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Will Cal-OSHA airborne standard go national?
State plan may be expanded by national office
With the Occupational Safety and Health Administration (OSHA) opening preliminary rulemaking on a national infectious disease standard, infection preventionists pondering the end result of the effort may follow the old admonition, "look to California."
Just as it did with the first versions of the bloodborne pathogen standard years ago, Cal-OSHA enacted an Aerosol Transmissible Diseases standard that became effective in August 2009. With health care worker unions already expressing support for a national version of the standard, it appears OSHA may use the regulation as a template.
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.
However, some IPs in California ran into problems trying to comply with the standard during the H1N1 pandemic, when fit-testing and respirator supply issues were an overwhelming problem.
"The standard didn't allow for any flexibility in the event of a lack of supplies, such as during a pandemic," says Susan Dolan, RN, MS, CIC, public policy chair of the Association for Professionals in Infection Control and Epidemiology (APIC). "[Infection preventionists] found that very challenging in addition to the cost issues. Anecdotally, our members were just really concerned that there wasn't enough evidence or justification for having such a standard. That was the piece that seemed to be a disconnect for our members."
In that regard, APIC is not likely to support a national version of a standard it resisted at the state level. "We did not understand the need or justification for California's aerosol transmissible disease standard, given the studies that were examined by OSHA and stakeholders that did not demonstrate that the TB rate in HCWs was any higher than the general population," APIC stated in its comments submitted to OSHA.
California's airborne 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), vaccinations and fit-testing. The standard also calls for employers to: