thesynergist | NEWSWATCH
OSHA's COVID-19 ETS for Healthcare Settings Is in Effect
OSHA’s emergency temporary standard to protect healthcare workers from contracting SARS-CoV-2 became effective on June 21 upon publication in the Federal Register. The ETS focuses on workers in healthcare settings where suspected or confirmed COVID-19 patients are treated, including workers in hospitals, nursing homes, and assisted living facilities; emergency responders; home healthcare workers; and employees in ambulatory care settings. OSHA estimates that there are approximately 10.3 million workers in the healthcare establishments that must comply with the requirements of the standard. During a June 10 media briefing to announce the standard, U.S. Secretary of Labor Marty Walsh told reporters that OSHA tailored the ETS to reflect “the reality on the ground, the success of the vaccine efforts, plus the latest guidance from CDC and the changing nature of the pandemic.” Jim Frederick, acting assistant secretary of labor for occupational safety and health, described key elements of the ETS as ensuring that workplaces develop and implement a COVID-19 plan, that patient screening and management as well as standard and transmission-based precautions are in place, and that employers provide workers with appropriate personal protective equipment. Additional requirements address specific aerosol-generating procedures on persons with suspected or confirmed COVID-19, physical distancing and barriers, cleaning and disinfection, ventilation, and health screening and medical management of employees. The ETS also requires paid time off for workers to get vaccinated and to recover from any side effects. Walsh explained that for many companies, this time off can be paid through a refundable tax credit under the American Rescue Plan that was passed earlier this year. Employers had until July 21 to comply with all requirements of the ETS. A compliance directive issued by OSHA on June 30 outlines procedures for how the agency’s compliance safety and health officers will enforce the ETS’ requirements for written COVID-19 plans, screening and management of patients and non-employees, personal protective equipment, aerosol-generating procedures, physical distancing, vaccination, recordkeeping, and reporting. Other requirements covered in the directive include those related to physical barriers, cleaning and disinfection, ventilation, training, anti-retaliation, and screening and medical management of employees. The directive will be effective for no more than 12 months from June 21, 2021, the effective date of the ETS, unless it is canceled or extended by a superseding directive from OSHA. A PDF of the directive is available for download from OSHA’s website. In addition to the ETS, OSHA has published new general industry guidance for employers and workers not covered by the standard. OSHA’s new guidance encourages COVID-19 vaccination and focuses on exposure risks to unvaccinated workers or otherwise at-risk workers, including those with medical conditions that may affect their ability to have a full immune response to vaccination. The agency stresses that COVID-19 spreads primarily among unvaccinated people who are in close contact with one another, especially in poorly ventilated spaces. The new OSHA guidance discusses measures to mitigate the spread of COVID-19 in higher-risk workplaces in industries such as manufacturing, meat and poultry processing, high-volume retail and grocery, and seafood processing where unvaccinated and otherwise at-risk employees work in close contact for prolonged periods of time. The full regulatory text of the ETS is available on OSHA’s website along with the agency’s new general industry guidance.
EPA Stops Expediting Requests for New SARS-CoV-2 Disinfectants
EPA will stop prioritizing public health emergency requests for new surface disinfectant products for use against SARS-CoV-2, the agency announced on April 28. Among the requests that EPA will no longer expedite are new product registrations, SARS-CoV-2 claims, and electrostatic spraying directions for products intended to kill the virus on surfaces. According to CDC, the main route by which SARS-CoV-2 spreads is through exposure to respiratory fluids carrying infectious virus; the risk of infection through contact with contaminated surfaces or objects is considered low. EPA intends to shift resources to the evaluation of novel products such as those that kill airborne SARS-CoV-2. EPA’s List N already includes more than 500 disinfectants that meet the agency’s criteria for use against SARS-CoV-2 on surfaces. The agency will continue to update List N and will review registration requests for new surface disinfectants for SARS-CoV-2 through its standard registrations process. For more information, visit EPA's website.
CDC Updates Guidance on Aerosol Transmission of SARS-CoV-2
Updated guidance published by CDC in May emphasizes that SARS-CoV-2 is transmitted by exposure to infectious respiratory fluids, including inhalation of very fine respiratory droplets and aerosol particles that contain infectious virus. Previous CDC guidance acknowledged airborne transmission of SARS-CoV-2 but maintained that most infections were spread through close contact.
According to CDC, very small fine droplets and aerosol particles can remain suspended in the air for minutes to hours. In addition to inhalation of the virus, the agency’s updated guidance states that SARS-CoV-2 can be transmitted via deposition of infectious respiratory droplets and particles on exposed mucous membranes in the mouth, nose, or eye as well as by touching mucous membranes with soiled hands contaminated with the virus.
