OSHA: Annual fit-testing requirement stands

OSHA: Annual fit-testing requirement stands

But national office cautious about citing

Despite widespread protests from the infection control community, the Occupational Safety and Health Administration (OSHA) has not rescinded its controversial requirement for annual respirator fit-testing for workers who may be exposed to tuberculosis patients.

In response to an inquiry from Hospital Infection Control, an OSHA spokesman said the "agency’s announcement in the Dec. 31, 2003, Federal Register still applies." Compliance with the provisions became mandatory on July 2, 2004.

However, OSHA has advised its inspectors to contact the national office before citing the provision. A memorandum to OSHA offices states, "the national office is interested in what efforts health care employers have taken to comply with the standard . . . and what problems compliance officers are seeing in these facilities. Therefore, any area office planning to issue a citation related to a violation of the new requirements under 1910.134 should contact the directorate of enforcement prior to issuing the citation."

Last year, OSHA announced it was dropping the proposed TB standard but folding some of its provisions into the existing 1998 respiratory standard. The 1998 general respiratory provisions have not been applied previously to health care because OSHA’s plan was to create a separate TB regulation, which was issued as a proposed rule in 1997.

With TB in steep decline nationally, ICPs led a successful effort to scuttle the proposed TB standard. While that regulation was dropped, the new requirements are now in place. That means that annual respirator fit-testing for health care workers — a procedure many ICPs have protested is labor-intensive and unnecessary — is now be required.

OSHA’s memo to its field offices states, "The old [respiratory] standard required fit-testing initially and whenever respirator design or facial changes occurred that could affect the proper fit of the respirator. Examples of conditions which would require additional fit-testing of an employee include [(but are not limited to)] the use of a different size or make of respirator, weight loss, cosmetic surgery, facial scarring, the installation of dentures, or absence of dentures that are normally worn by the individual. The new standard also requires fit-testing in these instances. But these changes are not always easily discernable, which is one reason the new standard also requires fit-testing to be performed annually."

In a related development, the Centers for Disease Control and Prevention has called a Nov. 30 to Dec. 1, 2004, public meeting in Atlanta to exchange information and seek individual input on the following topics:

• current state of scientific knowledge regarding transmission of certain infectious agents through the air, focusing on the scientific basis for respiratory protection of workers and patients;
• current state of scientific knowledge regarding respiratory protection as related to droplet nuclei and certain aerosol-transmitted agents;
• strategies for improving the quality and effectiveness of respiratory protection;
• research needs to fill current knowledge gaps.