OSHA can enforce annual fit-testing rule

'Wicker Amendment' defeated in Congress

Annual fit-testing is once again the unqualified rule for tuberculosis. A Congressional caveat that prohibited the U.S. Occupational Safety and Administration from using federal funds to enforce the annual fit-testing rule for TB has been defeated in the House of Representatives.

Defeating that provision, which had been in place since 2003, was a major goal of health care worker unions and some professional organizations, such as the American Industrial Hygiene Association.

"Science will trump ideology," said Bill Borwegen, MPH, safety and health director of the Service Employees International Union (SEIU). "Evidence-based research will trump ideology. There have been enough studies to show the value of annual fit-testing. Until there's research to show otherwise, this is the prudent approach that we should be taking."

The vote came in the wake of concern about extensively drug-resistant (XDR) TB and the well-publicized case of Andrew Speaker, who traveled internationally while the Centers for Disease Control and Prevention sought his quarantine. Rep. Roger Wicker, R-MS, who sponsored the amendment to the appropriations bill, argued that annual fit-testing was onerous but not protective.

Some hospitals had continued their annual fit-testing programs despite the Wicker Amendment, but many employee health professionals now face the prospect of ramping up their fit-testing programs to comply. "Our members are concerned about doing this on annual basis," says Denise Knoblauch, RN, BSN, COHN-S/CM, executive president of the Association of Occupational Health Professionals in Healthcare and clinical case manager at the OSF SFMC Center for Occupational Health at Saint Francis Medical Center in East Peoria, IL.

Some feel that too much emphasis has been placed on the annual repetition of the fit-tests. "Those organizations that are saying it's going to improve the safety of health care workers I think are giving their members a false sense of security," says Pat Sullivan, MSN, RN, employee health coordinator at Vassar Brothers Medical Center in Poughkeepsie, NY.

Such questions about respirator fit-testing are reflected in the recently released Guideline for Isolation Precautions.

In a debate before the House Appropriations Committee, Wicker argued that the prohibition had saved millions of dollars in health care costs but not led to a single known case of tuberculosis infection among health care workers. Yet other members of Congress countered that the decision should be left up to occupational health experts — and both OSHA and the National Institute for Occupational Safety and Health maintain that annual fit-testing is necessary to ensure that the respirators are not leaking.

In fact, the annual fit-testing rule remained in effect for other diseases requiring respiratory protection, such as SARS and pandemic influenza. In the event of a pandemic, the American Nurses Association will tell members to insist on having a fit-tested respirator, says Erin McKeon, ANA's associate director of governmental affairs.

"Our advice would be that if you have not been provided a fit-tested respirator or you have not been fit-tested in the last year, do not treat those patients," she says.