OSHA

OSHA / en Sat, 26 Apr 2025 03:54:12 -0500 Mon, 13 Jan 25 17:06:44 -0600 OSHA ends efforts to establish COVID-19 safety standard /news/headline/2025-01-13-osha-ends-efforts-establish-covid-19-safety-standard The Occupational Safety and Health Administration Jan. 13 <a href="https://www.federalregister.gov/public-inspection/2025-00632/occupational-exposure-to-covid-19-in-healthcare-settings">announced</a> that it terminated efforts to establish a final COVID-19 safety standard to protect workers in health care settings. The agency said it halted its efforts due to the end of the COVID-19 public health emergency, adding that any ongoing risk of COVID-19 faced by health care workers would be better addressed in an OSHA rulemaking effort that addresses infectious diseases more broadly.&nbsp; The AHA previously <a href="/news/headline/2022-04-27-aha-testifies-osha-hearing-covid-19-emergency-temporary-standard">urged</a> OSHA not to finalize the rule, saying it was unnecessary and would cause confusion. Mon, 13 Jan 2025 17:06:44 -0600 OSHA AHA Comments on OSHA Proposed Emergency Response Standard /lettercomment/2024-07-19-aha-comments-osha-proposed-emergency-response-standard <div class="container"><div class="row"><div class="col-md-8">July 19, 2024The Honorable Douglas Parker Assistant Secretary U.S. Department of Labor Occupational Safety and Health Administration 200 Constitution Avenue, N.W. Washington, D.C. 20210Re: Docket No. 2007-0073, Emergency Response Standard (Vol. 89, No. 24), Feb. 5, 2024Dear Assistant Secretary Parker:On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the �� Association (AHA) appreciates the opportunity to comment on the Occupational Safety and Health Administration’s (OSHA) proposed emergency response standard.OSHA’s proposed rule would replace its existing fire brigade standard, expanding its scope beyond firefighters to encompass a wide range of emergency personnel, including hospital-based ambulance services. Specifically, hospital-based ambulance services would fall under the proposed rule’s definition of emergency service organizations (ESOs).<a href="#fn1">1</a> As ESOs, hospital-based ambulance services would be required to meet the rule’s voluminous provisions, including those related to written emergency response plans, hazard vulnerability assessments (HVA), training, personal protective equipment, medical screening, behavioral health services, and workplace violence control, among many other requirements. It also would require ESOs to incorporate by reference 22 wide-ranging National Fire Protection Agency (NFPA) standards.Ensuring workforce safety is a paramount priority for hospitals and health systems, and the AHA appreciates OSHA’s efforts to improve workplace safety for emergency medical services (EMS) workers in ESOs, including hospital-based ambulance services. However, while we share your ultimate objectives, we are concerned that the standards as proposed include provisions that would be impossible to achieve for hospital and health system-based ambulance services. For example, many of the provisions directly relate to the risks faced by firefighters and address situations that do not exist for ambulance personnel. They also fail to account for the myriad regulatory requirements already placed on hospitals and health systems and their ambulance services. In addition, there are several places where the language in the proposed standards is confusing and certain provisions that would be particularly onerous to meet for certain hospital ambulance services, such as those operating in rural areas.As such, we recommend that OSHA permit hospital-based ambulance service ESOs to meet the proposed standards through existing requirements specific to their operations, such as those required for accreditation by The Joint Commission, other Centers for Medicare &amp; Medicaid Services-approved hospital accreditation bodies, or the Commission for the Accreditation of Ambulance Services (CASS).The AHA’s detailed comments and key concerns about the proposed rule are discussed below.<h2>National Fire Protection Agency Provisions Incorporated by Reference</h2>The proposed rule incorporates by reference 22 NFPA standards. The NFPA standards have been developed mostly by fire-based organizations, including fire equipment manufacturers, labor representatives, enforcement representatives, special experts/interests, and other fire-centric stakeholders. As a result, many of these standards are most appropriate for fire-based ESOs and not representative of the working conditions for non-firefighter ESOs, such as hospital-based ambulance services. Indeed, many of the NFPA standards referenced in the rule would be challenging, if not impossible, for EMS organizations to interpret and comply with, and would be inappropriate for their services.For example, the NFPA 1582 Standard on Comprehensive Occupational Medical Program for Fire Departments includes a vague description of exposure to combustion products and requires more detailed medical screening and surveillance. It is not clear if this is intended to apply to non-fire-based EMS personnel who may be present at fire scenes. Nevertheless, in such situations, hospital-based ambulance services are kept waiting far from the fire scene, and fire service responders bring patients out of such sites to be treated by the ambulance responders. While this type of medical screening and surveillance is appropriate for firefighters, it is inappropriate for hospital-based ambulance services that are not permitted to enter environments that would expose them to these substances. Another example is NFPA 1021 Standard for Fire Officer Professional Qualifications (2020 ed). It requires that persons serving in an incident command position at a scene must be trained to the level of Fire Officer I, II, and III. Thus, the OSHA proposed rule would require that non-fire-based EMS officers be trained consistent with this fire-centric standard which requires knowledge of Firefighter II, Fire Instructor I, and related job performance requirements as defined in Sections 4.2 through 4.7 of this standard.By contrast, the most common accrediting body for EMS is the Commission for the Accreditation of Ambulance Services (CASS), which has standards that are more appropriate for EMS, including hospital-based ambulance services. As such, we urge OSHA to allow hospital-based ambulance ESOs to comply with the CASS standards rather than the NFPA standards referenced in the proposed rule.<h2>Community Vulnerability Assessment</h2>The AHA is concerned with hospitals and health systems’ ability to comply with the proposed rule provisions requiring ESOs to perform a comprehensive Community Vulnerability Assessment (CVA). This is defined in the rule as “the process of identifying, quantifying, and prioritizing the potential and known vulnerabilities of the overall community that may require emergency service from the ESO, including the community’s structures, inhabitants, infrastructure, organizations, and hazardous conditions or processes.”We are particularly concerned about the provision’s sweeping wording. While hospitals are required by the Medicare conditions of participation to conduct hazard vulnerability assessments (HVA) of their communities, these are not nearly as expansive as the CVA required by the proposed rule. Hospital-based ESOs do not have, and do not need to have, access to many of the community structures in the area they serve. This is different from fire service ESOs which generally need access to these structures, businesses or other community infrastructure to perform fire inspection responsibilities. As a result, hospital-based ESOs would be unable to meaningfully comply with the CVA requirements in the proposed rule.AHA members also have expressed concerns about the economic impacts associated with conducting such a comprehensive CVA of the communities they serve. Hospital-based ESOs often cover large geographic footprints; therefore, complying with the proposed rule’s CVA requirements would necessitate hiring additional full-time staff just to meet these requirements. This would be a significant and time-consuming undertaking, involving the efforts of multiple individuals from the ESO to perform the duties related to this assessment, including the drafting and maintenance of the CVA and related documents. Given this, the heavy administrative burdens already imposed on hospitals and the workforce shortages with which they continue to struggle, the AHA recommends that OSHA permit hospital-based ESOs to meet the requirements of the proposed CVA through their existing compliance with the Medicare conditions of participation for conducting an HVA.