OSHA in Health Care Facilities

Covid-19 and Beyond

Background• Occupational Safety and Health Administration

• Solely focused on employee safety• Performs inspections• Complaints, programmed inspections, catastrophic incidents, and

random• Fines for Serious and Other Than Serious $13,653 effective

1/15/2021• Fines for Willful $136,532

Inspection TriggersEmployee Complaint

“Catastrophic Incident”• Mandatory report

• Hospitalization• Amputation• Loss of an eye• Fatality

Programmed Inspections• National Emphasis Program (NEP)

• COVID-19• Nursing home targeted program (2002-2015)

“General Duty Clause” 5(a)(1) or IA 88.004

SEC. 5. Duties• (a)Each employer --

• (1) shall furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees;

Discussion

• Not Government• State plans include government

Each Employer

• “Could have, or should have known”• Actual recognition not required

Recognized Hazard

• Prevent “normal or routine” job functions

• Prevent normal daily activities

Serious Physical Harm

Hazard Identification• Loss History/300 Logs

• Trade Groups

• Inspections

• Employee Involvement and non-retaliation

Job Hazard Alalysis ( JHA)

Routine Tasks

Non-Routine

Tasks

Predictable Hazards Controls

Hierarchy of Controls

1. Eliminate the Hazard

2. Engineering Controls

3. Administrative Controls

4. Personal Protective Equipment (PPE)

OSHA rules applied to COVID in health care (before NEP)• Certified JHA – 1910.132 (d) (2)

• Written Respirator Program – 1910.134 (c) (1)

• Respirator not Provided – 1910.134 (a) (2)

• General Duty Clause – 5 (a) (1)

• Appendix D Voluntary use – 1910.134 (c) (2) (i)

Potential fines $65,000+

Covid-19 NEP

Federal Enforcement began March 26, 2021

• State Plans Submitting

Prioritizes “High Potential for Exposure” Workplaces• Hospitals, emergency treatment, nursing homes, and

assisted living facilities

Prioritizes “Fatalities, hospitalization, complaints” over “Programmed Inspections”

Specifically references CDC guidelines

Specified Document Review in NEP (pre-walk through)• Safety and Health Programs

• Disaster and Emergency Planning Including COVID-19

• JHA

• Hierarchy of Controls

• Isolation Rooms/Cohorting

Specific Standards referenced in the NEP

• 29 CFR Part 1904, Recording and Reporting Occupational Injuries and Illness.

• 29 CFR § 1910.132, General Requirements-Personal Protective Equipment.

• 29 CFR § 1910.134, Respiratory Protection.

• 29 CFR § 1910.141, Sanitation.

• 29 CFR § 1910.145, Specification for Accident Prevention Signs and Tags.

• 29 CFR § 1910.1020, Access to Employee Exposure and Medical Records.

• Section 5(a)(1), General Duty Clause of the OSH Act.

Clarification of key terms• Source Control: Standard mask (homemade

or purchased) to control spread worn by the individual. This is not technically a respirator and does not directly count as “PPE”.

• Filtering Facepiece Respirator (N95 or KN95) -PPE worn by an individual to protect themselves. This is a respirator and respirator regulations apply.

• “Certified” – OSHA does not Certify anything. An employer’s certification means that the employer certifies a document as true and accurate. Other certifications are from recognized certifying bodies (i.e. American National Standards Institute a.k.a ANSI)

Exercise 1: Job Hazard Analysis

• Task: Administration of Medications

• Discuss: Hazards

Exercise 2: Hierarchy of Controls

• Hazard: Aerosol Borne Pathogens

• Discuss: Control Methods

COVID-19 Emergency Temporary Standard

• Applies to Healthcare only• Healthcare activities outside healthcare facilities

• Goes into effect when published in the Federal Register• For 6 months from date of publication (?)

• May lead to a permanent standard

• First released on the OSHA website 10 June 2021

ETS Key Elements

• COVID hazard assessment

• Covid written plan

• PPE (Vaccine)

• Training

• PTO

• Employee involvement

More Info

• www.osha.gov/coronavirus/ets

I’m neither a psychic nor an attorney…

But….

Potential future pitfalls

• “Aerosol Borne Pathogens”• Influenza?

• Employee Training• Respirator use in other areas

• Workplace Violence

• Transportation Employee Safety

Review

• OSHA Fines for Employee safety issues = $13,000+ per citation

• Identify Hazards

• Hierarchy of Controls

• Documents

• Training

Thank You!Questions?