OSHA Finalizing COVID-19 Rule in Healthcare Settings
OSHA has briefly reopened comments and slated a public hearing for April 27 as it moves to finalize its Emergency Temporary Standard (ETS) to protect healthcare workers (HCWs) from COVID-19.
The ETS was originally issued June 21, 2021, with OSHA requiring multiple protections, including barriers, social distancing, and upgraded ventilation. Since most HCWs are vaccinated, and the CDC issued new guidelines, OSHA is considering relaxing some of its requirements.
”OSHA is considering suggestions that requirements be relaxed for masking, barriers, or physical distancing for vaccinated workers in all areas of healthcare settings, not just where there is no reasonable expectation that someone with suspected or confirmed COVID-19 will be present,” the agency noted.1
As this report was filed, the deadline for submitting comments was April 22. The virtual hearing will begin on April 27 and, if necessary, will continue on subsequent days.
Since the CDC guidelines changed, the ETS is no longer in alignment with some provisions, including isolation and return to work requirements. “OSHA is considering whether it is appropriate to align its final rule with some or all of the CDC recommendations that have changed between the close of the original comment period for this rule and the close of this comment period,” the agency stated. “OSHA seeks comment on this approach.”
Noting some healthcare employers found the ETS provisions overly prescriptive, OSHA “is considering restating various provisions as broader requirements without the level of detail included in the Healthcare ETS and providing a ‘safe harbor’ enforcement policy for employers who are in compliance with CDC guidance applicable during the period at issue.”
OSHA also is seeking comment on linking regulatory requirements to measures of local risk, similar to what the CDC has done for healthcare settings and in guidance for prevention measures in the community.
In a question that will not likely yield a definitive answer, OSHA asked for comment on the likelihood of future SARS-CoV-2 variants arising, or even a completely different coronavirus strain that causes similar disease in humans. OSHA described the latter scenario as “a hypothetical COVID-22.’’
“OSHA is considering specifying that this final standard would apply not only to COVID-19, but also to subsequent related strains of the virus that are transmitted through aerosols and pose similar risks and health effects,” the agency stated. This point also has been made by critics, saying a standard applicable to other respiratory viruses would have more utility and staying power than measures strictly for COVID-19.
Acknowledging the previous comment period for the ETS closed before delta and omicron variants appeared, OSHA asked for new studies or data on “the rate of infection, long COVID, hospitalization, and death among healthcare workers compared to those rates among the general adult population.”
OSHA requested more information on several other key indicators:
- The average number of days HCWs have been out with COVID-19 infection or quarantine;
- The percentage of HCWs who have taken sick days due to COVID-19 infection;
- The health effects of breakthrough infections in fully vaccinated employees, including hospitalizations, long COVID, and mortality;
- The percentage of healthcare workers who, due to age or compromised immunity, are at elevated risk of severe COVID-19.
In a separate action, OSHA announced a temporary increase in “focused” inspections of hospitals and skilled nursing facilities that treat or handle COVID-19 patients.2 The new inspection program began March 9, and will end on June 9. Facilities may be selected for inspections if they meet any of the following criteria:
- Follow-up inspection after a COVID-19-related citation or hazard alert letter (HAL) was issued;
- Follow-up or monitoring inspections for randomly selected closed COVID-19 unprogrammed activity, including COVID-19 complaints and Rapid Response Investigations;
- Monitoring inspections for randomly selected, remote-only COVID-19 inspections where citations were issued previously.
OSHA called for its area offices to “generate a list” of previously inspected establishments where COVID-19 citations or HALs were issued, including remote-only inspections where COVID-19-related citations were issued, the agency states.
“OSHA’s goal is to mitigate the spread of COVID-19 and future variants of the SARS-CoV-2 virus and ensure the health and safety of healthcare workers at heightened risk for contracting the virus,” the agency noted. “Through this initiative, OSHA will assess employer compliance efforts, including the readiness of hospitals and skilled nursing care employers to address any ongoing or future COVID-19 surges.”
OSHA inspection instructions to its compliance officers include revisiting previously cited problems and conducting a general walk-around assessment in common areas and those designated for treatment of COVID-19 patients.
“Determine whether the employer has implemented a COVID-19 plan that includes preparedness, response, and control measures for the SARS-CoV-2 virus,” OSHA stated. “Verify the existence and effectiveness of all control measures, including procedures for determining vaccination status by reviewing relevant records. Verification of vaccination protocols may be an indicator of a facility’s overall COVID-19 mitigation tactics. OSHA will refer any vaccination-related deficiencies to the Centers for Medicare & Medicaid Services.”
In addition to reviewing OSHA illness and injury logs, inspectors will assess the facility’s procedures for conducting hazard assessments and protocols for personal protective equipment use.
“Conduct a limited records review of the employer’s respiratory protection program,” OSHA stated. “The records reviewed may be limited to the written respiratory protection program and fit tests, medical evaluations, and training records for the interviewed employees.”
REFERENCES
- Occupational Safety and Health Administration. Occupational exposure to COVID-19 in healthcare settings. Fed Regist 2022;87: 16426-16431.
- OSHA. COVID-19 focused inspection initiative in healthcare. March 2, 2022.
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