Tuesday, April 12, 2005

CDC Gives Potentially Deadly Guidance To Health Care Workers

What is it about health care workers that makes people think they somehow don't need the same protections as normal human beings? Way back in the mid-1980's when we started organizing for a standard to protect health care workers from hepatitis B and AIDS in the workplace, we regularly received incredulous looks from people who should have known better, but somehow assumed that health care workers had some magic immunity to the communicable diseases of their patients. OSHA standards, personal protective equipment, all that stuff was for real workrs, not hospital workers. Some people, like Congressman Roger Wicker, still seem to think that ill-fitting respirators will somehow magically protect health care workers from tuberculosis, even though he's not making the same argument for a worker exposed to asbestos

Unfortunately, even the Centers for Disease Control and Prevention seems to fall prey to this misconception. A coalition of 12 unions* has asked the Centers for Disease Control to immediately withdraw the "Interim Guidance for Protecting Health Care Workers Caring for Patients Potentially Exposed to Aerosolized Yersinia pestis (Plague) from a Bioterrorism Event" that "advises that a surgical mask is sufficient to protect healthcare workers caring for patients exposed to plague." The guidance also states that in the event of an acutal biological warfare attack, some OSHA respirator requirements, such as fit testing and medical clearance may have to be suspended.

This guidance is completely at odds with scientific evidence, legal requirements under the Occupational Safety and Health Act, existing NIOSH and OSHA guidance and recommendations for protecting responders, and the Worker Safety and Health Support Annex of the of National Response Plan issued in December 2004. This guidance, if followed, would put healthcare workers at risk of serious and potentially deadly exposure. We ask that this inaccurate and harmful document be withdrawn immediately.
To begin with, a surgical masks are designed to protect patients, not health care workers. They are essentially sneeze guards, designed to keep surgical personnel from breathing or sneezing into a patient's exposed wound, chest cavity or brain. Surgical masks are not respirators designed to filter out contaminants. Unlike properly fitted respirators, surgical masks do not form a tight seal around the face, which means that airborne particles can easily bypass the mask, and be inhaled by the health care worker.

Second, OSHA respirator requirements are not useless, bureaucratic procedures only to be used when there is no "real" emergency. As the letter states, in order for workers to be assured that a respirator is actually protecting them against contaminants, it must be NIOSH certified and workers must have "individual respirator fit testing to rule out those respirators that cannot achieve a good fit on individual workers; and proper training of employees that must wear or have the potential to wear respirators."

In other words if a respirator is not certified by NIOSH, it may not be an effective protective respirator. (It may just be a dust mask or a surgial mask). Even if a worker is wearing a certified respirator, it won't be protective if it doesnt fit properly and airborne contaminants are find their way through the edges. Finally, if workers aren't trained to put on respirators and make sure they are working properly, they won't work properly. It really doesn't matter if the hazardous particles come from terrorists or the rat next door. The faulty guidance is particuarly puzzling as the National Institute for Occupational Safety and Health is part of the CDC. Don't they talk?

And, as the letter points out, the need to follow proper respiratory protection protocols is not some lefty union propaganda, but was also confirmed in the Worker Safety and Health Support Annex of the National Response Plan issued in 2004,to which CDC's parent agency, the Department of Health and Human Services was a signatory.

Finally, we've seen (and we're still seeing) what can happen when proper respiratory protection is ignored. Hundreds of World Trade Center rescuers and cleanup workers still suffer high levels of disabling respiratory ailments, such as asthma, sinusitis, persistent coughs and impaired breathing, among the workers who labored to clean up the World Trade Center site.

As the letter concludes:

Failure to provide healthcare workers and other responders adequate protection not only endangers these workers, it undermines the effectiveness of any emergency response and thus endangers the public as well.

CDC's interim guidance on protecting healthcare workers caring for patients in the event of a bioterrorist plague attack is irresponsible and puts workers and the public in danger. It should be immediately withdrawn.

Our members are facing these threats now and they need protection today.
The bottom line is that even in an emergency, you can't just toss a bunch of respirators at health care workers and assume they're protected. They aren't. And giving them a false sense of security will only make them less careful. Without proper equipment, they will get sick. And they will die. And if we lose our front-line health care workers in a real emergency, where will we be?

*The letter was signed by Peg Seminario, AFL-CIO Director of Occupational Safety and Health, on behalf of the American Federation of Government Employees, American Federation of State, County and Municipal Employees, American Federation of Teachers, Building and Construction Trades Department, Communications Workers of America, International Association of Firefighters, International Brotherhood of Teamsters, International Union, UAW, Service Employees International Union, United American Nurses, United Food and Commercial Workers and the United Steelworkers of America.