OSHA pushes TB standard into long-term action plan

Move spells end to rules on fit-testing

A tuberculosis standard requiring annual respirator fit-testing and skin testing is all but dead as the U.S. Occupational Safety and Health Administration (OSHA) removed it from the "proposed-rule" stage. In its semiannual unified regulatory agenda, OSHA placed the TB rule in its "long-term action" category, and called future activities "undetermined."

"Long-term action’ is a euphemism for dead,’" says Bill Borwegen, MPH, occupational safety and health director for the Service Employees International Union (SEIU) in Washington, DC. "Like when you say somebody passed away’ instead of died.’ Well, this is dead. Dead as a doornail," he explained.

The timing is particularly ironic, Borwegen says, in the wake of a smallpox vaccination plan. "It’s a clear indication that we do not have a comprehensive approach to the bioterrorism threat," he says. "Everybody’s working on the smallpox vaccination program but nobody’s looking at these larger infection control issues posed by bioterrorism agents. Nobody’s looking at how many negative pressure rooms hospitals have," he adds. "Nobody’s requiring hospitals to set up rudimentary respiratory protection programs." A TB rule would have provided protections against other airborne diseases, Borwegen contends.

Were TB provisions outdated?

But others have argued strongly that the provisions of the TB rule became outdated even before the final draft was completed. The Association for Professionals in Infection Control and Epidemi-ology (APIC) worked actively against the standard and hailed OSHA for backing down.

Even some TB experts found the news heartening. The work on the OSHA standard was one of several influences on hospitals and others as they improved their TB protections in the 1990s, notes Lee Reichman, MD, MPH, executive director of the National Tuberculosis Center at the University of Medicine and Dentistry of New Jersey in Newark and author of Time Bomb: The Global Epidemic of Multi-Drug Resistant TB (New York City: McGraw Hill; 2001). But as TB prevention practices improved, a standard was no longer necessary, he says.

"More power to them," Reichman remarks. "There are not many government agencies that can admit they’re wasting a lot of time and effort." The provisions of the rule would have added burdens to hospitals without preventing TB transmission, he contends. "The underlying issue of all of this is the dangerous case of tuberculosis as the undiagnosed case. As soon as it is diagnosed, it’s not dangerous anymore."