The Occupational Safety and Health Administration (OSHA) has issued an emergency temporary standard (ETS) to protect healthcare workers from COVID-19, putting regulatory teeth into recommended practices by the Centers for Disease Control and Prevention (CDC).1 

“OSHA has determined the most impactful action we can take at this time is to issue an emergency temporary standard that is focused on healthcare settings where workers are most likely to come into contact with someone carrying the virus,” Jim Frederick, Acting Assistant Secretary of Labor for Occupational Safety and Health, said at a June 10, 2021, press conference. “This includes workers in hospitals, nursing homes, and other high-risk areas in healthcare settings.”

President Biden issued an executive order on Jan. 21, 2021, calling for OSHA to take action to protect workers, which the agency can do most quickly by issuing an ETS.

OSHA determined that healthcare workers are in “grave danger” from COVID-19 but did not broach the controversial subject of vaccine mandates some hospitals are adopting. Hospitals and other facilities under the regulation are required to “provide reasonable time and paid leave for vaccinations and vaccine side effects.”

The OSHA standard is effective upon publication in the Federal Register, which Frederick said will be as soon as possible. At that point, employers must comply with most provisions within 14 days, but can take up to 30 days for requirements involving physical barriers, ventilation, and training.

“While we are heartened by the pace of vaccinations and the current trajectory of the virus, not all workers are protected yet,” Frederick said. “These are workers who go to work day in and day out to take care of us to save our lives. We must make sure that we do everything in our power to return the favor – to protect them while they care for us.”

Will ETS Become Permanent Standard?

The temporary standard also serves as a proposed permanent standard, which means it will be open to review and comment for six months before possibly being finalized. Although infection preventionists historically have preferred the flexibility of CDC guidelines to regulations, there is some momentum for OSHA to finalize the ETS.

It also could, after the pandemic, form the basis for a long-discussed infectious disease standard by OSHA, but that remains to be seen.

The ETS requirements generally apply to all settings where any employee provides healthcare services or healthcare support services. “Our estimates are that there are approximately 10.3 million employees or workers in the establishments that will need to comply with the requirements of the standard,” Frederick said.

OSHA posted a flow chart for employers who are unsure if the regulation applies to their facility or employees.2

“The ETS does not apply to the dispensing of prescriptions by pharmacists in retail settings, healthcare support services not performed in a healthcare setting (e.g., off-site laundry, off-site medical billing), and telehealth services performed outside of a setting where direct patient care occurs,” OSHA states in the chart.

In addition to hospitals and nursing homes, the standard applies to emergency responders, home healthcare workers, and ambulatory care facilities where suspected or confirmed COVID-19 patients are treated, according to an OSHA fact sheet on the standard.3

“The ETS exempts fully vaccinated workers from masking, distancing, and barrier requirements when in well-defined areas where there is no reasonable expectation that any person with suspected or confirmed COVID-19 will be present,” OSHA states, which is in keeping with CDC guidelines.

In situations where all employees may not be vaccinated, OSHA requires employers to “provide and ensure each employee wears a facemask when indoors and when occupying a vehicle with other people for work purposes.”

Employees must “use respirators and other PPE (personal protective equipment) for exposure to people with suspected or confirmed COVID-19, and for aerosol-generating procedures on a person with suspected or confirmed COVID-19,” OSHA states.

OSHA also has a technical requirement on ventilation calling for HVAC systems to be used in accordance with manufacturer’s instructions and design specifications for the systems. Air filters must be rated Minimum Efficiency Reporting Value (MERV) 13 or higher if the system allows it.

All healthcare facilities with more than 10 employees must develop and implement a written COVID-19 plan that “includes a designated safety coordinator with authority to ensure compliance, a workplace-specific hazard assessment, involvement of non-managerial employees in hazard assessment and plan development/implementation, and policies and procedures to minimize the risk of transmission of COVID-19 to employees.”

The plan does not have to be in writing for facilities with 10 or less employees, nor do these small sites have to create a COVID-19 log. All others must establish a log of all COVID-19 cases in healthcare workers “without regard to occupational exposure,” OSHA states. Employers also must report work-related COVID-19 fatalities and in-patient hospitalizations of workers to OSHA.

Enforcement Planned

While essentially codifying CDC recommendations, Frederick warned that OSHA will continue to respond to complaints of unsafe working conditions and conduct inspections to ensure compliance with the standard.

“Throughout the pandemic, healthcare workers in these settings continue to be the source of the highest number of complaints OSHA has received,” he said.

“We will continue inspections under our national emphasis program to hold bad actors accountable for failing to protect employees. When we open up an inspection, we are showing up to investigate,” Frederick added.

In a provision protecting workers from retaliation, OSHA states healthcare facilities must “inform employees of their rights to the protections required by the standard and do not discharge or in any manner discriminate against employees for exercising their rights under the ETS or for engaging in actions required by the standard.”

OSHA requires that regulated sites adopt Standard and Transmission-Based Precautions consistent with CDC recommendations.

“Ensure all employees receive training so they comprehend COVID-19 transmission, tasks, and situations in the workplace that could result in infection, and relevant policies and procedures,” OSHA states.

Other key provisions include many practices healthcare facilities already have adopted, but these now can be enforced under the OSHA regulation. These include:

Patient screening and management: Limit and monitor points of entry to settings where direct patient care is provided; screen and triage patients, clients, and other visitors and non-employees; implement patient management strategies.

Aerosol-generating procedures on a person with suspected or confirmed COVID-19: Limit employees present to only those essential. Perform procedures in an airborne infection isolation room, if available, and clean and disinfect surfaces and equipment after the procedure is completed.

Physical distancing: Keep people at least six feet apart when indoors.

Physical barriers: Install cleanable or disposable solid barriers at each fixed work location in nonpatient care areas where employees are not separated from other people by at least six feet.

Cleaning and disinfection: Follow standard practices for cleaning and disinfection of surfaces and equipment in accordance with CDC guidelines in patient care areas, resident rooms, and for medical devices and equipment.

In all other areas, clean high-touch surfaces and equipment at least once a day and provide alcohol-based hand
rub that is at least 60% alcohol or provide readily accessible handwashing facilities.

Health screening and medical management:

  • Screen employees before each workday and shift.
  • Require each employee to notify the employer promptly when the employee is COVID-19 positive, suspected of having COVID-19, or experiencing certain symptoms.
  • Notify certain employees within 24 hours when a person who has been in the workplace is COVID-19 positive.
  • Follow requirements for removing employees from the workplace.
  • For employers with more than 10 employees, provide medical removal protection benefits in accordance with the standard to workers who must isolate or quarantine.

REFERENCES

  1. Occupational Safety and Health Administration. Subpart U — COVID-19 Emergency Temporary Standard. https://www.osha.gov/sites/default/files/covid-19-healthcare-ets-reg-text.pdf
  2. Occupational Safety and Health Administration. Is your workplace covered by the COVID-19 healthcare ETS? Published June 2021. https://www.osha.gov/sites/default/files/publications/OSHA4125.pdf
  3. Occupational Safety and Health Administration. Fact Sheet: Subpart U—COVID-19 healthcare ETS. Published June 2021. https://www.osha.gov/sites/default/files/publications/OSHA4122.pdf