CDC’s guidance also stresses that SARS-CoV-2 transmission can occur when individuals inhale virus in the air farther than six feet from an infectious source. According to the updated guidance, enclosed spaces with inadequate ventilation or air handling and increased exhalation of respiratory fluids—such as if an infectious person is engaged in physical exertion or raises their voice—can increase the risk of SARS-CoV-2 transmission indoors.
The World Health Organization recognizes close-range inhalation as a mode of transmission for SARS-CoV-2. According to WHO, “the virus spreads mainly between people who are in close contact with each other” and infection can occur when an individual inhales aerosols or droplets that contain the virus. The organization also notes the role of aerosols in the spread of SARS-CoV-2 in poorly ventilated or crowded indoor settings.
CDC’s new guidance on SARS-CoV-2 transmission is available from the agency's website.
OSHA to Consider Potential for Heat Illness Prevention Rulemaking
The topic of heat illness prevention appears for the first time on the Department of Labor’s regulatory agenda, which was most recently updated on June 11 for spring 2021. According to the agenda, OSHA plans to issue a request for information in October of this year to explore the potential for rulemaking on heat illness prevention.
OSHA currently relies on the general duty clause of the Occupational Safety and Health Act to protect workers from heat stress. The agency predicts that it may become more difficult to protect workers from heat hazards in this way following the 2019 decision of the Occupational Safety and Health Review Commission to overturn a general duty clause heat stress citation in the case Secretary of Labor v. A.H. Sturgill Roofing, Inc.
The spring 2021 regulatory agenda notes that heat stress thresholds, heat acclimatization planning, exposure monitoring, and medical monitoring are among many issues OSHA must consider regarding the regulation of heat hazards.
Standards for heat exposure are in place in the states of California, Washington, and Minnesota. Recently, the Virginia Department of Labor and Industry released a proposal to draft a new standard on occupational exposure to heat illness. AIHA submitted comments (PDF) in support of Virginia’s intent to develop and adopt a standard “to reduce/eliminate employee injuries, illnesses, and fatalities due to exposure to excessive heat at indoor and outdoor places of work.”
Further details on OSHA’s rulemaking activities related to heat illness prevention are available from the regulatory agenda.
Fact Sheet Focuses on Use of Portable Air Cleaners during COVID-19
A new fact sheet published by the National Institute of Environmental Health Sciences Worker Training Program (WTP) outlines guidance on the selection and use of portable air cleaners to protect workers from exposure to SARS-CoV-2. The fact sheet is intended to help employers, building operators, and others select and use portable air cleaners to remove virus-contaminated air from indoor spaces. WTP stresses the importance of ventilation and filtration to prevent transmission of COVID-19, especially in work settings with inadequate ventilation or those that require people to be close together for extended periods of time. In indoor spaces where adequate ventilation is difficult to achieve, the fact sheet suggests that portable air cleaners can be considered to supplement heating, ventilation, and air conditioning system ventilation and filtration.
The WTP fact sheet also describes key steps for selecting portable air cleaners.
The fact sheet is available as a PDF.
CDC Fact Sheet Discusses Upper-Room Ultraviolet Germicidal Irradiation
A new CDC webpage focuses on upper-room ultraviolet germicidal irradiation (UVGI), which the agency says can be effective at reducing exposures to SARS-CoV-2 in some group settings. UVGI is the use of ultraviolet energy to kill viral, bacterial, and fungal organisms, and upper-room UVGI describes a disinfection zone of UV energy located above people in occupied rooms. According to CDC, UVGI kills airborne pathogens in the room where they are released, and fixtures are installed to prevent direct UV exposures to people in the room.
The agency recommends UVGI for indoor spaces with insufficient or no mechanical HVAC systems or spaces where adequate natural ventilation cannot be maintained year-round. UVGI can be used in high-risk indoor settings such as hospital waiting rooms and other areas where sick people are likely to be; crowded spaces like lobbies; restaurants, break rooms, cafeterias, and other places where people remove masks to eat or drink; and areas where it is difficult to maintain six feet of distance from others.
The new page also discusses considerations for installation, maintenance, implementation, and selection of upper-room UVGI systems.
NIOSH Mask Guidance Builds Upon ASTM Standard for Face Coverings
Interim guidance published by NIOSH describes agency criteria for manufacturing masks that help protect workers from SARS-CoV-2. The criteria comprise all requirements described in ASTM F3502-21, Standard Specification for Barrier Face Coverings, as well as additional quantitative leakage and labeling criteria from NIOSH.
