OSHA Issues COVID-19 Emergency Temporary Standard
As a direct result of President Biden’s Executive Order (EO) regarding the health and safety of American health workers, the Occupational Safety and Health Administration (OSHA) issued an emergency temporary standard (ETS) on June 10, 2021, effective immediately upon publication in the Federal Register on June 21, 2021. The EO acknowledges an increased health risk to employees in healthcare settings where suspected or confirmed COVID-19 patients are treated and authorizes OSHA to issue an ETS to protect healthcare workers. The ETS will remain in place for up to six months, during which time the establishment of a permanent rule may be considered. Employers are required to comply with most provisions by July 6, 2021, except for certain provisions (i.e., those associated with physical barriers, ventilation, and training as further described herein), which have a July 21, 2021, deadline.
The ETS applies to many patient care settings including general hospitals; trauma centers; specialty hospitals; teaching hospitals; and ambulatory care facilities, including physician offices, dental offices, surgery centers, specialty care clinics, and urgent care centers. While many healthcare providers have voluntarily implemented COVID-19 prevention methods throughout the pandemic, the ETS establishes mandatory, nationwide standards that will be federally enforced. OSHA maintains that discretion will be used for employers making a “good faith effort” to comply with the ETS protocols; however, employers should properly prepare and not assume they will be recipients of such goodwill.
The ETS is cumbersome at 916 total pages. While not all-encompassing, PYA condensed the main provisions into the following list, providing a roadmap for immediate next steps to help guide compliance.
10 Key ETS Provisions
1. Employers must develop and implement a COVID-19 plan for each workplace to proactively and continuously identify and mitigate hazards (i.e., exposure to COVID-19) before employees are injured or develop disease. They must designate at least one safety coordinator to implement and monitor compliance with the plan. If the organization has more than 10 employees, the plan must be in writing. The plan should address identified workplace hazards, along with policies and procedures to minimize risk of transmission of COVID-19 to employees. Additionally, the policies and procedures must adhere to Standard and Transmission-Based precautions consistent with current Centers for Disease Control and Prevention (CDC) guidelines, which include infection control measures, such as appropriate use of personal protective equipment (PPE) and use of disposable or dedicated patient care equipment.
2. Employers must perform a hazard assessment as part of the COVID-19 plan. This must be accomplished using a team-based approach (i.e., including management, employees, and others as appropriate) and may include observing employee work habits and evaluating employee feedback. The hazard assessment is intended to identify potential exposure risks and provide a framework for control implementation.
3. With certain exceptions, employees must wear a facemask that covers their noses and mouths while indoors or in vehicles together. Excepted individuals include those fully vaccinated who work in well-defined areas where there is no reasonable expectation that any person with suspected or confirmed COVID-19 will be present. Employers must provide a sufficient number of facemasks to each employee as needed and must ensure each employee changes facemasks at least once daily, whenever soiled or damaged, or more frequently if required per patient care duties. A respirator (N95 or higher level) is required for those providing direct care to patients with confirmed COVID-19 and is recommended for use in circumstances where a respirator would enhance protection for employees not directly exposed to confirmed COVID-19 patients. An employee may choose to wear a respirator in place of a facemask if usage complies with the mini respiratory protection program. Respirators require both proper fit and filtration to be considered compliant.
4. Access to patient care areas must be limited and monitored to minimize exposure. All individuals entering the facility, including patients, family members, and delivery people, must be asked specific questions to determine whether the person is COVID-19 positive or has any related symptoms. Triage policies must be in place for any individual experiencing COVID-19 symptoms or illness. Such policies may include restricted entry, rescheduling of the appointment, examination room isolation, or instructing the patient to wait in his or her vehicle. The number of employees caring for suspected or confirmed COVID-19 patients should also be limited, and patient care should be carried out in an airborne infection isolation room when aerosol-generating procedures are performed. All surfaces and equipment must be properly disinfected after each use.
5. All individuals must maintain six-feet distance indoors, unless the employer can demonstrate that it is not feasible for an identified activity or in areas where employees are in movement such as in a hallway. Where individuals are not able to socially distance, a physical barrier must be installed. Such barriers are not required in direct patient care areas. Fully vaccinated workers are exempt from social distancing and other barrier methods used in the prevention of COVID-19 spread, although many healthcare organizations continue to maintain diligent physical distancing procedures.
6. Standard practices for cleaning and disinfection must be followed in compliance with the most current CDC guidelines. This includes routine cleaning of patient care areas, resident rooms, and all medical devices and equipment. All other high-touch surfaces must be properly disinfected at least once daily. Alcohol-based hand rub, containing at least 60% alcohol, must be available if readily accessible handwashing stations are not provided. Employers who own or control buildings with an existing heating, ventilation, and air conditioning system must make sure that system usage follows manufacturer standards; that circulation of outside air and air changes per hour are maximized; and, where compatible, air filters are rated with a Minimum Efficiency Reporting Value of 13 or higher.
