There’s an old adage: You make your own breaks.

For years, the LHSFNA Division staff, working through the AFL-CIO’s Pandemic Flu Workgroup, has pushed hard for an infectious disease standard from the Occupational Safety and Health Administration (OSHA). Side efforts were also pursued on a state-by-state basis, including one in California.

The point is to ensure that the nation’s frontline healthcare providers are protected from contagious diseases through the use of proper ventilation, work practices and personal protective equipment (PPE). They must be protected from airborne, droplet (coughing or sneezing) and contact exposures. When it comes to the much needed PPE, which is the last means of defense, workers should be provided with NIOSH-approved respirators, not just surgical masks. Respirators are designed to protect the wearer from inhalation of hazardous particulates and chemicals, and they seal tightly on the face to prevent inward leakage when the wearer inhales. In contrast, surgical masks are designed to prevent external contamination if the wearer coughs or sneezes. While surgical masks may also provide some protection to wearers from splashes and large drops, they do not seal tightly and do not guard against inhalation of small particulates like viruses.

If a contagious disease were to decimate the ranks of the nation’s healthcare professionals, it would spread more widely, make the public more broadly vulnerable and vastly increase deaths and other losses in its wake. Yet, many healthcare employer organizations consistently oppose a standard, saying that the voluntary guidelines of the Centers for Disease Control (CDC) are adequate. They add that the use of certain PPE – for example, respirators – may deter sick people from seeking treatment. In contrast, safety advocates suggest that the higher cost of respirators relative to surgical masks is the real reason these employers oppose a regulatory rule.

H1NI Virus Different Than Seasonal Flu

The H1N1 pandemic is different from seasonal flu in a number of important ways:

  • It is a novel virus never seen before.
  • There is no immunity to the novel H1N1 virus.
  • There is currently no vaccine for the novel H1N1 virus
  • The virus preferentially infects younger people
  • Most cases of severe and fatal infections have occurred in adults between ages 30 and 50 years, indicating it disproportionately affects people of working ages
  • About one-third to half of the patients who have died had been previously healthy young and middle-aged people.

In addition, concern is great that the virus may become more virulent in the fall.

Given the heightened concern raised by these circumstances, the H1N1 pandemic should not be considered the same as seasonal flu, nor should the worker protection measures normally applicable for seasonal flu be recommended. Workers need a higher level of protection.

[From the Union Statement at the Health Care Infection Control Practices Advisory Committee of the Centers for Disease Control, June 15, 2009.]

Now, along comes this year’s H1N1 flu, commonly known as swine flu, and, sure enough, many healthcare employers are ignoring the CDC-recommended use of N95 respirators. Although H1N1 has so far proved far less deadly than initially feared, it has swept through the country and the world, sharply raising concerns among health officials and the general public.  This global spread resulted in the official declaration of H1N1 as a pandemic. Recently, the World Health Organization (WHO) moved this flu up to a Phase 6 of pandemic alert, its highest phase.

Coincidentally, a proposal for an aerosol-transmitted disease (ATD) standard, five years in the making, was already scheduled to be heard by the California OSHA (Cal/OSHA) Standards Board on which LIUNA Vice President Jose A. Moreno serves. With the onset of H1N1, this proposed standard suddenly garnered renewed interest. Already prepared, the LHSFNA worked with LIUNA public employee members in California – many of whom are nurses or other healthcare providers – to present testimony at the hearing. Other safety and union advocates added their perspective, and, on May 21, 2009, by a 6 – 0 vote, the state became the first in the nation to adopt an ATD standard. Now, pressure will mount for federal OSHA to follow suit.

The Cal/OSHA standard requires employers whose employees are likely to encounter ATDs to take various actions to mitigate exposure risk, depending on the nature of the facility. In some cases, these actions include the use of more powerful respiratory protection. The facilities covered in California include hospitals, primary care facilities, laboratories, emergency medical services, homeless shelters, drug treatment programs and jails.

“You’ve heard some say I’d rather be lucky than good,” recounts LHSFNA Senior Safety & Health Specialist Travis Parsons, “but, in this case, we were both. We’d been working on airborne disease protection for years, but this pandemic pushed it over the top. We’re also lucky that, so far, this flu has been mild, but a serious one could come at any time. OSHA needs to get moving on a national infectious disease standard right away.”

[Steve Clark]