May 22, 2009 The Pump Handle 4Comment

By Bill Borwegen

While the news coming out of California this week has focused on the budget crisis, something else of historic importance in advancing worker protections was achieved by California’s healthcare workers.  Yesterday in a 6-0 vote, the CalOSHA Standards Board adopted the nation’s first aerosol transmissible diseases standard.

In 1986 when unions petitioned OSHA for a bloodborne pathogens standard to protect against HIV and Hepatitis, the American Dental Association told us that if dentists wore gloves, everyone would be scared and that no one would go to the dentist.   Since this standard passed in 1991, CDC reports that hepatitis B cases among healthcare workers have plummeted from 17,000 cases a year to less than 400. 

When California passed the nation’s first safer needle law in 1998, it led to the passage of more than 20 state laws and President Clinton signing the federal Needlestick Safety and Prevention Act in an Oval Office ceremony the day before the 2000 Presidential election.  Today, according to researchers at the University of Virginia, needlesticks have been cut by more than half (51%).

As we have confronted TB, SARS and now Novel H1N1, occupational health and safety professionals continue to wage a pitched battle with segments within the infection control community to ensure the implementation of sufficient respiratory protection for healthcare and other workers exposed to on-the-job airborne biological threats.   While CDC, NIOSH and OSHA are all calling for adequate respiratory protection to protect healthcare and other workers from respirable H1N1 virus particles with at least fit tested N95 respirators, around half of the nation’s state and local health departments (with the acquiescent of CDC) are claiming that leaky loose fitting surgical masks are sufficient.

Yesterday’s action by the CalOSHA Standards Board to unanimously adopt a CalOSHA Airborne Transmissible Disease (ATD) Standard is a historic day for healthcare that will lead to protections against airborne transmitted diseases that mirror what has been achieved for protecting healthcare workers exposed to bloodborne biological hazards.  The next steps will be to educate California’s workers about their rights under this new CalOSHA standard, ensure comprehensive enforcement, and now push for a similarly protective airborne disease standard from federal OSHA.

When I was growing up, my father and many of my cousins became fire fighters.  Back then it was considered macho to stand and hold onto the railing on the back of the fire truck and breathe smoke instead of wearing a respirator.   Today fire fighters would not allow a co-worker to enter a burning building without their Self Contained Breathing Apparatus.  Yet little thought is given when an unprotected healthcare worker enters the room of a patient with H1N1 or some other airborne respiratory disease. 

As I have witnessed a change in the safety culture among firefighters in my lifetime, I hope the day will come within the healthcare industry when it will no longer be acceptable for a healthcare worker to risk their health to provide patients with the quality care they need and deserve.

And today no one would go to the dentist if their dentist did not wear gloves.

Bill Borwegen, MPH is Occupational Health and Safety Director for Service Employees International Union. He can be reached at

4 thoughts on “Action in California Chips Away at Healthcare Sector’s Lack of Safety Culture

  1. Thank you for the thoughtful and informative post, Bill.

    I have a question for you and/or any others who read this about engineering controls and ATD. Does the CalOSHA Standard only mention PPE? Or is there stuff in there about engineering controls?

    The reason I ask is because one of the first things I learned about in my introduction to industrial hygiene was the hierarchy of controls. I realize that eliminating the hazard is not a luxury that health care providers would be afforded in this particular instance. But there may be some ventilation systems, etc. that spread or contain airborne pathogens more readily than others. Which leads me to my other questions:

    Can you (or any respondents) speak to any research that has been done on any engineering controls’ effectiveness at reducing risk of airborne transmissable disease?

    How is exposure assessment conducted with airborne pathogens? Are there methods for quantifying the concentration of pathogens in air?

    I clearly know very little about this aspect of OEH, so even the most basic information would likely be interesting to me.

    Thank you.

  2. See
    for the agenda, follow the links in the Business portion of the meeting to get the final adopted standards. I think the unanimous adoption says that there is a commitment to improve safety of health care workers. I agree that the culture of safety in some health care organizations eaves a lot o be desired.

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