On June 25, 2021, the Occupational Safety and Hazard Agency published its COVID-19 Emergency Temporary Standard (ETS) with an expected compliance date of no later than July 21, 2021. What does the ETS include?
COVID-19 Plan
Each organization must have a written plan, designated workplace safety coordinator, and workplace-specific hazard assessment. Non-managerial employees must have input into the hazard assessment and the plan development and implementation. A key component of the plan is the monitoring component that is designed to monitor the workplace to ensure ongoing effectiveness of the plan with updates when needed. In addition, written policies and procedures focusing on how to minimize risk of transmission of COVID-19 to employees must be developed and implemented. The COVID-19 plan must also define who must wear masks, who is exempt from wearing masks and where that exemption is applicable in well-defined terms. If an exemption process is implemented for persons who are fully vaccinated, there must be a defined process to determine the employees’ vaccination status. Keep in mind, that these requirements are not only applicable to employees but any contracted person providing services within your organization.
Screening and Management
The ETS continues to obligate organizations to limit and monitor all points of entry to settings where direct patient care is provided, screen and triage patients, visitors and non-employees entering the care setting (e.g., delivery personnel, police, business personnel) for symptoms of COVID-19, and implement patient management strategies. The CDC’s COVID-19 Infection Prevention & Control Recommendations are incorporated into the ETS by reference. Be certain to review these recommendations as there are components that are mandatory.
Personal Protective Equipment (PPE)
At the core of the ETS is guidance on PPE. Organizations must provide facemasks and assure that employees wear facemasks properly (Full nose and mouth covered) and that they are worn when required in addition to ensuring employees use respirators and other PPE for exposure to people with suspected or confirmed COVID-19. The use of respirators is voluntary and can be either provided by the organization or the employee and used in lieu of a facemask.
Aerosol-Generating Procedures
Pay particular attention to the definition of aerosol-generating procedures contained within the ETS. Review your policies and procedures to ensure that the definitions referenced within your policies and procedures align with this definition; then review the locations where aerosol -generating procedures are performed to ensure compliance with the limitations related to the number of employees present and cleaning procedures for equipment and the care setting after the procedure. Note these requirements are effective for any person with confirmed OR suspected COVID-19 infection.
Standard and Transmission-Based Precautions
Of great importance is the inclusion of the CDC’s Guidelines for Isolation Precautions. These guidelines are not new, but their inclusion in the ETS makes them mandatory. Most healthcare organizations utilize these guidelines already, but a review and update of your policies and procedures would be a prudent activity at this time. The link to the CDC’s Guideline for Isolation Precautions is provided for you at the end of this article.
Cleaning and Disinfection
Compliance with the CDC's COVID-19 Infection Prevention and Control Recommendations is a mandatory component of the Emergency Temporary Standard along with establishing a process to ensure that patient care areas, all medical equipment, all high-touch surfaces in other areas, and equipment must be cleaned at least once per day with an appropriate disinfecting product. Alcohol-based hand sanitizers or handwashing sinks that are easily accessed must be provided. Keep in mind the Life Safety Code limitations on the quantities and locations for Alcohol-based hand sanitizer products. Be certain to read the following documents: CDC’s COVID-19 Infection Prevention and Control Recommendations, CDC’s Guidelines for Environmental Infection Control, and CDC’s Cleaning and Disinfecting Guidance as components of each of these have been incorporated into the OSHA's ETS and hence compliance is now mandatory.
Ventilation
One of the most important components to Infection Prevention is management of the circulating air or ventilation. As expected with any type of system or equipment, operating it according to the manufacturer’s instructions for use (IFUs) or Operator’s Manual is paramount along with ensuring that routine maintenance and inspection of the system or equipment occurs according to the IFUs. Use of an air filter of MERV 13 or higher is recommended only if your system or equipment permits this. Due to the complexity of assessing your systems and making any necessary changes, this component of the ETS does not take effect until July 21, 2021
Health Screening and Medical Management
The ETS goes further and sets the expectation of screening for COVID-19 symptoms in each employee before each shift. Note the ETS advises that employees can self-monitor and then notify their employer if they are experiencing COVID-19 symptoms or have a positive COVID-19 test. The organization then must have a process to notify certain unprotected employees of when a person who has been in their workplace is COVID-19 positive. This notification must occur within 24 hours. The organization must then follow requirements for removing and returning employees to work in accordance with guidance from a licensed healthcare provider or specific CDC guidance incorporated by reference and reflected with the CDC’s Isolation Guidance and Return to Work Healthcare Guidance. (See links below)
Vaccination
The ETS encourages organizations to provide reasonable time and paid leave for the vaccination process and any side effects experienced post vaccination. Many healthcare organizations are making the COVID-19 vaccine mandatory for employees who do not have a medical or religious exemption.
Physical Distancing and Physical Barriers
One of the most challenging requirements included within the ETS and one that organizations have been struggling with is the physical distancing and physical barrier requirements. The ETS advises the following: (1) ensure each employee is separated from all other people by at least 6 feet in indoor spaces (2) install physical barriers that are either cleanable or disposable at fixed workstations in non-patient care areas. This component, like the ventilation requirements has an effective date of July 21, 2021. Note there are some exceptions/exemptions for vaccinated persons in certain work locations/environments noted within the Standard.
Training
Last but not least, the Standard speaks to employee training specific to the transmission of COVID-19. This training should address the specific tasks and situations in the workplace that could result in COVID-19 transmission and the skills and techniques that must be employed to mitigate the risk of transmission. The organization's policies and procedures need to define the education/training process. This is a perfect opportunity to reinforce basic hygiene and cleaning techniques. Consider challenging each department to identify all the patient care equipment and surfaces within the patient care environment along with the high-touch surfaces such as telephones within the work environment that need to be cleaned, and develop a reference chart for staff to know which cleaning product can be used on which equipment or surface.
Recordkeeping and Reporting
In alignment with most OSHA requirements, the organization must establish a log of all instances of COVID-19 without regard to occupational exposure and make certain records available to employees. In alignment with other OSHA requirements, any COVID-19 fatality classified as work-related or contracted because of work, must be reported to OSHA within 8 hours. Additionally, hospitalization of any work-related COVID-19 patient must be reported within 24 hours of awareness.
To help organizations develop their COVID-19 program and required documents, appended here are the CDC reference documents. In addition, OSHA has placed many plan templates, policies, and other documents on their COVID-19 Healthcare ETS webpage for reference or use.
CDC Resources/References:
COVID-19 Infection Prevention and Control Recommendations
Guidelines for Isolation Precautions
Guidelines for Environmental Infection Control
Cleaning and Disinfecting Guidance
Return to Work Healthcare Guidance
OSHA Resources/References:
OSHA COVID-19 Healthcare ETS webpage
Need help understanding the requirements or getting the work done? Reach out to Courtemanche & Associates to learn more about how we can help you.