November 5, 1996

Nina Yeung, B.S., M.T.
North Shore Medical Center, Inc
1100 Northwest 95th Street
Epidemiology Department Miami, Florida 33150-2098

Dear Ms. Yeung;

This letter is in response to your letter of October 3, requesting clarification of the discrepancy between the Joint Commission and OSHA posting requirements for isolation rooms. Our compliance directive - CPL 2.106 - Enforcement Procedures and Scheduling for Occupational Exposure to Tuberculosis - is a compliance directive that references several standards but is not a standard or regulation for the control of Tuberculosis. The purpose of the Tuberculosis directive is to assure compliance with certain provisions of the 1994 Centers for Disease Control (CDC) Recommendations on preventing the spread of Tuberculosis. The directive provides information and enforcement procedures to our compliance staff on using some OSHA standards to address some of the CDC recommendations. You should know that the directive was developed with the review and cooperation of a variety of stakeholders representing the health care industry and labor organizations.

The specific discrepancies you mentioned between the confidentiality requirements of the Joint Commission and the posting requirements under the directive and 29 CFR 1910.145 are not viewed by OSHA as being a discrepancy. The confidentiality issue was one of the points that was carefully considered based upon our stakeholder comments. If a hospital, due to confidentiality reasons, does not want to identify an isolation room as respiratory isolation room then OSHA would allow the facility to use terms such as "STOP," "HALT," or "NO ADMITTANCE." We would further expect and require that additional wording be placed on the sign directing anyone wanting to enter the isolation room to confer with nurses station first. We would then expect that the entry requirements for the isolation room be explained and/or provided at the nurses station. If this approach is used the staff at the facility must all be trained to recognize the procedures in place and be aware of what the signs mean.

OSHA certainly wants to protect patient confidentiality as much as the hospital does. If we can be of any further assistance please give my office a call at (202) 219-8036.

Sincerely,



Ruth McCully, Director
Office of Health Compliance Assistance




October 3, 1996

Ruth McCulley
U.S. Dept of Labor OSHA
General Industry Compliance Assist.
200 Constitution Ave. N.W.
Room N-3107
Washington, D.C. 20210

Dear Ms. McCulley:

The Broward, Florida OSHA agency, Ms. Vergie Bain, has referred me to you regarding an issue which appears to be conflicting under the JCAHO Standards on patient confidentiality and the OSHA Regulations CPL2.106 - Enforcement Procedures and Scheduling for Occupational Exposure to Tuberculosis. The facility is requesting your assistance in reviewing your present regulation in order to improve the overall performance of facilities on a national level and enable the regulatory agencies to utilize a multidisciplinary process when developing standards and regulations by which we must abide.

Upon review of the present JCAHO Standards and patient confidentiality regarding identification of isolated patients (i.e. pulmonary, respiratory, or AFB) I contacted Louis Head, M.D. of the Joint Commission, Hospitals South Team. Dr. Head has indicated that by posting an isolation sign with a major message (e.g., "special respiratory isolation", "Respiratory isolation", or AFB isolation) outside of the isolation or treatment room the facility would be deficient in maintaining a required standard such as patient confidentiality. The facility was instructed to provided a color coded STOP sign or message referring one to the nursing station.

OSHA Regulations, accident prevention signs and tags (29 CFR 1910.145) states that in accordance with 1910.145(f)(8), a warning shall be posted outside the Respiratory isolation or treatment room. 1910.145(f)(4) requires that a signal word (i.e. `STOP', `HALT', or `NO ADMITTANCE') or biological hazard symbol be presented as well as a major message (e.g., "special respiratory isolation", "Respiratory isolation", or AFB isolation). A description of the necessary precautions, e.g., respirators must be donned before entering. Respiratory isolation rooms in an emergency department or a message referring one to the nursing station for instructions must also be posted.

As you can see these regulations clearly conflict pertaining to a very important issue. Where patient confidentiality is of utmost concern, we must equally be concerned with the environment of care for our internal and external customers within the facility.

The facility would appreciate your assistance in reviewing the present conflict and await your prompt response in order to meet the requirements of both agencies.

Sincerely,



Nina Yeung, B.S., MT (ASCP)
Infection Control Coordinator