After listening to employers ranging from funeral directors and dentists to administrators of small hospitals and surgery centers, a Small Business Advocacy Review Panel advised the Occupational Safety and Health Administration to put the brakes on its infectious disease rulemaking.
The panel asked OSHA to halt work on a rule while it considers the infectious disease risk of different job tasks and work settings. If the agency moves forward, the panel suggested expanding the scope of the Bloodborne Pathogen Standard rather than creating a new rule, limiting the settings that would be covered, or even restricting the rule to training requirements.
In short, the panel’s report reflected the sentiment expressed by small business representatives in four November 2014 conference calls that a new infectious diseases rule would be burdensome and unnecessary.
Health care facilities are already diligent in their efforts to comply with guidelines and rules from CDC, the Centers for Medicare & Medicaid Services, The Joint Commission, and state and local health departments, says Dee Tyler, RN, COHN-S, FAAOHN, executive president of the Association of Occupational Health Professionals in Healthcare (AOHP). Overlapping regulations can create confusion, she says.
“We do not believe that specific regulation by OSHA on infectious disease will significantly improve current efforts in healthcare institutions to prevent infection exposure to workers,” she says.
Ironically, the small business review of the proposed infectious disease rule occurred just as two nurses became infected while caring for the nation’s first domestic case of Ebola.
“The Ebola outbreak has been the strongest example of why we need an OSHA infectious disease rule to protect health care workers,” contends Mark Catlin, health and safety director of the Service Employees International Union (SEIU).
“We had the [public] health officials and health care institutions primarily saying don’t worry, everything’s ready, no problem,” he says. “Within less than a month, it was pretty clear that the health care industry really wasn’t prepared to protect workers from Ebola.”
Mandatory vs. voluntary?
As OSHA considers how to move forward on the infectious disease rule, one question remains at the forefront: Are the current guidelines sufficient to protect health care workers?
The panel’s report spells out that concern as OSHA’s rationale for a new standard — that enforcement would improve adherence to infection control and result in a safer environment for both workers and patients.
“When these practices are consistently and rigorously followed, they have proven effective at preventing the spread of infections. OSHA believes that the evidence shows, however, that many employers do not consistently adopt or rigorously enforce these guidelines, leaving both workers and patients at risk of contracting infectious diseases,” the report said.
An infectious disease rule remains a regulatory priority, according to the fall 2014 regulatory agenda.
While the Ebola outbreak highlighted the risk to health care workers, other non-bloodborne diseases such as avian influenza or multi-drug resistant Staphylococcus aureus (MRSA) present an ongoing threat, says Jordan Barab, deputy assistant secretary of labor, told HEH.
“We’re in an age now where we have all kinds of infectious diseases that are antibiotic resistant,” he says. “Those are obviously workplace hazards and OSHA needs to have the rules to ensure that workers are protected.”
Barab notes that the small business representatives argued that they were already following voluntary guidelines — and, conversely, that it would be too burdensome to comply with the infectious disease rule as outlined in a draft proposal. The draft included requirements for employers to have a “worker infection control plan,” annual training, and “medical removal protection” that would provide pay and job protection for workers furloughed because of work-related exposures or illness.
While The Joint Commission requires hospitals to follow appropriate guidelines, there is no avenue for workers to file a complaint if they feel they are not adequately protected, Barab says.
OSHA will consider the small business comments as it drafts a proposed rule, a process that may take at least a couple of years, he says. The small business review process is “only the first of many steps we go through in which we solicit public input,” he says.