Hospitals feel the pain of annual fit-test rule

Most have few EHPs, many fit-tests

Do you feel overwhelmed by the annual fit-testing rule? You’re in good company. Most of your peers at hospitals around the country rank the difficulty with compliance as a 7 out of 10 or worse, according to a survey by the American Association of Occupational Health Nurses (AAOHN) in Atlanta.

At most hospitals, employee health professionals are on their own with this burden — and they only have a staff of three or fewer to accomplish it, the survey found.

"It validates what we’ve been hearing from members who have these concerns," says AAOHN president Susan Randolph, MSN, RN, COHN-S, FAAOHN, clinical instructor in the Occupational Health Nursing program at the University of North Carolina at Chapel Hill. "We’re looking for ways to help them comply and have an effective program."

Annual fit-testing continues to be a controversial issue nationally. In late November, the Centers for Disease Control and Prevention (CDC) plans to hold a stakeholder meeting to discuss fit-testing issues. The CDC’s draft tuberculosis guidelines have been held up by disagreement between some CDC divisions and the National Institute for Occupational Safety and Health (NIOSH) over wording on fit-testing. The current draft calls for periodic fit-testing, while NIOSH supports the annual fit-testing required by the U.S. Occupational Safety and Health Administration.

AAOHN contacted 2,196 hospital-based occupational health nurses by e-mail. They received a response from 714 to the on-line survey, a response rate of 33%. Most of the respondents (72%) work in nongovernmental, not-for-profit hospitals; 70% of them reported a high level of difficulty complying with the rule.

Federal government hospitals were those least affected by the fit-testing rule. Some 43% of those hospitals have a more than five-employee health staff, and 72% fit-test fewer than 500 employees.

Yet it’s common for hospitals to fit-test a large portion of their staff. Almost a third (32%) of respondents said they are fit-testing between 1,000 and 5,000 employees. About a quarter (26%) fit-test between 500 and 999 employees, and 28% fit-test between 100 and 499 employees.

That task is most difficult when employee health professionals have little or no help. Just more than half (52%) reported that employee health is solely responsible for fit-testing, while 28% worked with individual departments and 20% worked with an outside vendor or provider.

Doing it alone is a position Lori Schaumleffel, RN, COHN-S, ARM, coordinator of Employee Health Services at Mercy Hospital of Folsom, CA, is accustomed to. She is the only employee health professional in her hospital, and she has clerical help for just eight hours a month.

"I’m not unusual. There are lots of folks in larger facilities [doing it alone]," she says. Now, with the new rule, "my responsibility is to fit-test everyone in the facility who needs to be fit-tested," notes Schaumleffel.

She can’t pawn off the duties onto managers. "My managers are spread very thin. I don’t think that’s unusual, that the managers have already a huge amount of work to do in regards to compliance issues. Adding fit-testing, which requires equipment and space and time, is more difficult for the manager to accomplish."

Schaumleffel has begun fit-testing about 250 employees — about two-thirds of the hospital staff. The high-risk staff, such as those who work in the ICU, emergency department (ED), and respiratory therapy, are receiving their updated fit-tests first. California is requiring compliance for high-risk staff by Oct. 18 and for lower-risk staff by Jan. 18.

Some other employee health duties will have to be set aside while she accomplishes the fit-testing. Meanwhile, she hopes the AAOHN survey leads to a sharing of "best practice" information on fit-testing. "The survey opens up discussion to help us learn from each other," she adds.

(Editor’s note: Further information on the AAOHN fit-test survey is available from the web site at