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Timeline of respirator use in health workers
1993: The Labor Coalition to Fight TB in the Workplace petitioned the U.S. Occupational Safety and Health Administration for a tuberculosis standard.
1994: The Centers for Disease Control and Prevention issues tuberculosis guidelines. Its provisions include the use of respiratory protection when caring for patients with TB.
1997: OSHA proposes a tuberculosis rule that requires an exposure control plan, risk assessment, infection control practices, and respiratory protection.
2003: The outbreak of Severe Acute Respiratory Syndrome in Canada and Asia raises questions about respirator use and fit-testing. Forty-five percent of the cases in Toronto were among health care workers.
2003: OSHA withdraws the proposed TB rule. Health care facilities must continue to follow the respiratory protection standard, which requires annual fit-testing.
2004: An amendment to an appropriations bill (sponsored by Rep. Roger Wicker, R-MS) prohibits OSHA from using federal funds to enforce annual fit-testing.
2006: The SARS Commission report in Canada criticized authorities for failing to adequately protect health care workers. It criticized the failure of Ontario hospitals to provide fit-tested respirators, saying "action to reduce risk need not await scientific certainty."
2007: Renewal of the Wicker Amendment fails. OSHA resumes enforcement of annual fit-testing.
2009: California adopts the first Aerosol Transmissible Disease standard, which calls for respirator use with novel pathogens but allows for bi-annual fit-testing through 2014.
2009: In keeping with recommendations from an Institute of Medicine panel, CDC calls for the use of fit-tested respirators when caring for patients with novel H1N1, but offers flexibility in the case of supply shortages. OSHA announces plans to enforce the CDC guidelines.