<h2>Ambiguous Definitions</h2>The proposed standards incorporate a number of terms without specific definitions. This makes both assessing the proposal, as well as future compliance expectations, unclear and is one of our biggest concerns with the proposed standard. For instance, the proposed standard includes a disjointed and confusing description of covered job duties: “Employers that are emergency service organizations as defined in paragraph (b) of this section, that provide one or more of the following emergency response services as a primary function; or the employees perform the emergency service(s) as a primary duty for the employer: firefighting, EMS, and technical search and rescue. For the purposes of this section, this type of employer is called an Emergency Service Organization (ESO), and the employees are called responders.”It then offers these defined terms:<ul><li>“Emergency Service Organization (ESO) means an organization that provides one or more of the following emergency response services as a primary function: firefighting, EMS, and technical search and rescue; or the employees perform the emergency service(s) as a primary duty for the employer” and</li><li>“Personnel (called responders in this section), as part of their regularly assigned duties, respond to emergency incidents to provide service such as firefighting, EMS, and technical search and rescue. It does not include organizations solely engaged in law enforcement, crime prevention, facility security, or similar activities.”</li></ul>The combination of the proposed standard’s statement of coverage and these two definitions raises questions about the application of the standard in a variety of scenarios. For instance, would the standard apply when a hospital-based responder is doing administrative work? If the ESO provides both emergency and non-emergency responses, are both functions subject to the standard? Are ESO dispatchers, trainers and others who never engage in front-line emergency responses as part of their day-to-day work considered responders because they “respond” to emergency incidents?Unfortunately, the proposed standard fails to recognize that a large portion of the work performed by hospital-based responders is not any sort of emergency response, but instead normal day-to-day activities, including various administrative duties and nonemergency patient transport between facilities. The AHA recommends that OSHA clarify the people and situations in which the standard does not apply, specifically excluding situations when hospital-based ambulances are engaged in nonemergency responses and administrative and other staff that do not engage in front-line emergency response. We also encourage OSHA to examine all the definitions of terms used in the proposed rule to ensure that they are clear and understandable to the regulated community.<h2>Impact on Hospital-based ESOs in Rural and Super-rural Communities</h2>Of particular concern to the AHA is the potential impact that the proposed rule would have on hospital-based ESOs serving rural and super-rural communities. These ESOs often operate on an extremely limited budget and have very few EMS personnel and ambulances but are at the same time critical to ensuring emergency transport and care access. As is the case for many EMS organizations in the U.S., hospital-based ESOs are experiencing significant challenges with staffing, recruitment and retention of active employees.The requirements of this rule would place too high of a burden on these already financially stressed hospitals and their ESOs. Indeed, it may very well result in a reduction in their ability to continue to provide critical emergency services. For example, the costs for the proposed equipment, training and administrative requirements all far exceed the limited funding and resources currently available to such ESOs. In addition, the availability of specialized services to fulfill requirements for the proposed extensive employee medical and fitness evaluations simply do not exist in many such communities.The AHA agrees that it is important to monitor and support the health and safety of our hospital-based ambulance staff. However, the proposed rule goes beyond what is necessary to effectively protect our workforce. Instead, there should be a balance between that effort and strategies that are reasonable and sustainable, many of which are already in place. For example, The Joint Commission, which accredits nearly 90% of U.S. hospitals, already maintains and enforces standards establishing a safety and health management system within hospitals that applies to both patients and employees. There are six core elements comprising such a safety and health management system: management leadership, employee participation, worksite analysis, hazard prevention and control, safety and health training, and annual evaluation.<a href="#fn2">2</a>Therefore, we urge OSHA to consider the unintended consequences of implementing this proposed rule, and specifically the impact it will have on small rural and super-rural hospital-based ESOs and the communities they serve.<h2>Personnel Recruitment and Retention</h2>The proposed rule includes requirements that would negatively impact the ability of hospital-based ESOs to recruit and retain personnel in roles that are already difficult to fill. Specifically, the NFPA has no explicit physical standards for EMS responders. Yet, the proposed rule nevertheless seeks to apply criteria similar to those applicable to firefighters to EMS personnel, including a variety of requirements related to their physical and medical status.<a href="#fn3">3</a>Although professional firefighters are typically subject to rigorous physical fitness testing prior to hire, most hospital clinical employees, including ambulance responders, are required to pass a basic medical evaluation and physical aptitude test. Increased fire-centric physical and medical requirements, such as those included in the proposed rule, would disqualify a significant portion of those interested in such positions. Moreover, given OSHA’s proposed requirements for ongoing medical and physical fitness evaluations, many current hospital-based ambulance employees could be disqualified despite the fact they are licensed, skilled and experienced.Beyond the initial requirements relative to hiring employees for these roles, the proposed standards would require medical status and health of emergency response employees would need to be subject to employer surveillance and monitoring. The cardiac and pulmonary/respiratory health of providers is the focus of these efforts, with an emphasis on exposures to toxic, hazardous and carcinogenic substances (although the proposed standard does not define those terms), particularly with a focus heavily on the inhalation of the byproducts of combustion. Once again, while this type of employer surveillance and monitoring is appropriate for firefighters, it is inappropriate for hospital-based ambulance services that are often not permitted to enter environments that would expose them to these substances.Further, under the proposed standard, ESOs would also have to develop fitness programs and make fitness resources available to employees during working hours. This would compel hospital-based EMS services to allow employees to participate in physical fitness programs while working. For many hospital-based ESOs, it is unclear how those obligations would or could be met. Hospital-based ESOs often utilize a high-performance model for their ambulance services, in which a crew of two emergency medical technicians/paramedics are dynamically deployed to a specific geographic area for eight to 12-hour shifts. That geography is then set to specific response time standards, generally with very little downtime. Taking those crews out of service for an hour of exercise while they are working will almost certainly result in gaps in coverage and longer response times for those communities, putting community members seeking emergency care at increased risk.Finally, the new standard also would establish requirements related to employees’ mental health. It would require employers to establish mental health programs that both monitor the mental health of their employees and provide their employees with access to mental health resources, at no cost to the employee. At a minimum, these programs would be required to include diagnostic assessment, short-term counseling, crisis intervention and referral for behavioral health conditions arising from the team member’s or responder’s performance of emergency response duties. Hospitals and health systems are acutely aware of the mental health challenges experienced across their communities, including within their own workforces. They are taking a number of steps to connect patients, community-members and workers alike to the necessary mental health services and supports. However, in many communities across the nation, shortages of behavioral health providers has challenged hospitals’ and health systems’ efforts. While we appreciate that the standards related to mental health service access are well-intended, the AHA is concerned that there would not be enough providers available to conduct such behavioral health assessments at no cost to responders.As discussed above, the AHA urges OSHA to allow hospital-based ambulance services to comply with the CASS standards rather than impose these fire-centric standards in the proposed rule.