On June 21, 2021, OSHA published in the Federal Register a new Emergency Temporary Standard (ETS) to protect healthcare workers. OSHA's new ETS is now in effect.
ETS for Healthcare Workers
The new ETS applies to all settings where any employee provides healthcare services or healthcare support services, including:
- 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.
However, the new ETS does not apply to the following:
(i) the provision of first aid by an employee who is not a licensed healthcare provider;
(ii) the dispensing of prescriptions by pharmacists in retail settings;
(iii) non-hospital ambulatory care settings where all non-employees are screened prior to entry and people with suspected or confirmed COVID-19 are not permitted to enter those settings;
(iv) well-defined hospital ambulatory care settings where all employees are fully vaccinated and all non-employees are screened prior to entry and people with suspected or confirmed COVID-19 are not permitted to enter those settings;
(v) home healthcare settings where all employees are fully vaccinated and all non-employees are screened prior to entry and people with suspected or confirmed COVID-19 are not present;
(vi) healthcare support services not performed in a healthcare setting (e.g., off-site laundry, off-site medical billing); and
(vii) telehealth services performed outside of a setting where direct patient care occurs.
The ETS also 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.
Upon publication in the Federal Register, covered employers must comply with most provisions within 14 days thereafter, i.e., by July 5, 2021, and must comply with provisions involving physical barriers, ventilation, and training within 30 days after publication, i.e., by July 21, 2021. OSHA will use its enforcement discretion for employers who make a good faith effort to comply with the ETS, but fail to do so by the applicable deadline.
Summary of Requirements
Covered employers must do all of the following:
- 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:
- Screen employees before each workday and shift;
- Require each employee to promptly notify the employer when the employee is COVID-19 positive, suspected of having COVID-19, or experiencing certain symptoms;
- Notify certain employees within 24 hours when a person who has been in the workplace is COVID-19 positive;
- Follow requirements for removing employees from the workplace.
- Employers with more than 10 employees must provide "medical removal protection benefits" to workers who must isolate or quarantine. The details of this requirement are as follows:
- Employers must continue to provide the benefits to which the employee is normally entitled and must also pay the employee the same regular pay the employee would have received had the employee not been absent from work, up to $1,400 per week, until the employee meets the return to work criteria specified by the ETS.
- For employers with fewer than 500 employees, the employer must pay the employee up to the $1,400 per week cap but, beginning in the third week of an employee's removal, the amount is reduced only by two-thirds of the same regular pay the employee would have received had the employee not been absent from work, up to $200 per day ($1,000 per week in most cases).
- Employers' payment obligation is reduced by the amount of compensation that the employee receives from any other source, such as a publicly or employer-funded compensation program (e.g., paid sick leave, administative leave), for earnings lost during the period of removal or any additional source of income the employee receives that is made possible by the virtue of the employee's removal.
- Whenever an employee returns to the workplace after a COVID-19 related workplace removal, that employee must not suffer from any adverse action as a result of that removal from the workplace and must maintain all employee rights and benefits, including the employee's right to their former job status, as if the employee had not been removed.
- 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.
- Report work-related COVID-19 fatalities and in-patient hospitalizations to OSHA.