On June 21, the US Department of Labor’s (DOL’s) Occupational Health and Safety Administration (OSHA) issued the Emergency Temporary Standard (ETS). This federal update mandated home care agencies to implement new practices. The ETS was published to protect healthcare and healthcare support workers from occupational exposure to COVID-19 in certain settings.

OSHA’s Emergency Temporary Requirements Could Become Permanent

The 258-page interim rule, which creates a new Subpart U in the OSHA standards, can be found in the Federal Register here. Agency leaders have had a short time to familiarize themselves with the content and implement changes. In some cases, providers were given less than 14 days to comply with new requirements.

Home care providers have until August 20 to submit comments to OSHA electronically for Docket No. OSHA-2020-0004 via the Federal eRulemaking Portal at www.regulations.gov. Online instructions can be found there.

What are OSHA Emergency Temporary Standards?

OSHA said that they are reviewing the latest guidance, science, and data. And they consult with the Centers for Disease Control and Prevention (CDC) to determine if guidance for healthcare settings meets the health and safety requirements needed to keep workers safe. Here is an overview of the COVID-19 Healthcare ETS found in 29 CFR § 1910.502.

COVID-19 Plan

The emergency standard requires home care agencies to conduct a workplace hazard assessment. This risk analysis should include documentation of a COVID-19 risk plan, identifying high-risk areas, roles, or situations, a plan to decrease identified hazards, and names and titles of individuals who will manage plan implementation. Designation of a COVID-19 Safety Coordinator is required.

Patient Screening and Management

OSHA requires screening of all patients. Additionally, individuals who enter healthcare facilities and offices must be screened. The minimum standard for compliance is asking questions about COVID-19 symptoms and illness. Entry points should be limited. And telehealth is encouraged where appropriate.

Standard and Transmission-Based Precautions

The Standard Precautions and Transmission-based Precautions sections remind healthcare workers and support staff that Healthcare workers should use standard precautions with all patients. Transmission-based precautions add a layer of protection for workers and should be used in conjunction with standard precautions when there is a known or suspected infectious agent.

Personal protective equipment (PPE)

Respirators are required only for certain circumstances under the ETS. When they are used, employers must provide workers with respirators that are either certified by NIOSH under 42 CFR Part 84 or authorized under an Emergency Use Authorization (EUA).

Aerosol-Generating Procedures

Aerosol-generating procedures (AGPs) such as breathing treatments are high risk for healthcare workers caring for persons with suspected or confirmed COVID-19. Therefore, employers must provide each employee a respirator that complies with the Respiratory Protection Standard), gloves, protective clothing, and eye protection.

Physical distancing

Employers should encourage telework or remote work whenever possible. Staggering work shifts and tasks are also encouraged to keep staff socially distanced. Employers are to endure individuals working at least six feet away from each other when indoors.

Physical Barriers

Physical barriers may be used for workstations where it isn’t easy to keep 6 feet of distance between workers and other individuals. The barriers should be solid and made from impermeable materials like plastic or acrylic, and they should be easily cleaned or replaced.

Cleaning and Disinfection

When employers become aware that a COVID-19 positive person was in the workplace in the past 24 hours, cleaning and disinfection are required. Measures for cleaning should be done by the CDC’s Cleaning, and Disinfecting Guidance found here.

Facility Ventilation

The ETS requires employers to maintain HVAC systems to function as designed. OSHA makes recommendations for MERV-13 air filter use because they are effective against viruses.

Health Screening and Management

Employers must remove workers who have a known or suspected case of COVID-19. Once an employer confirms a known case of COVID-19 in their facility, they have three notification obligations that organizations must complete in 24 hours. Employers must notify employees who had close contact with the infected individual. Also, they must report the COVID-19 infection and date to all employees who were in that work area on that day. Additionally, employers should contact other known employers of the worker to advise them of infection and possible contact.

Vaccination

Under the ETS, employers must support COVID-19 vaccination for each employee by providing reasonable time and paid leave for any side effects experienced following vaccination. OSHA presumes that an employer should provide four hours of paid leave for each dose of the vaccine, plus 16 additional hours of leave for any side effects from the dose.

Employee Training

Employers are required to provide staff training on the ETS standards including:

• COVID-19 infection, transmission, prevention
• COVID-19 mitigation
• patient screening and management
• situations in the workplace that could result in COVID-19 infection
• company policies on COVID-19 prevention
• personal protective equipment
• workplace disinfection and cleaning
• health screening and medical management
• company COVID-19 sick leave policies and other related benefits
• requirements of the ETS, how the employee can obtain copies of the ETS
• the identity of the safety coordinator(s) specified in the COVID-19 plan

Anti-Retaliation

Employers are prohibited from action against an employee for exercising their rights under the ETS.

No Cost to Employees

Workers should be free from any cost associated with the implementation of the ETS standards. No cost means employers must provide PPE, respirators, and any other supplies free of charge.

Reporting COVID-19 Cases

Employers must report an employee COVID-19 fatality to OSHA within eight hours of learning about the incident. Employers must also report each employee COVID-19 hospitalization within 24 hrs of notification. If an employer reports a hospitalized employee and the worker subsequently dies, a second report is unnecessary.

Agencies can report to OSHA by:

• Calling the nearest OSHA office;
• Calling the OSHA 24-hour toll-free number at 1-800-321-6742 (OSHA); or
• By electronic submission, report online

Concerns About the Rule

OSHA announced last week that they are extending the comment period to August 20.

Over 120 comments from providers have already been submitted. Some are concerned that:

• Training and implementation could take at least six months.
• Standards add too many burdens providers are facing, including of staffing shortages
• Many parts of the rule conflict with state and local regulations
• Ventilation and HVAC barrier requirements could impede airflow.
• Compliance will take time and effort away from caring for patients.
• Standards are wasteful, requiring employers to provide respirators to staff that are not required to wear them or don’t have the benefit of fit-testing
• ETS requirements contradict OSHA’s own PPE and respiratory protection standards

Home care providers have until August 20 to submit comments to OSHA electronically for Docket No. OSHA-2020-0004 via the Federal eRulemaking Portal at www.regulations.gov. Online instructions can be found there.

Summary

The ETS could become another hurdle for agencies in an industry that is already challenged to its limits. Take a moment to let regulators know how the new federal standards could affect your agency today.

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