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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

OSHA drafts national infectious disease standard: Ebola outbreak could give regulation political clout

By Michele Cohen Marill, Editor, Hospital Employee Health

Infection control measures -- including hazard identification and exposure control -- would become mandatory under a proposed infectious diseases rule by the Occupational Safety and Health Administration (OSHA).

OSHA has been working on the rule for years, so the timing with the first cases of Ebola in the U.S. is coincidental. But ongoing Ebola events provide a compelling backdrop for OSHA action, particularly the recent infection of two nurses in Dallas and the subsequent decision by the Centers for Disease Control and Prevention to increase the “margin of safety” with enhanced infection control for health care workers.

“Workers currently face a number of infectious diseases, and there are always new threats over the horizon – MERS, Avian Flu, and, of course, Ebola,” an OSHA spokesperson told HEH. “The infectious disease standard would require employers to have a plan to protect their employees from any infectious disease, rather than going on a disease-by-disease basis.”

The 38-page draft entitled “OSHA’s Infectious Diseases Regulatory Framework” was recently posted on a government regulatory site and has not yet been published for formal review and comment. Employee health professionals expressed concern with provisions that involve significant documentation and policy writing. Parts of the proposed regulation also could overlap with existing state and local health laws, requirements from accrediting bodies and even other OSHA standards, says Dee Tyler, RN, COHN-S, FAAOHN, executive president of the Association of Occupational Health Professionals in Healthcare (AOHP).

“We can make things so complex that healthcare providers and organizations find it impossible to comply with all the regulations and become distracted from their primary mission,” she says.

Likewise infection preventionists may also have concerns about issues of policy-writing and documentation, particularly since they recently sounded the alarm about being overwhelmed by Ebola training demands. CDC guidelines are recommendations and are not enforceable as regulations. Currently, only California hospitals face enforcement action if they don’t follow infection control guidelines. The national OSHA draft standard is modeled in part on the California Aerosol Transmissible Disease standard -- which covers diseases that are spread by the droplet and airborne routes -- and includes some existing requirements in the OSHA Bloodborne Pathogen Standard.

The draft OSHA infectious disease standard would require hospitals and other health care employers to:

  • Create a written “worker infection control plan,” which would include a determination of jobs that involve possible exposure and standard operating procedures for infection control.
  • Update the plan at least annually, with input from frontline workers with potential for exposure.
  • Conduct infectious disease hazard evaluations.
  • Ensure that employees have access to personal protective equipment and use it properly.
  • Investigate exposure incidents.
  • Provide vaccinations free of charge for influenza, measles/mumps/rubella, pertussis and varicella and any other vaccine in the worker infection control plan or that is considered medically appropriate for an employee.
  • Obtain signed declination statements from employees who decline a vaccine. (The proposed rule is silent on employer mandates for vaccination.)
  • Conduct training at least annually.
  • Provide pay and job protection for employees who are furloughed or ill because of an exposure (except for most cases of the common cold or seasonal influenza).
[Editor’s note: A copy of the draft version of the OSHA infectious diseases rule is available at using document number OSHA-2010-0003-0245.]