On the back burner: TB rule faces indefinite delay
Rulemaking agenda offers no date for final version
The U.S. Occupational Safety and Health Administration’s (OSHA) tuberculosis regulation remains alive, barely, as the agency included it on its most recent regulatory agenda, but without a target date for a final rule. Previously, OSHA had indicated that publication of a final TB rule was imminent. The rulemaking was delayed as the agency focused on completing the ergonomics standard by the end of 2000.
Now it’s a long-term action
In the regulatory agenda that was published in the Federal Register on May 14, OSHA listed occupational exposure to tuberculosis as one of its "long-term actions." OSHA officials declined to comment on the change.
The proposed standard faced stiff opposition, including vigorous arguments from the Association for Professionals in Infection Control in Washington, DC, that the standard presented an unnecessary burden and a misdirection of resources. In January, an Institute of Medicine panel issued a report that supported the need for a regulation but criticized key provisions of OSHA’s proposed rule. The proposed standard on tuberculosis fails to provide enough flexibility to hospitals at low-risk and relies on outdated and flawed estimates of the tuberculosis threat, the panel concluded.
OSHA officials already had acknowledged that the final TB standard would differ from the version proposed in 1997 on issues such as the frequency of respiratory fit-testing and skin testing. The indefinite time line for a final rule may indicate more extensive changes.
When OSHA began working on a TB rule in 1994, tuberculosis cases were rising nationwide. Outbreaks occurred in several U.S. hospitals, including cases of the deadly multidrug-resistant strain. TB cases have declined by 35% since 1992. The Centers for Disease Control and Prevention (CDC) issued guidelines for preventing TB spread in health care facilities in 1990, then updated them in 1994. The CDC now is reviewing those guidelines with another update expected in 2002.
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