7. Employees must:
- Be screened prior to each workday and shift.
- Immediately notify the employer if they test positive for COVID-19, suspect having COVID-19, or experience COVID-19-related symptoms.
- Notify within 24 hours any potentially exposed employees (i.e., those who have not worn PPE while in contact with the infected individual or those who have worked in the same physical space around the same time as the infected individual), when an individual who has been in the workplace tests positive for COVID-19.
- Follow requirements for removing employees from the workplace and keeping employees removed until they meet specific return-to-work criteria.
- In organizations with more than 10 employees, provide medical removal protection benefits to employees who must isolate or quarantine.
8. Employers must provide reasonable time off and paid leave for vaccinations and vaccine-related side effects. However, the ETS does not afford employers financial assistance for either employee time off or paid leave and does not provide a special funding allocation similar to previous COVID-19 relief funding programs.
9. All employees must receive training to thoroughly understand the transmission of COVID-19, workplace occurrences that could result in an infection, and all relevant COVID-19 policies and procedures. Additional training is required if changes occur that affect employees’ risk, if policies and procedures change, or if the employer has reason to believe the necessary skill or understanding was not retained through initial training.
10. If an organization employs more than 10 employees, it must establish a log to document all employee instances of COVID-19 without regard to occupational exposure. All employers must report any work-related COVID-19 in-patient hospitalizations (within 24 hours) and fatalities (within 8 hours) to OSHA.
Immediate Key Next Steps
- Conduct a hazard assessment. If a hazard assessment was previously completed as part of your organization’s response to COVID-19, ensure the assessment is incorporated into your COVID-19 plan. To initiate or refresh an assessment given team-based requirements, identify team members including management and other employees, and determine the most appropriate assessment approach (i.e., survey your facility(s) to observe employee work habits, or conduct an employee survey and evaluate results). The goal of the assessment is to determine if employees could be exposed and if controls are in place to mitigate such risks.
- Develop a formal COVID-19 plan. In most cases, a formal or even informal COVID-19 plan is already in place to minimize the risk of COVID-19 transmission. Review any existing plan (or develop a new plan) per OSHA’s “traditionally identified seven core elements of successful safety and health programs,” and appoint a COVID-19 coordinator, if not already identified, and charge him or her with plan implementation.
- Establish and maintain an exposure log. If your organization employs more than 10 individuals, establish a log to document all employee instances of COVID-19 (regardless of whether the instance is connected to an exposure at your organization, with some exceptions). The log must include each COVID-19-positive employee’s name; at least one form of contact information, such as phone number or email address; occupation; workplace location; date of the employee’s last day at the aforementioned workplace; date of positive test and/or diagnosis of COVID-19; and the date the employee first had one or more COVID-19 symptom(s). All information must be logged within 24 hours of the employer learning the employee is COVID-19-positive. Though not required, log retrospective information dating back to the start of the pandemic, if available. Treat such log as a confidential medical record, only to be disclosed as required by the ETS or other federal law.
- Install physical barriers where necessary. Identify work locations outside of direct patient care areas where physical distancing of six feet is not feasible. Consider the most appropriate type of solid barrier for your organization (i.e., cleanable or disposable). Design, construct, and install barriers to prevent droplets from reaching employees when they are in their normal sitting or standing location relative to their workstation. The ETS does not specify the type of material to use.
- Evaluate COVID-19-related policies and procedures. Review existing and/or implement new policies and procedures associated with the provision and use of PPE, such as facemasks and respirators; employee screening and reporting protocols; process for notifying any potentially exposed employees; removal and return-to-work requirements; and provision of medical removal protection benefits, as applicable.
- Prepare for and conduct training for all employees. Review existing and/or implement COVID-19 training curriculum and procedures. Ensure each employee receives training by an individual knowledgeable about the ETS and in a language and at a literacy level the employee can understand. Training must encompass COVID-19 transmission, symptoms and ways to reduce risk, patient screening and management, situations that could result in an infection, policies and procedures related to PPE use, cleaning and disinfection, health screening and medical management (e.g., medical removal), and anti-retaliation rights and responsibilities. Develop a policy that describes when subsequent training is required, and although not explicitly required, document all training for both existing and new employees.
The ETS will be updated accordingly as OSHA continues to monitor trends in COVID-19 infections and death rates as the pandemic and vaccination rates continue to evolve. Detailed information regarding compliance assistance; guidance; worker’s rights; and COVID-19 laws, regulations, and policies can be found on the OSHA website.
|Realty Trust Group (RTG), a PYA affiliate and innovative provider that focuses on healthcare real estate and other support services solutions, has released a new white paper, “COVID-19 Briefing: Summary of OSHA’s Emergency Temporary Standards Subpart U”, which pertains to these recent OSHA regulations. In this briefing, RTG offers several key takeaways and immediate considerations for the environment of care and healthcare facility and property management teams.
For further information about OSHA guidance please attend our upcoming webinar on this topic, or contact a PYA executive below at (800) 270-9629.