<h2>Training, Including Vehicle Operating Training</h2>The OSHA proposed rule would require that each person in an emergency vehicle wear a seat belt or safety harness before the vehicle moves. The AHA recommends that OSHA revise this requirement to include exceptions in cases where seatbelts are inaccessible. For instance, in specialized vehicles utilized for infectious diseases, the interior of an ambulance is draped to reduce contamination, including on a seatbelt. Personal protective equipment worn in these cases could potentially be torn when wearing a seatbelt exposing the responder to harm.<h2>Compliance Timelines</h2>OSHA has proposed a phased-in timeline for compliance with the proposed standard, starting six months after the final rule’s effective date for certain provisions (e.g., mental and physical health requirements), 12 months for other provisions (e.g., health and fitness program) and 24 months for the remaining provisions (e.g., annual skill evaluation).While the AHA appreciates OSHA’s intent to advance emergency responder health and safety, we believe that the timeline for implementation is far too short and will put hospital-based ESOs at a large and inappropriate risk of noncompliance. The AHA recommends that OSHA extend the start of the implementation timeline for all provisions by at least two years and allow for longer periods for phasing in the various requirements to provide hospital-based ESOs adequate time to review and develop a plan for compliance with the final rule.<h2>Conclusion</h2>The AHA, together with our hospitals and health systems, remains committed to ensuring that all our employees can work in a hazard-free and safe environment, including our hospital-based ambulance services. However, we have serious concerns about the impact that this proposed rule would have on employee recruitment and retention as well as the financial hardship it would create for hospital-based ESOs, particularly those located in rural and other underserved communities. We urge OSHA to make the modifications recommended above, which will both ensure a hazard-free and safe working environment and continued access to care.The AHA appreciates your consideration of these issues. Please contact me if you have questions or feel free to have a member of your team contact Roslyne Schulman, AHA’s director for policy, at <a href="mailto:rschulman@aha.org?subject=RE: AHA Comments on OSHA Proposed Emergency Response Standard letter">rschulman@aha.org</a>.Sincerely,/s/Molly Smith Group Vice President Public Policy<hr><ol><li id="fn1">ESOs encompasses employers whose primary function is not as an emergency service provider but have employees whose primary duty for the employer is to perform emergency services.</li><li id="fn2"><a href="https://www.osha.gov/sites/default/files/2.2_SHMS-JCAHO_comparison_508.pdf">https://www.osha.gov/sites/default/files/2.2_SHMS-JCAHO_comparison_508.pdf</a></li><li id="fn3"><a href="https://ogletree.com/insights-resources/blog-posts/oshas-proposed-emergency-response-standard-a-closer-look-and-an-analysis-for-covered-employers/ target=">https://ogletree.com/insights-resources/blog-posts/oshas-proposed-emergency-response-standard-a-closer-look-and-an-analysis-for-covered-employers/</a></li></ol></div><div class="col-md-4"><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2024/07/AHA-Comments-on-OSHA-Proposed-Emergency-Response-Standard-20240719.pdf" target="_blank" title="Click here to download the AHA Comments on OSHA Proposed Emergency Response Standard letter PDF.">Download Letter PDF</a></div><a href="/system/files/media/file/2024/07/AHA-Comments-on-OSHA-Proposed-Emergency-Response-Standard-20240719.pdf" target="_blank" title="Click here to download the AHA Comments on OSHA Proposed Emergency Response Standard letter PDF."><img src="/sites/default/files/inline-images/Page-1-AHA-Comments-on-OSHA-Proposed-Emergency-Response-Standard-20240719.png" data-entity-uuid="64228bd6-1d92-44b7-b391-4228a6df3a48" data-entity-type="file" alt="AHA Comments on OSHA Proposed Emergency Response Standard letter page 1." width="692" height="900"></a></div></div></div> Fri, 19 Jul 2024 13:25:28 -0500 OSHA OSHA to require certain employers to submit certain injury, illness data /news/headline/2023-07-17-osha-require-certain-employers-submit-certain-injury-illness-data The Occupational Safety and Health Administration July 17 released a <a href="https://public-inspection.federalregister.gov/2023-15091.pdf">final rule</a> requiring employers in certain high-hazard fields, including health care, with 100 or more employees to electronically submit data from their Log of Work-Related Injuries and Illnesses (Form 300) and Injury and Illness Incident Report (Form 3010) once a year beginning in January 2024. They also must include their legal company name when making electronic submissions to OSHA from their injury and illness records. The requirements apply to establishments covered by federal OSHA, as well as establishments covered by states with their own occupational safety and health programs (i.e., State Plans). OSHA plans to publicly report some of the data on its website.&nbsp; Mon, 17 Jul 2023 15:20:35 -0500 OSHA OSHA to cite employers for each instance of certain respiratory protection violations /news/headline/2023-01-27-osha-cite-employers-each-instance-certain-respiratory-protection-violations Beginning March 20, the Occupational Safety and Health Administration may in certain cases cite for penalty each instance an employer violates certain standards, including for respiratory protection, the agency said in <a href="https://www.osha.gov/memos/2023-01-26/application-of-instance-by-instance-penalty-adjustments">guidance</a>&nbsp;yesterday to its regional administrators.&nbsp; &nbsp; “Instance-by-instance citations may be applied when the text of the relevant standard allows (such as, but not limited to, per machine, location, entry, or employee), and when the instances of violation cannot be abated by a single method of abatement,” the guidance states. &nbsp; The change applies to general industry, which includes the health care field, and “is intended to ensure OSHA personnel are applying the full authority of the Occupational Safety and Health Act where increased citations are needed to discourage non-compliance,” the <a href="https://www.dol.gov/newsroom/releases/osha/osha20230126-3">agency said</a>.&nbsp; &nbsp; In <a href="https://www.osha.gov/memos/2023-01-26/exercising-discretion-when-not-to-group-violations">separate guidance</a>, OSHA also reiterated its discretion to not group violations resulting from separate and distinct worksite conditions or conduct, but instead to “cite them separately to more effectively encourage employers to comply with the intent of the OSH Act.”&nbsp; Fri, 27 Jan 2023 16:02:00 -0600 OSHA Workforce Messages <div class="container"> <div class="row"> <div class="col-md-8"> <h2>Mandated Staffing Talking Points</h2> <h3>Patient safety is always the number one priority. Nurses need to be empowered with flexibility to determine appropriate staffing for the needs of their patients.</h3> <ul> <li>Hospitals and health systems are committed to safe nurse staffing to ensure quality care and optimal patient experience.</li> <li>One size doesn’t fit all when it comes to safe staffing. The number of patients for whom a nurse can provide safe, competent and quality care is dependent upon multiple factors. <ul> <li>Patients in need of care in the unit;</li> <li>Type and degree of illness;</li> <li>The overall care team including caregivers who may not be nurses;</li> <li>Physical layout of the unit.</li> </ul> </li> <li>We want to empower nurses so they can best tailor clinical care for the patient.</li> <li>Nurses, not legislators, should determine patient care. Mandatory nurse ratios do not allow for innovation and new team-based care models that we saw emerge during the pandemic.</li> </ul> <h2>Flexibility</h2> <ul> <li>We agree that safe staffing is a critical component of good care. Mandated nurse staffing ratios remove needed flexibility from nurses for the care they provide.</li> <li>Mandated nurse staffing ratios are a static and ineffective tool that cannot guarantee a safe health care environment or quality level to achieve optimal patient outcomes.</li> <li>Care needs can change instantly. Nurses at the unit level need flexibility to adapt to the changing patient needs throughout the day.</li> <li>Static ratios do not recognize the times when a nurse can safely care for a patient in times of low intensity like discharge.</li> <li>Increasing the number of nurses on a shift does not necessarily translate to higher quality care. <ul> <li>Care is provided as a team with each member playing a key role based on their expertise and skills.</li> <li>Lack of flexibility and mandated ratios will lead to nurses handling aspects that take them away from bedside care such as housekeeping or transport, among other duties.