There has been much discussion in recent months about the threat of an Avian flu pandemic. But according to a group of unions, not enough serious attention has been given to protection the nation's health care workers, and by extension, the entire health care system.

The American Federation of State, County and Municipal Employees (AFSCME) and several other labor organizations petitioned the Occupational Safety and Health Administration (OSHA) for an emergency temporary standard to protect health care workers against pandemic flu.

The unions have several problems with the nation's current pandemic flu plan. First, it calls for voluntary guidance instead of mandatory requirements, which means that employers can choose to ignore them. In addition, the plan lacks a comprehensive exposure control plan that would require worker training, communication of hazards to employees, medical surveillance and recordkeeping, all of which are typically contained in OSHA workplace standards. OSHA's highly successful Bloodborne Pathogens standard, for example, contains all of these elements.

The labor petition seeks not only to protect health care workers, but also to protect the nation's health care system in light of a recent Congressional Budget Office report that predicted that hospitals, clinics and doctors offices would be overwhelmed and the system would be strained as health care workers became sick or stayed home ito take care of sick family members or to protect themselves.

The unions' biggest problem the Centers for Disease Control and Prevention’s main Web site for pandemic flu preparedness features the Department of Health and Human Services’ “weak recommendations for protecting workers, including advice to use a surgical mask:”

Surgical masks will not protect wearers from exposure to respirable airborne droplets that contain pandemic flu virus for two important reasons. First, surgical masks are designed to provide a barrier to large droplets that are not respirable. Unlike respirators, masks are not designed to capture respirable particles and thus they are not respirators. Secondly, they do not provide a sufficient seal against the wearers’ face to prevent significant leakage into the workers’ breathing zone. Surgical masks are NOT certified by NIOSH as respiratory protection devices. Therefore, surgical masks must NOT be used to protect workers from exposure to respirable droplets that will be generated by patients infected with pandemic influenza. Only NIOSH approved respirators should be worn.

On the other hand, the unions point out, the Centers for Disease Control and Prevention (CDC) Interim Recommendations For Infection Control In Health-Care Facilities Caring For Patients With Known Or Suspected Avian Influenza, May 21, 2004, and OSHA’s Guidance For Protecting Workers Against Avian Flu recommend, at a minimum, NIOSH approved N95 filtering facepiece respirators, and that OSHA’s respirator standard (1910.134) be followed.

The path to a mandatory standard will be rocky, however. First, OSHA has not successfully issued an Emergency Temporary Standard (ETS) in 25 years. If the Assistant Secretary determines that "employees are exposed to grave danger from exposure to substances or agents determined to be toxic or physically harmful or from new hazards," OSHA can issue an Emergency Temporary Standard, which also serves as a proposed standard until the final standard is issued which must be done within six months. OSHA has rarely used this provision of the act, even in the rare case that the agency has issued an ETS, the courts have often overturned it.

It has now been 15 years since OSHA first ventured into the area of infectious diseases with its bloodborne pathogens standard, designed to protect workers against hepatitis B and AIDS. That standard was also a product of a petition by AFSCME and a number of other unions. The standard has been highly successful in protecting health care workers. In 1987, for example, there were 8,700 cases of Hepatitis B infection among health care workers. In 1995, just four years after publication of OSHA's standard, only 800 new cases related to occupational exposure were reported by the Centers for Disease Control and Prevention (CDC).

Despite the standard's success, however, OSHA has not issued another communicable disease standard since, aside from a revision of the Bloodborne Pathogens standard in 1999. The agency was on the verge of issuing a standard to protect workers against tuberculosis at the end of the Clinton administration, but that proposal was withdrawn by the Bush administration after strong opposition from the American Hospital Association (AHA)and the Association of Infection Control Practitioners (ACIP).

The AHA and ACIP have more recently ganged up with Congressman Wicker (R-MS) to pass language in OSHA budget bills that prohibits enforcement of annual fit-testing for health care workers who wear respirators to protect themselves from tuberculosis, leaving health care workers highly vulnerable to air-borne diseases if the hospital chooses not to fit test employees to ensure a tight-fitting respirator.

The other unions joining the petition are the American Federation of Labor and Congress of Industrial Organizations (AFL-CIO), American Federation of Teachers (AFT), Communications Workers of America (CWA), United American Nurses (UAN), and United Steelworkers (USW).

Last November, the United Food and Commercial Workers union, which represents poultry workers, asked the Bush administration "to initiate coordinated protection for poultry workers on the front lines by initiating a Cabinet-level meeting to discuss worker issues and the potential pandemic."

The poultry industry is a major force in the U.S. economy, generating more than $35 billion per year in revenue. The nation's 200,000 poultry workers produce 500 million pounds of chicken every week. We must have a plan to protect these workers-the chicken catchers and those that slaughter, process, and package the millions of chickens and turkeys that Americans eat each year.

AFSCME's pandemic flu page can be found here. Also, check out Effect Measure and the Flu Wiki for much more pandemic flu information.

Labels: AFL-CIO