Complaints flood OSHA over TB fit-testing

AHA, AOHP urge comment period, new rule

A fight is brewing over requirements for annual fit-testing of filtering face-piece respirators to protect against TB. Opponents to annual fit-testing at hospitals have flooded the U.S. Occupational Safety and Health Administration (OSHA) with letters asking for reconsideration of its decision to apply the general respiratory protection standard (1910.134) to tuberculosis. Worker advocates have responded with letters asking OSHA to stand firm.

"[O]ne of the reasons OSHA withdrew the TB rule is that there appears to be greater compliance with the CDC [Centers for Disease Control and Prevention] guidelines than there was when we proposed the standard," says OSHA spokesman Frank Meilinger. "Nevertheless, OSHA does have the responsibility to ensure that workers exposed to tuberculosis are adequately protected, and the existence of the CDC guidelines does not supplant that responsibility."

When OSHA withdrew the proposed tuberculosis standard on Dec. 31, 2003, it also rescinded the temporary TB respiratory rule, which did not require annual fit-testing. The issue of fit-testing had been a contentious part of the proposed tuberculosis rule. However, the general industry respiratory protection standard has required annual fit-testing, medical screening, training, and record keeping for everything except TB since 1998. That would include severe acute respiratory syndrome or other airborne infectious diseases.

The American Hospital Association decried OSHA’s recent action as a new mandate without a public comment period or rule-making. "[T]he General Industry Respiratory Protection Standard is not applicable to occupational exposure to biologic agents or to patients with communicable infectious diseases," AHA executive vice president Rick Pollack wrote to OSHA. "To now apply the General Industry Respiratory Protection Standard intended for chemical aerosols to biologic agents, such as TB, constitutes a significantly different action [than what was debated during the TB rule-making], and as such, OSHA must provide an opportunity for public comment to examine the scientific basis required for such an action."

Other organizations have taken a similar position, arguing that OSHA needs to consider the distinct characteristics of airborne biologic hazards. Both the Association of Occupational Health Professionals in Health Care (AOHP) and the American Association of Occupational Health Nurses have written OSHA, asking for a separate standard to address airborne biologic hazards.

"We want a safe working environment for our employees, and we want that based on science and on practices that are going to protect our workers," says MaryAnn Gruden, MSN, CRNP, NP-C, COHN-S/CM, past president of AOHP and manager of employee health services at Western Pennsylvania Hospital in Pittsburgh.

Yet worker advocates are arguing that health care workers should receive the same protections as other workers. Twelve unions joined forces as "the Coalition to Fight TB in the Workplace" and offered "strong and unequivocal support" for OSHA’s decision to apply the general industry respiratory protection standard to TB. The American Public Health Association also wrote OSHA in support of its action.

In fact, the AHA letter represents an admission that hospitals have not been adequately protecting health care workers against other infectious diseases, says Bill Borwegen, MPH, director of occupational health and safety for the Service Employees International Union and author of the coalition’s letter. "They’re telling OSHA and the public at large that [they] haven’t been following this for a long time. It’s quite a startling disclosure," he says.