Time for Feds to turn to ATD standard

By: July 28th, 2009 Email This Post Print This Post

Unlike Las Vegas, what happens in California doesn’t necessarily stay to California.

The July 20 issue of Inside OSHA reports that the House Appropriations Committee would like to see OSHA develop an airborne transmissible disease (ATD) standard in fiscal 2010 similar to the one recently approved in California.

Among other diseases, an ATD standard would protect workers, especially those in healthcare, from novel influenza H1N1.

Looks like imitation as the sincerest form of flattery is alive and well on the federal level.

Don’t bet against it happening, given the spotlight on pandemic influenza and the proposed $41.5 million budget increase for OSHA for fiscal 2010.

The report from the committee claims that the flu outbreak last spring points out “significant deficiencies” in protecting healthcare workers, according to Inside OSHA.

In particular, some heath departments and healthcare facilities ignored OSHA and CDC recommendations for the use of certified respirators for workers exposed to H1N1 flu patients, the article explains.

The same issue of Inside OSHA reported that OSHA is busy developing an eTool for pandemic influenza. In addition to including information on controls, training, and risk communication, the tool will address how to assess risk during pandemic influenza, which OSHA says has been a source of confusion, according to the publication.

Comments

By Diana Scheide on July 28th, 2009 at 9:17 am

I feel it is very important for OSHA to use science instead of imagination to make their recommendations. To date there is no evidence that N95s are necessary to preventt transmission of Flu. Infact if N95s are not used correctly they will put healthcare workers at higher risk of getting ill. Masks with face shields not only offer adequate protection they are easier to use with much less opportunity for error in use.

Interesting. Can’t talk about other facilities, but in our cinical system (7,000+ employees and 50+ centers) we only had one case of H1N1 in an employee who got it at work. And that was from a coworker who did not heed our instructions to stay home if sick. We have had a number of employees come back positive, but they also had family members with the disease. We have had at least a hundred cases seen in our system.

While I have no issue in regulations that spell out what is required, we still have to recognize that these are diseases that are in the community. As one IH testified when OSHA held the meetings on TB. If I could have the worlds best infection control program in my facility; if the disease is in the community, my rates of the disease will be no lower than in the community.

By Tina Lamberski, RN CIC on July 28th, 2009 at 10:32 am

Healthcare reform dollars and expenditures are significantly wasted and squandered when legislators attempt to jump on fear-based allocations to create laws to “contain” infectious diseases. Where is the scientific and professional expert outcry at this waste? Will they then require N95 masks in churches, schools, courts, and even government offices to “contain” the flu?
What do they think the healthcare professionals employed in hospitals are doing every day? Intentionally and maliciously placing our workers and patients at risk, without OSHA’s “federal regulations”?
Consider the blindness of government legislation early on for AIDS; TB; and other diseases du jour…most well-intentioned and government funded “emergency infection control measures” have created more fear, expense and unnecessary oversight than any documented successes.
Physician, hospital and professionals first do no harm… Let Public Health and its caregivers’ health and risks be guided by scientifically valid standards and those who understand and enforce them.
From: An Infection Control professional..now an “Infection Preventionist”.. and member of APIC.

By Jean Schreiber on July 28th, 2009 at 11:45 am

This administration seems to like to address the miniscule issues and hopes it will help the big ones. What about having one kind of N95 mask available? Presently we have to fit test for each different brand of N95 mask. The national stockpile can not guarantee what brand of N95 mask they will ship to you. This places employees at MORE risk than anything else.

By David LaHoda on July 28th, 2009 at 11:54 am

I like your macro approach with the one respirator idea, the reason why it won’t work is $$$$$. See Profiting from H1N1″. There is just too much money to be made by respirator manufacturers. And I don’t blame them.

I must say I agree with Tina’s comments. It is my understanding that H1N1 is a droplet-borne viral infection and therefore N95’s would not be necessary. Surgical masks should be sufficient to contain secretions from ill patients. These are certainly easier and more economial to use for both staff and patients.
With the looming legistlation to “control healthcare costs” which is a more PC way of saying doctors and facilities will have more regulations and less reimbursements, shouldn’t we be looking for more efficiency and less financial waste while still provide safe and effective services to our patients and staff?

We should follow the recommendations of experts – IDSA and SHEA. They have studied the epidemiology of this virus and do not support N-95 blanket use. Why wouldn’t I trust my experts?

The focus should be on early isolation, education that workers protect themselves as opposed to not using anything and stay home when we are sick.

By Starrette Mitchell on July 28th, 2009 at 3:51 pm

If an organization fails to have the workers use the N95 respirators or fails to have a fit test performed before the worker uses the respirator what would be the fine?

By David Webb on July 28th, 2009 at 3:54 pm

My understanding is the CDC Infection Control Practices Advisory Committee recently accepted SHEA’s recommendations regarding droplet precautions for H1N1. There are more steps before CDC can change it’s policy: meetings with employee untions, publication of IOM report, etc. There is hope the CDC guidelines may change by October 1st but obviously these hurdles may be harder to get by than anticipated.

By David LaHoda on July 28th, 2009 at 5:19 pm

That’s a good question. Last fiscal year OSHA fines under the respiratory standard for all healthcare facilities averaged $172. That probably represents some ticky-tacky fines where no penalties were assessed bringing down the average for the serious violations. Be aware that now, in egregious situations, OSHA is allowed to assess PPE/respiratory- type fines on a per employee basis. If you are on the wrong side of that equation, it could get expensive.

In the near future we’ll be reporting in this blog and in Medical Environment Update on specific fines for OSHA violations in healthcare facilities.

You cannot legislate for stupidity. Writing another law that already duplicates other regulatory requirements in place is a waste of resources and does not stop the problem – HCW who CHOOSE to be non-compliant with PPE use. It happens in HCF everyday, despite the existing regulations and countless hours of education given by the Infection Preventionist, clinical educator etc. at orientation and annually. It’s a “it’s not going to happen to me” mindset that needs to be overcome. And all of you know as well as I do that human behavior is the hardest thing to change…

 

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