</li> </ul> </li> </ul> <h2>Care Team</h2> <ul> <li>Mandated approaches to nurse staffing require outdated care models that do not incorporate newer technologies or the interprofessional team-care model. What matters most for good care is the experience of the nurses in the unit, the composition of the care team and the needs of the patients.</li> <li>In the interprofessional team-care model, the nurse, respiratory therapist, and case manager work together to ensure quality and optimal patient outcomes.</li> <li>Mandated approaches to nurse staffing limit innovation and increase stress on a health care system already facing an escalating shortage of nurses.</li> <li>Patient safety is the top priority for everyone in health care.</li> </ul> <h2>Workplace violence</h2> <h3>Our health care workers' crucial life-saving roles have never been more evident, which is why their safety, protection and well-being, remain our top priority.</h3> <ul> <li>Hospitals and health care systems have long had robust protocols in place to detect and deter violence against their staff. Since the onset of the pandemic, however, violence against hospital employees has increased — and there is no sign it is receding.</li> <li>To support hospitals' efforts, the AHA created the Hospitals Against Violence member advisory group, and we have worked to address violence in hospitals and health systems and in the communities we serve. We have developed tools and resources to highlight and share with the field numerous programs and resources to combat violence.</li> <li>The AHA has urged the U.S. Attorney General to support legislation that would increase protections for health care workers from assault and intimidation. While we may never reduce violence in our hospitals to zero – because we are there to serve in the most challenging settings and circumstances – we can insist on zero tolerance for abusive behavior.</li> <li>People who dedicate themselves to saving lives deserve a safe environment, free of violence and intimidation.</li> <li>Last year, we developed a focused <a href="/system/files/media/file/2021/10/building-a-safe-workplace-and-community-framework-for-hospitals-and-health-systems.pdf">framework</a> for hospital, health system and security leaders. We also collaborated with the International Association for Healthcare Security and Safety to create <a href="/system/files/media/file/2021/10/creating-safer-workplaces-guide-to-mitigating-violence-in-health-care-settings-f.pdf">a guide for hospital and health system leaders</a>.</li> <li>The AHA/IAHSS guide focuses on employee well-being, promotes data-driven approaches, embeds safety and security into existing workflows and electronic medical records, and helps facilities develop relationships to improve security. It also includes <a href="/system/files/media/file/2021/10/building-a-safe-workplace-and-community-framework-for-hospitals-and-health-systems.pdf">a framework for building safer workplaces</a>, actionable steps for mitigating violence in hospitals and health care settings, and links to resources including webinars and podcasts.</li> </ul> <h2>OSHA Emergency Temporary Standard</h2> <ul> <li>The health and safety of all health care workers remains a top priority for the AHA and our members.</li> <li>We are committed to following the science-based and quickly evolving guidance issued by the Centers for Disease Control and Prevention (CDC). Throughout the course of the pandemic, hospitals have followed these protocols to ensure the safety of front-line staff and patients.</li> <li>Hospitals and health systems already have protocols in place to protect their workforce.</li> <li>While we acknowledge and appreciate OSHA’s consideration of additional flexibility for employers and other potential changes to the ETS, hospitals diligent efforts have helped protect health care workers by ensuring that the latest evidence-based practices and policies are followed.</li> <li>With CDC guidance and recommendations, CMS’ vaccination requirement and strictly enforced OSHA general standards, we strongly believe that an inconsistent OSHA COVID-19 health care standard is not necessary, would cause confusion and will ultimately lower hospital employees’ morale and worsen unprecedented personnel shortages in hospitals.</li> <li>It is essential to a well-functioning health care system that only one set of science-based standards be applied to health care providers, and that these standards be aligned across federal agencies.</li> <li>CMS already enforces CDC infection prevention and control guidelines as well as its vaccination mandate via the Medicare Conditions of Participation. Together with this, OSHA has sufficient authority through its existing general standards to protect health care employees from the hazard of COVID-19, not to mention other hazards.</li> </ul> <h2>Protecting Workers</h2> <ul> <li>Maintaining front-line workers’ health and safety is central to a successful response to the pandemic, and no one has more of a stake in doing so than the nation’s hospitals.</li> <li>Through the efforts of their organizational leadership, infection control officers, hospital engineers and material managers, and other front-line staff, they have done everything in their power to ensure that health care workers and patients are protected and that the latest evidence-based practices and policies are followed.</li> <li>Even in the midst of incredible challenges, like unprecedented surges of patients, severe shortages of PPE and other critical supplies, these dedicated experts scrambled to do all they could to support patients and staff alike, seeking supplies of PPE and other necessary supplies when severe shortages were hitting the US. They showed dedication and ingenuity in the face of a sometimes overwhelming situation.</li> <li>And this is precisely why it is essential to a well-functioning health care system that only one set of science-based standards be applied to health care providers, and that these standards be aligned across federal agencies. Enforcement of unaligned rules would not help and could actually cause harm by focusing compliance efforts on contradictory or unnecessary tings.</li> </ul> <h2>Workers Infected on the Job</h2> <ul> <li>It is tragic that so many have died during COVID. What we have learned from talking to hospitals to understand how workers became infected is that the most common infections took place outside of the hospital setting.</li> <li>What you may not be aware of is a JAMA study that looked at this issue and found that health care workers were more likely to catch COVID-19 in the community than from the workplace.</li> </ul> <h2>Supply Chain Issues</h2> <ul> <li>From the beginning, the AHA worked with the federal agencies to sound the alarm to strengthen our current supply chain and we are actively engaged with all stakeholders to find solutions.</li> <li>This was a once in a lifetime pandemic that began in China and no one could have anticipated that the supply chain would shut down. Everyone has been affected by supply chain issues and hospitals are no different.</li> <li>Hospitals have served as a catalyst by launching innovative initiatives with the private sector, like the 100 Million Mask Challenge.</li> <li>We pushed all levers to increase supplies of PPE so that front line caregivers were protected to the best of our ability. This included calling on the Administration to fully implement the Defense Production Act, urging Congress to provide more resources to acquire PPE.</li> <li>We agree that strengthening the supply chain, including scaling up the capabilities for the stockpiling and rapid distribution of PPE must be a high priority of the federal and state governments going forward.</li> <li>We also support efforts to incentivize and strengthen the domestic production of essential medical products, such as PPE.</li> </ul> </div> <div class="col-md-4"> <a href="/system/files/media/file/2022/03/Workforce-messages-3-23-22.pdf" title="Click here to download the Workforce Messages PDF."