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

Small hospitals tell OSHA proposed new infectious disease regulations could bust their already strained budgets

A proposed rule designed to protect health care workers from infectious diseases places a costly burden on small hospitals, clinics, doctors’ offices and long-term care centers, representatives from those facilities recently told the Occupational Safety and Health Administration

In three days of hearings to gather information from small businesses, OSHA heard concerns about recordkeeping, unnecessary regulation and the provision for job protection of employees removed from work because of exposures.

“Just this year alone, 20 small hospitals closed. [That shows] what the costs can do to small hospitals,” said Leslie Marsh, MSN, RN, chief executive officer of Lexington Regional Medical Center in Nebraska.

OSHA presented a framework for an infectious diseases rule in October that is patterned after the Bloodborne Pathogen Standard and California’s Aerosol Transmissible Diseases Standard. It would require health care facilities to maintain a worker infection control plan, with input from frontline health care workers and annual updates. The plan would include hazard assessments, standard operating procedures that outline protective measures and exposure response, and a list of vaccinations offered to employees with possible declination statements.

In one provision, the draft rule would require employers to maintain pay, benefits, seniority and job status for employees who were removed or restricted from work due to a workplace exposure to an infectious disease for a period of up to 18 months – except for the common cold or influenza. Several of the small employers said they were concerned about the potential cost of that payment beyond workers’ compensation.

They also noted that they follow guidelines from the Centers for Disease Control and Prevention and requirements from OSHA, the Center for Medicare and Medicaid Services, state and local health departments, and accrediting agencies. OSHA’s draft rule would require employers to “consider applicable regulations and current guidelines” but would not specifically make CDC guidelines mandatory.

“We are all very, very highly regulated already,” said Judy Dahl, RN, assistant director of nursing at Johnson Memorial Health Services in Dawson, MN. “So much of what [OSHA requires in the proposed rule] is really redundant to what we’re already doing.”

Dahl also expressed concern about what would trigger the provisions of the proposed rule.

“The thing that bothers me the most is how you decide what is an exposure at work versus what is a community exposure,” she told OSHA officials at the hearings.

--Michele Marill

For more on this story see the January 2015 issue of Hospital Employee Health