Sometimes when you smell something…
I guess this is all part of the “return to normalcy” program upon which we are (seemingly) currently embarked, but it does appear that the regulatory “sticks” are being brought to bear (how come they never come bearing carrots – sigh!) as our adherence to the various mandates, disputed mandates, mandates that aren’t mandates at the moment, but could become mandates in the future, etc., is being assessed for compliance.
First up, we have our fiends, oops, friends, from the Occupational Health and Safety Administration (OSHA) who are bouncing back from their smackdown from The Supremes to provide a little focused (from March 9 until June 9) entertainment for those healthcare organizations they feel are at greater risk to employees because of their care, etc., for COVID patients. (Start here: https://www.osha.gov/news/newsreleases/trade/03072022-0 ). The criteria for inclusion in the enhanced inspection experience is as follows:
- Follow-up inspection of any prior inspection where 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 (UPA), to include COVID-19 complaints and Rapid Response Investigations (RRIs); or
- Monitoring inspections for randomly selected, remote-only COVID-19 inspections where COVID-19-related citations were previously issued.
The types of facilities they’re targeting is pretty focused as well:
- General Medical and Surgical Hospitals
- Psychiatric and Substance Abuse Hospitals
- Nursing Care Facilities (Skilled Nursing Facilities)
- Assisted Living Facilities for the Elderly
In terms of how they’ll be administering this program, it does appear that those of you in the studio audience who have not been visited upon during the pandemic are less likely that those of whom the inspection experience was all too real.
That said, even with the December removal of the mandated requirements in the initial Emergency Temporary Standard—leaving only the elements related to reporting—compliance with all the elements of the initial ETS would result in a finding of compliance after they conduct a thorough review of the COVID response/protection plan (including your OSHA logs) and a walkaround to determine active compliance under the Respiratory Protection Standard, among other existing standards.
Part of me has a hard time figuring out how, particularly in the limited availability of contact tracing, one could determine that any COVID case involving staff was definitively the result of an occupational exposure, but I guess that’s one of the key elements for which they would be assessing recordkeeping compliance.
The information provided would seem to indicate that OSHA’s intent is to establish a permanent standard in this regard, but I’m not sure about the long-term likelihood of that actually happening. I can’t help but think about the TB standard that never quite made it all the way to prime time and, clearly, there’s enough regulatory content in existing standards (Recordkeeping; General Duty Clause; Respiratory Protection; PPE) to be able to appropriately police organizations’ response plans.
I won’t be surprised if the COVID-specific stuff fails to make it all the way to permanence, but I suppose the lessons learned will have applications beyond the current Public Health Emergency. One interesting note is that, while the OSHA vaccine/mask mandate combo were rebuffed, the guidance (https://www.osha.gov/laws-regs/standardinterpretations/2022-03-02 ) does indicate that if issues with vaccinations are noted during the inspections, they will be notifying CMS of any compliance issues, so better make sure that the vaccination ducks are in a row. Which leads us to…
And of course, the Chicagoans are getting right back to it on the vaccination front (https://www.accreditationqualitycenter.com/articles/no-slow-start-tjc-enforcing-vaccine-requirements ), to no one’s surprise. At this point, I think we’ll have to wait and see how much of a focus this will be during the triennial survey visits.
Certainly folks have been working extraordinarily hard in the face of various obstacles in order to provide a safe environment for patients and staff; and just as certainly, there’s a lot that’s been learned over the past 24 months. Hopefully, at least some of the grading will be against that learning / living curve.
About the Author: Steve MacArthur is a safety consultant with The Greeley Company in Danvers, Mass. He brings more than 30 years of healthcare management and consulting experience to his work with hospitals, physician offices, and ambulatory care facilities across the country. He is the author of HCPro's Hospital Safety Director's Handbook and is contributing editor for Healthcare Safety Leader. Contact Steve at stevemacsafetyspace@gmail.com.