June 10, 2021
Opening Remarks
Jim Frederick: Acting Assistant Secretary of Labor for Occupational Safety and Health (OSHA)
- A conclusion was reached of a need for an Emergency Temporary Standard (ETS) for healthcare settings.
- Posted on the OSHA website today (6/10/21) at OSHA.gov.
- Updated guidance from OSHA. Specifically updates to the guidance posted January 29. It is newly posted and live on the OSHA website today.
Specifics of the New Emergency Temporary Standard
Andy Levinson: Acting Director of Standards at OSHA
- Subpart U, primarily 1910.502 and 1910.504 (mini-respirator program).
- Healthcare workers are covered under the standards.
- The standards target workers who are suspected to have, confirmed with, or exposed to COVID.
- There are a number of provisions excluding various retail and other healthcare settings
- First-Aid (unrelated to covid), pharmacists only in retail settings, non-hospital ambulatory care settings (for non-Covid settings), and physicians (non-Covid settings).
- There are a number of provisions excluding various retail and other healthcare settings
- Employers must develop a standard for their workplace.
- Employers must develop a plan for the workplace setting, monitor the plan for effectiveness, and include several policies and procedures to minimize the risk of Covid transmission to workers.
- Additional procedures and provisions
- Included are patient screening and monitoring procedures, screening or triaging patients and visitors entering the workplace, procedures to follow for standard and transmission-based guidelines in compliance with CDC.
- Facemasks for all employees, respirators if diagnosed with covid, and eye protection, isolation gowns and gloves for all workers.
- Can use a respirator instead of a facemask for workers not exposed to Covid-19.
- Limit employees present to those essential for a procedure and must use a ventilation room if the workplace has one.
- Physical distancing and barriers in the facility.
- Sanitizing frequently touched surfaces.
- Must provide alcohol-based hand washing machines or soap and water.
- Update HVAC systems – Merv 13 standard or higher (if system can handle it).
- Airborne isolation rooms must be maintained and updated to meet criteria laid out.
- Screen each worker each day and before the work shift (in person or self-monitored), required to notify employer if testing positive for Covid or have symptoms, must notify workers within 24 hours if they are exposed to Covid.
- Provisions for removing workers if they have tested positive for Covid.
- Must pay workers if they are out of work due to being sick with Covid.
- Reasonable time off from Covid symptoms and vaccine symptoms.
- Paid leave for vaccine recovery and Covid recovery to a reasonable standard.
- Workplace guidance written in language to a level that employees can understand.
- Additional requirements to inform workers of anti-retaliation rates, and not to discharge or discriminate against employees for using their rights.
- All requirements of the standard must be implemented at no cost to the workers.
- If more than 10 employees in the workplace, there must be a way to keep track of Covid spread.
- Must inform OSHA of Covid fatalities at work within 24 hours.
- Must inform OSHA of Covid hospitalizations at work within 24 hours.
- Mini-respirator program for employers who can wear a facemask but choose to wear a respirator instead.
- Employers must train employees how to do a user seal check and how to use the respirator.
Updates to the January 29 Guidance from OSHA
Lee Anne Jillings: Director of Technical Support and Emergency Management at The U.S. Department of Labor OSHA
- Updates to the Jan. 29 guidance
- Help identify Covid-19 exposure risk to workers who are not yet vaccinated and procedures to follow.
- Procedures in high-risk workplaces for unvaccinated workers:
- Where people are not vaccinated or status unknown
- Manufacturing
- Meat Processing
- Retail and Grocery
- Seafood processing
- Guidelines are recommendations, not strict rules.
- Intended to give guidance to prevent serious death or illness in the workplace.
- Workers are instructed to follow recommended precautions for their own protection.
- Steps for wearing face coverings, distancing, cleaning, and sanitation, etc. are included.
- Employers should engage with workers to determine how to implement multi-layer protection to protect unvaccinated or at-risk workers.
- Paid time off to get vaccinated
- Instructions for how to stay working if vaccinated
- Physical distancing
- Face coverings for at-risk or unvaccinated individuals
- Education and training on Covid training and procedures in an understandable way
- Visitors wear face coverings
- Sanitation
- HVAC updates
- Logging hospitalization or death
- Anonymous worker submissions of potential hazards in the workplace
- For higher-risk workplaces with unvaccinated people or at-risk people
- Close contact, duration of contact, risk of contact is important
- Stagger breaks, arrival, and departure times
- One-way signs in office and updated ventilation
- For assembly or processing lines
- Proper spacing for at-risk or unvaccinated workers
- Retail
- Suggesting masks for unvaccinated customers
- Credit card readers cleaned and farther away
- Move re-stocking to off-peak or closed hours
- OSHA will monitor the need for updated guidance in the future
Questions
What is the applicability of the ETS in different settings?
