Five million U.S. workers are exposed to TB in the course of their work each year. The occupational risk of exposure to TB at homeless shelters is particularly acute. TB rates among the homeless are estimated to be 150 to 300 times the nationwide rate. The U.S. Occupational Safety and Health Administration (OSHA) responded to the risk to homeless shelter workers by proposing a regulation mandating that shelters take prescribed actions to identify shelter residents who represent a potential risk and to remove those residents from the homeless shelter environment. This article concludes that the risk of TB exposure within homeless shelter workers is best viewed as a public health problem rather than as exclusively a worker protection problem. Accordingly, in addition to seeking worker protections through regulatory controls, OSHA should seek to promote occupational health and safety through a public health response as well.
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