Federal occupational safety officials have shelved plans to require hospitals to create facilities and procedures to limit the spread of TB and other infectious respiratory diseases. Union leaders are angered by the decision, saying the proposed guidelines would help protect heath care workers in the event of a SARS outbreak or the release of smallpox.

The Occupational Safety and Health Administration struck the TB rule from its semiannual regulatory agenda in the new Federal Register. According to OSHA Administrator John Henshaw, the rule was removed due to the drop in reported TB cases -- down by 43 percent since 1993 -- and because many workplaces already use TB guidelines issued by CDC. However, the national decline in TB cases has not been uniform. CDC reported increases in TB in 20 states from 2000 to 2001.

"The CDC has got good guidelines, and that's where the vigilance comes from. We know the CDC guidelines are working. We are also still doing enforcement under our general duty clause," said Henshaw. Health care trade organizations and hospital groups lobbied hard against the rule, citing declining TB cases and arguing in favor of the current CDC guidelines. The rule would have required hospitals to set up costly negative pressure isolation rooms and have on hand special filtering respirators, among other controls.

The American Federation of State, County and Municipal Employees first began pressing for a regulation in 1997, when OSHA first published its proposed TB rule. But the agency failed to issue a final rule and instead twice reopened the process to public hearings and comments. "This decadelong challenge is taking on renewed urgency today because workers are also facing the threat of SARS. ... It is outrageous that this administration continues to ignore this issue," AFSCME President Gerald McEntee said in a prepared statement.

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