Protecting Health Care Workers from Infectious Disease: Experience with Cal/OSHA's Aerosol Transmissible Disease Standard

Infectious diseases, such as tuberculosis, have long been a hazard to health care workers (HCWs). In 2003, HCWs bore the brunt of the SARS outbreak in several countries. Other infectious disease challenges have included Methicillin-resistant Staphylococcus aureus (MRSA), drug resistant TB, H1N1, and recently Ebola. In 1991 OSHA adopted the Bloodborne Pathogens Standard, the first major standard to specifically address infectious diseases. Federal OSHA did not succeed in promulgating its 1997 proposed TB standard, but in 2009 the Cal/OSHA Aerosol Transmissible Disease standard was adopted. This standard addressed protection of workers in health care, laboratories, emergency services, corrections, drug treatment programs, and similar environments. A companion standard addressed protection of workers from zoonotic diseases.

After 5 years, California’s ATD Standard remains a unique standard in the U.S. Enforcement of the ATD Standard has involved a high degree of coordination and cooperation with public health agencies. Investigations revealed a number of common problems in hospitals, laboratories, corrections, and other establishments covered by the standard, many of which also weren’t complying with existing public health regulations and guidelines. Disease exposures investigated by Cal/OSHA during the past five years included influenza, meningitis, measles, and tuberculosis. The ATD standard has allowed Cal/OSHA to require a higher level of protection for California HCWs than has been enforced in other jurisdictions

This presentation will discuss some Cal/OSHA investigations, the lessons learned, and how this information could be used by other jurisdictions in protecting health care workers and in adopting similar regulations.