OSHA to consider infectious disease standard

By: April 27th, 2010 Email This Post Print This Post

OSHA isn’t focusing on just aerosol transmissible disease for new regulations; instead it is considering a standard applying to all possible routes of infectious disease transmission.

That was the information conveyed by David Michaels, assistant secretary for OSHA during his regulatory Web chat, April 26.

The Infectious Disease request for information (RFI) is currently with the Office of Management and Budget for review, and a fact sheet on the RFI says that such regulation could protect 16.5 million healthcare and social service workers from infectious diseases via contact, droplet, and airborne transmission routes.

This is a departure from OSHA’s regulatory agenda announcement last fall that identified only aerosol transmissible disease hazards as the reason for considering a new standard, similar to the one enacted in California.

The fact sheet notes that workplace-acquired infections are not only a persistent problem but there are also increasing levels of drug-resistant microorganisms to them.

OSHA is also concerned that most infection control measures in healthcare facilities are patient-safety oriented that perhaps overlook worker safety considerations, according to the fact sheet.

The RFI will collect information on:

  • How diseases are transmitted and the practices in place to safeguard workers
  • Implementation of recognized infection control measures in preventing work-related infections, and what voluntary measures are currently being followed
  • Workplaces other than traditional healthcare facilities with elevated exposure risk

What do you think of having an OSHA standard that specifically addresses infectious disease from contact, droplet, and airborne transmission routes? Let us know in the comment section below.

Editor’s note: Click here for the RFI, which was published in the Ma May 6 Federal Register. Submit comments electronically, for docket number OSHA-2010-0003 at www.regulations.gov. The comment period closes August 4.

Comments

By Marlene Waymack on April 27th, 2010 at 10:47 am

The CDC guidelines cover Isolation Precautions for infectious diseases with exquisite and complete detail. The bloodborne pathogen standard provides protection for the workers but the CDC isolation guidelines also provides for the protections of the workers. To have both a CDC standard and an OSHA standard for Isolation Precautions would be non-productive.

By David LaHoda on April 27th, 2010 at 11:05 am

Except that CDC guidelines are not law, while OSHA standards are.

By Lori Wermerskirchen on April 27th, 2010 at 12:19 pm

I think there needs to be a standard in place for protecting the employee during critical times such as with a large flu outbreak when it will be hard to have clinics covered with enough staff.

After reviewing the article I would appreciate the acknowledgement of already existing well established isolation practices (protecting HCW) that have been recommended by the CDC & updated in (2007) to protect the HCW. PPE not only protects the HCW from BBP but also from transmission of disease as well. The use of gowns, gloves, eye wear and respiratory protection serves that HCW the protection required by the Isolation Practice standards of 2007 HICPAC(CDC). I would appreicate OSHA recieving guidance from already established organizations with infectious disease guidelines i.e. CDC – APIC – SHEA before a new standard is put in place. The need for additional guidance for this issue is not warranted but reinforcemnet for the isolation practices is where all HCW could use a little improvement.

By David LaHoda on April 27th, 2010 at 3:05 pm

Amy. OSHA invites stakeholder comments. Go to the fact sheet link in the above post for information on how to comment. But as I stated in a previous comment, all the guideline you reference are not statutory. They do not have the force of federal law as an OSHA standard would.

By Carolyn Fiutem on April 28th, 2010 at 7:34 am

Actually, when you look at the CMS CoPs and JC standards, your IP programs are supposed to be based on evidence-based guidelines. With any JC or CMS survey, I have had surveyors look for implementation of CDC guidelines and more recently, the SHEA compendium practices. I’ve also had they inquire on my program and the use of recommendations in the APIC text. One CMS surveyor indicated to me about 5-6 years ago, that the expectation was IP programs were to implement all type I recommendations from the myriad of CDC guidelines. Comments from other JC or CMS surveyors would be helpful.

