APIC launches TB letters to try to reopen debate

Rep. Wicker trying to open OSHA docket

Undaunted by a string of setbacks in its long-fought campaign to block a federal tuberculosis standard, the Association for Professionals in Infection Control and Epidemiology (APIC) rallied its members recently for a grass-roots letter-writing campaign. With finalization looming for the Occupational Safety and Health Administration’s (OSHA) TB standard, APIC called upon ICPs attending its 27th annual conference in Minneapolis to write their senators and representatives.

"We are really asking our members at the grass roots to help with this process," APIC president Susan Slavish, BSN, MPH, CIC tells Hospital Infection Control. "They need to let their representatives know how important this is to them."

Emphasizing that the primary risk to health care workers is the undiagnosed TB case, APIC has long objected to OSHA’s focus on respirators and other controls for workers treating known TB patients in isolation. "It’s the unidentified cases that caused the problem, not cases that are put into isolation," says Slavish, an ICP at Queens Medical Center in Honolulu. But after years of testifying and lobbying that have thus far come to naught, Slavish was asked if APIC was downright stubborn about scuttling the TB standard. "Well, yes, we are," she says. "We believe if we are going to have a standard, it should be based on science. The standard that OSHA developed is not entirely based on science at this point in time. We don’t think it is in the best interest of the patient, the employee in the hospital, or the health care industry to have this standard in place."

APIC’s stance has drawn fire from labor unions, which charge that it shows little concern for health care workers.

"We are very concerned about protecting health care workers against infections, but we think this particular standard is not the way to do it because it isn’t dealing with the science of TB transmission," Slavish emphasized.

The APIC plan is to urge members of Congress to sign off on a proposal by Rep. Roger Wicker (R-MS) that the OSHA docket on the TB standard be reopened to include new information on the waning epidemic in the United States. A sample APIC letter distributed at the meeting emphasized that "TB incidence in the U.S. is currently at the lowest level in recorded history. OSHA would be remiss and premature in issuing a rule without consideration of the most current information available."

A steadfast ally of APIC in the TB battle, Wicker was instrumental in getting funding approved for a study by the Institute of Medicine in Washington, DC, to determine what effect the OSHA standard would have on minimizing risk of TB transmission to health care workers. The IOM study is expected to be completed by December, but OSHA is not bound by any requirement to wait for the results before finalizing the rule. An OSHA spokesman, who spoke on condition of anonymity, said the agency is proceeding with the rule, and it will be finalized by the end of the year. "We’re going forward with plans to publish a final rule on TB sometime later this year," he says. "The plans haven’t changed."

In addition to the ongoing IOM review, APIC wants OSHA to include a May 4, 2000, IOM paper that supports efforts to screen immigrants and other at-risk populations, but does not call for any additional measures in health care. Likewise, APIC wants the docket to include the results of an ongoing study by the American Thoracic Society on the current risk of TB in institutional settings.

"[OSHA] knows that there is going to be a change in [presidential] administrations, and that might slow things down," Slavish says. "They would like to get it out and finalized, because they are concerned with the election coming up."

APIC urged ICPs to contact their senators and representatives by early July, when members of the national office in Washington, DC, will be appealing directly to Congress.

(Editor’s note: The alert and the sample letter are expected to be posted on the APIC Web site at www. apic.org.)