Natalie Firestone, a registered nurse who is vice president of Healthcare Risk Management for Near North Health Care Practice in Chicago, said that TB and hepatitis B and C are diseases with high probability of occupational risk.

TB, she explained, is highly communicable. It primarily affects the lungs, but can also attack the spine, kidney and other parts of the body. TB deaths are high in the 20-49 year-old population, she said. Ms. Firestone explained that TB deaths in the United States are on the rise because of the HIV-AIDS epidemic, and because of immigration of people with a high TB rate in their country.

The disease, she said, is communicated through talking with someone with TB, singing, coughing and sneezing. Those most susceptible to the disease are family members and co-workers, she said, because of their close proximity to the carrier of the disease. TB, she added, can be cured in its active stage.

Symptoms of TB, she said, are a cough that goes on for weeks with no sign of improvement, chest pain, fever, chills, weight loss and night sweats.

Those at risk in the workplace, she said, are healthcare workers because they see patients every day who may come in with a “cough or night sweats, and the nurse or physician doesn't make a good assessment.”

Other workers at risk include:

Correctional institution employees. Ms. Firestone said she is working with a correctional facility that has a policy of isolating anyone being admitted to the jail. The facility, she said, then does TB tests and blood tests for other diseases before housing them with other inmates.

Employees or volunteers at homeless shelters. “A lot of homeless people, we find, have TB,” she said. “Obviously they don't have the patience or the sources to get help, so we find they're transmitting it to each other.”

Workers at long-term care facilities. One facility she works with, prior to letting a new resident come into the facility, requires testing, she said.

Drug treatment center employees.

Also at risk are employers with potential exposure to suspected or confirmed TB cases, and employers with a large population of foreign-born employees. She recommended that employers check their risk assessment for TB in the workplace.

What do you do if you suspect a co-worker or client has TB? Ms. Firestone said the person in question should get a TB screening, or a PPD, she said. Any contact or high-risk groups should also be screened. If the PPD comes back positive, chest X-rays would be the next step, she said.

Some of the loss control steps a risk manager can do include performing a risk assessment and classifying the facility based on how many people in the community have active TB. Also, she said, all employees should be taught to recognize the symptoms of TB. She recommended CDC and OSHA guidelines, available on the organization's Web sites.

Ms. Firestone said that engineering controls include using ventilation systems in TB isolation rooms, and using negative pressure rooms and HEPA filters where there is an increased risk of exposure.

Meanwhile, Hepatitis A, B and C, viral infections that can damage the liver, can be dormant for decades, she said.

She said it is very contagious and is the most common blood-borne infection in the United States. An estimated 1.8 percent of Americans, she said, have been infected with hepatitis. Out of that number, 15 percent will be immune. The 85 percent who do get the infection will not show symptoms but will carry the virus. Eighty percent of those will suffer liver damage inflammation; 20 percent will develop cirrhosis.

“The reason why I think hepatitis is so frightening and why each of you need to worry about it in the work force is because the symptoms may take days, weeks, months, decades,” she said.

Hepatitis A, she said, is spread through food and feces, which could put food preparation workers and day-care employees handling dirty diapers at risk.

Hepatitis B is spread through bodily fluids, while Hepatitis C can only be spread “if the carrier's blood gets in someone else's vein,” she said.

Employees at risk for Hepatitis B include healthcare, emergency and public safety workers; drug treatment center workers; staff members of institutions for the mentally impaired; and prison staff members. Those at risk for Hepatitis C include laboratory workers, healthcare, emergency and public safety workers, and drug treatment center workers.

Victor Barnes, deputy director of the division of HIV prevention at the Center for Disease Control in Atlanta, cited Atlanta-based Home Depot for its proactive approach to employee education. Mr. Barnes said Home Depot has had a human immunodeficiency virus, or HIV, education outreach program in place since 1991.

“Essentially they took it upon themselves to educate their managers to HIV and HIV infection,” he said, at first as “a caution to address [Occupational Safety and Health Administration] standards.” Because of the high potential for cuts and injuries at Home Depot, the company saw any sort of blood-borne pathogen as “an important issue to address,” he noted.

The organization now implements both National Red Cross and CDC workplace education programs, he said.

Mr. Barnes added that one major cola bottling company has been “roundly criticized” by the media for not adopting more stringent policies for treatment of employees in its plants in Africa. This, he added, illustrates some of the problem areas large multinational organizations “can get into unless their policies are extremely well thought out.”

Mr. Barnes concluded that, “ultimately most businesses will be touched by HIV in one way or another,” adding that the workplace is an effective place to educate employees and their families.

Reproduced from National Underwriter Property & Casualty/Risk & Benefits Management Edition, May 6, 2002. Copyright 2002 by The National Underwriter Company in the serial publication. All rights reserved.Copyright in this article as an independent work may be held by the author.