I agree with the previous posts that this would be a repetition of the CDC guidelines where compliance is the expectation of the regulatory agencies. I also think there are other concerns to be addressed before passing a law to enforce the use of respiratory protection as a blanket response to incidences similar to the H1N1 scare last year. Facilities wanted to follow the recommendations, but the availability of the suggested respiratory protection not only contradicted the CDC droplet transmission guidelines, but the bigger problem was that there was a shortage of available masks. My opinion is that the barriers should be addressed before enforcing an action by making it a law.

By Priscilla Schilling on April 28th, 2010 at 9:41 am

Federal Regulation F441 (Infection Control)for skilled nursing facilities has recently been updated with new surveyor guielines and the regulation states to follow CDC guidelines. It is much more stringent on disinfecting care equipment, isolation precautions (incl standard precautions and transmission based precautions) and linen handling. It covers the health care worker as well as teh residents. We also find that the two laws may contradict each other. I do not feel another law is necessary.

By Rosemary Barker on April 28th, 2010 at 10:13 am

My concern is that OSHA does not really understand the use of precautions in healthcare facilities and undiagnosed infectious disease. I go all the way back to the greatly debated N-95 respirator use and fit testing. The concern was the conversion of healthcare workers to positive TB testing. It was not the identified, isolated TB patient that was the source of these conversions, but the UNIDENTIFIED source. The time and expense that went into that was phenomenal. I can just see this scenario repeating itself.

By Marlene Waymack on April 28th, 2010 at 2:26 pm

The expectation of Joint Commission and CMS that we abide by the CDC guidelines is more powerful than any law OSHA could carve out. If we fail JC inspections we fail to be Joint Commission accredited. That would be the the worst outcome for a hospital. All hospitals have many policies and procedures in place to this end. We protect our employees in every way possible with all sorts of PPE, not just to pass surveys, but because our employees are so valuable to us. We want our employees to be well cared for and able to contribute to patient care.

By David LaHoda on April 28th, 2010 at 2:55 pm

Marlene:

I appreciate your comments and believe in the strong safety culture of your organization, but accreditation and conditions of participation are one thing while federal law and enforcement through OSHA is another matter completely.

I disagree with your minimizing about how much leverage an OSHA standard imposes. If it were not for the Needlestick Prevention Act amendment to the Bloodborne Pathogens Standard I don’t believe healthcare, hospitals included, would be as far along now in protecting workers from contaminated sharps if left just to the oversight the Joint Commission.

Also, while accreditation may be the carrot and stick for hospitals, a large percentage of healthcare is delivered in settings were there is no accreditation or CMS oversight. I know, because I consult with these types of facilities every day—and shudder, sometimes at the lack of basic infection control measures for both patients and employees. Remember, while accreditation and CMS is essential for many facilities, it can be sloughed off by many other facility types, along with the health and safety of workers there.

I do hope, though, that you and your like-minded colleagues will take the opportunity to make you opinions heard when the comment period for the RFI opens. The fact sheet referenced in the post above is looking for input on “what voluntary measures are currently being followed.”

We will be sure to publish the comment period notification in OSHA Healthcare Advisor.

By Eulin Kuranga on April 29th, 2010 at 9:04 am

A law to enforce already best practice guidelines is not necessary. However if OSHA decides to do this, the experts who develop the guidelines should be consulted so there will be one voice. Employers will need to look only at one source for compliance. How will updates decided on by the experts be handled? Will the law be able to change in a timely manner with updates based on facts of disease transmission? Or will it just say, for example, follow recommended guidelines.

By Sandra O'Kelly on April 29th, 2010 at 10:33 am

Standards are in place and hospitals are accountable through various agencies as already well described. The proposed regulation opens up the dilemma of staff who are exposed outside of the healthcare setting and want to blame the employer. And what about the employee who has been trained, has access to adequate PPE and does not follow guidelines? Will a law really help the employees or just burden an already over-regulated and struggling health care system?

