During the Trump administration, the federal Occupational Safety and Health Administration (OSHA) came under heavy criticism for not doing enough to protect health care and other essential workers against risk of exposure to COVID-19. On his very first day in office, the new President pledged to rectify that situation. It took almost six months but on June 10, 2021, OSHA finally issued new OSHA requirements for frontline health care workers. Here’s an overview of the new Emergency Temporary Standard (ETS) and the 15 things labs must do to comply with it.
Whom the ETS Covers The ETS, which took effect on June 21, applies to settings where an employee provides healthcare services or healthcare support services, including labs, hospitals, nursing homes, assisted living facilities, emergency response, home healthcare and ambulatory facilities that treat confirmed or suspected COVID-19 patients. However, it doesn’t cover:
- Non-hospital ambulatory care settings where all non-employees are screened before entry and people with suspected or confirmed COVID-19 aren’t allowed to enter;
- Well-defined hospital ambulatory care settings where all employees are fully vaccinated and all non-employees are screened before entry and people with suspected or confirmed COVID-19 aren’t allowed permitted to enter; or
- Healthcare support services not performed in a healthcare setting, e.g., off-site laundry, off-site medical billing).
- COVID-19 Plan
The ETS requires employers to create and implement a COVID-19 plan for each workplace. You can use a standard plan for all workplaces, as long as they’re substantially similar. The plan must be in writing if there are more than 10 employees. Elements the plan must include:
- Designation of one or more persons who are knowledgeable in infection control principals and practices to act as workplace COVID-19 safety coordinator with authority to ensure plan compliance;
- Workplace-specific hazard assessment to identify COVID-19 hazards, carried out with the participation of non-managerial employees or their representatives;
- Ongoing plan monitoring; and
- Implementation of appropriate engineering controls, administrative/work controls and personal protective equipment (PPE) to eliminate or minimize identified hazards.
- Patient Screening & Management Controls
In settings where direct patient care is provided, the employer must screen and triage all clients, patients, residents, delivery people and other visitors, as well as other non-employees entering the facility.
- Standard and Transmission-Based Precautions
The ETS requires employers to implement policies and procedures to ensure compliance with the Standard and Transmission-Based Precautions set forth in the CDC’s ‘‘Guidelines for Isolation Precautions.’’
- Face Masks
Employers must provide, and ensure that employees wear, facemasks (defined as “a surgical, medical procedure, dental, or isolation mask that is FDA-cleared, authorized by an FDA EUA, or offered or distributed as described in an FDA enforcement policy”) when they’re indoors or in a vehicle with other people for work purposes. The employer must provide ample numbers of face masks and ensure that employees change them at least once a day or more often, as necessary.
Exceptions: Face masks aren’t required:
- When an employee is alone in a room;
- While an employee is eating and drinking at the workplace, as long as employees are at least 6 feet apart or separated by a physical barrier;
- When employees wear respiratory protection;
- When it’s important to see an employee’s mouth and clear plastic facemasks are too dangerous;
- When employees can’t wear face masks due to medical conditions, religious beliefs or disabilities; or
- When the employer can show that use of a face mask would create a serious hazard to an employee.
- Other PPE
When employees are exposed to or perform aerosol-generating procedures on a person with suspected or confirmed COVID–19, the employer must provide and ensure employees properly use a respirator, gloves, an isolation gown or protective clothing and eye protection. The ETS “encourages” employers to select elastomeric respirators or PAPRs instead of filtering facepiece respirators to prevent shortages and supply chain disruption.
- Additional Precautions for Aerosol-Generating Procedures
When an aerosol-generating procedure is performed on a person with suspected or confirmed COVID–19, the employer must:
- Limit the number of employees present to only those essential for patient care and procedure support;
- Ensure that the procedure is performed in an existing airborne infection isolation room (AIIR), if one is available; and
- Clean and disinfect the surfaces and equipment in the room or area where the procedure was performed after it’s done.
- Social Distancing
Other than for momentary exposure when people are in movement, e.g., passing through aisles or hallways, employer must ensure that each employee is separated from other people by at least 6 feet when indoors unless the employer can demonstrate that such physical distancing isn’t feasible for a specific activity (e.g., hands-on medical care).
