You may remember last December when OSHA announced its final decision to withdraw the tuberculosis standard by explaining in a press release that it was "enhancing" respiratory protection for health care workers.
Its reasoning was that when OSHA's new respirator standard was issued, the agency was still been working on the tuberculosis standard -- which would include new language on respiratory protection. OSHA decided that until the TB standard was issued, health care workers would remain covered under OSHA's old, less protective respiratory protection standard, rather than the new, enhanced standard.
When OSHA withdrew the TB standard, it announced that health care workers would be covered under the new respiratory protection standard, which included fit testing for anyone who would be using a respirator. Hence, the enhancement.
Everyone happy? Not exactly. The American Hospital Association (AHA) and the Association for Professionals in Infection Control (APIC)had fits and went running to their old friend -- and TB standard foe -- Mississippi Congressman Roger Wicker (R) who immediately gave OSHA a call. Now OSHA is reportedly considering a six-month delay in requiring that hospitals annually fit their employees for respirators.
The problem with this extension goes way beyond protection against TB. Respirators protect against other airborne diseases, including bioterrorism agents.
Critics say delaying the July 1 enforcement date would undermine homeland security efforts to prepare for a bioterrorist attack involving smallpox, bubonic plague or other airborne infectious diseases. The Department of Homeland Security has announced that chances of a major terrorist attack this summer are high.So what's the problem? Is fit testing too costly? Not exactly.
“They really have been exerting a lot of pressure on health care institutions to be ready for a terrorist attack, including bioterrorism,” said Darryl Alexander, occupational safety and health program director for the American Federation of Teachers. The union represents about 50,000 registered nurses.
OSHA estimates the total cost of compliance at $11.7 million annually, an amount considered economically insignificant. For example, OSHA estimated that the cost to a small health care facility would be eight-thousandths of 1 percent of revenues.So what's the big deal about fit-testing anyway? Who needs it?
OSHA said in December that the best available evidence shows that 5 percent to 50 percent of workers would lack a proper fit without annual testing.
Mark Nicas, an adjunct associate professor at the University of California-Berkeley School of Public Health, said a poorly fitting respirator might provide 70 percent protection compared with 95 percent for one that fits well.
“Would you want to treat someone with smallpox if there’s 30 percent leakage?” Nicas asked. “For smallpox, it takes just one organism in the lungs to infect.”