AHA urges against standard, SEIU cites need
Citing a steep decline in tuberculosis cases nationwide, the American Hospital Association (AHA) urged the Occupational Safety and Health Administration (OSHA) to continue its cooperative, nonregulatory approach to protecting health care workers from exposure to tuberculosis.
Even if future TB cases are fewer than previously estimated, TB remains a serious occupational threat that requires OSHA action, the Service Employees International Union (SEIU) in Washington, DC, told the agency.
The comments were among those received this spring on the draft risk assessment and Institute of Medicine report related to the draft tuberculosis standard. Many arguments about the need for a standard focus on the projected risk of occupational exposure to TB.
Expert reviewers pointed out weaknesses in OSHA’s draft risk assessment and said it is difficult to determine the actual risk of nosocomial transmission.
"There is sufficient evidence to conclude there is a real risk of occupational TB infection, so OSHA and other regulatory agencies have a duty to act," Richard Menzies, MD, director of the respiratory epidemiology unit at McGill University in Montreal wrote in a review that was opened for comment this spring. "However, the agencies also have a duty to acknowledge the limitations of the current evidence, in order to encourage further investigation where it is most needed, and to allow for future revision when new evidence is available." (See Hospital Employee Health, March 2002, p. 25.)
That mixed message was mirrored in a National Academy of Sciences/Institute of Medicine (NAS/IOM) report, Tuberculosis in the Workplace, which was released in January 2001. (See HEH, March 2001, p. 31.) While the IOM panel endorsed the concept of a TB standard to set minimum protections for health care workers, the experts said the proposed standard fails to provide enough flexibility to hospitals at low-risk and relies on outdated and flawed estimates of the tuberculosis threat.
In his comments, AHA executive vice president Richard Pollack cited the efforts of hospitals to comply with TB guidelines from the Centers for Disease Control and Prevention (CDC) in Atlanta. (The CDC currently is preparing an update of those guidelines.)
"Proposed OSHA requirements that go beyond these [CDC] recommendations would place an additional and unneeded burden on all hospitals," Pollack said.
Meanwhile, OSHA overestimated the occupational exposure and underestimated the community exposure of health care workers, he said.
"Given the current declining rates of TB disease, the lack of transmission in health care facilities, the current extent to which TB guidelines have been implemented in hospitals, and the inability to totally prevent TB exposure, the AHA questions whether the issuance of a final OSHA TB standard is justified," he said.
Yet the lower risk is still an unacceptable risk, argued the SEIU. "Even with the reduction in estimated cases, the risk of tuberculosis infection clearly meets the legal definition of what would constituent a material impairment of health,’" the union contended, citing Menzies’ comments.
"In such cases, OSHA is legally bound under the Occupational Safety and Health Act of 1970 to act to assure that no employee will suffer material impairment to their health,’" the union said.
The SEIU also wryly noted the resources currently being devoted to protect health care workers and others from a potential smallpox attack: "While it is important to protect these workers from the potential threat posed by smallpox, where is our government’s commensurate response to protect some of these very same workers from the very real and existing threat posed by tuberculosis?"
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