health
    Bureau of Tuberculosis Control
    125 Worth Street, Box 74
    New York, New York  10013

    (212) 788-4153 - FAX (212) 788-4179

Nursing Organization Liaison Forum
    American Nurses Association
    600 Maryland Avenue, SW
    Washington, DC  20024

    (202) 651-7120

Office of Minority Health
    5515 Security Lane, Suite 1000
    Rockville, Maryland  20852

    (301) 443-5084 - FAX (301) 594-0767

Office of Minority Health Resource Center (OMH-RC)
    PHS-DHHS
    PO Box 37337
    Washington, DC  20013-7337

    (800) 444-MHRC [(800) 444-6472]
    TDD: (301) 589-0951
    FAX: (301) 589-0884

Pharmaceutical Manufacturers Association
    1100 15th Street, NW, Suite 900
    Washington, DC  20005

    (202) 835-3550 - FAX (202) 835-3597

Services Employees International Union, AFL-CIO
    1313 L Street, NW
    Washington, DC  20005

    (202) 898-3434 - FAX (202) 898-3491

Society for Hospital Epidemiology of America
    875 Kings Highway, Suite 200
    Woodbury, New Jersey  08096

    (609) 845-1636 - FAX (609) 853-0411

Substance Abuse and Mental Health Services Administration
    5515 Security Lane
    Rockwall II Building, Room 880
    Rockville, Maryland  20852

    (301) 443-8391 - FAX (301) 443-8345

UMDNJ New Jersey Medical School
    National Tuberculosis Center
    65 Bergen Street, Suite GB1
    Newark, New Jersey  07107-3001

    (201) 982-3270 - FAX (201) 982-3268

United States - Mexico Border Health Association
    JUNTOS Program
    6006 North Mesa, Suite 600
    El Paso, Texas  79912

    (915) 581-6645 - FAX (915) 833-4768

           Fernando J. Gonzalez, MD, MPH
           Bi-National TB Control Project Coordinator

University of California, San Diego Medical Center
    Preventive Pulmonary Medicine
    225 Dickinson Street
    San Diego, California  92103-8377

    Attn:  Andrew Ries, MD

University Hospital & Clinics
    Infection Control Department
    DC092.00  212 Dockery Hall
    One Hospital Drive
    Columbia, Missouri  65212

U.S. Department of Health and Human Services
    Division of Federal Occupational Health

    (301) 594-0260

U.S. Department of Labor - OSHA
    Office of Training and Education
    1555 Times Drive
    Des Plaines, Illinois  60018

    (708) 297-4810

U.S. Government Printing Office
    Superintendent of Documents
    Washington, D.C.  20402

    (202) 512-2356

Utah (State of)
    Industrial Commission of Utah
    Utah Job Safety and Health Consultation Services
    160 East 300 South, 3rd Floor
    PO Box 146650
    Salt Lake City, Utah  84114-6650

    (801) 530-6855 / (800) 222-1238 - FAX (801) 530-6992

    Consultant:  Eldon Tryon, PhD

Wasatch Homeless Health Care Program
    404 South 400 West
    Salt Lake City, Utah  84101

    (801) 364-0058 - FAX (801) 364-0161



                              APPENDIX B

  Centers for Disease Control and Prevention, Education and Training
                        Materials Order Form.


                Division of Tuberculosis Elimination
                 Educational and Training Materials

Please indicate desired quantity in the blank provided.  All materials are
free of charge.


For Health Care Providers

Multidrug Resistant Tuberculosis - 1994
___    (00-6529)      8-page article on the causes, treatment, and
                     control of drug-resistant tuberculosis

Core Curriculum on Tuberculosis, 3rd Edition - 1994
___    (00-5763)      95-page training guide on important clinical and
                     public health aspects of TB control
___    (00-6077)      Set of 82 slides that accompany this training
                     guide (Slides limited to one set per order)

TB Care Guide - 1994
___    (00-6470)      57-page booklet for clinicians on care of TB
                     patients, with a tear-off card for dosage
                     calculation and reference

TB Treatment:  A Clinical Guide - 1994
___    (00-6471)      Fold-out chart with 8 panels with tables on TB
                     treatment and medications for clinicians'
                     reference

TB Facts for Health Care Workers - 1993
___    (00-5655)      7-page booklet on TB transmission, diagnosis,
                     prevention, and treatment

Think TB! - Poster listing the symptoms of tuberculosis
___    (00-6186)      English language - 1992
___    (00-6406)      Spanish language - 1993

Improving Patient Adherence to Tuberculosis Treatment - 1994
___    (00-5988)      55-page booklet on measuring, predicting, and
                     improving compliance

Mantoux Tuberculosis Skin Testing - Visual aids for training to
administer and interpret the Mantoux test
___    (00-5564)      Wall chart - 1990
___    (00-5457)      Videotape - 1991

