OSHA chief concedes TB rule a lower priority

Ergonomics rule is the agency’s prime goal

Picking his battles as political change looms for the nation, Occupational Safety and Health Administration (OSHA) chief Charles Jeffress said the tuberculosis standard may not be finalized by year’s end and that an ongoing review of the need for the regulation "might affect what we do."

Completion of an ergonomics standard to protect health care workers and other employees from repetitive motion injuries and similar hazards was the clear prior-ity in a speech by Jeffress this week at the Frontline Healthcare Workers Safety Conference in Washington, DC. "In terms of injuries serious enough to cause you to lose time from your job, it’s more dangerous today to be a nurse in a nursing home than it is to be a worker on a construction site," he said.

Health care workers are suffering particularly from back injuries and other musculoskeletal disorders (MSDs) from lifting and moving patients, he said. "Our approach to solving that is to require an ergonomics program for all employers who have employees at risk," he said. "That has been what we are working on. . . . I want to make it very clear: We will complete an ergonomics standard this year. Our team is committed to that. The president, the vice president, and the secretary of labor are committed to that. We will develop a standard to protect workers from MSDs."

While pledging to overcome political opposition and complete the ergonomics standard by year’s end, Jeffress made no mention of the long-embroiled TB standard. In an interview afterward with Hospital Infection Control, Jeffress, OSHA’s assistant secretary of labor, remained committed to finalizing the controversial 1997 proposed TB rule but said the ergonomics battle has taken priority. "There are a lot of things on the plate at the moment," he said. "With the TB standard, our goal is to finish that by the end of the year. Because of our work on ergonomics, we may miss that by a few months."

The Institute of Medicine (IOM) in Washington, DC, is reviewing the need for the OSHA TB standard and expects to issue a report by December. (See highlights of IOM hearing testimony, p. 121.) However, as part of a political deal made in funding the study, OSHA is not bound by any requirement to wait for the results before finalizing the rule. Thus, OSHA officials have taken the position in previous comments to HIC that the agency is proceeding with finalization of the rule regardless.

However, Jeffress conceded that "OSHA always has to adapt and respond to the information, so whatever information comes out [of the IOM study], pending where we are in the process, it might affect what we do." Still, Jeffress expects the IOM to support the need for the standard. Despite declines in TB incidence, there are still drug-resistant strains circulating and increasing prevalence in the foreign-born entering the United States, he noted. "We think the information we have in our record is the same kind of information the IOM study is using," Jeffress said. "I would be surprised to see a much different conclusion."

A delaying tactic

The IOM panel review of the standard is "a delaying tactic," Mary Foley, RN, MS, president of the American Nurses Association, told attendees at the safety conference. "We believe it is really time for a tuberculosis standard in health care," she said. "We would really like to ask Secretary Jeffress and Labor Secretary Herman to move on that."

The Association for Professionals in Infection Control and Epidemiology (APIC), the most outspoken critic of the standard, was the main lobbying group behind the IOM study. Emphasizing that the primary risk to health care workers is the undiagnosed TB case, APIC has long objected to OSHA’s focus on respirators and other controls for workers treating known TB patients in isolation. Earlier this year, APIC also urged its members to write Congress requesting that the OSHA docket on the TB standard be reopened to include new information on the waning epidemic in the United States.

APIC argues that the proposed rule is no longer needed because TB incidence in the United States is at the lowest level in recorded history. APIC president Susan Slavish, BSN, MPH, CIC, has told HIC previously that APIC hopes to stall finalization of the rule at least until the upcoming election changes the political landscape in Washington.

It appears, based on Jeffress’ comments, that will be the case.