OSHA reopens docket on proposed TB standard
OSHA reopens docket on proposed TB standard
Math error, poor studies cited by one
The Occupational Safety and Health Administration (OSHA) made a math error that resulted in an overestimate of health care workers’ risk for getting TB infection on the job, says a newly released review of the risk assessment of OSHA’s proposed TB standard. The review also says studies OSHA used to reach its conclusions about workplace risk didn’t contain the information needed to make a truly good assessment.
The true risk, however, "probably wouldn’t be drastically lower," says Mark Nicas, PhD, a certified industrial hygienist and a professor at the University of California at Berkeley who carried out the review. He noted that the studies, though far from perfect, were all that were available.
OSHA made Nicas’ findings (along with a second peer review by Richard Menzies, MD, head of the Montreal Chest Clinic at McGill University) available for public comment for the first time on Jan. 17, when the agency reopened its rule-making docket for a 60-day period. Also, comments on a previously published report by the Institutes of Medicine (IOM) assessing the risk of TB in the workplace are now being accepted for the rule-making docket for the first time.
The reopening of the docket signals a return to business as usual at OSHA, says Amanda Edens, MPH, an OSHA industrial hygienist and the project officer who has overseen the development of the proposed standard. After the fall election, "we didn’t get our assistant secretary, John Henshaw, until the end of last year," she points out. "It took some time to get Henshaw squared away. Now things are back on track."
Once comments on the peer reviews and the IOM report have been collected, the decision about what to do next rests entirely in Henshaw’s hands, notes Edens. "We’ll either move forward with the proposed standard or not. Those are the only choices," she says.
The IOM, in its report on TB-related risks in the workplace, made three criticisms of the proposed standard. In some settings, the proposed frequencies of skin testing might result in boosting and lead to workers being incorrectly identified as new reactors, the IOM committee said. The agency’s proposed risk-assessment categories, the IOM committee continued, needed to be more graduated. Finally, the proposals related to respiratory protection were not stringent enough in some cases, such as for high-risk jobs like autopsies. In other instances (namely, low-incidence health care facilities) the proposals were too harsh, the IOM said.
Weighing risks for varying prevalences
OSHA’s risk assessment, which has undergone one revision, uses a mathematical formulation to estimate annual risks on the job for acquiring latent TB infection — and, by extension, for morbidity and mortality — in areas where background TB rates are respectively low, medium, and high.
Those conclusions, in turn, were used by the agency to gauge lifetime risks. Thus, the agency estimates the risk in low-prevalence areas to be between 4 and 72 cases of TB infection (with a weighted average of 30) per 1,000 workers. For moderate-prevalence areas, the risk is estimated to be between 0.77 to 14.1 (with a weighted average of 11.8) per 1,000, and for high-prevalence areas, the agency pegs the risk at between 1.54 to 28 (with a weighted average of 11.8) per 1,000.
Unlike other federal agencies (such as the Environmental Protection Agency), OSHA does not use a cut-point to determine when risk is high enough to justify government regulation. All the agency is obliged to do is show that workers "are at a substantial risk" for death or impairment to health, says Edens. In an earlier landmark ruling on the subject of when OSHA could step in and regulate, the U.S. Supreme Court defined "reasonable risk" very loosely, noting that most people would call a risk of one in a thousand significant, but not one in a billion.
Deadline for comments on the IOM report and the two peer reviews is March 25. To order copies of the peer reviews, call (202) 693-2350 and ask for Exhibits 185 and 186 of the TB standard. Comments may be submitted electronically to http://ecomments.osha.gov or by mail (postmarked by March 25) to Docket Office, Docket H-371, Room N-2625, Occupational Safety and Health Administration, U.S. Dept. of Labor, 200 Constitution Ave. NW, Washington, DC 20210. To read the January 2001 IOM report on TB in the workplace, go to www.nap.edu/books/0309073308/html.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.