In the May 6, 2010 Federal Register, OSHA published a Request for Information (RFI) to collect information from the healthcare industry on “occupational exposure to infectious agents in settings where healthcare is provided.” This includes hospitals, outpatient clinics, clinics in schools and correctional facilities and “healthcare-related” settings ranging from laboratories that handle potentially infectious materials to medical examiner offices to mortuaries. OSHA is specifically interested in current infection control strategies and practices and will use the information to “determine what action, if any, the Agency may take to further limit the spread of occupationally-acquired infectious diseases in these settings.” The deadline for comments is August 4, 2010. Download our Healthcare Alert for a brief summary.
The RFI is concerned with contact, droplet and airborne disease transmission. Contact might be direct (patient-to-patient) or indirect (touching contaminated doorknobs or bedding). Droplets containing microorganisms are generated when an infected person coughs, sneezes or talks or during certain medical procedures. Airborne transmission occurs when infectious droplet nuclei or particles containing infectious agents that remain suspended in air are inhaled, enter the respiratory tract and cause infection. Since air currents can disperse these droplet nuclei or particles over long distances, airborne transmission does not require face-to-face contact with an infected individual.
The RFI notes that while infection control guidelines are widely recognized and required by Centers for Medicare and Medicaid Services (CMS) and The Joint Commission (TJC), day-to-day compliance, surveillance and oversight is left to each individual employer. The lack of adherence to voluntary infection control procedures is of particular interest to OSHA: “Several observational studies have shown limited adherence to recommended practices by healthcare personnel.” They cite “significant gaps in compliance” with CDC practices including respiratory infection control practices, posted alerts, patient masking and separation, hand hygiene, PPE use, staff training and written procedures. In other surveys, only 8% and 33% of doctors reported using recommended respiratory protection or practicing recommended hand hygiene, respectively, with only 25% and 43% of nurses practicing appropriate respiratory precautions or recommended hand hygiene measures. According to the RFI, the healthcare sector as a whole experiences 1.3 times the injury and illness rate for private industry, with hospitals even higher, at 1.8, and nursing homes fully double. Also cited is “a weak culture of worker safety in this sector” related to a lack of data on the prevalence of infections among healthcare workers (HCWs) and a lack of effort by healthcare employers in tracking or documenting them. Translated, OSHA thinks too many of an estimated 16.5 million HCWs are getting sick at work and that voluntary standards are not working in large part due to poor safety programs and lack of regulatory oversight. The good news is that hospital-based HCWs who perceived that their institution had a strong commitment to safety were reportedly almost three times more likely to be compliant with standard precautions than those who did not.
Exposure control deficiencies can already be cited under existing OSHA standards such as the Respiratory Protection standard or the General Duty Clause, which requires employers to furnish a place of employment “free from recognized hazards that are causing or are likely to cause death or serious physical harm to employees,” but OSHA is interested in whether specific regulation is warranted. On April 19, 2010 Cal-OSHA issued its first citations (including willful) under a new, and reportedly the only in the U.S., Aerosol Transmissible Diseases (ATD) Standard after the handling of a patient with bacterial meningitis landed an Alta Bates Summit Medical Center employee and an Oakland police officer in intensive care. Proposed penalties for the hospital exceed $101,000. The ATD standard is prominently referenced in the RFI and looks to be a potential model for OSHA rulemaking.
This might also be a way to get at nosocomial infections, which OSHA cannot regulate directly since the victims are patients, not employees. The RFI notes that Hospital-Acquired Infections “are among the leading causes of death in the United States, accounting for an estimated 1.7 million infections and 99,000 associated deaths in 2002,” and that infectious agents are also transmitted from HCWs to patients. It makes a good point: How many industries could be thought by the government to infect and cause the death of 99,000 of their customers, perhaps annually, and not have it result in immediate drastic intervention or corporate extinction?
In short, OSHA clearly sees the healthcare industry as relatively high-risk and having a poor safety culture, and it appears that an occupational infection control regulation is coming. The RFI is collecting data on current practices, challenges and outcomes, and healthcare facilities should begin immediately preparing for OSHA intervention by implementing effective programs ranging from infection control to personnel and patient hygiene to ISO Management Systems. This is a wakeup call for senior healthcare managers to take decisive action and begin building a strong culture of safety in their facilities and across the industry.
Dr. Scott Harris, PhD, MPH is the Global Risk Manager for IESO, LLC. His experience covers over 27 years of Environmental, Health and Safety Management in Federal and State government, consulting, general industry and University instruction. Before joining IESO Scott was a Federal On-Scene Coordinator for EPA Region 6, a member of their Emergency Readiness Team and the Regional Coordinator of the BioWatch Program. He held DOD “Top Secret” and DOE “Q” security clearances, and directed multi-agency planning, emergency response and recovery activities for chemical, biological and radiological releases and exercises within the five-state region.
Scott received his PhD in Environmental Science, with a specialization in Disaster and Emergency Management, from Oklahoma State University, and holds degrees in Geology (B.S.) and Public Health (MPH) from Western Kentucky University. As a faculty and Course Director at the NC OSHERC, part of the University of North Carolina at Chapel Hill Gillings School of Global Public Health, Dr. Harris instructs courses at their Summer and Winter Institutes, including Fundamentals of Environmental Health and Environmental Regulations for Safety and Health Professionals.
Last 6 posts by admin
- IESO Presenting at Clean Gulf Conference - October 26th, 2011
- The Free "OSHA in Healthcare" Webinar - October 14th, 2011
- IESO Presenting at AOHP 2011 Conference - September 26th, 2011
- Arc Flash Train-the-Trainer Course - September 13th, 2011
- IESO Presenting at 2011 PureSafety Conference - August 2nd, 2011
- IESO Presenting at the 2011 TN Safety Congress - July 25th, 2011