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APIC: We helped kill OSHA’s TB rule
Rule withdrawn from agency’s agenda
Amid a nationwide decline in tuberculosis cases and opposition to new rules on skin testing and respirator fit-testing, the Occupational Safety and Health Administration (OSHA) is prepared to withdraw its proposed tuberculosis standard.
Even before the agency released a new regulatory agenda that omitted the TB rule from further consideration, the Association for Professionals in Infection Control and Epidemiology (APIC) declared victory in its campaign against it. The American Hospital Association also had urged OSHA to rely on voluntary guidelines rather than a regulatory standard.
"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," the Washington, DC-based association announced on its web site.
"OSHA officials have devoted the better part of a decade to developing this rule, and we commend them for recognizing and acknowledging the fact that a standard is not scientifically justified," Jennifer Thomas, APIC director of governmental affairs, tells Hospital Employee Health.
The OSHA rule, proposed in 1997, would have required annual skin testing and respirator fit-testing. In 2001, a National Academy of Sciences/ Institute of Medicine panel released a report endorsing the need for a TB standard but criticizing the OSHA proposal for a lack of flexibility based on the risk of transmission and flawed estimates of the tuberculosis threat. OSHA recently had asked for comment on the IOM report and the risk assessment used to draft the rule.
Meanwhile, the Centers for Disease Control and Prevention in Atlanta is revising its TB guidelines, which includes recommendations that vary based on a risk assessment.
OSHA’s decision to abandon the rule drew a sharp rebuke from health care worker advocates. Instead of killing the rule, the agency should expand it into an airborne infectious disease control standard that could be part of bioterrorism readiness, asserts Bill Borwegen, MPH, director of occupational health and safety for the Service Employees International Union (SEIU) in Washington, DC.
"They’re just piecemealing this whole problem," he says. "They need a much larger program to protect health care workers from airborne infections. It would be the first time employers would be required to set up good, solid respiratory protection programs. That could do as much to protect workers against smallpox as TB."
Employee health professionals took a more restrained view of the impact of the OSHA action. "I really don’t think anything will change in terms of enforcement or attention to TB," says Geoff Kelafant, MD, MSPH, FACOEM, medical director of the occupational health department at the Sarah Bush Lincoln Health Center in Mattoon, IL.
OSHA inspectors and surveyors from the Joint Commission on Accreditation of Healthcare Organizations will continue to ask about skin testing, fit-testing, and other protective measures, says Kelafant, who is chairman of the medical center occupational health section of the American College of Occupational and Environmental Medicine in Arlington Heights, IL.