What are your thoughts about the costs of annual TB fit-testing?

Posted At : January 16, 2008 11:25 AM | Posted By : Steve MacArthur
Related Categories: OSHA

So I see that OSHA--thanks to President Bush signing off on the federal budget--now has the ability to enforce its annual fit-testing requirements for tuberculosis (TB).

This one is going to have some hidden costs. The fact of the matter is, compliance even with initial fit-testing is certainly (based on my observations) inconsistent at best, so some folks are going to have to come at annual fit-testing basically from ground zero.

At any rate, it seems to me that somewhere in the regulatory language (maybe in the post-TB standard stuff) there was some sort of cost estimate that was fairly minimal. And, as I think about it, this isn't even getting into the issue of fit-testing staff members who are going to be using PAPRs in the event of a decon event.

It'll be interesting to see if OSHA actually goes after this with any gusto--could get ugly.

What do you think? Is this a big deal? You can click on the comment links below to post your thoughts.

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First the annual requirement is mostly due to bad science. The CDC themselves stated that HCW TB rates continue to decline. OSHA has this habit of lumping healthcare into "General Industry" trying for a "one size fits all" approach. which in many cases does not fit the healthcare environment. The old standard requiring fit testing upon initial hire and "periodically thereafter" was too vague. With healthcare every 3 - 4 years would be appropriate. HCWs are not like general industry where the respirators are worn day-in and day-out. They are only worn upon the occasional admission of a known or suspect TB patient. We have over 13,000 employees, to fit test only 50% of the employees annually will be a major undertaking which will cost the organization 10's of thousands of dollars in time and materials. Previously OSHA 's enforcement of respiratory protection was based upon complaints. Now that the muzzle is off, it will be interesting to see if the dog really does bite.

# Posted By Access_Four | 1/17/08 2:07 PM

I know a lot of facilities are pulling their hair out on this one. We are taking the approach that the rule only applies to staff that have a potential for exposure to TB. If your really look at this, the numbers are normally not that high. We also feel that the use of PAPR's is an all around better respirator to look at. Better filtration. You are not breathing 98 degree air and it does not require an annual fit test or fit check prior to use. Most of the hood type can be disinfected so reuse should not be that big a deal.

I also would challenge you to read the OSHA Respiratory Standard definition of IDLH. If your respirator slips in a TB environment, are you not in an environment that could be dangerous to your life or health? So how come an N95 is acceptable?

# Posted By Bruce_Cunha | 1/17/08 5:11 PM

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