Sunday, January 15, 2006

Protecting workers from bird flu

While public attention has been focused on a general pandemic with bird flu, there is another dimension that should not be forgotten: bird flu as an occupational illness. The two most obvious at-risk jobs are health care worker and poultry worker. Last week Jordan Barab at Confined Space gave a detailed rundown of the issues and prospects for a petition to OSHA to establish an Emergency Temporary Standard, filed by a group of unions led by the American Federation of State, County and Municipal Employees (AFSCME).

You should read Jordan's post for the links and the details, but essentially the unions are unhappy OSHA is not taking the same stand for mandatory requirements they took 15 years ago regarding the Bloodborne Pathogens Standard. Under the current "plan" employers can ignore OSHA, CDC and NIOSH recommendations. The issue goes beyond protecting the workers (although that surely would be sufficient grounds), but also involves protecting the integrity of the health care system itself in the event of a pandemic.

Even some of the voluntary guidance is inadequate, calling for the use of surgical masks as protection (see pandemic flu plan, p. S4-8). These masks are inadequate as Personal Protective Equipment (PPE). Jordan has more details. When N95 filtering faceplate respirators are used (and they seem to be recommended only when in the presence of aerosol generating procedures), the mask only provides good protection when adequately fitted, a procedure that must be done carefully and at adequate intervals. Forget it.

OSHA hasn't done a thing about infectious disease protection for workers for 15 years, since the Bloodborne Pathogens standard for hepatits B and AIDS, also initiated by an AFSCME petition. The standard has been spectacularly successful, reducing hepatitis B in health care workers 90% since 1987. An additional proposal by the Clinton administration to protect workers from TB via annual respirator fit testing was withdrawn by Bush upon request by the American Hospital Association (AHA)and the Association of Infection Control Practitioners (ACIP), the employers and management class of the health care industry. They not only prevented the fit testing requirement, but using CongressThing Wicker (R-MS) as a sock puppet, they got language in OSHA budget bills to prohibit annual fit testing (details at Confined Space here)

As for the other occupational group at risk, poultry workers, the United Food and Commercial Workers union which represents some of them is asking the Bush administration "to initiate coordinated protection for poultry workers on the front lines by initiating a Cabinet-level meeting to discuss worker issues and the potential pandemic." Not likely. Some of the large poultry producers, for their own protection, are initiating bird testing programs for infection at their own expense. The program is voluntary but the industry claims 90% of the producers have signed up. When exactly it will be in full effect is not clear. But the aim is to encourage confidence among consumers and protect their investments, not protect workers, although realistically if there is an influenza pandemic, workers may be more likely to get the disease from people than the birds they work with.

One thing seems clear to us. Health care institutions need to start immediately to get their house in order with respect to worker protection. They can't wait for the Bush administration, although OSHA should be pushed and pushed hard. But laying in adequate supplies of N95 respirators and having some kind of plan about fitting them properly is a step that shouldn't be delayed. And easily accessible and plentiful dispensers of alcohol-based gel hand wash tissues should be placed throughout the institution. The use of UV disinfection should also be considered. And all this could be done without being forced by the government (and that is unlikely to happen soon).

These things are to the hospitals' short and long term benefit, not to mention to public's health. They just make sense. Do I think they will do it? Sure I do.

And we're the Andrew Sisters.