Why Spirometry Training Is Required For Those Performing The Test In An Industrial Setting
The 1978 OSHA Cotton Dust Standard (29 CFR1910.1043) was the first to require that those performing spirometry undergo a two day training program and states that "Technicians who perform pulmonary function testing should have the knowledge required to produce meaningful results". The technician must be able to judge the degree of effort and cooperation of the subject. The test results obtained by a technician who lacks these skills are not only useless, but convey false information which could be harmful to the employee. It goes on to say: "Persons who successfully complete the course will be certified by OSHA or their designee" (NIOSH). Since then four OSHA Standards have been promulgated which spell out specific spirometry training requirements. These are: 29 CFR 1910.1026(Asbestos), 29 CFR1910.130 (1-3 Butadiene), 29 CFR1910.1027 (Cadmium), 29 CFR1910.1028 (Benzene). In addition, 14 other Standards require pulmonary system evaluations. Further, NIOSH recommends that pulmonary function tests be performed for those exposed to an additional 73 chemicals. To ignore this recommendation puts both the worker and the company at risk, given that they represent the weight of informed medical opinion.
In 1979, under the auspices of the American Thoracic Society (ATS), governmental agencies involved with spirometry testing (NIOSH, EPA, NCHS, etc.) and pulmonary specialists from across the country developed the first set of comprehensive performance standards for the spirometry test. This consensus standard was created to bring scientific rigor to this medical test and eliminate variability in findings due to differences in testing techniques and equipment performance specifications. This Standard has been updated twice, in 1987 and 1994. NIOSH and OSHA both recommend that the ATS Standards be used for the basis of all spirometry training (OSHA Standards and Compliance letter, 3/5/90). OSHA further justified their training requirements in their Standards and Compliance letter dated 1/26/81 that "the NIOSH approved training courses are very specialized and are designed to develop a high degree of uniformity in pulmonary function results. The goal of these courses are to assure that any technician testing a particular subject's pulmonary function would obtain the same results."
In a strongly worded position paper, (01/17/00) the American College of Occupational and Environmental Medicine (ACOEM) states the "Spirometry technicians in the occupational setting complete a NIOSH approved spirometry course as part of their training, and further, that they attend a refresher course every three years to discuss testing problems and to encourage technicians to remain vigilant and enthusiastic during spirometry testing of workers". For the complete text, go to www.acoem.org.. It goes on to say that
"Most companies now view NIOSH approval as minimal assurance that the course will adequately teach basic principles of spirometry. The NIOSH approved Spirometry Certification courses teaching this Standard provide safeguards for both the worker receiving the test and the health professional administering it. Given the litigious nature of occupational medicine, companies requiring this training for their medical staff recognize the value of such training to their risk management goals since the training is geared towards recognizing and avoiding the obvious and more subtle pitfalls of the test".
Clinics and physician practices providing occupational medical services have argued that such training is not needed; however, the American Association for Respiratory Care (AARC) in their 1996 Spirometry Update of the AARC Clinical Practice Guidelines, states that these standards (which are almost identical to the ATS Guidelines) be applied to testing in the pulmonary lab, skilled nursing facilities, clinic and treatment facilities, the physicians' office and public screening.
The Need For Spirometry Refresher Training
This two day seminar is offered to those who have already successfully completed the two day NIOSH approved course. The purpose of refresher training is two fold:
• To update students on the changes that have occurred in the ATS/ERS OSHA adopted Standard that occurred in 2005.
• To sharpen testing skills which tend to erode over a period of time.
Although the NIOSH Standard does not provide for a refresher/retraining course, it does, along with OSHA recommend refresher training be undertaken every five (5) years. The American College of Occupational and Environmental Health (ACOEM), which frequently advises OSHA on policy, strongly urges that all who provide spirometry testing undergo refresher training every three years to discuss testing problems and to encourage technicians to remain vigilant and enthusiastic during spirometry testing of workers.