An interim guidance document for health care workers who might be exposed to plague during a bioterrorism attack has been withdrawn for additional review and discussion, a Centers for Disease Control and Prevention spokesman confirmed April 12.

The guidelines drew immediate fire from labor unions, who in an April 11 letter called on CDC Director Julie Gerberding to withdraw what they termed an "irresponsible" interim guidance.

The unions said they were "greatly disturbed" by CDC's guidelines, which they claim would put health care workers at risk of serious and potentially deadly exposure.

CDC spokesman Von Roebuck told BNA there has been comment on the guideline since they went up on the centers Web site a week ago, including calls from hospitals.

A National Institute for Occupational Safety and Health spokesman told BNA April 12 that CDC recognized that additional review and discussion would be needed on the guidelines. The guidance was posted because there were questions about how to protect healthcare workers during the TOPOFF 3 exercises--a comprehensive terrorism response exercises held last week in Connecticut and New Jersey (35 OSHR 309, 4/7/05).

Earlier Guidance Available.

Without the interim guidance, the NIOSH spokesman said, people could refer to the existing guidance from 1999, the "Bioterrorism Readiness Plan: A Template for Healthcare Facilities," which can be found at http://www.bt.cdc.gov/agent/plague.

The NIOSH spokesman also said there will be a response to the AFL-CIO letter.

In its letter to CDC, the AFL-CIO According to the letter from the AFL-CIO to said: "The guidance is completely at odds with scientific evidence, legal requirements under the Occupational Safety and Health Act, existing [National Institute for Occupational Safety and Health] and OSHA guidance and recommendations for protecting responders, and the Worker Safety and Health Support Annex of the National Response Plan issued in December 2004."

Signed by Peg Seminario, director of occupational safety and health for the AFL-CIO, the letter was written on behalf of the American Federation of Government Employees; American Federation of State, County and Municipal Employees; American Federation of Teachers; Building and Construction Trades Department, AFL-CIO; Communications Workers of America; International Association of Firefighters; International Brotherhood of Teamsters; United Auto Workers; Service Employees International Union; United American Nurses; United Food and Commercial Workers; and United Steelworkers of America.

Event Could Suspend Rules.

On April 4, CDC issued its "Guidance for Protecting Health Care Workers Caring for Patients Potentially Exposed to Aerosolized Yersinia pestis from a Bioterrorism Event." The guidelines said that in a large bioterrorism event, circumstances "may require the suspension of some of the respiratory protection requirements found in the Occupational Safety and Health Administration Respiratory Standards (29 CFR 1910.134), such as fit testing and medical clearance" (35 OSHR 309, 4/7/05).

OSHA's respiratory protection standard requires that fit tests be conducted for those workers who must wear respiratory protection.

According to the unions, there is "NO scientific or medical evidence, historical or contemporary, that has demonstrated" that a surgical mask-- recommended by CDC to be sufficient to protect healthcare workers--provides adequate protection.

Misperception of Airborne Agents.

"Furthermore, there is a widely held misperception within the infection control community and perpetuated by the CDC that many biological agents are exclusively droplet transmitted, not airborne," the letter said. It cited a CDC workshop on respiratory protection for airborne infectious agents held in November 2004, which demonstrated that "this is simply a false and misleading dichotomy."

The letter also said:

• NIOSH Interim Recommendations for the Selection and Use of Protective Clothing and Respirators Against Biological Agents specify the use of powered air purifying respirators or a NIOSH-approved pressure demand self contained breathing apparatus.

• The NIOSH minimum level of protection is similar to the level of respiratory protection recommended by OSHA in its Best Practices for Hospital Based Receivers of Victims from Mass Casualty Incidents Involving the Release of Hazardous Substances, issued in January.

• The Worker Safety and Health Support Annex of the National Response Plan issued in 2004 to which the Department of Health and Human Services--CDC's parent agency--is a signatory, states that " 'developing, implementing, and monitoring an incident personal protective equipment program, including the selection, use, and decontamination of PPE; implementation of a respiratory fit-test program; and distribution of PPE,' is a key part of a response plan to protect workers in the event of a major incident, including a bioterrorist attack."

In addition, the letter said the terrorist attacks of Sept. 11, 2001, clearly demonstrated the need for adequate PPE. The lack of respiratory protection equipment, proper fit testing or training, resulted in "extensive and serious adverse respiratory effects" among many firefighters and others who responded, it said.

If health care workers are not provided with the proper equipment, they cannot be expected to participate and respond in the event of a bioterrorism attack, the letter said. "As was clearly demonstrated during the failed smallpox vaccination program, absent adequate protection, participation will not occur," the letter added.

By Ellen Byerrum