Too much, too late: that’s what healthcare groups are saying about a new rule from the Occupational Safety and Health Administration (OSHA) designed to protect healthcare workers from COVID-19.

“This rule is long and complex, and would require changes in hospital policies, procedures, and structures,” Stacey Hughes, executive vice president of government relations and public policy at the American Hospital Association, wrote in a letter to the Department of Labor, which includes OSHA. “Hospitals and health systems are just now emerging from the disruption caused by the COVID-19 pandemic. Our members have told us that they need more time to implement the many new requirements” contained in a 253-page set of rules known as the emergency temporary standard (ETS).

“While we appreciate that OSHA is attempting to protect healthcare workers through the COVID-19 healthcare ETS, we believe the ETS was issued much too late and as a result, will disrupt the ongoing efforts of medical groups to balance the needs of patients against the imperative to protect employees,” said Anders Gilberg, senior vice president of government affairs at the Medical Group Management Association (MGMA), which represents physician offices, in a letter to Labor Secretary Marty Walsh. “We urge you to rescind the ETS, or at a minimum, delay its effective date until stakeholders such as MGMA have adequate opportunity to provide input on the standard.” (Gilberg is a member of the MedPage Today editorial board.)

The American Medical Association (AMA) also weighed in. “With little to no warning, OSHA is requiring physician practices to undertake new infection control efforts,” AMA executive vice president and CEO James Madara, MD, wrote to the labor secretary. “Without adequate time to review the ETS, it is unclear if these steps are necessary or duplicative. In order to ensure that there is ample opportunity for review, analysis, and input, the AMA strongly urges you to delay the effective date and extend the comment period of the ETS.”

Requirements for COVID Plans, Masks, Ventilation

OSHA announced the ETS on June 10; it was published in the Federal Register on June 21 and went into effect that day.

“This standard is necessary to give our healthcare workers deeply needed protections,” said Acting Assistant Secretary of Labor for Occupational Safety and Health Jim Frederick in a press release. “This tailored standard allows OSHA to help the workers most in danger of contracting the virus, while the updated guidance will give other businesses across the country the information they need to help protect unvaccinated workers and continue mitigating spread in the workplace.”

The ETS requires healthcare facilities to have a COVID-19 plan and includes rules on the use of personal protective equipment such as masks and respirators, screening of patients for COVID-19, and use of physical distancing, adequate ventilation, and physical barriers. OSHA estimates that implementation of the standard will prevent more than 295,000 cases of coronavirus and 776 deaths among healthcare workers over a 6-month period, and produce a net economic benefit of nearly $23 billion.

The standard applies to any setting where employees provide healthcare or healthcare support services, including skilled nursing homes and home healthcare, with some exemptions for healthcare providers who screen out patients who may have COVID-19, the agency noted, adding that OSHA will update the standard, if necessary, to align with CDC guidelines and changes in the pandemic.

No Vaccination Requirement

The Association of Professionals in Infection Control (APIC), which represents infection preventionists, has several issues with the standard. “APIC is concerned that the OSHA ETS does not require or even recommend COVID-19 vaccination for employees, which we know to be the most effective way to protect employees and prevent transmission,” the group said in a published assessment. “APIC recommends that OSHA’s most important employee protection act should be to mandate COVID-19 vaccination for all employees.”

“All they’ve said is the employer has to give paid time off to get vaccinated, and they also have to give them paid time off should they experience side effects from the vaccine,” APIC president Ann Marie Pettis, RN, BSN, said during a phone interview at which a public relations person was present. “We’re very much in support of that; we’re just surprised there is not stronger language about getting vaccinated.”

In addition, the assessment noted, “APIC is concerned that many parts of the ETS are not up to date with current scientific evidence or CDC guidelines, especially post-vaccination guidance. Sections relating to patient and employee screening and management, physical distancing, and physical barriers need to be updated to be consistent with current knowledge surrounding transmission, as indicated in CDC guidance. CDC guidance is updated frequently to capture best practices as our knowledge of virus transmission evolves.”

N95 Use at Issue

One example of this is the standard’s requirement for the use of N95 masks, said Pettis, who is director of infection prevention at University of Rochester Medicine in New York. “They’re requiring it any time you have somebody that’s under investigation as a possible COVID patient, as well as if you know somebody is positive for COVID … That’s different than what many of us were doing,” because many state health departments, including Pettis’ own in New York State, do not require that.

“My organization, throughout this whole thing, has only required an N95 for aerosol-generating procedures, and we made them available for staff who would feel safer by wearing an N95 — there were a few, but there weren’t many,” she added.

Infection preventionists are uncertain about how to deal with the rule, Pettis said. “Here we are, all trying to dig our way out” of the rules and restrictions put in during the pandemic, but this rule “just feels like we’re going backwards,” she said. In addition, since this is only a temporary standard with OSHA awaiting public comment, “no one is sure how much time and effort to put in … Things are going to change based on the feedback. If our experience with the federal government is any guide, I doubt they’ll change too much, but that would just be my guess.”

OSHA did not respond by press time to a query from MedPage Today about why the ETS was issued now. The agency is accepting comments on the ETS until July 21, including on the issue of whether the standard should be made permanent.