ANA Continues Respiratory Protection Advocacy

ANA has been working on many fronts to support mandatory respiratory protections for nurses at risk for infection by airborne biohazards. ANA's recent efforts are directed toward implementing the annual fit-test requirements for respirators used to protect nurses and other health care workers and ANA is also working to impact the federal planning for pandemic/avian flu. As we work to educate Members of Congress about the need to support a higher level of protection, we need your help in demonstrating the real-world impact of these federal policies.

The Wicker Rider
For the last two years in a row, Rep. Roger Wicker (R-MS) has been successful in attaching a rider to appropriations legislation that prohibits the Occupational Safety and Health Administration (OSHA) from enforcing the annual fit-test requirement for respirators used to protect nurses and other health care workers. Despite ANA's objections, Rep. Wicker has once again attached this rider to the FY 2007 Labor, Health and Human Services, and Education Appropriations Act (H.R. 5647).

The current OSHA general industry respirator standard requires all workers exposed to airborne hazards to be protected by respirators that are fit-tested at least once a year to ensure proper performance. The manufacturers of the respirators most commonly used in health care settings (N-95 particulate respirators) recommend annual fit-testing because small changes in weight, dental work, or facial hair can compromise a respirator's seal. The National Institute for Occupational Safety and Health (NIOSH) has found that non fit-tested respirators expose the wearer to eight times more contaminant than those that are fit-tested.

Currently, the only airborne pathogen currently found in the healthcare workplace that triggers this standard is tuberculosis (TB). Rep. Wicker argues that the fit-testing requirement is too burdensome for health care facilities and that recent reduction in tuberculosis cases have made the requirement obsolete.

ANA is concerned not only about the impact that this amendment will have on TB transmission, but also because the TB standard is the only current means to require health care facilities to obtain and test respirators needed to protect health care workers from all of the other air-borne biohazards that do not have their own enforceable standards (e.g., SARS, pandemic flu, and agents of bioterrorism). The Canadian SARS experience proved that fit-testing must occur before an infectious disease outbreak. Dozens of Canadian nurses were infected with SARS while wearing respirators that did not work. One nurse wearing an ill-fitting respirator died from the disease.

The FY 2007 Labor, HHS Appropriations bill is not expected to be finalized until after the November elections. When the bill comes to the floor of the House of Representatives, ANA will champion an amendment to strike the Wicker rider. You can help! Contact your Member of Congress and urge them to support a higher level of protection for nurses, advocacy materials are available at www.anapoliticalpower.org

Pandemic Flu Preparedness
ANA is also working to impact federal planning for pandemic/avian flu. ANA is concerned that the current pandemic flu plan released by the Department of Health and Human Services (HHS) in November, 2005 states that surgical masks provide sufficient protection for health care workers during most contacts with pandemic flu patients. The World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC) and the Occupational Health and Safety Administration (OSHA) have all issued guidelines supporting the use of N-95 respirators for these patient contacts, but these guidelines are not enforceable. ANA is concerned that state planners and health care facilities are using the HHS planning materials alone, and are not including the purchase and fit-testing of N-95 respirators in their pandemic plans.

ANA worked with the Congressional Nursing Caucus on a letter to the Secretaries of the Departments of HHS and Labor to urge a higher level of health and safety protection. This letter which was signed by a bipartisan group of 88 Representatives, was distributed on May 25, 2006. The letter, championed by Representatives Lois Capps, RN (D-CA) and Steven LaTourette (R-OH) states, "We should not wait until nurses experience a high rate of infection before we act to protect them from pandemic flu… We urge you to revise the HHS plan and OSHA standards to provide effective protection of workers from pandemic influenza and to increase the procurement of respirators for the national stockpile." ANA is now working with HHS to review updated planning documents.

ANA has also been in contact with the Senate Health, Education, Labor and Pensions (HELP) Committee to urge them to include effective workplace health and safety protections in their legislation reauthorizing the Bioshield programs. ANA wrote to the members of the HELP Committee on July 13, explaining our position that fit-tested N-95 respirators, or their equivalent, are the minimum level of protection required by nurses who treat patients with known or suspected pandemic flu. This letter stated that ANA recommends that any RN who is called upon to respond to a pandemic event refrain from direct patient contact if they are not provided this level of protection. The Pandemic and All Hazards Preparedness Act (S. 3678) was approved by the Committee on July 19, 2006. Unfortunately, the bill as drafted does not contain a requirement that OSHA issue an enforceable pandemic flu worker protection standard. The bill does, however, include the goal of 'protecting health care workers and first responders from workplace exposure to biologicals and other hazards' as a measure that the Secretary of HHS must take into account in pandemic planning. ANA will continue to work with Congress to support enforceable workplace protections in the final Pandemic and All Hazards Preparedness Act.

Erin McKeon