Thursday, March 04, 2004

Unions Ask OSHA To Prevent Further Weakening of TB Protections

Several labor unions concerned about workplace tuberculosis exposure are meeting Assistant Secretary for OSHA, John Henshaw, to request that the agency not weaken current respiratory protections for workers exposed to tuberculosis or other airborne pathogens.

You may recall that on New Years Eve, OSHA officially withdrew its tuberculosis proposal. At the same time, OSHA announced that health care workers potentially exposed to TB would now be covered by the revised 1998 respiratory protection standard, instead of the old 1974 standard. Respiratory protection for workers exposed to TB was originally going to be addressed in the TB standard instead of the new respiratory protection standard because in 1998 there were still outstanding TB-related respirator issues and release of the TB standard was thought to be imminent. So, instead of bringing these workers into the new standard, they were to be covered "temporarily" under the old respirator standard. Once the TB standard was deep-sixed, OSHA brought health care workers under the new standard.

Fresh from their victory in killing the TB standard, however, the health care industry is having fits because the new standard requires that workers who wear respirators must be medically examined and fit-tested. The Association of Professionals in Infection Control (APIC) and the American Hospital Association wrote to OSHA protesting OSHA's decision. The AHA made the rather curious argument that "The dynamics of exposure and transmission for biologic agents contrast dramatically with the airborne chemical contaminants or particulate matter (e.g., asbestos) for which the General Industry Respiratory Protection Standard was developed."

In a letter to OSHA responding to the AHA letter, Marc Nicas, Adjunct Associate Professor at U.C. Berkeley, responded that
With regard to technical applicability, the standard does apply, because M. tb bacilli are carried on airborne particles that behave aerodynamically just like other airborne particles of comparable size, and although health care facilities cannot yet measure airborne M. tb concentrations, they can assess exposure potential.
The Coalition to Fight TB in the Workplace, wrote to OSHA pointing out that
As you know, proper and regular fit testing at least on an annual basis as is required by 1910.134 has proven crucial to protect workers from airborne hazards. The quality of the face seal that provides workers with protection has nothing to do with the airborne hazard confronted, but everything to do with how the respirator is designed to perform. As was reported by the CDC from the SARS experience in Toronto, a number of workers supplied with respirators, but who were not fit tested, ended up contracting SARS (MMWR May 16, 2003). Finally regular fit testing is particularly important when you are dealing with an airborne agent such as TB that does not possess any warning properties, and where no safe level of exposure has been established.
The Coalition, which includes more than a dozen unions, petitioned OSHA for a TB standard almost ten years ago.

Georges Benjamin, Executive Director of the American Public Health Association, also wrote OSHA, noting a study that highlighted the lack of understanding on the part of many healthcare facilities about the components of effective respiratory protection programs.