OSHA infectious disease rule moves forward
Long-anticipated draft standard comes out as nation’s hospitals struggle with Ebola
While a Dallas hospital struggled to care for the nation’s first Ebola case, the Occupational Safety and Health Administration quietly issued a draft of an infectious disease standard designed to protect health care workers. The proposed rule would make infection control measures mandatory and would add new requirements for hazard identification, exposure control, and documentation.
OSHA has been working on the rule for years, so the timing is coincidental. But Ebola events provided a compelling backdrop: the infection of two nurses and the subsequent decision by the Centers for Disease Control and Prevention to increase the "margin of safety" with enhanced infection control.
"Workers currently face a number of infectious diseases, and there are always new threats over the horizon MERS, Avian Flu, and, of course, Ebola," an OSHA spokesperson told HEH. "The infectious disease standard would require employers to have a plan to protect their employees from any infectious disease, rather than going on a disease-by-disease basis."
Employee health professionals expressed concern about new regulations requiring time-consuming documentation. For example, the draft rule would require an "exposure
determination" that involves listing all job classifications that include employees who could be exposed to infectious diseases.
Parts of the proposed regulation also could overlap with existing state and local health laws, requirements from accrediting bodies and even other OSHA standards, says Dee Tyler, RN, COHN-S, FAAOHN, executive president of the Association of Occupational Health Professionals in Healthcare (AOHP).
"We can make things so complex that healthcare providers and organizations find it impossible to comply with all the regulations and become distracted from their primary mission," she says.
Yet the Ebola outbreak illustrates why hospitals need consistent, mandatory rules to protect health care workers, counters Mark Catlin, health and safety director for the Service Employees International Union (SEIU).
"Currently, the majority of CDC guidance for infection control for protecting workers is optional. It’s simply guidance," he says. Employers may ignore or downplay some of the measures, he says.
The proposed standard creates a useful roadmap for developing a site-specific infection control plan that focuses on worker protection, he says.
"This is what’s been missing in the Ebola response," he says.
New job protection, vaccination rules
Currently, only California hospitals face enforcement action if they don’t follow infection control guidelines. The OSHA draft standard is modeled after the California Aerosol Transmissible Disease standard, which covers diseases that are spread by the droplet and airborne routes, and the Bloodborne Pathogen Standard.
The draft standard would require hospitals and other health care employers to create a "worker infection control plan," which would include the exposure determination. The proposed rule requires written standard operating procedures to be included in the plan, including hazard evaluation, exposure investigation, personal protective equipment and engineering, administrative and work practice controls, and transmission precautions (droplet, airborne and contact).
As with the Bloodborne Pathogen Standard’s exposure control plan, the worker infection control plan would require input from frontline staff and would be updated annually. Training would occur at least annually, and the proposed rule stipulates minimally what must be covered in the training.
The proposed infectious diseases rule contains some provisions that would establish new responsibilities for employee health:
- EH professionals would need to maintain records "for each employee who has occupational exposure during provision of direct patient care and/or performance of other covered tasks."
- Hospitals would be required to provide vaccinations free of charge for influenza, measles/mumps/rubella, pertussis and varicella and any other vaccine in the worker infection control plan or that is considered medically appropriate for an employee.
- Hospitals would obtain signed declination statements from employees who decline a vaccine. (The proposed rule is silent on employer mandates for vaccination.)
- Workers would receive "medical removal protection," including pay and job protection for employees who are furloughed or ill because of an exposure (except for most cases of the common cold or seasonal influenza).
- Hospitals would be required to ensure that contractors, vendors, and licensed independent practitioners with privileges comply with the worker infection control plan.
[Editor’s note: A copy of the proposed infectious diseases rule is available at www.regulations.gov with the document number OSHA-2010-0003-0245.]
