AJN/February 1998/vol.98, no.2 |
| Washington Watch | Issues Update | ANA Resources | Vital Signs |
by Connie Helmlinger
Despite its overall declining rate since 1992, tuberculosis remains a significant health problem and poses an occupational threat to health care workers nationwide. The Centers for Disease Control and Prevention reports that TB cases increased in 16 states in 1995 compared with the previous year.
To address this, the American Nurses Association, in conjunction with the Labor Coalition to Prevent Tuberculosis, has advocated for the tuberculosis standard for the past four years. They achieved a significant milestone last October when the draft standard was published by the Occupational Safety and Health Administration (OSHA). A vital push for the standard came from the ANA's Nurses Strategic Action Team, which blanketed OSHA with more than 3,000 cards in support of the standard.
"The standard is badly needed to ensure medical removal protection for workers infected with TB as a result of occupational exposure," states ANA occupational safety and health specialist Susan Wilburn, MPH, BSN, RN. Wilburn explained that "medical removal protection" means that if an employee contracts TB on the job, the employer is required to pay his or her salary and hold the job open as long as the employee is sick, up to 18 months. "The standard also offers an enforcement mechanism not found in the current guidelines."
The guidelines to which Wilburn refers are the CDC's Guidelines for the Prevention of Occupational Exposure to TB. While opponents to the OSHA standard cite the guidelines as being adequate to address the problem of occupational exposure in health care facilities, there is evidence that hospitals have not completely implemented the guidelines. A 1992 CDC/American Hospital Association survey, conducted two years after the guidelines were published, found that 89% of the hospitals responding didn't have adequate ventilation controls as recommended by the CDC.
In one example of the CDC guidelines' limited reach, three health care workers in a community hospital developed active disease following exposure to a patient with TB. These workers were wearing surgical masks rather than the high-efficiency particulate filtration (HEPA) respirators recommended by the CDC. While the draft standard doesn't require HEPA respirators, it does call for National Institute on Occupational Safety and Health respirators such as the N-95.
"In the face of the health care restructuring that has occurred in the past five years, health care facilities are unlikely to comply with a guideline that is not legally required," Wilburn points out. Noting that the 1991 OSHA Bloodborne Pathogen Standard has resulted in significant reduction in hepatitis B infection among health care workers, Wilburn predicted the TB standard would similarly protect health care workers from preventable infection in the workplace.
The standard would expand the scope of the CDC guidelines to the additional high-risk settings of homeless shelters, hospices, long-term care facilities for the elderly, correctional facilities, and drug treatment centers. In the coming months, the ANA will push for further expansion of the standard to include all long-term care facilities and extension of the medical removal protection to any worksite where a TB outbreak occurs.
The ANA will have submitted written comments on the standard by the time this is printed and will attend the OSHA public hearing on April 7 in Washington, DC, to provide expert testimony. Regional hearings also are being scheduled in Los Angeles (May 5), Chicago (May 19), and New York City (June 2). For more information, contact Susan Wilburn, (202) 651-7130. To provide feedback for the ANA's comments, complete the survey in the "What's New" section of NursingWorld at www.nursingworld.org.
The December 8, 1997, issue of Fortune magazine named the ANA's lobbying team among the top 100 powerhouse lobbying groups in the United States. At number 78, the ANA's legislative program is ranked as more effective than such groups as the United Mine Workers and the American Lung Association.
Indicative of the ANA's growing success in the legislative arena were the number of pro-nurse bills passed in 1997, including Medicare reimbursement for nurse practitioners and clinical nurse specialists and increased funding for the Nurse Education Act. The ANA also played a significant role in consumer protection legislation in the past few years, including the Health Insurance Portability and Accountability Act and the Mothers and Newborns Protection Act.
During the coming year, the ANA's lobbying team will work closely with key members of Congress to secure more support for its Patient Safety Act, introduced by Representative Maurice Hinchey (D-NY) last year. The bill would require hospitals to disclose nurse staffing levels, provide whistle-blower protection for health care workers who report unsafe working conditions, and require that hospital mergers and acquisitions be reviewed and approved by the Secretary of Health and Human Services.
The ANA also will push for passage of legislation based on the Consumer Bill of Rights and Responsibilities drafted by the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry last fall (see The American Nurse, November-December 1997, p.18).
To learn more about the ANA's legislative agenda, visit the ANA Web site at www.nursingworld.org.
Connie Helmlinger is periodicals manager at the American Nurses Association.