http://www.washingtonpost.com/wp-dyn/articles/A50884-2003May28.html

Proposed Safeguards Against TB Dropped

OSHA Says Disease Is Under Control

By Rob Stein

Washington Post Staff Writer

Thursday, May 29, 2003; Page A03

The Bush administration has dropped a plan to require hospitals and other facilities to protect their workers against tuberculosis, saying the measure is no longer necessary because the disease is under control.

The move drew harsh criticism yesterday from supporters of the regulations, who said the measure would have ensured that TB remains under control while also helping protect against other infectious diseases, such as severe acute respiratory syndrome, or SARS.

The Occupational Safety and Health Administration (OSHA) had proposed a number of requirements aimed at protecting workers in hospitals, prisons and other high-risk facilities from TB, such as setting standards for protective respirators, training and specially ventilated rooms for isolating infectious patients.

But OSHA on Tuesday announced in the Federal Register that the proposal will be dropped from the agency's agenda in the fall.

An OSHA spokeswoman said yesterday that the agency decided to drop the proposal because the resurgence of TB that had prompted it has subsided. In addition, the spokeswoman said, the federal Centers for Disease Control and Prevention in Atlanta has guidelines in place that are sufficient.

"The need for a specific OSHA standard has significantly diminished," the spokeswoman said. "The agency doesn't think a standard is the answer today as it might have been when it was proposed 10 years ago."

The American Hospital Association, which has long opposed the measure as unnecessary and costly, agreed. "There are many other regulations and initiatives that are in place that are quite effective. We just felt like it wasn't necessary," said Judene Bartley, a consulting epidemiologist for the association.

But critics said that the CDC guidelines are not mandatory and that there is a history in the United States of becoming lax about infectious diseases once an immediate threat appears to have diminished.

"I think it's a poor decision," said Rosemary Sokas, who chairs the American Public Health Association's occupational health section. "The CDC guidelines are voluntary. They are not regulations. The high-performing organizations follow them. But not everybody does because they are not required."

Many hospitals are under increasing pressure to cut costs, and infection control could easily suffer, Sokas said.

"It's really very clear that people don't automatically do the right thing. The good ones do. But that's not universally true across all hospitals," said Sokas, director of the division of environmental and occupational health sciences at the School of Public Health of the University of Illinois at Chicago.

The precautions that would have been required by the regulations would also have prevented the transmission of SARS, Sokas said.

"The United States has done extremely well so far. But some of that may be luck. I don't think it's a reason to sit back and put our feet up," she said.

The move was also criticized by labor unions, such as the American Federation of State, County and Municipal Employees, and by the American Nurses Association.

"This is a tremendous hit to workers all around the health care industry," said Butch de Castro, senior staff specialist for the association. "The CDC guidelines are not enforceable. There's a potential for decreased vigilance, which is what we've seen historically. A standard would ensure vigilance and compliance."

De Castro noted that many of the victims of SARS have been health care workers.

"I think considering the potential for droplet airborne transmission of an infectious agent like SARS, if we had a TB standard out there, that might help considerably in protecting health care workers," he said.

© 2003 The Washington Post Company