By David LaHoda on April 29th, 2010 at 10:43 am

At the risk of appearing glib, not running a red light probably qualifies as a best practice, but I’m not in favor of taking those laws off the books.

I envy all the commentary from facilities that value a best practices approach. But I can’t tell you how many times I’ve had managers say: “I don’t care about best practices, just tell what the minimum requirements of the law are.” And this from all types of healthcare facilities.

Your kind of comments, however misguided in my opinion, are just what OSHA wants to hear from stakeholders, so be sure to follow up on that or encourage your management to do so.

I agree with Eulin Kuranga, above. Our long-term care facility strives to remain compliant with best practice guidelines. If some facilities, as you’ve intimated, will not protect their employees unless the law demands it, then I can see where OSHA is coming from.
HOWEVER…a brief “facility policies MUST follow CDC (or APIC, SHEA) guidelines.
Adding another voice with its legalese to the noise of information overload will not result in increased compliance; only increased confusion. This is especially true when CDC & friends make revisions or new recommendations.
We could trim the federal budget a bit by keeping it simple.

Dave

OSHA can enforce CDC guidelines. The General Duty Clause would work perfectly when you have clearly identified safety issues and documented reduction/prevention processes. OSHA is using the GDC for H1N1 enforcement using CDC guidelines right now.

Issue with OSHA developing regulations is that the regulatory process it too slow to address the miriad of changing issues with infection control. Look at the issues CDC had just over if we needed N95 or masks for H1N1.

OSHA is still listing chemical exposure limits that were adopted in the 1970’s even thought they acknowledge that these need to be updated.

There is another part of the OSHA chat that is a bit concerning. The director states that HCW’s have a greater rate of TB. OSHA paid to have two independent scientific studies on this topic back when they proposed the TB standard. Both groups came back with findings that the rates of TB in HCW’s was no higher than in the general population. I would want to see good science indicating that there is an increased risk of infection in HCW’s prior to saying we need more regulations.

OSHA also needs to work on coming up with assistance for employers on how to get HCW’s to comply. As many of us know. HCW’s are a different type of worker and don’t necessarily feel they have to comply.

By EHS Manager on May 11th, 2010 at 7:48 am

I agree that OSHA does not do well in drafting highly technical standards. That is why OSHA often “incorporates by reference” existing technical standards, giving them the force of federal regulation, but not imposing an additional standard where a successful one already exists. Sounds like OSHA should simply adopt the CDC standard in this way. However, OSHA has sometimes adopted “best practice” standards by other organizations, in the process making these standards the minimum acceptable practice, creating a huigely onerous burden on organizations. Not being an expert in the CDC standard, would this be the case? Should the CDC standard become the legal minimum for *all* healthcare organizations? If so, it sounds like a candidate for adooption by OSHA.

Another commenter noted that OSHA is unable to update standards quickly — although the air contaminant standards mentioned were a huge political football and this is what has prevented their update. However, would the OSHA imprimateur be worthwhile to the healthcare community even if in the future it came to lag even years behind further updates by CDC? Then the OSHA standard would represent at least an enforceable minimum (something now lacking), and future CDC updates would continue to represent leading-edge best practice.

By Tina Lamberski, RN CIC on May 11th, 2010 at 11:07 am

All other comments noted, as an experienced and dedicated IP, 2 issues are not discussed: This type of Federal Regulation allows OSHA to levy fines and monetize another “best practice and guidelines standard” to their benefit; and perhaps there could be some related funding for IP activities and staffing in hospitals..though I doubt that the second possibility would ever happen.

By Public Health Nurse, Sheboygan Wisconsin on May 13th, 2010 at 12:07 pm

I feel strongly that OSHA needs to establish standards for infectious diseases as Multi-Drug Resistant Tuberculosis. Health care workers deserve to have leagal protected standards for such deadly diseases. Many Health Care facilities DO NOT follow CDC recomendations. We need law.

