OSHA Issues Temporary Emergency Standard for Healthcare Settings

Regulation | June 10, 2021 | by Cory Kallheim

The U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) issued an emergency temporary standard (ETS) for healthcare settings June 10. The standard focuses on healthcare workers most likely to have contact with someone infected with the virus.

The U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) issued an emergency temporary standard (ETS) for healthcare settings June 10. The standard focuses on healthcare workers most likely to have contact with someone infected with the virus.

In issuing the ETS, OSHA determined that employee exposure to SARS-CoV-2 (the virus that causes COVID-19) presents a grave danger to workers in healthcare settings where people with suspected or confirmed COVID-19 are reasonably expected to be present.

The ETS is effective immediately upon publication in the Federal Register (yet to be determined). Employers must comply with most provisions within 14 days, and with provisions involving physical barriers, ventilation, and training within 30 days. OSHA pledged to use its enforcement discretion to avoid citing employers who are making a good faith effort to comply with the ETS. If OSHA finds a grave danger from the virus no longer exists for the covered workforce or new information warrants a change, OSHA will update the ETS.

LeadingAge will continue to monitor any guidance from OSHA as well as review how this guidance compares and contrasts with current CDC and CMS guidance, but below is a summary of the key provisions of the ETS.

Who is subject to the ETS?

The ETS applies, with a few exceptions, to settings where any employee provides healthcare services or healthcare support services. This includes employees in hospitals, nursing homes, and assisted living facilities; emergency responders; hospice; home healthcare workers; and employees in ambulatory care facilities where suspected or confirmed COVID-19 patients are treated. Relevant to LeadingAge members, it does not apply to:

Home healthcare (and hospice) settings where all employees are fully vaccinated and all non-employees are screened prior to entry and people with suspected or confirmed COVID-19 are not present; or

Healthcare support services not performed in a healthcare setting (e.g., off-site laundry, off-site medical billing, corporate offices).

Also, for healthcare settings embedded in non-healthcare settings, the ETS applies only to the embedded healthcare setting and not to the remainder of the physical location. This seems to be the logical way to interpret the application to life plan communities and their different levels of care on a single campus.

Importantly, the ETS exempts fully vaccinated workers from the masking, distancing, and barrier requirements of the ETS when in “well-defined areas where there is no reasonable expectation that any person with suspected or confirmed COVID-19 will be present.” For more information on what this may mean see this OSHA flow chart.

Requirements of the ETS

Develop and implement a COVID-19 plan: Healthcare employers must develop and implement a written COVID-19 plan that includes a designated safety coordinator with authority to ensure compliance, a workplace-specific hazard assessment, involvement of non-managerial employees in the hazard assessment, development, and plan 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 /resident 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 hand washing 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.

Recordkeeping: Establish a COVID-19 log of all employee instances of COVID-19, without regard to occupational exposure, and follow requirements for making records available to employees/representatives.

Continue to Report work-related COVID-19 fatalities and in-patient hospitalizations to OSHA.