At-a-glance: CA drafts rules against airborne diseases

California's proposed aerosol transmissible diseases standard covers a range of issues, including the minimum air exchanges per hour in negative pressure rooms (12, although they can be six if HEPA filtration is used), vaccination, and fit-testing. The standard would require employers to do the following:

• Implement "source control measures" such as a respiratory hygiene/cough etiquette program, as recommended by the Centers for Disease Control and Prevention.

• Identify patients needing airborne infection isolation in a timely manner. If the facility doesn't treat patients with airborne infectious diseases, it must transfer the patient within five hours (or by 11 a.m., if the initial patient encounter occurs after 3:30 p.m.). Exceptions are provided when rooms are not available and when a transfer is medically contraindicated.

• Maintain an exposure control plan that outlines the job classifications that may involve aerosol transmissible disease exposure, high-hazard procedures, tasks requiring respiratory protection, and the control measures. The plan also must address medical surveillance, reporting of exposures, and evaluation of exposure incidents. It must be reviewed annually, and employees must be involved in that review.

• Have a system of communicating the infectious disease status of patients to which employees may be exposed that complies with medical confidentiality requirements. Employees who the evaluating physician determines might be infectious, and therefore need to be removed from their normal assignment for infection control purposes, must be provided with an appropriate alternate assignment or be paid if they are furloughed. This "precautionary removal" period ends when the person has passed the incubation period or if the employee gets sick or is otherwise unable to work.

• Provide annual training to employees with potential exposure to patients with aerosol transmissible diseases.

• Have adequate supplies of personal protective equipment.

• Provide fit-tests every two years for employees who do not perform high-hazard procedures and at least annual fit-tests for those in areas where high hazard procedures are performed. Additional fit-tests would be required for employees who have a physical change, such as significant weight gain or loss, dental changes, or cosmetic surgery.

• Provide powered air-purifying respirators (PAPRs) to employees performing high-hazard procedures "unless the employer determines that this use would interfere with the successful performance of the required task or tasks."

• Provide vaccines for susceptible health care workers with the potential for exposure. Employees who decline a recommended vaccine must sign a declination statement.

• Conduct TB tests at least annually for employees with occupational exposure (or perform annual symptoms screens for employees who are baseline positive for latent tuberculosis infection).

• Employers would be able to use a streamlined version of the respirator medical evaluation questionnaire, which would potentially reduce the number of employees who are referred to a physician for further evaluation.

As with existing regulations, the proposed rule establishes a fit factor of 100 as the minimum acceptable fit factor for quantitative testing.

(Editor's note: You can view the proposed standard and explanatory information at