><img alt="Page 1 of Workforce Messages." data-entity-type="file" data-entity-uuid="d6978a26-9a7d-4181-8f69-25597309df42" src="/sites/default/files/inline-images/Page-1-Workforce-Messages-May-2-2022.png" width="1700" height="2200"></a> <div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2022/03/Workforce-messages-3-23-22.pdf" target="_blank" title="Click here to download the Workforce Messages PDF.">Download the PDF</a></div> </div> </div> </div> Mon, 02 May 2022 08:00:00 -0500 OSHA AHA urges OSHA not to finalize COVID-19 emergency temporary standard /news/headline/2022-04-22-aha-urges-osha-not-finalize-covid-19-emergency-temporary-standard The AHA today urged the Occupational Safety and Health Administration not to finalize its emergency temporary standard for occupational exposure to COVID-19, saying it continues to oppose establishing new regulations that are not fully aligned with the Centers for Disease Control and Prevention’s evolving evidence-based guidance. “With the constantly evolving, science-based CDC guidance and recommendations, CMS’ vaccination requirement and existing OSHA general standards, we strongly believe that an inconsistent and overly strict OSHA COVID-19 health care standard is not necessary, would cause confusion and will ultimately lower hospital employees’ morale and worsen unprecedented personnel shortages in hospitals,” AHA <a href="/lettercomment/2022-04-22-aha-urges-osha-not-finalize-covid-19-emergency-temporary-standard">wrote</a>. “It is essential to a well-functioning health care system that only one set of science-based standards be applied to health care providers, and that these standards be aligned across federal agencies.” OSHA last month&nbsp;<a href="https://www.osha.gov/coronavirus/healthcare/rulemaking">requested</a> additional comments on certain topics in its interim final rule, and announced an informal public hearing beginning April 27 to gather additional information from stakeholders as it develops a final rule. Fri, 22 Apr 2022 17:06:30 -0500 OSHA AHA Urges OSHA Not to Finalize COVID-19 Emergency Temporary Standard /lettercomment/2022-04-22-aha-urges-osha-not-finalize-covid-19-emergency-temporary-standard April 22, 2022 Douglas L. Parker Assistant Secretary of Labor for Occupational Safety and Health Occupational Safety and Health Administration 200 Constitution Ave NW Washington, DC 20210 Re: Docket No. OSHA–2020–0004, Occupational Exposure to COVID–19 in Health Care Settings; Occupational Safety and Health Administration Notice of Limited Reopening of Comment Period (Vol. 87, No. 56), March 23, 2022. Dear Assistant Secretary Parker: The �� Association appreciates the opportunity to submit comments on the Occupational Safety and Health Administration’s (OSHA’s) notice of a limited reopening of the comment period on the interim final rule establishing an Emergency Temporary Standard (ETS) on Occupational Exposure to COVID-19. For more than two years, through multiple surges of infections in communities and several variants of the SARS-CoV2 virus, health care workers across the country have battled COVID-19 and worked tirelessly and courageously to care for patients with and without COVID-19. These health care workers’ crucial life-saving roles have never been more evident than during the course of this pandemic. And our organizational leaders, engineers, supply chain managers and others have been there with them, supporting their efforts, seeking supplies of personal protective equipment (PPE), re-engineering ventilation systems as needed, sharing updates on the latest clinical care guidance, arranging for staff vaccinations as soon as they became available, and performing countless other tasks to support and protect staff. The safety and protection of all health care workers remains a top priority for the AHA and its members. The AHA, together with hospitals and health systems, remains committed to following the science-based and sometimes quickly-evolving guidance issued by the Centers for Disease Control and Prevention (CDC). Throughout the course of the pandemic, hospitals have followed these strict, evidence-based protocols to ensure the safety of front-line staff and patients. Since the authorization and approval of several COVID-19 vaccines, hospitals have been actively engaged in efforts to vaccinate their communities, starting with their employees and then expanding beyond their workforce into the local populace. These vaccination efforts remain the most promising route to ending the pandemic. The majority of hospital staff are now fully vaccinated1, which is the strongest protection against illness, hospitalization and death. Hospitals, through the diligent efforts of their organizational leadership, infection control officers, hospital engineers and material managers, and other front-line staff, have helped ensure that health care workers are protected and that the latest evidence-based practices and policies are followed. Maintaining front-line workers’ health and safety is central to a successful response to the pandemic, and no one has a more vested interest in doing so than the nation’s hospitals. While we acknowledge and appreciate OSHA’s consideration of additional flexibility for employers and other potential changes to the Occupational Exposure to COVID–19 in Health Care Settings interim final rule, we continue to oppose the establishment of new regulations that are not fully aligned with the CDC’s evolving evidence-based guidance. As we have discussed, CDC guidance and recommendations have long been the national standard for safe operations and have been utilized by health care providers since the beginning of the COVID-19 public health emergency (PHE). Hospitals and health systems are held to those standards by Centers for Medicare &amp; Medicaid Services (CMS) regulators. Moreover, hospitals and most other health care settings also are now subject to a COVID-19 vaccination requirement, strictly enforced by CMS, which applies to all eligible staff working at a facility that participates in the Medicare and Medicaid programs, regardless of clinical responsibility or patient care, including staff who work in offsite locations in which they interact with patients or with staff who interact with patients. Finally, as OSHA itself has acknowledged2, the agency has sufficient authority to help protect health care employees from the hazard of COVID-19. That is, OSHA maintains and vigorously enforces its general duty clause and other general standards, including the Personal Protective Equipment (PPE) and Respiratory Protection Standards. With the constantly evolving, science-based CDC guidance and recommendations, CMS’ vaccination requirement and existing OSHA general standards, we strongly believe that an inconsistent and overly strict OSHA COVID-19 health care standard is not necessary, would cause confusion and will ultimately lower hospital employees’ morale and worsen unprecedented personnel shortages in hospitals. It is essential to a well-functioning health care system that only one set of science-based standards be applied to health care providers, and that these standards be aligned across federal agencies. Therefore, the AHA does not believe that finalizing the OSHA interim final rule will provide any additional benefit beyond what hospitals have already been doing, and continue to do, to protect their workforce throughout the pandemic and afterwards, as the PHE ends and COVID-19 becomes endemic. As such, we urge OSHA not to finalize its interim final rule. However, if OSHA decides to finalize the COVID-19 health care standard, our responses to the topics and questions raised in OSHA’s notice follow. <h2>A.1—ALIGNMENT WITH CDC RECOMMENDATIONS FOR HEALTH CARE INFECTION CONTROL PRACTICES</h2> OSHA acknowledges that evolving CDC recommendations have resulted in inconsistencies between those recommendations and some of OSHA’s health care ETS provisions. The agency is therefore seeking comment on whether it would be appropriate to align its final rule with some or all of the CDC recommendations that have changed between the close of the original comment period for this rule and the close of this comment period. AHA Comment. The AHA is concerned that a final rule that adopts by reference specific versions of CDC guidance will inevitably result in OSHA’s standard becoming increasingly more outdated as the scientific understanding of COVID-19 grows and recommended health care infection control practices evolve. Embedding static versions of CDC’s guidance into the ETS will lead to disparate standards that will confuse health care employers and their employees, and could result in excessive burden and, potentially, harm. The CDC is in the best position to determine how health care providers should evolve their practices to mitigate spread of the virus. Moreover, in the ETS interim final rule, OSHA notes that it has a longstanding de minimis enforcement policy that allows employers to rely on documents that are at least as protective as a document incorporated by reference. However, as more of the U.S. population is fully vaccinated and up-to-date with booster shots, and the pandemic begins to slow down and eventually enter its endemic stage, CDC’s COVID-19 guidance and recommendations are likely to become less stringent over time. But OSHA’s de minimis enforcement policy will result in inappropriate over-regulation of health care employers because the ETS standards will no longer comport with CDC’s evidence-based guidance. The AHA believes that because the science surrounding COVID-19 is constantly evolving, OSHA should not embed static versions of CDC’s guidance into the ETS. This will inevitably lead to disparate standards that will confuse health care employers and their employees, and could result in excessive burden and, potentially, harm. The CDC is in the best position to determine how health care providers should change their practices to mitigate spread of the virus. Therefore, the AHA recommends that OSHA incorporate by reference relevant CDC guidance and