(Sorry-hit “enter” mistakenly)
I would plea with Mr. Lahoda to truly refer to the recommendations rather than to re-write, expand or comment on the recommendations in a regulation.

Appreciate the opportunity to join the lively comment section.

As an occupational healthcare provider I find OSHA Standards give solid foundations for HCW programming that have taken into consideration good science, political reality, labor needs, and business necessity. CDC does an excellent job but comes at it from more of a pure science perspective and tends to be patient safety oriented. I like it that there is OSHA that is decicated to the worker and hope that OSHA maintains its role in worker safety while continuing partnership with the JC, CDC, and others so that there will be balance.

By Robert Taylor on July 26th, 2011 at 11:14 am

“Unnecessary risks are being taken by patients seeking the liberation treatment.” says Dr. Avneesh Gupte of the CCSVI Clinic. “It has been our contention since we started doing minimally invasive venous angioplasties nearly 6 years ago that discharging patients who have had neck vein surgery on an outpatient basis is contra-indicated. We have been keeping patients hospitalized for a week to 10 days as a matter of safety and monitoring them for symptoms. Nobody who has the liberation therapy gets discharged earlier than that. During that time we do daily Doppler Ultrasounds, blood work and blood pressure monitoring among other testing. This has been the safe practice standard that we have adopted and this post-procedure monitoring over 10 days is the subject of our recent study as it relates to CCSVI for MS patients.”
Although the venous angioplasty therapy on neck veins has been done for MS patients at CCSVI Clinic only for the last 18 months it has been performed on narrow or occluded neck veins for other reasons for many years. “Where we encounter blocked neck veins resulting in a reflux of blood to the brain, we treat it as a disease,” says Gupte. “It’s not normal pathology and we have seen improved health outcomes for patients where we have relieved the condition with minimal occurrences of re-stenosis long-term. We believe that our record of safety and success is due to our post-procedure protocol because we have had to take patients back to the OR to re-treat them in that 10-day period. Otherwise some people could have run into trouble, no question.”
Calgary MS patient Maralyn Clarke died recently after being treated for CCSVI at Synergy Health Concepts of Newport Beach, California on an outpatient basis. Synergy Health Concepts discharges patients as a rule without in-clinic provisions for follow up and aftercare. Post-procedure, Mrs. Clarke was discharged, checked into a hotel, and suffered a massive bleed in the brain only hours after the procedure. Dr. Joseph Hewett of Synergy Health recently made a cross-Canada tour promoting his clinic for safe, effective treatment of CCSVI for MS patients at public forums in major Canadian cities including Calgary.
“That just couldn’t happen here, but the sooner we develop written standards and best practices for the liberation procedure and observe them in practice, the safer the MS community will be”, says Dr. Gupte. “The way it is now is just madness. Everyone seems to be taking shortcuts. We know that it is expensive to keep patients in a clinical setting over a single night much less 10 days, but it’s quite absurd to release them the same day they have the procedure. We have always believed it to be unsafe and now it has proven to be unsafe. The thing is, are Synergy Health Concepts and other clinics doing the Liberation Treatment going to be changing their aftercare methods even though they know it is unsafe to release a patient on the same day? The answer is no, even after Mrs. Clarke’s unfortunate and unnecessary death. Therefore, they are not focused on patient safety…it’s become about money only and lives are being put at risk as a result.”
Joanne Warkentin of Morden Manitoba, an MS patient who recently had both the liberation therapy and stem cell therapy at CCSVI Clinic agrees with Dr. Gupte. “Discharging patients on the same day as the procedure is ridiculous. I was in the hospital being monitored for 12 days before we flew back. People looking for a place to have the therapy must do their homework to find better options. We found CCSVI Clinic and there’s no place on earth that’s better to go for Liberation Therapy at the moment. I have given my complete medical file from CCSVI Clinic over to my Canadian physician for review.” For more information Log on to http://ccsviclinic.ca/?p=866 OR Call on toll free: 888-419-6855.

 

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