Tuberculosis - Guidance for safety representatives

Tuberculosis (TB) is a disease caused by a bacterial infection. Although TB was very common in the 19^th century, deaths from the disease began to fall as living standards improved and effective medicines were developed. Unfortunately, in the last 20 years there has been a considerable increase in the number of reported cases within the UK. There are now around 9,000 new cases of TB every year, mainly within inner city areas. Around 40% of all cases are within London.

It is more common among people who live in overcrowded conditions, have poor access to healthcare or have a weakened immune system because of another illness.

TB mainly affects the lungs or lymph glands, but can affect any part of the body. People can be infected for many years without showing any signs. The bacteria that cause the disease take the form of tiny droplets that are spread through coughing, sneezing or even speaking.

Most cases of TB are very easily treated with antibiotics. Although there have been a number of cases of tuberculosis that are resistant to some drugs, almost all strains are treatable and the patient will usually recover. Untreated TB, however, will compromise a person's immune system and trigger other medical conditions. It can be fatal - every year around 350 people die from TB within the UK.

The chances of developing the disease increase if you:

• have lived in a country where TB is common
• have been in close contact with someone with TB
• are either a child or very elderly, or have a compromised immune system
• are homeless, live in overcrowded conditions or have chronic ill health through lifestyle factors such as alcoholism or drug abuse.

Although TB can be highly infectious, it should be stressed that most people who become infected do so as a result of long periods of exposure with an infectious person, rather than by casual contact.

In addition, many people would have been immunised during their childhood. Although the BCG vaccine only gives partial protection, it has been a major factor in decreasing the levels of TB within the UK.

In recent years the Department of Health have stopped vaccinating children automatically and are instead concentrating on those who are most at risk. Therefore, it should be borne in mind that many young people, as well as those brought up abroad, may never have been vaccinated against TB and thus have no resistance.

Tuberculosis in the workplace

Although TB is unlikely to be an occupational risk in most workplaces, there are some occupations where trade union members are likely to be at risk. These are particularly in health care, or any occupation that involves close contact with other people or visiting people in their homes. This means that teaching and other education staff, social care workers, many voluntary sector workers, and anyone working in overcrowded conditions could be at risk. Clearly the risk is going to be greater in areas where there is a higher incidence of TB, such as parts of London, Manchester, Birmingham, Leicester and some other inner city areas.

However, TB can be controlled through increased awareness and hygiene policies. If people recognise the symptoms they are more likely to seek treatment. If those infected are identified and treated at the early stages of infection, this is likely to prevent them later developing the full disease. In addition, where workers are at higher risk, consideration should be given to prevention through immunisation for those not yet vaccinated.

The Law

Tuberculosis is, like any infection that can be contracted through work, covered by Control of Substances Hazardous to Health (COSHH) Regulations. In addition, any incidents of a worker contracting TB through work must be reported under the Reporting of Industrial Diseases and Dangerous Occurrences Regulations (RIDDOR).

Employers are required to carry out a risk assessment if any staff are likely to come into contact with TB through their work. They must also put in place preventative measures to reduce the risk, provide staff with information and training, and keep risk assessments up to date. Employers should also provide health checks for staff if appropriate.

Many safety representatives have complained that their employers only carry out COSHH risk assessments for chemicals, and not for infectious diseases such as Legionnaires, Hepatitis B or TB.

Checklist for safety representatives

If you cover a workplace in an area where there is believed to be a high incidence of TB, and workers could be put at risk as a result of contact through their employment, then it is important that you take action to ensure that all staff are protected. This means seeking an agreement with your employer on what precautions need to be taken. It should be stressed that it is important that the response to TB should be proportionate and that in many areas, or many workplaces, it is unlikely that TB would be a major risk.

What safety representatives can do is identify whether or not any of their members are likely to be placed in contact with TB as a result of their work. If so, they should:

• ensure that there is a programme for ensuring that all workers are notified of the risk of TB, how to identify any early signs and also what they should do if they think they may be infected
• if the work involves direct contact with clients who may have TB, ensure that there are arrangements in place for obtaining infection control advice
• for healthcare workers, ensure that they have access to routine screening for TB and that a post-exposure management system is developed
• consider whether or not vaccination for high-risk staff is appropriate.

Detailed advice is already available for NHS staff on tuberculosis, however other organisations could consider seeking specialist advice on developing a policy on TB. In any case, employers should consult with safety representatives on the risk assessment process and the development of a policy.

In addition, unions could consider using World TB Day on the 24^th March as a way of increasing awareness of TB among members, particularly those in health and social care, teaching and other high risk groups.

Further information

Health Protection Agency TB pages: http://www.hpa.org.uk/infections/topics_az/tb/menu.htm

Department of Health pages: http://www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics
/Tuberculosis/index.htm