Subject: Federal Regulations to Prevent Infection Of Health-Care Workers Will Be Costly Date: Published: 7/2/92 (153 lines) Source: Wall Street Journal. Copyright Dow Jones & Co. Inc. Health: Federal Regulations to Prevent Infection Of Health-Care Workers Will Be Costly ---- By Jonathan Weil Staff Reporter of The Wall Street Journal Starting next Monday, Oklahoma's Emergency Medical Services Authority in Tulsa, which handles 70% of the state's ambulance service, will add a $38.05 surcharge to the bills of the 92,000 people it transports annually. The reason: to cover added costs from new federal rules designed to protect health-care workers from being infected by human immunodeficiency virus, which causes AIDS, or hepatitis B. The roughly 80 new regulations, the last of which will take effect July 6, range from requirements for protective clothing to rules prohibiting workers from applying lipstick around patients. The rules will cover 5.6 million workers nationwide in places from hospitals and nursing homes to linen services, funeral homes and doctors' and dentists' offices. The Occupational Safety and Health Administration, which is issuing the rules, puts the annual cost of compliance at $812 million. But health providers contend the cost will be far higher for what they argue is a regulatory overreaction to the threat of AIDS and other infectious diseases. "It's a typical example of bureaucrats in the federal government trying to allay any anxiety. Intuitively, you know it's going to cost a lot of money for very little benefit," complains James Todd, executive vice president of the American Medical Association in Chicago. OSHA administrator Dorothy Strunk says it is the health-care employers who are overreacting. "We feel we properly estimated the costs of the standard and the benefit," Ms. Strunk says. "And the standard was absolutely necessary. Most of these things were things that they were already doing." The Labor Department agency estimates that the annual cost of the new regulations to dental offices, for example, is $87.4 million, or $873 for each office. But many dentists say the actual cost is up to 20 times higher. St. Petersburg, Fla., dentist Curtis Gause says complying with the regulations already is costing his office $15,000 for its eight dentists and three specialists. All that will be passed on to patients in the form of a $10 surcharge. "We don't need this overkill that's literally going to add hundreds of millions of dollars to patients' health-care bills," Dr. Gause says. Many doctors, dentists and other providers plan surcharges between $5 and $40, while others simply appear to be working the costs into their regular fees. "The doctors are going to pass the cost to the patient," says Kathryn Hawkins, an independent infection-control practitioner in Houston. "The basic idea by OSHA is a good idea because infection control has widely been ignored. But someone's going to have to pay for it." While a Florida dentist is the only health-care worker known to have passed the AIDS virus to patients, according to the Centers for Disease Control, at least 47 cases of health-care workers contracting AIDS from patients have been documented. About 8,700 health workers become infected with the hepatitis B virus yearly, and some 200 die from it each year. Under the new rules, health-care practitioners must wear protective clothing such as wrap-around eyeglasses, full-length gowns, gloves and masks when they touch patients. The rules also bar employees from washing protective clothing at home. Either the clothing must be disposable, in which case it must be treated as biohazardous waste, or laundered on the premises or by a professional cleaning service. In addition, used needles must be stored in puncture-proof containers. Health-care employers must keep confidential medical records on all employees for 30 years after the duration of their stay. And in dental offices, all hand pieces must be autoclaved, a process of highly pressurized steam cleaning. A single violation of any of the rules can result in a fine of up to $70,000. While some of the requirements have been standard medical practice for years, others are new, such as one requiring all containers of hazardous materials to be so labeled. Even for the two-doctor oral-surgery practice of Steven Gutenberg of Washington, D. C., that means labeling thousands of containers, including those containing common household goods. This is because many health-care facilities, such as his, buy in bulk and bottle liquids themselves. Likewise, the cost of the extra hours spent labeling containers, meant to protect employees, is passed on to patients. The bottom line for Dr. Gutenberg's patients: a $20 fee charged for infection-control services, which he insists only covers costs. Perhaps nowhere will the costs of the regulations be felt as much as within the emergency medical-service sector. At Oklahoma's Emergency Medical Services Authority, a public utility, the planned $38.05 surcharge just covers costs, including the cost of nonpaying patients, says its director, Steve Williamson. Already, the service has ordered more than $204,000 in disposable plastic stretcher linen and $380,000 in disposable protective equipment, such as wraparound eyewear, gowns and smocks. Together those items will cost $94,000 for certified medical waste haulers to carry off, as required by the new OSHA standards. Mr. Williamson estimates the company's 60-ambulance fleet may have to be increased by 10% or more, at a cost of $170,000 for each fully equipped ambulance, to keep enough ambulances in compliance with the regulations available at all times. And that means more staff. Total cost: well in excess of $1 million. According to Mr. Williamson's interpretations, if blood splatters in an ambulance, the new regulations require all affected rescue-crew members to change clothes and shower before their next run, something they may have to do several times each day. And in a life-or-death situation, "When you're upside down trying to get somebody out of a car, it's pretty difficult not to get blood all over you," Mr. Williamson says. He adds: "This is crazy. I don't think anybody had any idea the extremes this is going to take the industry. You just can't eat a million bucks." OSHA's Ms. Strunk says such concerns are exaggerated. She says that under the new rules health-care workers need not always wear full-body protective clothing when treating patients, as many have interpreted. Rather, she says, during nonsurgical procedures a long-sleeved shirt to protect a worker's upper body is sufficient. And workers shouldn't worry about having to change a gown with only a tiny amount of blood on it before visiting a different patient, she says. But according to the standards, "If a garment is penetrated by blood or other potentially infectious materials, the garment shall be removed immediately or as soon as feasible." It does not make exceptions for small amounts of blood. Perhaps the greatest source of confusion among employers is the broad manner in which the regulations can be interpreted. For example, under the regulations, saliva in dental procedures is categorized as a potentially infectious material and therefore must be treated as biohazardous waste. Some dentists fear that used paper cups would have to be disposed of by certified medical haulers. "This is a common-sense standard. And a Dixie cup is not infectious waste," responds Ms. Strunk. "For years, employers beat OSHA because we came out with too many specific specification standards. Now the employers are coming and saying, `Where's the specificity? ' They can indeed, and should, use their best professional judgment." [This article is made available here by Dow Jones Co. for the personal and non-commercial use of callers to this bbs, in the hope that it will be of some help to those who are suffering from the disease and others who are seeking to help them.]