In April, the American Hospital Association (AHA) urged the Occupational Safety and Health Administration (OSHA) not to establish a permanent healthcare COVID-19 standard based on the agency’s June 21, 2021, emergency temporary standard (ETS). The AHA voiced its opposition to establishing a permanent standard not aligned with evolving evidence-based guidance from the Centers for Disease Control and Prevention (CDC).
The group suggested a permanent standard could create confusion, lower employee morale, and worsen healthcare staffing shortages.
The AHA also noted that hospitals and other healthcare facilities are subject to a vaccine mandate issued by the Centers for Medicare & Medicaid Services (CMS), as well as OSHA’s own personal protective equipment (PPE) and respiratory protection standards.
The majority of hospital staffs now are fully vaccinated, according to the AHA.
The AHA also acknowledged OSHA’s vigorous enforcement under the General Duty Clause of the Occupational Safety and Health (OSH) Act. OSHA has both a national emphasis program (NEP) and an ongoing enforcement initiative for COVID-19 exposures in health care. The NEP includes non-healthcare industries like correctional facilities, grocery and discount department stores, meat and poultry processing, and restaurants, as well as healthcare facilities. The enforcement initiative, which is scheduled to last until June 9, is aimed at hospitals and skilled nursing care facilities.
A permanent healthcare COVID-19 standard would not offer any additional benefit beyond what hospitals already are doing to protect frontline healthcare workers, according to the group.
The AHA offered several comments for OSHA’s consideration if the agency decides to proceed with the rulemaking. The group suggested that OSHA:
- Refrain from embedding static versions of CDC guidance in permanent regulations, as CDC guidance evolves as more evidence surrounding COVID-19 and the SARS-CoV-2 virus emerges.
- Include less prescriptive employer requirements. The AHA characterized the 2021 ETS as overly complex and specific, offering as an example ventilation requirements that were duplicative of or less comprehensive than CMS requirements.
- Drop a requirement for paid leave for travel to a vaccination site because most hospitals vaccinate their own staff on-site.
- Adopt CDC evidence-based guidance for infection prevention and control measures, which are based on percentages of vaccinated staff and levels of SARS-CoV-2 transmission in the community.
- Avoid confusing or overly burdensome requirements, such as including healthcare facility construction activities in a permanent standard, because exposure risks vary among contractors.
The AHA also urged the agency not to apply a permanent COVID-19 standard to subsequent novel strains of the SARS-CoV-2 virus—what OSHA called a “hypothetical COVID-22.”
On March 23, OSHA announced a limited reopening of comment on adopting the ETS as a permanent standard. The agency also announced a virtual, informal public hearing on the rulemaking to be held April 27.
OSHA asked for comment on aligning the COVID-19 standard with CDC guidance and recommendations, triggering the standard’s requirements based on community transmission levels and the possible application of the standard in instances of a novel coronavirus disease, as well as eliminating certain infection control requirements in areas where healthcare employees are not expected to encounter people with suspected or confirmed COVID-19.