- Workers on-site offering vaccine at clinics (if screening of people coming in beforehand) – Guidance and standards will not apply
- Places where Covid-19 testing occurs because screening is not possible – guidance will apply
- Skilled nursing facilities and nursing homes – guidance will apply
- Non-hospital intermediate care facilities unless screening is done before hand – guidance will apply
- If the facility treats people with Covid symptoms it is covered under the guidance
- Covers home healthcare in similar situations
- All parts of a hospital – guidance will apply
- If there is a well-established area of ventilation and people are vaccinated without Covid-positive people present the guidance is relaxed
- Dental services – guidance will apply
- Unless they are screening out Covid-19 symptoms in the practice
Do employers have to require fully vaccinated employees to take protective measures under the ETS?
- Targeted to workers who may have Covid-19 – workers need to take precautions regarding their vaccination status.
- Targeted towards healthcare workers who are at a greater risk than the rest of the general population.
Will DOL or OSHA be saying anything to states to encourage alignment with the ETS?
- Already working with states, and will be continuing to have interaction with them.
- States have 30 days after publication of the ETS to provide documentation that they are at least as effective as the OSHA standard.
When are the ETS expected to be published in the federal register?
Putting pieces together as quickly as possible, but the process is still going on and being prepared – hope for it to be published as quickly as possible.
Does the ETS apply to campus health services at college campuses?
Same delineation as ambulatory care facilities as long as it has care under the OSHA Act and not under municipally or state-operated facility.
What will enforcement look like in non-healthcare settings?
Working on how to respond in a variety of ways. National emphasis program is still in place and still targeting workplaces that put a significant number of workers at higher risk. Responsive to complaints by workers reporting covid hazards in their workplace.
Could you clarify paid time off and what will qualify?
Employers with 500 people or fewer – reimbursement under American Rescue Plan for paid time off for covid-related measures.
Would re-use of respirators be allowed if a facility is not experiencing shortages of one-use?
Limited to situations where there is limited availability of one-use. Not the case today. The guidance is being rolled back on this front.
Does OSHA have guidance for how it expects employers to determine workers vaccination status or if an employee lies about it?
- OSHA provides the employer with a variety of ways to determine vaccination status – will leave it up to nuance of individual workplaces to decide.
- If employee provides false information about vaccination status – counts as misconduct where employer can treat it as such.
Does the ETS cover workplaces where the state does not require a mask?
Yes, within the context that has been discussed so far.
If workers and patients are in a homecare setting where screening has happened, does the ETS still apply?
The ETS applies unless all vaccinated providers and patients are screened ahead of time for Covid symptoms.
If a facility has no confirmed cases, is a regular mask the only type required for PPE?
- Dependent upon the facility (healthcare, non-healthcare, etc.) – would need to understand the details.
- Base requirement is FDA approved facemask – unless expectation of dealing with suspected or confirmed Covid cases (then into respirators).
Is an employer exempt during the time for no-expected Covid cases?
Nursing homes will always be under Ethe TS because of the high-risk they are under, but there are some provisions that may not apply (like the respirator one).
Do fully vaccinated individuals have to comply with PPE requirements?
Yes, if in workplace settings that are under the OSHA guidance – regardless of vaccination status.
Is PPE required at all times or just during exposure to suspected or confirmed cases?
Only while exposed – otherwise just regular facemask.
Does nebulizer treatment count under the ETS?
Aerosol generating medical procedures – open suction of airways, CPS, endotracheal operations, medical or surgical post-mortem procedures, dental procedures involving various procedures (if they are not screening out Covid symptoms).
Does general guidance apply to states without an ETS?
Some states do utilize the guidance, but some do not – up to the state.
Where there are workplaces with mixed vaccinations, expectation that recommendations apply to all employees or just unvaccinated?
Only unvaccinated people need to wear a mask and stay 6’ apart. Ventilation fixed for all workers (can’t just do it for some).
If all employees are vaccinated, are there components of the guidance that still recommended?
Recommend facilitating vaccination for other workers and paid time off to get vaccinated and recover from side-effects.
If cases are confined at long term care facilities, do they only have to use respirators in that area or through entire facility?
Only when dealing with suspected or confirmed cases – so only workers treating patients with Covid or suspected Covid, not everyone.
Should we be expecting any further standards or guidance out of OSHA or just the one that was released today?
OSHA will continue to monitor and update if what is necessary to assist workers and employers with any changes over time. Must be in alignment with the science that is currently available and will update to follow that.