other standards by linking directly to the live online CDC document. We further recommend that whenever CDC substantially updates its guidance, OSHA issue an announcement indicating when compliance with the changes will be required. For instance, if CDC makes minor changes to its guidance, such as identifying an additional aerosol-generating procedure for which a respirator is recommended, then a short timeframe to allow for compliance is reasonable. However, if CDC makes a major change to its guidance, for instance recommending significant changes to ventilation systems for COVID-19 units, that change would necessitate that hospitals are allowed a longer time to come into compliance. <h2>A.2—ADDITIONAL FLEXIBILITY FOR EMPLOYERS</h2> OSHA notes that some employers expressed concern that the provisions of the health care ETS were overly prescriptive. The ETS specified how employers were required to implement particular policies and procedures, such as the criteria for medical removal and return to work, cleaning, ventilation, barriers, and aerosol-generating procedures. OSHA is considering restating various provisions as broader requirements without the level of detail included in the ETS and providing a ‘‘safe harbor’’ enforcement policy for employers who are in compliance with CDC guidance applicable during the period at issue. AHA Comment. In general, the AHA supports OSHA’s consideration to establish broader, less-detailed requirements in a final rule, with a “safe harbor” enforcement policy linked to the relevant CDC guidance. The ETS included many requirements that were overly specific and complex, leading to confusion and wasted efforts. For example, the physical distancing standards and the related physical barrier requirements were overly specific, did not account for employee vaccination status or other controls in place and prevented individual health care facilities from using their internal risk assessments for other approaches to ensure the safety of their employees, such as the use of higher-level PPE. In fact, the AHA continues to recommend that OSHA remove the physical barrier requirements from the ETS altogether. As noted in <a href="/lettercomment/2021-08-20-ahas-comments-occupational-safety-and-health-administrations-oshas-covid" target="_blank">our comments</a> to the ETS, we believe the efficacy of the barrier requirement in reducing the transmission of COVID-19 in hospitals remains unproven, especially in hospitals where multiple other controls are already routinely used (e.g. high level of vaccination, masking, ventilation). Further, physical barriers may cause harm by interfering with the ventilation system airflow, fire and life safety protection systems, as well as increasing the risk of ergonomic and communication concerns. The AHA also recommends that OSHA simplify the ventilation requirements contained in the ETS. As noted in our previous comments to the ETS, we remain concerned that the ventilation requirements may be misunderstood by hospital leadership because they partially duplicate, but are not as comprehensive as, the current ventilation consensus standards that are adopted by CMS and which health care facilities already follow: the American Society of Heating, Refrigerating and Air-Conditioning Engineers/American Society for Health Care Engineering (ASHRAE/ASHE) Standard 170, Ventilation of Health Care Facilities. Therefore, we recommend that OSHA allow facilities installing new or upgrading existing air handling systems to follow the latest edition of the CMS adopted standard for health care ventilation, ASHRAE/ASHE 170. Regarding existing systems, the AHA recommends that OSHA permit facilities to evaluate their existing air handling systems to determine if improvements can be made to the filtration. The AHA agrees that the other provisions of the ETS mentioned in this section of the notice, such as the criteria for medical removal and return to work, cleaning and aerosol-generating procedures also should be less specific, and instead refer directly to the applicable CDC guidance. Please see our previously submitted <a href="/lettercomment/2021-08-20-ahas-comments-occupational-safety-and-health-administrations-oshas-covid" target="_blank">comment letter</a> for additional recommendations on ways to simplify the OSHA health care rule. Further, if a safe harbor enforcement policy is instituted, it is critical that OSHA’s area offices and the compliance safety and health officers (CSHOs) conducting inspections and initiating enforcement actions are thoroughly trained on the evolution of CDC’s guidance and recommendations over time so that they can apply the safe harbor policy appropriately. <h2>A.4—TAILORING CONTROLS TO ADDRESS INTERACTIONS WITH PEOPLE WITH SUSPECTED OR CONFIRMED COVID–19</h2> OSHA is considering the need for COVID-19-specific infection control measures in areas where health care employees are not reasonably expected to encounter people with suspected or confirmed COVID-19. This could include eliminating certain requirements that were included in the health care ETS and that applied to all areas of covered health care settings. For example, OSHA notes it could consider imposing cleaning requirements or medical removal provisions only with respect to staff exposed to COVID-19 patients or eliminating facemask requirements for staff not exposed to COVID-19 patients. If OSHA did restrict infection control requirements to particular areas of a facility or particular staff, it could consider balancing that narrower scope with a new ‘‘outbreak provision’’ to ensure that health care employers would still have a duty to address an outbreak quickly if an outbreak occurs among staff in the areas normally subject to fewer requirements. AHA Comment. The AHA notes that CDC already addresses such considerations in its various COVID-19 and more general guidance documents, including which infection prevention and control measures should be taken if health care personnel are exposed to individuals with suspected or confirmed COVID-19. If OSHA were to incorporate relevant CDC COVID-19 health care personnel guidance by directly referencing the live documents – for example the infection prevention and control guidance, the isolation and work restriction guidance, and the interim guidance for managing health care personnel with SARS-CoV-2 infection or exposure to SARS-COV-2 – then such “tailoring of controls” as envisioned in this section of the notice would be unnecessary. However, in the absence of such specific reference to CDC live guidance, the AHA would not support this approach as it would further drive a wedge between OSHA’s rule and CDC’s evidence-based guidance. A.5.1—BOOSTER DOSES In the ETS, certain requirements take account of whether individuals are ‘‘fully vaccinated,’’ which is defined in paragraph (b) of the ETS as meaning ‘‘2 weeks or more following the final dose of a COVID–19 vaccine.’’ Subsequent to the publication of the ETS, the Advisory Committee on Immunization Practices (ACIP) has recommended additional doses and booster doses. CDC has also adopted the concept of ‘‘up to date’’ to describe vaccination recommendations beyond the primary vaccination series. OSHA is seeking comment on how these ACIP and CDC recommendations might impact the requirements in the ETS that take account of individuals’ vaccination status (e.g., fully vaccinated, up to date). AHA Comment. Currently, according to CMS’ interim final rule requiring COVID-19 vaccinations, staff at health care facilities must be fully vaccinated, which is defined by CMS as two weeks or more since the individual completed a primary vaccination series for COVID-19. Since the CMS rule takes preeminence in settings participating in the Medicare or Medicaid program, it would be confusing and counterproductive if OSHA, in a rule that is not intended to mandate employee vaccination, were to define “fully vaccinated” differently. However, CDC’s guidance for health care workers does call out the additional protections afforded those who are “up to date” with their vaccinations, meaning that they have completed their primary vaccine course and have had any booster shots that are recommended for those in their age or risk group. CDC’s guidance provides some additional flexibilities for those who are up to date with their vaccines. The AHA recommends that OSHA’s definition of “fully vaccinated” be consistent with CMS’ definition, and that it align additional flexibilities with those granted to health care workers who are “up to date” on their vaccines as CDC does. <h2>A.5.2—EMPLOYER SUPPORT OF EMPLOYEE VACCINATION</h2> The Healthcare ETS included a provision requiring employers to inform employees about the safety, efficacy, and benefits of vaccination and provide reasonable time and paid leave to each employee for vaccination and side effects experienced following vaccination. The agency seeks comments on several possible changes. OSHA is considering an adjustment to the requirement that would include paid time up to four hours for employees to