OSHA outlines new emergency temporary standard on COVID-19 safety for healthcare workers

By A.J. Plunkett (aplunkett@decisionhealth.com)

Be prepared to implement the elements of a new OSHA emergency temporary standard (ETS) on COVID-19 safety for workers in your hospital or other parts of your healthcare system where potential exposure to the deadly coronavirus is possible.

Some elements of the emergency standard will be effective as quickly as 14 days from when it is published in the Federal Register and 30 days for the rest of it, according to fact sheets posted by OSHA. The main section of the rule adding Subpart U to OSHA's regulations was released on June 15 and the full 868-page rule was prepublished in the Federal Register June 17, with an official publication date of June 21, 2021. 

Many of the elements in the ETS, such as patient screening and management and precautions against transmission, should already be in place in your hospital or health organization. However, any healthcare workplace with more than 10 employees will be required to have a written plan developed and implemented according to OSHA requirements.

That includes a requirement that employees be given reasonable time off and paid leave to receive a COVID-19 vaccination and deal with any side effects.

The plan also requires training with the relevant policies and procedures outlined, recordkeeping and reporting on training and in-house occupational exposures to COVID-19 including fatalities, as well as an anti-retaliation policy.

There is also an element requiring what OSHA is calling a mini respiratory protection program.

The temporary emergency standard has been both hailed nursing organizations as necessary to continue to protect healthcare works during the continuing pandemic and criticized by the American Federation of Teachers because it covers only the healthcare industry.

Review your current COVID-19 policies and procedures and work now on translating those into OSHA documents. The standard, which is being offered also as a proposed rule to be made permanent in OSHA requirements under Subpart U.

Here are the basic elements, according to the OSHA Fact Sheet:

• COVID-19 plan: Develop and implement a COVID-19 plan (in writing if more than 10 employees) 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.
• 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.
• Standard and Transmission-Based Precautions: Develop and implement policies and procedures to adhere to Standard and Transmission-Based precautions based on CDC guidelines.
• Personal protective equipment (PPE): Provide and ensure each employee wears a facemask when indoors and when occupying a vehicle with other people for work purposes; provide and ensure employees use respirators and other PPE for exposure to people with suspected or confirmed COVID-19, and for aerosol-generating procedures on a person with suspected or confirmed COVID-19.
• 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 6 feet apart when indoors.
• Physical barriers: Install cleanable or disposable solid barriers at each fixed work location in non-patient care areas where employees are not separated from other people by at least 6 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.

Ventilation: Ensure that employer-owned or controlled existing HVAC systems are used in accordance with manufacturer’s instructions and design specifications for the systems and that air filters are rated Minimum Efficiency Reporting Value (MERV) 13 or higher if the system allows it.

• Health screening and medical management: (1) Screen employees before each workday and shift; (2) Require each employee to promptly notify the employer when the employee is COVID-19 positive, suspected of having COVID-19, or experiencing certain symptoms; (3) Notify certain employees within 24 hours when a person who has been in the workplace is COVID-19 positive; (4) Follow requirements for removing employees from the workplace; (5) Employers with more than 10 employees, provide medical removal protection benefits in accordance with the standard to workers who must isolate or quarantine.
• Vaccination: Provide reasonable time and paid leave for vaccinations and vaccine side effects.
• Training: 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.
• Anti-Retaliation: 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.  Requirements must be implemented at no cost to employees.
• Recordkeeping: Establish a COVID-19 log (if more than 10 employees) of all employee instances of COVID-19 without regard to occupational exposure and follow requirements for making records available to employees/representatives. Report work-related COVID-19 fatalities and in-patient hospitalizations to OSHA.
• Reporting COVID-19 fatalities and hospitalizations to OSHA: Report to OSHA each work-related COVID-19 fatality within 8 hours of learning about the fatality, and each work-related COVID-19 in-patient hospitalization within 24 hours of learning about the in-patient hospitalization.
• Mini respiratory protection program (29 CFR 1910.504): Under certain circumstances in the ETS, and only for employees who are not exposed to suspected/confirmed sources of COVID-19 or other hazards that may require respirator use covered under the normal Respiratory Protection Standard (29 CFR 1910.134), the employer must provide training on inspecting, putting on, removing, and using respirators like N-95s; the limitations and capabilities of the respirator; procedures and schedules for storing, maintaining, and inspecting respirators; how to perform a user seal check; and how to recognize medical signs and symptoms that may limit or prevent the effective use of respirators

For a list of FAQS go to https://www.osha.gov/coronavirus/ets/faqs. For more fact sheets and a link to the full rule, go to OSHA’s web site on the standard: https://www.osha.gov/coronavirus/ets

* This article was updated June 18 to reflect the full release of the emergency temporary standard on the Federal Register.