Empowered OSHA targets airborne infectious regs

Agency may fire first salvo in March

In a move that could affect hospital infection prevention programs, the U.S. Occupational Safety and Health Administration is taking the first steps toward a possible airborne infectious diseases standard.

In fact, in a web-based address, Labor Secretary Hilda L. Solis highlighted airborne infectious diseases as one of the top concerns in her new regulatory agenda. "The lack of compliance with everyday infection control procedures has received increased focus because of the 2009 H1N1 pandemic. OSHA is interested in whether current procedures are adequate enough to prevent infections among exposed workers," she said. "Reducing workers' risk of exposure of health and safety hazards is a priority of my administration," Solis added.

OSHA will be hiring 100 additional inspectors in the fiscal year 2010 budget, she says. As of mid-December, OSHA had not yet cited any hospitals for failing to use N95 respirators to protect health care workers caring for 2009 H1N1 patients. But OSHA had conducted "several" inspections, Solis said. "OSHA has moved aggressively to address the hazards of H1N1 pandemic influenza in the workplace," relying on existing standards and the General Duty Clause, said Jordan Barab, then acting head of OSHA, in a separate web-based chat. (OSHA chief David Michaels was confirmed by the U.S. Senate on Dec. 4.)

OSHA's decision to enforce the recommendation from the Centers for Disease Control and Prevention for health care workers to use N95s when caring for patients with 2009 H1N1 has been contentious, reviving the longstanding divisions between infection preventionists and industrial hygienists on this issue. Many IPs believe surgical masks provide adequate protection and wrote a letter to President Obama asking for a halt to the OSHA enforcement.

Barab, who will remain as deputy assistant secretary for OSHA, helped promulgate the ergonomics standard when he was previously at OSHA from 1998 to 2001, and he previously worked in health and safety with the AFL-CIO and the American Federation of State, County and Municipal Employees. Sensing political momentum, the unions are preparing to rejoin the fight for an airborne standard that was last waged as a failed attempt to get passage of a specific standard for tuberculosis. Though in deep decline nationally, TB is circulating globally in an extremely drug resistant form and will no doubt be cited as one justification for an airborne regulation.

"This White House is concerned about worker safety and health," says Bill Borwegen, MPH, health and safety director for the Service Employees International Union (SEIU). "I know it might be a departure from the previous administration, but we think it's a very healthy development and we applaud the leadership of the Obama administration in protecting health care workers."

Although the National Institute for Occupational Safety and Health (NIOSH) is not a regulatory agency, it also has an ambitious agenda to address health care hazards. In a statement published in the NIOSH online newsletter, enews, NIOSH director John Howard stated, "I do not think we can return to an era when a health care worker's exposure to transmissible diseases such as influenza can be merely considered 'diseases of life' for which a health care worker 'assumes the risk' when he or she offers their labor to a health care employer."

OSHA said it plans to issue its Request for Information related to airborne infectious diseases in the Federal Register in March. The California Aerosol Transmissible Diseases standard may provide a template for an OSHA standard. Cal-OSHA was able to achieve support for the standard from both the California Hospital Association and labor unions representing health care workers. While it requires fit-tested N95 respirators (or greater protection) for health care workers caring for patients infected with a novel pathogen, it also temporarily allows fit-testing to occur biannually rather than every year. That provision was based on the premise that future research will clarify fit-testing issues and it automatically expires in 2014.

"There is evidence that a lack of adherence to voluntary infection control recommendations has resulted in the transmission of disease to workers. OSHA is seeking information on the extent to which voluntary recommendations are being followed and whether mandatory regulations would be more effective," the agency said. Specifically, the agency said it will seek information on:

  • Studies and data describing the nature and scope of occupational exposure and illness from airborne infectious diseases.
  • The efficacy of current control measures for reducing occupational exposures.
  • Components of an effective infection control program.
  • Information to help decide whether to pursue rulemaking.

(Editor's note: Look for an e-mail alert from Hospital Infection Control & Prevention as soon as OSHA issues its call for comments on this matter.)