Business of Medicine
OSHA COVID-19 Healthcare Emergency Temporary Standard
OSHA has determined that employee exposure to SARS-CoV-2, the virus that causes COVID-19, presents a serious danger to workers in healthcare settings where people with suspected or confirmed COVID-19 are reasonably expected to be present. The agency has determined that existing standards and regulations, and the OSH Act’s General Duty Clause, are inadequate to address the COVID-19 hazard for these workers. Additionally, it has become clear that a Federal standard is needed to ensure sufficient protection for healthcare workers in all states. OSHA has issued an emergency temporary standard (ETS) to address this hazard.
The ETS is aimed at protecting workers facing the highest COVID-19 hazards—those working in healthcare settings where suspected or confirmed COVID-19 patients are treated. This includes employees in hospitals, nursing homes, and assisted living facilities; emergency responders; home healthcare workers; and employees in ambulatory care facilities where suspected or confirmed COVID-19 patients are treated. The ETS exempts fully vaccinated workers from masking, distancing, and barrier requirements when in well defined areas where there is no reasonable expectation that any person with suspected or confirmed COVID-19 will be present.
Understanding COVID-19 ETS Subpart U
The COVID-19 ETS is one standard with multiple sections, all contained in Subpart U. The ETS sections are:
- 1910.502 – Healthcare: Except as otherwise provided in the standard, applies to all settings where any employee provides healthcare services or healthcare support services.
- 1910.504 – Mini Respiratory Protection Program: Addresses limited requirements for situations where respirators are used in accordance with specific provisions in 1910.502. *See Mini Respiratory Protection Program*
- 1910.505 – Severability: Provides that each section of Subpart U and each provision within those sections is separate and severable from the other sections and provisions.
- 1910.509 – Incorporation by Reference: Contains materials adopted as part of the ETS, including: Centers for Disease Control and Prevention (CDC) guidance, consensus standards for personal protective equipment (PPE), and EPA’s list of approved disinfectants.
The ETS is effective immediately upon publication in the Federal Register. Employers must comply with most provisions within 14 days, and with provisions involving physical barriers, ventilation, and training within 30 days.
To determine if your workplace is covered by the ETS: Is your workplace covered?
How to Protect Workers from COVID-19
The main section of the ETS (1910.502 – Healthcare) requires employers to develop and implement effective COVID-19 plans. Controlling COVID-19 requires employers to use multiple overlapping controls in a layered approach to better protect workers. The key requirements of the ETS are:
- COVID-19 plan: Develop and implement a COVID-19 plan (in writing if more than 10 employees) that includes a designated safety coordinator with authority to ensure compliance, a workplace-specific hazard assessment, involvement of non-managerial employees in hazard assessment and plan development/implementation, and policies and procedures to minimize the risk of transmission of COVID-19 to employees.
- Patient screening and management: Limit and monitor points of entry to settings where direct patient care is provided; screen and triage patients, clients, and other visitors and non-employees; implement patient management strategies.
- Standard and Transmission-Based Precautions: Develop and implement policies and procedures to adhere to Standard and Transmission-Based precautions based on CDC guidelines.
- Personal protective equipment (PPE): Provide and ensure each employee wears a facemask when indoors and when occupying a vehicle with other people for work purposes; provide and ensure employees use respirators and other PPE for exposure to people with suspected or confirmed COVID-19, and for aerosol-generating procedures on a person with suspected or confirmed COVID-19.
- Aerosol-generating procedures on a person with suspected or confirmed COVID-19: Limit employees present to only those essential; perform procedures in an airborne infection isolation room, if available; and clean and disinfect surfaces and equipment after the procedure is completed.
- Physical distancing: Keep people at least 6 feet apart when indoors.
- Physical barriers: Install cleanable or disposable solid barriers at each fixed work location in non-patient care areas where employees are not separated from other people by at least 6 feet.
- Cleaning and disinfection: Follow standard practices for cleaning and disinfection of surfaces and equipment in accordance with CDC guidelines in patient care areas, resident rooms, and for medical devices and equipment; in all other areas, clean high-touch surfaces and equipment at least once a day and provide alcohol-based hand rub that is at least 60% alcohol or provide readily accessible handwashing facilities.
- Ventilation: Ensure that employer-owned or controlled existing HVAC systems are used in accordance with manufacturer’s instructions and design specifications for the systems and that air filters are rated Minimum Efficiency Reporting Value (MERV) 13 or higher if the system allows it.
- Health screening and medical management: (1) Screen employees before each workday and shift; (2) Require each employee to promptly notify the employer when the employee is COVID-19 positive, suspected of having COVID-19, or experiencing certain symptoms; (3) Notify certain employees within 24 hours when a person who has been in the workplace is COVID-19 positive; (4) Follow requirements for removing employees from the workplace; (5) Employers with more than 10 employees, provide medical removal protection benefits in accordance with the standard to workers who must isolate or quarantine.
- Vaccination: Provide reasonable time and paid leave for vaccinations and vaccine side effects.
- Training: Ensure all employees receive training so they comprehend COVID-19 transmission, tasks and situations in the workplace that could result in infection, and relevant policies and procedures.
- Anti-Retaliation: Inform employees of their rights to the protections required by the standard and do not discharge or in any manner discriminate against employees for exercising their rights under the ETS or for engaging in actions required by the standard.
- Requirements must be implemented at no cost to employees.
- Recordkeeping: Establish a COVID-19 log (if more than 10 employees) of all employee instances of COVID-19 without regard to occupational exposure and follow requirements for making records available to employees/representatives. *Please read and grab the log here: Covid-19 OSHA Log* NOTE: Your obligation to complete this new, special COVID-19 log is in addition to your obligation to log work-related cases on your normal OSHA 300 log. See the blue sidebar on this OSHA page to see the three criteria for recording a COVID-19 case on your OSHA 300 log.
- Promptly report work-related COVID-19 fatalities (within 8 hours) and in-patient hospitalizations (within 24 hours) to OSHA. Please read more information regarding this here: Reporting
About Risk Consultants
Risk Consultants of America is a consulting firm specializing in environmental health and safety (EHS) services, as well as risk management, insurance and loss control support for companies and their clients. They are a solutions-based company with a focus on regulatory compliance and increasing worker productivity.
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The information provided in this resource does not constitute legal, medical or any other professional advice, nor does it establish a standard of care. This resource has been created as an aid to you in your practice. The ultimate decision on how to use the information provided rests solely with you, the PolicyOwner.