receive a vaccine (including travel time) and paid sick leave to recover from side effects. The agency also is considering requiring employer support for employees who wish to stay up to date on vaccination and boosters in accordance with the Advisory Committee on Immunization Practices and CDC recommendations. OSHA seeks comment on these approaches. AHA Comment. If OSHA is intent on promulgating this rule based on its legislative mandate to protect the health and safety of employees, it should focus its requirements on those processes or equipment that are essential for employee health and safety and refrain from addressing issues of employee time off. These issues are more appropriately dealt with in discussions between employers and employees or their union representatives. Other required vaccines are dealt with in this way, and while it might have been appropriate to call for a different approach as we were still learning about the impact of the COVID-19 vaccines, that is no longer necessary. However, if OSHA intends to continue to pursue these changes to its provisions, we note that in most cases, employee vaccination would not typically include travel time, as hospitals and health systems usually vaccinate their employees within their health care facility. Moreover, hospitals typically provide benefits to employees, including paid sick time or paid time off for employee illness, which we assume would include employer coverage for vaccine side effects. Further, it would be useful for OSHA to clarify that if paid sick time or paid time off is a part of the employee’s employment package, this requirement has been met. OSHA is considering whether to limit the provisions that provide support for vaccination to employees not covered by the CMS vaccination rule. AHA Comment. The AHA does not support this proposal. Hospitals and health systems want uniform policies to apply to staff unless there is a substantive and clear reason for a distinction to be made. CMS’ vaccine mandate does not apply to certain employees only in limited circumstances, including if they are working in off-site offices, providing telehealth services, or working exclusively from home such that their risk of exposure to COVID-19 is no different than that of anyone else in the community and their chance of transmitting it to a person while that person is being treated by the hospital or health system is negligible. It is unclear why OSHA would establish a provision in this rule that calls out those individuals for specific support to get vaccinated. In addition, it inadvertently could be a source of discontent for those on the staff whose jobs include more direct contact with COVID-19-positive-patients but who are not offered the same support. <h2>A.5.3—REQUIREMENTS FOR VACCINATED WORKERS</h2> During the initial comment period, stakeholders raised questions about whether the Healthcare ETS requirements should be relaxed or eliminated based on the vaccination status of the individual worker involved, the general vaccination rate of the entire staff, and/or the general vaccination rate of the community. OSHA is considering suggestions that requirements be relaxed: <ul> <li>for masking, barriers, or physical distancing for vaccinated workers in all areas of health care settings, not just where there is no reasonable expectation that someone with suspected or confirmed COVID-19 will be present;</li> <li>in health care settings where a high percentage of staff is vaccinated; and/or</li> <li>for exposure notification for vaccinated employees.</li> </ul> AHA Comment. The AHA urges OSHA to adopt the CDC’s evidence-based guidance and recommended routine infection prevention and control practices during the COVID-19 pandemic. In certain instances, CDC factors into its recommendations the vaccination status of health care personnel based on scientific evidence of a lower risk of illness for those individuals. In addition, several of the CDC’s recommended infection prevention and control measures, such as use of source control and screening testing, are influenced by levels of SARS-CoV-2 transmission in the community. For instance, CDC’s infection control guidance states that in health care facilities located in counties with low to moderate community transmission, health care personnel who are up to date with all recommended COVID-19 vaccine doses could choose not to wear source control (i.e. respirators or well-fitting facemasks or cloth masks) or physically distance when they are in well-defined areas that are restricted from patient access (e.g., staff meeting rooms, kitchen). OSHA regulations that are inconsistent with CDC’s recommendations would be confusing and counterproductive in health care settings. <h2>A.6—COVERAGE OF CONSTRUCTION ACTIVITIES IN HEALTH CARE SETTINGS</h2> OSHA notes that it did not expressly include employers that engage in construction work in hospitals, long term care facilities and other settings that are covered by the ETS. The construction industry was not included in its industrial profile for the rule. OSHA is considering clarifying this coverage and seeks comment on this approach. For example, it is considering the same coverage for workers engaged in construction work inside a hospital as for workers engaged in maintenance work or custodial tasks in the same facility. OSHA could consider exceptions for construction work in isolated wings or other spaces where construction employees would not be exposed to patients or other staff. AHA Comment. While OSHA’s full intention here is unclear, the agency seems to be referring to the inclusion of contracted construction crews under the health care ETS requirements in the same way that other health care support services3 are included. It is our understanding that this would include, for instance, consideration of contracted construction employees in the development of the host health care employer’s COVID-19 plan, communication and coordination between host employers and contractors about the specifics of the plan and sharing of additional information as necessary on an ongoing basis and notification of other employers whose employees have been in close contact with the COVID-19-positive-person in the host employer’s workplace. Hospitals, particularly large hospitals, have hundreds of different kinds of contracts for a wide variety of services, making it hard to respond thoughtfully to the notion of including contract employees, as if their jobs, their risk exposure and the opportunity for the hospital or health system to prevent infection were similar. They are not. Contract nursing or physician staff may have similar risk profiles to other nurses and doctors who are employed by the hospital. Contractors providing periodic elevator maintenance services, picking up expired drugs for disposal, or re-constructing areas of the facility that have been repurposed to accommodate different needs have very different risk profiles. All hospitals have run into barriers in trying to track the vaccination status of contract staff. There are particular struggles for those located in rural areas, who have encountered resistance from contractors in obtaining information on the vaccine status of contract employees. CMS has recently clarified its guidance to be clear that hospitals are not expected to maintain information on the vaccine status of contract employees; however, they are expected to have policies in place to ensure those organizations with whom they contract have clarity about the need for the workers in patient care and other related areas of the hospital to be vaccinated or exempted. The AHA encourages OSHA to address any policies related to contractors in the final rule with a clear understanding of the differences in risks and a realistic view of what such a requirement would mean for the contractors, many of which are national or regional in scope and serve a wide variety of hospitals. Hospitals assess different kinds of risks for different contract activities and apply appropriate safeguards. For example, when there is construction done in the health care environment, there are existing guidelines commonly used to conduct risk assessments in the planning phase of projects and mitigation efforts based on the risk assessments for infectious diseases and other environmental risks. Specifically, the Facilities Guidelines Institute, an independent, not-for-profit organization dedicated to developing guidance for the planning, design, and construction of hospitals and other health care facilities, provides support for the development of safe, effective health care built environments. We believe that duplicative or inconsistent rules applied to contracted construction work in hospitals may prove confusing and burdensome. The AHA encourages OSHA to address these concerns in the final rule if the construction industry is included. <h2>A.8—TRIGGERING REQUIREMENTS BASED ON THE LEVEL OF COMMUNITY TRANSMISSION</h2> When employees are treating people with suspected or confirmed COVID-19, the ETS requires certain