By Gary Evans, Medical Writer
Under the Centers for Disease Control and Prevention’s (CDC) current guidance for healthcare workers, many requirements for those workers are triggered based on the level of community transmission of COVID-19 (e.g., controls needed in areas of substantial or high transmission, controls not needed in areas of low or moderate transmission),” OSHA stated in reopening the ETS for comment.1 “OSHA is considering linking regulatory requirements to measures of local risk, such as CDC’s community transmission used in CDC’s guidance for healthcare settings or the CDC’s COVID-19 Community Levels used in CDC’s guidance for prevention measures in community settings.”
Such an approach would create the flexibility many have been calling for, which have come with the warning that requirements set in regulatory stone could quickly be outdated by the changing nature of the pandemic.
“One of the concerns is that, as COVID-19 surges and drops, [OSHA] has got to be careful about putting out expectations at the level of pandemic,” says Connie Steed, RN, an infection prevention consultant in Greenville, SC.
“There needs to be some flexibility, something along the lines of the control measures being based on a risk assessment,” says Steed, a former president of the Association for Professionals in Infection Control and Epidemiology (APIC).
OSHA announced plans to finalize the ETS on March 23, 2022, but set a short deadline of April 22 to receive written comments while slating an open hearing for April 27, 2022.
The Society for Healthcare Epidemiology of America (SHEA) asked OSHA to extend the comment period by at least another month to May 23, 2022.
“Conversion of the [ETS] to a final rule would be highly consequential for hospitals,” SHEA stated in comments to OSHA. “Professionals in the fields of healthcare epidemiology and infection prevention are the premiere subject matter experts on the protection of healthcare personnel and the patients they serve against the transmission of infectious diseases in healthcare facilities. The experiences of SHEA members since the ETS publication are important for OSHA’s assessment of whether the standard is effective in meeting or exceeding OSHA’s intended outcome on the protection of healthcare personnel, and whether this standard is sustainable as a permanent standard.”
As this report was filed, APIC had not submitted formal comments to OSHA, but the immediate past president of the association said the flexibility issue certainly will be noted, along with a request that OSHA remain in alignment with CDC guidelines on COVID-19.
“We were hoping that the ETS was not going to be made permanent,” says Ann Marie Pettis, BSN, RN, CIC, FAPIC. “Whatever they come out with, they have to really make sure it has broad applications for any infectious disease outbreak or pandemic. It should not just be specific to COVID-19.”
The ETS was originally issued on June 21, 2021, with OSHA requiring multiple protections, including barriers, social distancing, and upgraded ventilation.2 With most healthcare workers now vaccinated and many infection prevention measures in place, OSHA is considering relaxing some of the requirements.
“OSHA is considering suggestions that requirements be relaxed for masking, barriers, or physical distancing for vaccinated workers in all areas of healthcare settings, not just where there is no reasonable expectation that someone with suspected or confirmed COVID-19 will be present,” the agency said in a Federal Register notice.
With CDC guidelines changing, the ETS no longer is in alignment with some provisions, including isolation and return to work requirements.
“OSHA is considering whether it is appropriate to align its final rule with some or all of the CDC recommendations that have changed between the close of the original comment period for this rule and the close of this comment period,” the agency stated. “OSHA seeks comment on this approach.”
Noting that some healthcare employers found the ETS provisions overly prescriptive, OSHA “is considering restating various provisions as broader requirements without the level of detail included in the Healthcare ETS and providing a ‘safe harbor’ enforcement policy for employers who are in compliance with CDC guidance applicable during the period at issue.”
In a question that likely will not yield a definitive answer, OSHA asked for comment on the likelihood of future SARS-CoV-2 variants arising, or even a completely different coronavirus strain that causes similar disease in humans. OSHA described the latter scenario as “a hypothetical COVID-22.”
“OSHA is considering specifying that this final standard would apply not only to COVID-19, but also to subsequent related strains of the virus that are transmitted through aerosols and pose similar risks and health effects,” the agency stated.
This point has been made by critics as well, saying a standard applicable to multiple respiratory viruses would have more utility and staying power than measures strictly for COVID-19.
Regarding changing vaccination recommendations and requirements, OSHA is considering how they might affect the requirements in the ETS that take account of individuals’ vaccination status (e.g., fully vaccinated, up to date) and seeks comment on that as well.
“OSHA is considering an adjustment … that would include paid time up to four hours, including travel time, for employees to receive a vaccine and paid sick leave to recover from side effects,” the agency stated.
Acknowledging the previous comment period for the ETS closed before Delta and Omicron variants appeared, OSHA asked for new studies or data on “the rate of infection, long COVID, hospitalization, and death among healthcare workers compared to those rates among the general adult population.”
OSHA requested more information on several other key indicators, which are paraphrased as follows:
- the average number of days healthcare workers have been out with COVID-19 infection or quarantine;
- the percentage of healthcare workers who have taken sick days due to COVID-19 infection;
- the health effects of breakthrough infections in fully vaccinated employees, including hospitalizations, long COVID, and mortality;
- the percentage of healthcare workers who, because of age or compromised immunity, are at elevated risk of severe COVID-19.
REFERENCES
- Occupational Safety and Health Administration. Occupational exposure to COVID-19 in healthcare settings. Published March 23, 2022. https://www.osha.gov/laws-regs/federalregister/2022-03-23-0
- Occupational Safety and Health Administration. Subpart U — COVID-19 Emergency Temporary Standard. https://www.osha.gov/sites/default/files/covid-19-healthcare-ets-reg-text.pdf
Under the CDC's current guidance for healthcare workers, many requirements for those workers are triggered based on the level of community transmission of COVID-19. Such an approach would create the flexibility many have been calling for, which have come with the warning that requirements set in regulatory stone could quickly be outdated by the changing nature of the pandemic.
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