TB? Hold Your Breath

By David Michaels

How to not stop the spread of drug resistant tuberculosis? Give health care workers and first responders respirators that donât fit correctly.

It is hard to believe, but the House of Representatives will very soon (perhaps later today) be voting on an amendment to the Labor-HHS-Education Appropriations Bill that would prohibit OSHA from fully enforcing its respiratory protection standard to protect health care workers and first responders from tuberculosis. It would exempt tuberculosis exposures from the requirement for an annual fit test to make sure the respirator fits and protects the worker from exposure.

Even stranger is the fact that OSHA is now prohibited from enforcing its respirator standard for these workers. But the prohibition ends with this fiscal year, at the end of September. This amendment, sponsored by Rep. Roger Wicker (R-MS), is an attempt to extend this prohibition. 

Rep. Wicker has been at this for some time, spearheading the fight to not protect workers. He was successful in the past, when Republicans controlled Congress. This explains the current prohibition. (Our colleague Jordan, when he was writing in the Confined Space blog, documented the long, ugly history of Rep. Wickerâs efforts here and here and here.)

The public health community is clear about the importance of respirator fit testing. On behalf of the National Institute for Occupational Safety and Health, NIOSH Director Dr. John Howard recently reaffirmed the scientific basis for an annual fit test as required by OSHAâs existing respirator standard:

NIOSH believes that there is sufficient scientific evidence demonstrating the need for fit testing to ensure effective worker protection, as well as scientific evidence to support the regulatory requirement of annualized follow-up respirator fit testing promulgated by OSHA in its Respiratory Protection Standard.

We've posted Dr. Howard's letter on the website of the Project on Scientific Knowledge and Public Policy - the entire text is worth reading. The detail he provides about research on fit testing, aerosol behavior, and infectious agents demonstrates the serious and sustained attention NIOSH has given this issue. Members of Congress should listen to the experts and stop handcuffing OSHA. Anything less would be taking an unnecessary risk with health care workers' lives.

David Michaels heads the Project on Scientific Knowledge and Public Policy (SKAPP) and is Professor and Associate Chairman in the Department of Environmental and Occupational Health, the George Washington University School of Public Health and Health Services.