Hospitals are being slapped with hefty fines as they struggle with new federal guidelines for dealing with tuberculosis.
Last fall, the national Centers for Disease Control and Prevention in Atlanta issued proposed guidelines on how to prevent transmission of TB in healthcare facilities.
The CDC's guidelines were only suggestions, but the Occupational Safety and Health Administration said-as many hospitals and other healthcare providers had feared-that it would use the CDC's strict guidelines until OSHA completed its own.
"Most of these inspections by OSHA are coming from employee complaints, and some are resulting in some shocking fines," said Shanna Halpern, executive director of the center for healthcare environmental management at ECRI, a Plymouth Meeting, Pa.-based not-for-profit agency that monitors healthcare facilities' safety and use of devices.
Fines in the last two years have ranged from $5,000 to more than $150,000, according to ECRI.
Of 170 inspections of healthcare facilities-including 71 hospitals-from May 1992 through April of this year, just 10 were the result of regular inspections, ECRI said.
And the fines appear to be mounting, Ms. Halpern said.
Earlier this year, 316-bed EHS Good Samaritan Hospital in Downers Grove, Ill., was fined $162,000. Among the alleged violations, employees complained of being exposed to patients with TB, and proper protection, as recommended by the CDC, was not provided, OSHA reports said.
"Isolation rooms were not provided with ventilation to assure negative pressure with respect to the hallway," said one of OSHA's citations, which also described the violation as "willful," the most serious category of offenses.
In almost all cases, hospitals and healthcare facilities are fighting the OSHA fines. Good Samaritan, for instance, is appealing its fine.
The American Hospital Association and the American Medical Association have also opposed some of the requirements, saying healthcare providers would have to spend millions of dollars to comply (March 14, p. 24). An AHA survey earlier this year of 763 hospitals showed that some hospitals would have to spend $50,000 to $150,000 per room to improve ventilation associated with care for TB patients.
That same survey also showed 88% of the hospitals admit TB patients, and nearly 30% of those polled didn't have isolation rooms that meet CDC criteria.
OSHA is expected to complete its TB guidelines later this year.