control strategies (e.g., PPE) regardless of community transmission levels. Under the CDC’s current guidance for health care workers, many recommendations are triggered based on the level of community transmission of COVID-19 (e.g., controls needed in areas of substantial or high transmission, controls not needed in areas of low or moderate transmission). OSHA is considering linking regulatory requirements to measures of local risk, such as either what the CDC uses in its guidance for health care settings (i.e. community transmission) or what the CDC uses in its guidance for prevention measures in community settings (i.e. COVID-19 Community Levels). OSHA is seeking comment on that approach, including impacts of such an approach on compliance and enforcement. AHA Comment. CDC’s COVID-19 Community Levels recommendations do not apply in health care settings and should not be used by OSHA. Instead, the AHA would support OSHA’s deferring to CDC guidance for health care settings, which already incorporates community transmission levels in its recommendations. That said, some of our larger health systems with hospitals and other health care facilities located in many different communities are concerned about the complexity involved in tracking the level of community transmission across all their facilities and as the levels change over time. In rural communities, there may be areas of sparse population where this calculation of community transmission becomes a “small numbers” problem. That is, a very small number of individuals contracting COVID-19 can result in a shift of the community from one level to another. If OSHA finalizes policies that link to community transmission levels, we urge the agency to develop tools and resources to help hospitals and health systems comply in a way that would not be overly burdensome and take into consideration this complexity for health systems in its enforcement of the regulation. <h2>A.9—EVOLUTION OF SARS–COV–2 INTO A SECOND NOVEL STRAIN</h2> It is possible that a future variant of SARS–CoV–2 will have sufficient genetic drift to be designated another novel coronavirus strain but still result in a disease that is similar to the current illness. OSHA is considering specifying that this final standard would apply not only to COVID-19, but also to subsequent related strains of the virus that are transmitted through aerosols and pose similar risks and health effects. OSHA seeks comment on this approach and alternatives to addressing the potential for new strains related to SARS–CoV–2. AHA Comment. The AHA opposes applying OSHA’s COVID-19 health care standard to subsequent related strains of the SARS-CoV-2 virus. It would be inappropriate for OSHA to make assumptions about how an unknown strain of the virus would spread in health care settings and the steps needed to mitigate its spread. We appreciate your consideration of these issues. Please contact me if you have questions or feel free to have a member of your team contact Roslyne Schulman, AHA’s director of policy, at <a href="http://rschulman@aha.org" target="_blank">rschulman@aha.org</a> or (202) 626-2273. Sincerely, /s/ Stacey Hughes Executive Vice President __________ 1 COVID-19 vaccination coverage among hospital-based healthcare personnel reported through the Department of Health and Human Services Unified Hospital Data Surveillance System, United States, January 20, 2021-September 15, 2021, American Journal of Infection Control, Vol. 49, Issue, Pages 1554-1557, Dec.1, 2021, <a href="https://www.ajicjournal.org/article/S0196-6553(21)00673-8/fulltext" target="_blank">https://www.ajicjournal.org/article/S0196-6553(21)00673-8/fulltext</a> 2 <a href="https://www.ajicjournal.org/article/S0196-6553(21)00673-8/fulltext" target="_blank">https://www.osha.gov/coronavirus/ETS</a> 3 Health care support services are defined in the ETS as including patient intake/admission, patient food services, equipment and facility maintenance, housekeeping, healthcare laundry services, medical waste handling services, and medical equipment cleaning/reprocessing services. Fri, 22 Apr 2022 14:30:47 -0500 OSHA OSHA proposes to revoke Arizona’s occupational safety and health plan /news/headline/2022-04-20-osha-proposes-revoke-arizonas-occupational-safety-and-health-plan The Occupational Safety and Health Administration today <a href="https://public-inspection.federalregister.gov/2022-08424.pdf">proposed</a> revoking its approval of Arizona’s occupational safety and health plan, saying the state has failed to adopt OSHA’s emergency temporary standard for occupational exposure to COVID-19 and has a history of failing to meet its obligations under the plan. Under the federal Occupational Safety and Health Act of 1980, states may opt to develop and enforce their own occupational safety and health standards by obtaining federal approval for a state plan, a process Arizona completed in 1985. OSHA will accept comments on its proposal to revoke approval of the state plan for 35 days beginning tomorrow. If the agency decides to revoke approval of the plan, OSHA would automatically resume concurrent authority to set and enforce occupational safety and health standards in the state. OSHA last December <a href="/news/news/2021-12-30-osha-withdraws-ets-occupation-exposure-covid-19">withdrew</a> its emergency temporary standard for occupational exposure to COVID-19, but urged all health care employers to continue to implement the requirements while it develops a final standard. OSHA last month&nbsp;<a href="https://public-inspection.federalregister.gov/2022-06080.pdf">reopened</a>&nbsp;the comment period for certain topics in the interim final rule establishing the standard and scheduled an April 27 hearing to gather additional information from health care stakeholders. AHA plans to submit comments.&nbsp; Wed, 20 Apr 2022 15:29:24 -0500 OSHA AHA seeks longer comment period for emergency temporary standard /news/headline/2022-03-29-aha-seeks-longer-comment-period-emergency-temporary-standard AHA today urged the Occupational Safety and Health Administration to extend at least through May 23 its reopened comment period for the interim final rule establishing an emergency temporary standard for occupational exposure to COVID-19. Comments are currently due April 22.?&nbsp; &nbsp; “The AHA and its members are working diligently to assess the need for and impact of the potential provisions and approaches specified in the notice as well as OSHA’s request for additional studies, information and data related to the delta and omicron variants since the close of OSHA’s initial comment period in August 2021,” AHA <a href="/lettercomment/2022-03-28-aha-urges-osha-extend-comment-period-emergency-temporary-standard">wrote</a>. “An extension will enable hospitals and other stakeholders to deliberate, analyze and prepare thoughtful comments for OSHA’s review.”&nbsp;&nbsp; Tue, 29 Mar 2022 15:36:14 -0500 OSHA AHA Urges OSHA to Extend the Comment Period for Emergency Temporary Standard /lettercomment/2022-03-28-aha-urges-osha-extend-comment-period-emergency-temporary-standard March 28, 2022 Douglas L. Parker Assistant Secretary of Labor for Occupational Safety and Health Occupational Safety and Health Administration 200 Constitution Ave NW Washington, DC 20210 Dear Assistant Secretary Parker: On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, and our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the �� Association (AHA) is writing to request a deadline extension for the comment period reopening of Occupational Safety and Health Administration’s (OSHA’s) interim final rule establishing an Emergency Temporary Standard (ETS) on “Occupational Exposure to COVID–19” (Docket No. OSHA–2020–0004). The AHA urges OSHA to extend the comment deadline by at least an additional 30 days, through May 23. The AHA and its members are working diligently to assess the need for and impact of the potential provisions and approaches specified in the notice as well as OSHA’s request for additional studies, information and data related to the delta and omicron variants since the close of OSHA’s initial comment period in August 2021. An extension will enable hospitals and other stakeholders to deliberate, analyze and prepare thoughtful comments for OSHA’s review. As such, we are gathering input from our members regarding their views and concerns and the impact these possible changes to the ETS will have on their operations and employees. The AHA’s fact-finding with our members will enable us to provide the agency with substantive and data-informed comments. To provide comprehensive feedback, we respectfully request that OSHA allow for a minimum additional 30 days of public comment. Thank you for your consideration of our request. Please contact me if you have questions or feel free to have a member of your team contact Roslyne Schulman, AHA’s director of policy, at rschulman@aha.org or 202-626-2273. Sincerely, /s/ Stacey Hughes Executive Vice President Government Relations and Public Policy &nbsp; Mon, 28 Mar 2022 11:47:56 -0500 OSHA