A little more than a month after the CDC told healthcare facilities  how to protect staff members from swine flu, OSHA has posted instructions  on how to inspect and enforce for H1N1 influenza hazards.
The good news is that OSHA enforcement closely follows the CDC recommendations and shouldn’t present any surprises, especially if you have been following the issue of worker protection for H1N1. 
“OSHA has a responsibility to ensure that the more than nine million frontline health care workers in the United States are protected to the extent possible against exposure to the virus,” said acting Assistant Secretary of Labor for OSHA Jordan Barab in a November 20 news release.  “OSHA will ensure health care employers use proper controls to protect all workers, particularly those who are at high or very high risk of exposure,” Barab added.
The enforcement directive identifies very high and high exposures as:
Very High Exposure Risk. A job task or activity involving a medical or laboratory procedure during which there is a potential of occupational exposure to high concentrations of suspected or confirmed 2009 H1N1 influenza virus.
- Healthcare workers (for example, doctors, respiratory therapists, nurses, emergency responders, or dentists) performing aerosol-generating procedures on suspected or confirmed patients (such as, sputum inductions, endotracheal intubations and extubations, bronchoscopies, some dental procedures or invasive specimen collection).
- Healthcare workers present during performance of aerosol-generating procedures during autopsies (such as, medical examiners).
High Exposure Risk. A job task or activity involving a high potential for exposure to suspected or confirmed 2009 H1N1 influenza virus.
- Healthcare workers who are in close contact [working within 6 feet of suspected or confirmed patients or entering into a small enclosed airspace shared with the patient (e.g., size of an average patient room)].
- Staff transporting suspected or confirmed 2009 H1N1 patients in enclosed vehicles (such as emergency responders).
These are the type of situations where OSHA will seek confirmation that the healthcare facility has implemented a hierarchy of engineering, administrative, work practice controls, and followed the Respiratory Protection standard  for worker training and fit testing where respirators are required.
The new document also instructs OSHA inspectors to evaluate whether employers are ensuring that workers are following the current CDC guideline, which calls for respiratory protection that is at least as protective as a fit-tested disposable N95 filtering facepiece respirators for very high and high exposure procedures or situations.
OSHA says that “inspections will be conducted in response to worker complaints, referrals (including media referrals) or as part of fatality and/or catastrophe investigations.” The agency expects that most of the inspections will involve hospitals, emergency medical centers, doctors’ and dental offices and clinics.
As expected, OSHA inspectors will make allowances in the current pandemic for respirator shortage and provides details under which those conditions will apply. More on that in a later post.