- Physical Barriers
The employer must install cleanable or disposable solid barriers, at each fixed work location outside of direct patient care areas (e.g., entryway/lobby, check-in desks, triage, hospital pharmacy windows, bill payment) where employees aren’t at least 6 feet apart, except where the employer can demonstrate it isn’t feasible. The barrier must be located to block face-to-face pathways between individuals but can have a pass-through space at the bottom for objects.
- Cleaning & Disinfection
The employer must follow CDC cleaning and disinfection guidelines and standards in patient care areas, resident rooms and for medical devices and equipment. In all other areas, the employer must:
- Clean high-touch surfaces and equipment at least once a day, following manufacturers’ instructions for application of cleaners; and
- Follow the CDC’s “Cleaning and Disinfecting Guidance” in any areas, materials and equipment that have likely been contaminated by a person who’ COVID–19 positive within the last 24 hours;
The employer must also provide alcohol-based hand rub that’s at least 60% alcohol or provide readily accessible hand washing facilities.
- Ventilation
Employers who own or control buildings or structures must ensure that the existing heating, ventilation, and air conditioning (HVAC) system(s) is used in accordance with the manufacturer’s instructions and the system’s design specifications and that air changes per hour are maximized. All air filters must be rated Minimum Efficiency Reporting Value (MERV) 13 or higher, if compatible with the HVAC system(s). If MERV–13 or higher filters aren’t compatible, employers must use filters with the highest compatible filtering efficiency for the HVAC system(s). The ETS notes that this section doesn’t require installation of new HVAC systems or AIIRs to replace or augment functioning systems.
- Employee Screening, Contact Tracing & Removal
10.502(l)(1)(i) Each employee must be screened before each work day and shift via by asking the employee to self-monitor before reporting to work or in-person screening conducted by the employer. If employers require COVID–19 testing for screening purposes, they must provide the test at no cost to the employee. The employer must require each employee to promptly notify the employer when the employee (referred to collectively as the “Criteria”):
- Is COVID–19 positive;
- Has been told by a licensed healthcare provider that they’re suspected of having COVID–19; or
- Is experiencing COVID-19 symptoms.
Upon being notified that a person who’s been in the workplace is COVID-19 positive, the employer must, within 24 hours:
- Notify each employee who wasn’t wearing a respirator and other required PPE who had close contact (defined as being within 6 feet for a cumulative total of 15 minutes or more over a 24-hour period during the person’s potential period of transmission) with that person in the workplace;
- Notify all other employees who weren’t wearing a respirator and other required PPE and worked in a well-defined portion of a workplace (e.g., a particular floor) in which that person was present during the potential transmission period.
Notification must include the date and time of contact but not any employee’s name, contact information (e.g., phone number, email address), or occupation. The employer must immediately remove any employee it knows meets the Criteria and provide him/her a COVID-19 polymerase chain reaction (PCR) test at no cost to the employee:
- If the test results are negative, the employee may return to work immediately; and
- If the test results are positive or the employee refuses to take the test, the employer must keep the employee removed until he/she meets the criteria for return.
The employer must keep the employee removed for 14 days but can offer to provide a free COVID-19 test to him/her at least five days after the exposure and, if the test is negative, allow him/her to return after 7 more days.
- Mandatory Medical Removal Benefits
Employers with more than 10 employees must provide employees who are medically removed from work their normal pay and benefits up to $1,400 per week until they meet the requirements for returning to work.
Exception: Employees who refuse to be COVID-19 tested don’t get removal benefits.
- Return to Work
The employer must follow CDC guidelines in determining when employees who are medically removed may return to work.
- Paid Vaccination Leave.
The employer must provide employees “reasonable time and paid leave” (e.g., paid sick leave, administrative leave) for vaccination and to recover from any vaccination side effects.
- Training
Employers must ensure each employee receives training in a language and at a literacy level the employee understands so that the employee comprehends disease transmission, tasks and situations in the workplace that could result in COVID-19 infection, and relevant policies and procedures. It must also ensure employees receive additional training when changes occur that affect the employee’s risk of infection, if policies or procedures are changed, or when there’s an indication that an employee hasn’t acquired or retained the necessary understanding or skill.
Takeaway At first glance, the ETS laundry list of required COVID-19 safeguards appears fairly extensive and intimidating. The good news is that many, if not most of these requirements are measures that are already mandatory under CDC and public health guidance, including screening, cleaning, disinfection, PPE, face masks, physical barriers. What is new—and fairly controversial—are the benefit provisions, which you’d normally expect to find in labor standards rather than OSHA laws. 