TB/HIV - The Connection:  What Health Care Workers Should Know - 1993
___    (00-5316)      16-page booklet on diagnosis, prevention, and
                     treatment of TB in persons with HIV infection

Reported TB in the United States - 1993
___    (00-6481)      Statistics on tuberculosis cases and case rates
                     reported for 1993


For Drug Treatment Center Staff

What Drug Treatment Centers Can Do To Prevent Tuberculosis - 1991
3-page pamphlet on TB infection, disease, screening, and prevention for
drug treatment centers
___    (00-5748)      English Language
___    (00-6038)      Spanish language

For Correctional Facility Inmates

Tuberculosis Facts - 1991 - Pad of 40 tear-off sheets providing basic
information on the subject specified:
English language
___    (00-5983)      Exposure to TB
___    (00-5984)      The TB Skin Test
___    (00-5981)      You Can Prevent TB
___    (00-5985)      TB Can Be Cured
___    (00-5982)      TB and HIV (The AIDS Virus)

Spanish language
___    (00-6200)      Exposure to TB
___    (00-6201)      The TB Skin Test
___    (00-6198)      You Can Prevent TB
___    (00-6202)      TB Can Be Cured
___    (00-6199)      TB and HIV (The AIDS Virus)



                                        GUIDELINES
TB PREVENTION AND CONTROL

___    (00-5856)      Guidelines for preventing the Transmission of
                     Mycobacterium tuberculosis in Health Care
                     Facilities.  MMWR, 1994.
___    (00-6410)      Tuberculosis Control Laws - United States
                     1993.  MMWR, November 12, 1993.
___    (00-6330)      Control of Tuberculosis in the United States.
                     Reprint from the American Review of Respiratory
                     Disease, December 1992.
___    (00-6224)      National Action Plan to Combat Multidrug-
                     Resistant Tuberculosis.  MMWR, June 19, 1992.
___    (00-6223)      Prevention and Control of Tuberculosis in
                     Migrant Farm Workers.  MMWR, June 5, 1992.
___    (00-6148)      Prevention and Control of Tuberculosis Among
                     Homeless Persons and Prevention and Control of
                     Tuberculosis in U.S. Communities with At-Risk
                     Minority Populations.  MMWR.  April 17, 1992
___    (00-5897)      Prevention and Control of Tuberculosis Among
                     Foreign-Born Persons Entering the United States.
                     MMWR, July 13, 1990.


TB SCREENING AND TREATMENT

___    (00-6453)      Treatment of Tuberculosis and Tuberculosis
                     Infection in Adults and Children.  Reprint from
                     the American Journal of Respiratory and Critical
                     Care Medicine, May 1994.
___    (99-3307)      Screening for Tuberculosis and Tuberculosis
                     Infection in High-Risk Populations and Use of
                     Preventive Therapy for Tuberculosis Infection in
                     the U.S.  MMWR, March 18, 1990.
___    (00-6225)      Management of Persons Exposed to Mulitdrug-
                     Resistant Tuberculosis.  MMWR, June 19, 1992.


For Patients and the General Public

Questions and Answers about TB - 1994
___    (00-6469)      16-page booklet about TB transmission, skin test,
                     and treatment, including DOT and side effects of
                     medications

Stop TB! - 1994
___    (00-6474)      Poster describing the transmission and
                     pathogenesis of TB
___    (00-6475)      Pad of 50 tear-off sheets duplicating the Stop TB!
                     poster

Tuberculosis - Get the Facts! - 1990
One-page pamphlet on basic facts about TB transmission,
infection, and the tuberculin test
___    (00-5743)      English language
___    (00-5772)      Spanish language

Tuberculosis - The Connection Between TB and HIV (the AIDS Virus) - 1990
One-page pamphlet on the risk of HIV-related TB, tuberculin testing, and
preventive therapy
___    (00-5738)      English language
___    (00-5745)      Spanish language

TB/HIV Double Trouble - 1992
___    (00-6154)      Poster stressing the importance of tuberculin
                     testing for persons with HIV infection

To order tuberculosis educational and training materials or guidelines,
you may (1) call the National Center for Preventive Services Voice
Information System (recording) at (404) 639-1819; (2) FAX this form to
Information Services at (404) 639-8628; OR (3) mail this form to:
Information Services, NCPS, CDC, 1600 Clifton Road NE. Mailstop E-06,
Atlanta, Georgia 30333.

Please provide the following information:
Name:          _______________________________________________________

Address:       _______________________________________________________

              _______________________________________________________

              _______________________________________________________

              _______________________________________________________

Phone:         (     ) _______________________________________________


OSHA Standard Interpretation and Compliance Letters - Table of Contents OSHA Standard Interpretation and Compliance Letters - Table of Contents
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