AAOHN, AOHP seeking new respirator standard

Aim: Meet unique needs of health care workers

The Atlanta-based American Association of Occupational Health Nurses Inc. (AAOHN), and the Association of Occupational Health Professionals (AOHP) in Reston, VA, have jointly called for a new respirator standard that takes into account the unique needs of employees in the health care industry. The associations submitted their joint recommendation in response to the Occupational Safety and Health Administration’s (OSHA) recent notice of proposed rulemaking and call for comments on 29 CFR Part 1910.

The existing respirator standard, 1910.134, is appropriate for general industry, note the associations, but does not necessarily translate well into health care settings; airborne exposures are more likely to involve infectious microbes. The trend toward the emergence of newer, more virulent strains of infectious diseases such as SARS underscores this need, they say.

"As employee health professionals, our primary concern is the health and safety of the health care worker," says AOHP executive vice president MaryAnn Gruden, MSN, CRNP, COHNS/CM. "Our care needs to be based on the best scientific data available. Often, in hospital settings, there may be several hundred to several thousand employees who require an annual fit test under the existing standard," she says. "This would make it not only challenging, but close to impossible, for employee health professionals to be in compliance."

"The requirement for annual fit testing in health care has raised tremendous anxiety; compliance with the requirements would be very difficult for a hospital to handle," adds Lori Schaumleffel, RN COHN-S, a regional director for AAOHN in Folsom, CA.

Highlights of the response to OSHA from the two associations include recommendations for the agency to:

  • rename Sec. 1910.139, "Respiratory Protection for M. Tuberculosis" to "Respiratory Protection for Airborne Infectious Diseases"
  • determine respiratory protection requirements for health care workers based on the size of the infectious microbe;
  • clearly define surveillance procedures under the standard in a way that promotes the protection of workers’ health and safety, but in a way that is both practical and efficient. For example, conduct fit testing upon hire and then use annual surveys thereafter to determine any physical changes that affect the fit of the respirator.

Precedent already is set

OSHA already has set a precedent for recognizing unique situations when it comes to respirators, notes Gruden. "Tuberculosis as an airborne disease has been addressed separately; there is no need for annual fit testing," she notes. "But right now, it only covers TB; all other airborne diseases would be under the current standard. Because of the logistics of trying to implement annual fit testing, we feel you should put like hazards under one standard."

At the time that SARS became a concern, notes Schaumleffel, that double standard was in place. "OSHA has had a general respirator standard and a separate tuberculosis standard," she notes. "So, when OSHA came out with recommendations regarding SARS, they used the general respiratory guidelines, since the TB standard was written just for TB, but not for any other airborne disease."

"OSHA has already considered the logistical challenges and safety issues [of airborne diseases], and the result was the creation of the tuberculosis exemption standard, 29 CFR 139," Gruden re-emphasizes. "We believe OSHA should apply this same thinking and publish a more comprehensive rule that acknowledges the unique characteristics of the health care setting."

Partnering makes sense

It makes perfect sense for AOHP and AAOHN to team up in this effort, says Gruden. "Both organizations primarily comprise occupational health nurses," she notes. "AAOHN membership includes them in a variety of settings including health care, while AOHP is primarily in health care settings. So, we look for areas where there are common grounds and common concerns."

"Obviously, we have many nurses in AAOHN who work in the health care environment, and they [AOHP] are specifically in that environment, so we have a crossover," adds Schaumleffel. "This is an issue that is not something that needs to be addressed in general industry, so it obviously made sense for us to partner."

Will partnerships like this become more common in the future? "Absolutely," says Schaumleffel. "We are trying to expand our efforts in this area. You have more power in numbers, and there are often multiple organizations that focus on the same things. We all have limited resources, so to work together and maximize those resources is a good idea."

"I do see more of this happening," adds Gruden. "This is the second time we have partnered [the first was during the OSHA ergonomic standard process]." The benefits of partnering, she notes, include demonstrating the fact that your organization is not the only voice on your side of the issue, that there is support for your position and added concern about it.

"Numbers have strength, and AAOHN is a larger organization than we are," she notes. "We were really founded because occupational health nurses had very special needs. We are trying to address airborne pathogens, and seeking to build our name recognition so we will be seen as experts in this area."

For a complete copy of the AAOHN/AOHP comments, visit the AAOHN web site at www.aaohn.org, or the AOHP web site at www.aohp.org.

For more information, contact:

Lori Schaumleffel, RN, COHN-S, Employee Health, Mercy Hospital of Folsom (CA). Telephone: (916) 984-7266.

Mary Ann Gruden, MSN, CRNP, COHNS/CM, Manager for Employee Health Services, Sewickley Valley Hospital, 720 Blackburn Road, Sewickley, PA 15143-1498. Telephone: (412) 578-6792.