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CA proposes biannual fit-testing for HCWs
Draft targets airborne diseases
Once again a trendsetter in occupational health, California has created a draft standard on aerosol transmissible diseases that would allow biannual fit-testing of N95-filtering facepiece respirators until at least 2012 but would require the use of powered air purifying respirators (PAPRs) during high-hazard procedures.
Modeled after the bloodborne pathogen standard, the draft aerosol transmissible diseases standard calls for employers to maintain an exposure control plan that would outline source control measures, procedures for identifying suspect or confirmed cases, medical surveillance, communication with employees, training, and response to exposures.
Employers also would need to include information in the exposure control plan about how they would ensure an adequate supply of personal protective equipment.
The draft standard was designed to be flexible and applicable to various workplaces, from health care to homeless shelters. "It gives employers a way to tailor the control measures to the environment they're working in and also to their resources," says Deborah Gold, MPH, CIH, senior safety engineer with Cal-OSHA.
The standard still is under review. When it is formally proposed, Cal-OSHA will receive comments during a 45-day period, and the standards board will hold public hearings.
So far, more than 100 people have participated in the advisory committee process, including major organizations such as the California Nurses Association, the Service Employees International Union, and the California Hospital Association.
The draft standard grew out of concerns about respiratory protection, particularly after the U.S. Occupational Safety and Health Administration (OSHA) withdrew its tuberculosis standard in 2003, Gold says. That made health care employers subject to the general industry respiratory protection standard and its annual fit-testing rule.
Severe acute respiratory syndrome (SARS) heightened the awareness of airborne infectious disease risk to health care workers; 1,707 health care workers became ill from SARS worldwide, representing 21% of all cases, according to the World Health Organization.1 "Employees and employers in health care started wondering, 'How are we going to control these emerging infections?'" says Gold.
In planning for pandemic influenza, once again issues of respiratory protection are at the forefront. "There's been a push to do something on this issue," she says. "We don't want to write a new standard whenever a new pathogen comes out."
Cal-OSHA has been enforcing the annual fit-testing rule using state funds because of a Congressional prohibition on using federal funds for fit-testing enforcement. But the temporary biannual rule is designed to reduce the burden until there is further information from research on fit-testing by the National Institute for Occupational Safety and Health (NIOSH). Until Jan. 1, 2012, employers may increase the interval for repeat fit-testing to no more than two years for employees who do not perform high-hazard procedures, under the draft standard.
"This is the compromise that came out of advisory meetings," says Gold, although she acknowledges, "This could be challenged in rule-making."
The draft standard also requires employers to review and update their respiratory protection program annually and to provide annual training to employees.
The result is an increased focus on respiratory protection and airborne infectious diseases overall, Gold says.
1. World Health Organization. Summary of probable SARS cases with onset of illness from 1 November 2002 to 31 July 2003. 2003 Sep 26 [cited 2007 Mar 21]. Web: www.who.int/csr/sars/country/table2003_09_23/en.