Last rites (and a few lefts) for OSHA TB standard?

APIC expects agency to pull plug on proposed rule

Banished into regulatory oblivion, a 150-page proposed federal tuberculosis standard to protect health care workers may be officially tossed in the paper recycle bin in the near future. The Association for Professionals in Infection Control and Epidemiology (APIC) — which led the fight to defeat the rule proposed by the Occupational Safety and Health Administration (OSHA) — is openly speculating that the end is near for the regulation.

"After more than six years of high-energy dedication, hard work, political strategy, and perseverance in opposing the proposed OSHA TB rule, APIC learned Oct. 29 that the agency is expected to announce the dissolution of its proposed TB rule," a message on the APIC web site states. "Through our work with Congressman Roger Wicker (R-MS), we authored and shepherded bill language through Congress in 1999, calling for a third-party study of the proposed rule by the Institute of Medicine [IOM]. This study, which was issued in early 2001, echoed many of APIC’s concerns and seems to have sealed the fate of the TB rule."

Bill Wright, OSHA spokesman, tells Hospital Infection Control, "I’ve not heard anything like that; so I can’t confirm or deny it." However, the next OSHA regulatory agenda was slated to be released soon, as this issue went to press. APIC, at least, predicts that the proposed TB rule will be conspicuously absent when that regulatory agenda appears. "We’d also like to take this opportunity to thank all of our members who wrote to OSHA or provided public testimony over the years on the proposed TB rule," the APIC message states. "It’s great to know that our efforts really made a difference!"

The 1997 proposed OSHA standard was dealt a serious political blow when a scientific panel of the prestigious IOM concluded that the regulation was inflexible because it would impose requirements that provide little additional protection in low-risk areas while adding significant costs and administrative burdens on health care facilities. (See HIC, March 2001, under archives at

In addition, while warning that TB is still a threat to health care workers in certain situations, the IOM concluded that OSHA overestimated the progression of TB from infection to active disease, and from disease to death. That means the standard was justified in part on OSHA projections that were "inconsistent with available data and are unlikely to fit employed workers with reasonably good access to health care." Political pundits cite the rise of Republican lawmakers as the final nail in the coffin for the regulation.