July 30, 2004

A Federal Register Notice published on December 31, 2003 withdrew the standard 29 CFR 1910.139 -- Respiratory Protection for M. Tuberculosis. At that time, establishments whose respiratory protection programs for tuberculosis were formerly covered under 29 CFR 1910.139 were required to adapt their programs to comply with the requirements of 29 CFR 1910.134. Since the withdrawal made compliance with 1910.134 effective immediately, OSHA decided to delay enforcement of several portions of 29 CFR 1910.134 until July 2, 2004 for covered establishments to allow employers time to come into compliance.

The delay in enforcement applied only to respiratory protection used for protection from tuberculosis and did not apply to respirators used for protection from other bioaerosols which may be found in patient settings such as Severe Acute Respiratory Syndrome (SARS). Healthcare facilities that had employees exposed to any other airborne contaminants requiring respiratory protection were already required to have a respiratory protection program that was in compliance with 1910.134.

Effective July 2^nd, covered establishments must comply with 1910.134 when using respirators for protection from tuberculosis (TB). Most of the requirements in 1910.134 and the former 1910.139 are basically the same (see side-by-side comparison [PDF]), however five areas now have more detailed requirements. These are:

Medical Evaluations (e)
The old standard stated that employees should not be assigned to tasks requiring them to wear a respirator unless they are physically able to do the work and wear a respirator and the respirator user's medical status should be reviewed periodically (for instance annually). The new standard makes this a requirement and provides details on how it must be done. The new standard does not require a periodic evaluation.

Fit-Testing (f)
The old standard required fit-testing initially and whenever respirator design or facial changes occurred that could affect the proper fit of the respirator. Examples of conditions which would require additional fit testing of an employee include (but are not limited to) the use of a different size or make of respirator, weight loss, cosmetic surgery, facial scarring, the installation of dentures or absence of dentures that are normally worn by the individual. The new standard also requires fit-testing in these instances. But these changes are not always easily discernable, which is one reason the new standard also requires fit-testing to be performed annually. The new standard requires employers to follow one of the fit-testing methods detailed in Appendix A.

Written Program (c)
Both standards required written standard operating procedures. The new standard now requires details of each element of the facility's respirator program to be included in the written program.

Training (k)
The training required in the new standard includes several new elements and specifies that training must be done prior to an employee's first respirator use and at least annually thereafter. It also requires retraining whenever changes in the workplace make further training necessary.

Recordkeeping (m)
In addition to the written program, the employer is now required to keep all medical evaluation records and a copy of the current fit-test record for each respirator user.

As stated in the CDC's "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Facilities, 1994," "Personal respiratory protection should be used by a) persons entering rooms in which patients with known or suspected infectious TB are being isolated; b) persons present during cough-inducing or aerosol-generating procedures performed on such patients; and c) persons in other settings where administrative and engineering controls are not likely to protect them from inhaling infectious airborne droplet nuclei. These other settings include transporting patients who may have infectious TB in emergency transport vehicles and providing urgent surgical or dental care to patients who may have infectious TB before a determination has been made that the patient is noninfectious."

The need for a respiratory protection program for tuberculosis will vary with the facility. TB infection control measures that each health-care facility has taken must be based on a careful assessment of the risk for transmission of M. tuberculosis in that particular setting. Appropriate infection-control interventions can then be developed on the basis of actual risk.

The National Office is interested in what efforts health care employers have taken to comply with the standard during our lull in enforcement and what problems compliance officers are seeing in these facilities. Therefore; any Area Office planning to issue a citation related to a violation of the new requirements under 1910.134 should contact the Directorate of Enforcement prior to issuing the citation. Citations for violations of requirements that were in 1910.139 should be cited under the appropriate paragraph in 1910.134 and do not need to be passed by the national office.

Since the revocation of 1910.139, OSHA has been receiving public input from some representatives of the healthcare industry regarding respiratory protection for tuberculosis. Many hospitals likely have already instituted TB respiratory protection programs as part of an overall respiratory protection that follows the additional requirements of 1910.134. The Directorate of Cooperative and State Programs is assembling additional compliance assistance materials, in addition to those already available on the OSHA web site, to help hospitals ensure effective respiratory protection against TB. Those materials will be distributed as they are developed. For additional outreach information or guidance, please contact the Directorate of Cooperative and State Programs at (202) 693-2200.