APIC appeals to ICPs to write letters to OSHA

In launching a protest letter-writing campaign against new federal requirements regarding tuberculosis, the Association for Professionals in Infection Control and Epidemiology created the following template:

John L. Henshaw
Assistant Secretary of Labor
Occupational Safety and Health Administration
200 Constitution Ave. N.W.
Washington, DC 20210

Dear Assistant Secretary Henshaw:

I am writing as an infection control professional (ICP) at _________(Facility) in _________(City), ___(State). Health care facilities throughout the country are very concerned by a recent decision by the Occupational Safety and Health Administration to apply the General Industry Respiratory Protection Standard to respiratory protection against M. tuberculosis.

I appreciate OSHA’s decision to withdraw the proposed TB rule; however, if OSHA has decided that there is no scientific basis for the proposed OSHA TB rule and has revoked it (and rightfully so), why then is the agency now applying the General Industry Respiratory Protection Standard to exposure to TB? This would require not only respirators and initial fit-testing but also annual fit-testing, a more stringent requirement than in the now-withdrawn proposed TB rule.

Fit-testing was one of the most burdensome requirements in the proposed TB rule and the least scientifically justified. The incidence of TB is the lowest ever reported in the United States, and outbreaks have been controlled without this new burdensome and unnecessary mandate. Annual fit-testing has not been a part of TB control programs in facilities and will be difficult to implement with limited health care resources. If I thought for one moment that this would benefit the health care workers entrusted to my care, I would not be writing this letter. Annual fit-testing will not provide any added protection for workers who already are protected by my implementation of the respiratory protection recommendations in the 1994 CDC Guidelines.

[Please add facility-specific information such as:

  • number of true TB patients you actually serve in a year, vs. the number of people isolated every year;
  • number of HCWs entering and exiting rooms of isolated patients; or number of HCWs who would need fit-testing and annual fit-testing;
  • time and resources required to do this, and who at the hospital would be responsible (and what their other duties are);
  • anything else that will convey how this requirement will negatively affect you and your facility.]

OSHA made this decision without allowing time for public comment. The announcement was published in the Federal Register on New Year’s Eve 2003. A good-faith effort would have involved issuing a specific proposal to apply the General Industry Respiratory Protection Standard to patients with possible TB infection.

I am respectfully requesting that OSHA rescind its decision to include TB under the General Industry Respiratory Protection Standard, as it contradicts the very sound decision to withdraw the proposed TB rule. At the very least, OSHA should present the scientific rationale for its decision and allow a time period for public review and comment.

Thank you for your kind attention to my concerns.