Letter on OSHA's General Industry Respirator Standard

February 20, 2004

John L. Henshaw
Assistant Secretary of Labor
Occupational Safety and Health Administration
200 Constitution Avenue, NW
Washington, DC 20210

Dear Assistant Secretary Henshaw:

The American Public Health Association (APHA) would like to strongly support OSHA's reinstatement of the general industry respirator standard (29 CFR 1910.134) applicable to M. Tuberculosis (TB) exposure in the workplace. APHA is the largest and oldest organization of public health professionals in the nation, representing more than 50,000 members from over 50 public health occupations, including occupational health. While we were disappointed in the decision to withdraw the proposed tuberculosis (TB) rule, APHA wishes to emphasize the importance of appropriate respiratory protection in healthcare settings.

Because healthcare facilities have many potential respiratory hazards in their work environment, both chemical and biologic, only one of which is TB, there is already a need for the respirator standard (29 CFR 1910.134) to be implemented fully in most facilities. Certainly the specter of SARS is the most recent example of such a case, not to mention bird flu, monkey pox and bioterrorism preparedness. The U. S. Centers for Disease Control and Prevention (CDC) also continues to refer to respiratory protection programs in their guidance on TB, SARS and other biohazards preparedness instructions.

In August of 2000, APHA testified before the Institute of Medicine Committee on Regulating Occupational Exposure to Tuberculosis and voiced its full support for the need for OSHA to go forward with the promulgation of a TB standard. Our testimony at that time emphasized the following:

  1. Although national statistics on reported TB cases were declining (after an almost 8 year increase beginning in the mid 1980s), healthcare workers (HCWs) remained at increased risk of developing TB. This could be shown historically, during the resurgence of the 1980s and 1990s ( Bowden and McDiarmid, 1994; Snider, 1991; CDC,1995) and through infection risk probability calculations (Nikas, 2000). This of course is due to the nature of healthcare, where populations at high risk for TB converge for care. This further suggests the need for on-going vigilance as, during a renewed resurgence in the future, healthcare workers will surely be involved.

  2. APHA advocated for an OSHA standard as an assurance that the voluntary CDC Guidelines on TB prevention would be implemented. [By assurance, APHA referenced the Institute of Medicine Monograph titled “The Future of Public Health”, wherein, “assurance” is defined as one of three public health functions, with assurance being that of “seeing to the implementation of legislative mandates…..” IOM, 1988].

In a study of over 270 TB inspections OSHA performed between 1992-1994 --two to four years after CDC Guideline issuance--compliance varied between 56% and 88% (McDiarmid et al, 1996). This study further highlighted the lack of understanding on the part of many healthcare facilities about the components of effective respiratory protection programs.

In closing, please be assured of APHA's alignment with you in your agency's mission to protect the health and safety of healthcare workers and our pledge to work with you in achieving that goal.

Sincerely,

Georges C. Benjamin, MD, FACP
Executive Director

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References

    1. Bowden KM and McDiarmid MA. Occupationally Acquired Tuberculosis: What's known. J Occup Med. 36:320-325, 1994.
    2. Centers for Disease Control and Prevention. Proportionate Mortality from Pulmonary Tuberculosis Associated with Occupations in 28 States. MMWR January 13, 1995, ppg 14-21.
    3. Institute of Medicine, The Future of Public Health. National Academy Press, Washington, DC, 1988.
    4. Manangan LP, Perrotta DM, Banerjee SN, Hack D, Simomds D, Jarvis WR. Status of tuberculosis infection control programs at Texas hospitals, 1989 through 1991. Am J Infect Control. 1997: 229-35.
    5. McDiarmid MA, Gamponia MJ, Ryan MAK, Hirshon JM, Gillen NA, Cox M. Tuberculosis in the Workplace: OSHA's Compliance Experience. Infect Control Hosp Epidemiol 17:159-164, 1996.
    6. Nicas M. Regulating the Risk of Tuberculosis Transmission Among Healthcare Workers. Am Ind Hyg Assoc J. 61:334-339, 2000.
    7. Snider DE. Tuberculosis in: Weeks JL, Levy BS, Wagner GR eds. Preventing Occupational Disease and Injury. American Public Health Assn. 572-581, 1991.
    8. Sutton PM, Nicas M, Harrison RJ. Tuberculosis Isolation: Comparison of Written Procedures and Actual Practices in Three California Hospitals. Infect Control Hosp Epidemiol. 21:28-32, 2000.
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