After receiving numerous comments requesting the action, the Occupational Safety and Health Administration (OSHA) extended the comment period for its COVID-19 healthcare emergency temporary standard (ETS) to Aug. 20.

“OSHA is extending the comment period by 30 days to allow stakeholders additional time to review the ETS and collect information and data necessary for comment,” the agency announced.1 However, as of press time, OSHA had not granted multiple requests to delay the ETS for six months.

Comments can be submitted electronically for Docket No. OSHA-2020-0004 via the Federal eRulemaking Portal at www.regulations.gov. Follow the online instructions.

OSHA’s ETS to protect healthcare workers from COVID-19 became effective upon publication in the Federal Register on June 21.2 Employers must comply with most provisions within 14 days, but can take up to 30 days for requirements involving physical barriers, ventilation, and training. The ETS is in effect for six months, and OSHA requested comments on whether it should become a final rule after that period.

The American Hospital Association (AHA), representing about 5,000 facilities, requested the six-month delay, saying “changes in hospital policies and procedures are not simply a matter of changing words on paper; they require careful analysis and planning, the acquisition of needed materials and tools, and the retraining of personnel. For organizations that are already busy caring for their communities’ ill and injured, it will take time to accomplish all of these required changes.”2

The AHA cited ETS requirements that could increase risk, including barrier requirements that could impede airflow.

“Our members also are unsure how they will implement the provisions in the mini respiratory protection standard that permit employees who are not required to wear respirators to bring their own into the hospital,” the AHA stated. “Moreover, this provision will allow employers to provide respirators to employees who are not required to wear them, and without the benefit of fit testing, medical evaluation, or a written program. Many of our members have noted that these requirements, which contradict OSHA’s own PPE [personal protective equipment] and respiratory protection standards, raise huge liability exposures for the employer and put these employees at additional risk.”2

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) represent more than 14,500 nonprofit and proprietary skilled nursing facilities and skilled assisted living communities.

“Long-term care has been hit extremely hard by this pandemic and continues to confront substantial staffing challenges,” the AHCA/NCAL said. “While many of these standards are already in place in our provider’s communities, some of the new standards require a level of resources that many centers do not currently have available and will take extended time to fully implement. For example, designating a COVID-19 workplace safety coordinator is challenging for small or independent facilities with limited resources staffing-wise as well as financially due to census impacts from COVID-19.”

Designed to protect healthcare workers from COVID-19, the bulk of the ETS could be woefully out of date if mandated vaccination policies lead to immunizing virtually the entire hospital workforce against the virus.

“I hope there is an understanding that when you get people vaccinated some of these ETS requirements are not going to make sense,” says Connie Steed, MSN, RN, CIC, director of infection prevention and control at Prisma Health in Greenville, SC.

OSHA requires hospitals and other facilities under the regulation to “provide reasonable time and paid leave for vaccinations and vaccine side effects.” Beyond that, for the most part, those who are vaccinated must follow the OSHA regulations as if they were not immunized.

“I didn’t see anywhere in the standard where they say it is OK not to mask if you are vaccinated in a hospital,” Steed says. “I think people are asking the question, and what [OSHA] is saying is, ‘If you have a controlled area in the hospital where you know there is not going to be anyone with COVID — and you know everybody is vaccinated — you can take off a mask.”

Meeting those requirements without mandating staff vaccinations will be problematic. “It’s going to be hard. I think this pushes employers to require the vaccine,” Steed says, noting she is not in favor of the ETS being finalized as written currently.

While pointing out that approximately one-quarter of healthcare workers have not yet completed COVID-19 vaccination, OSHA left the door open for revisions as the pandemic continues and more people are vaccinated.

REFERENCES

  1. Occupational Safety and Health Administration. OSHA extends comment period for COVID-19 healthcare emergency temporary standard. July 8, 2021.
  2. American Hospital Association. AHA requests more time for hospitals navigating OSHA’s COVID-19 emergency temporary standards. June 29, 2021.