Experts agree on existing guidelines

Hard to stop OSHA’s actions

While many experts agree that the updated guidelines for tuberculosis (TB) prevention are redundant, there’s virtually no way to stop them from being introduced. The new guidelines, designed to curtail occupational TB infection, will be introduced and enforced by the Occupational Safety and Health Administration.

One of the largest opponents of the proposed guidelines is the Washington, DC-based Association for Professionals in Infection Control and Epidemiology (APIC). Other experts, however, are jumping on APIC’s bandwagon and insisting that the guidelines aren’t necessary.

Lee Reichman, MD, MPH, former president of the American Lung Association and director of the National TB Center in Newark, NJ, agrees with the APIC stance that the proposed standard is overkill.

"What is extraordinarily well-documented is that when after the rates went up and people started to use the then prevalent guideline, not the new stuff, then transmission was very hard to document," he tells Subacute Care Management. "High index of suspicion, isolation of infectious cases, treating them right away — with those kind of things it was very difficult to document transmission."

Although the center’s chest clinic has experienced only three conversions over the years, the state will be requiring that it spend nearly $500,000 on engineering controls, even though the center plans to vacate the building in several years. "I would think that the money could be better used for services or control," Reichman says.

The National TB Controllers Association in Atlanta has not come out with a position on the new guidelines. However, director Walter Page notes that Centers for Disease Control and Prevention (CDC) officials have argued in the past that its guidelines are sufficient for controlling TB if they are followed.

"CDC has taken the position a number of times saying, ‘Look, if you just follow the guidelines, none of these new stringent recommendations are needed.’ They have demonstrated from [outbreak] experiences in Miami and Chicago after they had outbreaks that once they followed the guidelines they were able to turn things around."

An OSHA TB standard may not have been so strongly challenged a few years ago when TB was resurging in the United States but now seems to be addressing a problem that has dramatically improved, adds Michael Tapper, chairman of the AIDS/TB committee of the Society for Healthcare Epidemiology of America (SHEA). (For strategies on conducting skin-testing in your facility, see the related story, p. 101.)

"This [OSHA standard] may just be the wheels of government turning slowly, but we are putting out a potentially very expensive solution to a problem which, fortunately, seems to be improving, " he tells SCM. "That doesn’t mean that we should be [complacent] about transmission of TB in health care settings, but it does seem that, at a time when medical resources are being severely pressed in a whole variety of areas, this is going to create a new administrative burden."

How great that burden will be remains unclear. The draft standard has already passed muster with the Office of Management and Budget but has reportedly been revised from earlier versions to minimize the impact on small businesses and other facilities with limited resources such as homeless shelters.