IOM panel hears debate on the need for TB rule
The heated debate over proposed tuberculosis (TB) regulations reached the Institute of Medicine (IOM) in August, as a committee considering the occupational risks of TB heard from critics and supporters as well as TB experts.
In 1997, the Occupational Safety and Health Administration (OSHA) issued a proposed standard on tuberculosis that includes annual fit-testing of respirators, as well as other screening and surveillance measures. Congress requested a study by IOM to determine the need for a standard.
Among the most vocal opponents of the standard is the Association for Professionals in Infection Control and Epidemiology (APIC) in Washington, DC, which argues that the standard is costly, burdensome, and unnecessary.
"OSHA proposes minimizing employee exposures by combining tasks and limiting the number of employees entering an isolated patient’s room," said Rachel Stricof, MT(ASCP), MPH, who testified for APIC recently before a panel from the IOM in Washington, DC. "This proposal is in direct conflict with the mission to care for patients.
"The risks to health care workers have clearly been demonstrated to be associated with the unidentified, unisolated, and untreated case; not with patients placed in appropriate [acid-fast bacilli] isolation," she said. "In addition, the majority of patients in isolation are suspect cases that are ultimately found to have another etiology for their symptoms."
Stricof also noted that TB cases nationwide declined by 31% between 1993 and 1999.
Yet representatives of health care workers told the IOM panel that hospitals won’t provide resources to protect workers against occupationally acquired TB without the weight of a regulation.
"Without an OSHA standard and the threat of inspection, they are unable, in this era of cost containment in the health care industry, to justify adequate staffing to provide the needed training and testing of workers to prevent exposure and analyze trends — let alone to provide adequate engineering controls and personal protective equipment to comply with the CDC [Centers for Disease Control and Prevention] guidelines," said Karen Worthington, MS, RN, COHN-S, senior occupational safety and health specialist for the American Nurses Association in Washington, DC.
Worthington also countered the argument that occupational exposure to TB is only a problem in hospitals in certain urban centers. "In this era of globalization, all health care workers are at risk for exposure to an active TB patient," she said.
The IOM panel is investigating the risk of TB to health care workers and how the recommendations of the CDC and proposed OSHA standard would impact that occupational risk.
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