As this report was filed, OSHA had finalized the COVID-19 standard to protect healthcare workers and submitted it to the White House.
On Dec. 8, 2022, OSHA sent the standard to the Office of Management and Budget, with a decision on its fate expected sometime in early 2023.
A polarizing document as an Emergency Temporary Standard (ETS), the draft version likely will draw similarly mixed reviews. The June 1, 2021, version — now expired pending finalization — required multiple protections, including barriers, social distancing, and upgraded ventilation. OSHA moved to finalize the ETS, opening it for comments in April 2022, holding a public hearing, and reopened the docket for final comments in May.1 In doing so, it noted consideration of less restrictive policies for healthcare workers who have been vaccinated.
“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 stated.2
OSHA also asked whether it is appropriate to align its final rule with some or all the CDC’s recommendations for healthcare. The resulting comments were divisive, with some urging following the CDC’s lead, and others — some citing the agency’s poor pandemic response — arguing for a strong, independent OSHA standard.
Epidemiologists and other clinicians urged OSHA to be flexible enough to change with CDC guidelines, which have been modified frequently during the pandemic.
“We encourage OSHA to design a COVID-19 standard that aligns with the CDC and directs healthcare facilities to follow the most up-to-date CDC COVID-19 guidance and recommendations,” said Sharon Wright, MD, testifying for the Society for Healthcare Epidemiology of America. “If OSHA instead was to codify public health guidance within a final rule, it would quickly become outdated and could hold healthcare facilities to obsolete and potentially unsafe protocols.”
David Michaels, PhD, OSHA chief from 2009 to 2017, was skeptical of an OSHA regulation that would change to reflect CDC guidance, in part because of the different standards the agencies use to create policy.
“OSHA standards that protect healthcare workers must be based on the best scientific evidence gathered through a transparent, public notice and comment process, and rigorous study of current science,” Michaels said. “That’s what the OSHA law requires. In contrast to OSHA’s evidence-based standards, CDC recommendations are not required by law to be based on the latest scientific evidence, nor do they go through any transparent public comment process as OSHA standards do.”
In a Dec. 8, 2022, statement that coincided with the submission of the OSHA draft standard, National Nurses United (NNU) called for a permanent standard that would “require employers” to protect nurses and other healthcare workers from occupational exposure to COVID-19.3
“The COVID-19 pandemic is not over,” Deborah Burger, RN, president of NNU, said in the statement. “New, more immune-evasive variants continue to circulate; bivalent booster vaccination rates are extremely low; and few public health measures remain in place. Nurses, other healthcare workers, and their patients remain at risk of COVID exposure, infection, illness, and death because their employers continue to fail to fully protect them.”
The NNU said a December 2022 survey of more than 2,800 nurses in 46 states revealed only 66% reported wearing a respirator for every encounter with a COVID-positive patient, even though it is scientifically clear COVID-19 is airborne and respiratory protection is required. Only 34% of nurses reported that they are informed of COVID exposures in a timely fashion, even though prompt testing and isolation are essential to preventing transmission.
“Many nurses continue to experience the devastating impacts of long COVID,” Burger said. “This is why we need a permanent standard, and why we must continue to maintain multiple measures of infection control — including masking, vaccinations, testing, ventilation, contact tracing and notification, proper isolation, and quarantining.”
REFERENCES
- Occupational Safety and Health Administration. COVID-19 healthcare rulemaking. 2022.
- Occupational Safety and Health Administration. Occupational exposure to COVID-19 in healthcare settings. Federal Register. March 23, 2022.
- National Nurses United. National Nurses United applauds OSHA for sending COVID-19 permanent standard for health care workers to OMB for review, urges OMB to take prompt action. Dec. 8, 2022.
As this report was filed, OSHA had finalized the COVID-19 standard to protect healthcare workers and submitted it to the White House. On Dec. 8, 2022, OSHA sent the standard to the Office of Management and Budget, with a decision on its fate expected sometime in early 2023.
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