OSHA expects to issue final TB reg in 2000
Study approved, but agency proceeding
The Occupational Safety and Health Admini stration (OSHA) expects to finalize its proposed tuberculosis regulation in the spring of 2000, despite recent congressional approval of an independent review of the merits of the controversial standard.
In what is being viewed as a political compromise, the U.S. House Appropriations Subcom mit tee on Labor, Education, and Human Services allocated $450,000 for an independent study of the TB standard by the National Academy of Sciences in Washington, DC. However, the language of bill HR 3194 states the study is approved "without any intent to delay pending regulations," giving OSHA the green light to continue finalizing a regulation it originally proposed in 1997.
"We will continue to go forward," says OSHA spokesman Bill Wright. "There is nothing in the appropriations and the final bill that says the agency has to stop the TB proposal. Congress may come back and say we want to have hearings or something, but right now, with what we have, the agency will continue and we plan to publish a final rule sometime in spring 2000."
The study has been previously characterized as a one-year review, most likely by the aca demy’s Institute of Medicine. However, calls to the national academy did not yield any further details about the nature and duration of the study. Regardless, while OSHA is moving ahead with the standard, the agency will not ignore any findings that eventually come out of the study, Wright says. "The agency would not turn a deaf ear to any bona fide study," he says. "It certainly would be reviewed. There would be options to amend a final rule based on the study, certainly. I would definitely say that if the study comes out prior to publication of the final rule, OSHA would certainly look at the study and review it. But the study can go forward and OSHA can pursue the final rule as well."
The Association for Professionals in Infection Control and Epidemiology has led the effort to get the study funded, but hopes that the review would delay or kill finalization of the standard appear to be dashed by the committee’s action. (See Hospital Infection Control, August 1999, p. 97, 100-102.) Still, just getting the study approved is a step, and it is possible that OSHA will change some of the requirements based on the independent review, says Eddie Hedrick, MT(ASCP), CIC, manager of infection control at the University of Missouri Hospital and Clinics in Columbia, and one of the ICPs who testified in the OSHA TB hearings.
"The fact that a study is being done is obviously important," he says. "Most people out in the real world would suggest this [TB standard] is a waste of money at this stage. We have suggested that all along, but it is now even more of a waste of money because there are extremely low levels of TB in the country, and it is obviously being controlled without a new standard."
Indeed, TB control programs that emphasize prompt identification of cases, rapid initiation of therapy, and sustained efforts to ensure therapy is completed have been credited for a 31% decrease in annual TB cases from 1992 to 1998. Yet while TB among American-born citizens is at an all-time low, TB continues to increase in the foreign-born, who account for almost half of the TB cases in the United States. Ultimately, OSHA should approve a standard that is in sync with TB guidelines by the Centers for Disease Control and Prevention, which revises its guidelines periodically based on current trends, Hedrick notes. "I’m not objecting to the fact that OSHA has something in place for [facilities] that don’t comply with common sense," he says. "But when you [require] fit-testing respirators, you’re costing people a fortune — with no yield, no value."
On the contrary, the IOM study itself is a waste of money because the standard is clearly warranted, counters Bill Borwegen, director of the occupational health and safety program at the Washington, DC-based Service Employees Inter na tional Union (SEIU) and one of the principal proponents of the regulation. Representing some 650,000 health care workers, the SEIU has lobbied for the TB regulation to prevent occupational TB infections. "They’re wasting taxpayer dollars to proceed with this study," Borwegen says. "It is going to be a meaningless study because OSHA is going to proceed with the rule anyway."
Reference
1. Department of Labor. Occupational Safety and Health Administration. Occupational exposure to tuberculosis; proposed rule. 62 Fed Reg 54,160-54,307 (Oct. 17, 1997).
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