The guidance introduces criteria for “Workplace Performance” and “Workplace Performance Plus” masks. The filtration efficiency for both types of masks must be tested according to ASTM F3502-21 and meet the standard’s filtration efficiency level 2. Workplace Performance masks must meet filtration efficiency level 2 at efficiencies of 50 percent or greater, while Workplace Performance Plus masks must have filtration efficiencies of 80 percent or greater. Similarly, Workplace Performance Plus masks must have a higher leakage ratio (10 or greater) than Workplace Performance masks (5 or greater). NIOSH explains that “a higher leakage ratio number means that fewer particles escape around the edges, indicating products provide better source control across users with a variety of facial sizes.”
NIOSH notes that Workplace Performance and Workplace Performance Plus masks cannot be used to replace respiratory protection and that individual performance for source control and the amount of inhaled particulate matter cannot be guaranteed because masks are not fitted to each wearer.
NIEHS Updates Worker Training Resources for COVID-19
The National Institute of Environmental Health Sciences (NIEHS) has released a new training resource, the Building Programs to Protect Workers Training Tool, which replaces the Essential and Returning Workers Training Tool as of April 2021. The tool is designed to inform workers about how to protect themselves and their coworkers from exposure to SARS-CoV-2.
The updated training tool builds on the previous version by adding an icebreaker discussion that asks workers about their concerns related to COVID-19 on the job, at home, and in their communities. The new version also adds a graphic illustrating virus transmission as well as information on asymptomatic and presymptomatic transmission, vaccines, portable air cleaners, and the use of ultraviolet light to disinfect air. The tool’s module on mental health and pandemic stress now includes study data on the mental health of U.S. adults during the COVID-19 pandemic.
The tool’s modules cover basic information about COVID-19 and its spread, treatment, and prevention; workers’ right to refuse unsafe work; assessing risks and evaluating job hazards; implementing the hierarchy of controls; and using personal protective equipment.
NIEHS cautions that the tool by itself is not sufficient training for workers who may be exposed to SARS-CoV-2 on the job. Workers must also be trained on their employers’ site-specific policies and procedures, and demonstrate competency in using PPE, following decontamination procedures, and using other protective measures.
The tool can be downloaded as a PDF or Microsoft PowerPoint presentation from the program’s COVID-19 webpage.
New Guidance, Resources on Beryllium Available from OSHA
New guidance and resources recently published by OSHA are intended to help employers and others protect workers from occupational exposure to beryllium. A memorandum published on April 21 outlines interim enforcement guidance for provisions in two final rules for beryllium issued last year by OSHA: one that revised the agency’s beryllium standards for construction and shipyards and a second that revises its beryllium standard for general industry. In May, OSHA published a new guide for small businesses intended to help them comply with the 2020 final rule for beryllium in general industry; two new “QuickCards” for workers—one that describes the beryllium lymphocyte proliferation test, a medical test for diagnosis of chronic beryllium disease, and another that covers information on beryllium medical surveillance; and new guidance for beryllium-exposed workers that explains certain medical surveillance requirements in OSHA’s standards.
OSHA’s new resources are collected on its beryllium webpage in a box labeled “Highlights.” Additional information on health effects associated with exposure to beryllium, exposure evaluation and controls, and OSHA standards and enforcement is also available.
OSHA’s 2020 final rule for beryllium in general industry revised provisions related to methods of compliance, personal protective clothing and equipment, hygiene areas and practices, housekeeping, medical surveillance, hazard communication, and recordkeeping. Changes to OSHA’s beryllium standards for construction and shipyards in 2020 focused on tailoring the standards’ requirements to exposures in these industries and sought to clarify requirements concerning materials that contain only trace amounts of beryllium.
NIOSH Evaluates Lead Exposures During Water Line Replacement Activities
A new health hazard evaluation report published by NIOSH assesses lead exposures among crews replacing lead water lines servicing residential homes. The agency conducted the evaluation in response to a request by an employer who was concerned about lead exposures among workers after two employees were found to have elevated levels of lead in their blood.
In July and September 2019, NIOSH personnel visited work sites to observe work processes and conduct exposure assessments for nine lead service line replacement workers. Eight of these individuals were considered “active workers” as they were directly involved with the lead service line replacement work. During NIOSH’s evaluation, agency staff held confidential medical interviews with all nine workers and two additional supervisors; collected personal air samples from the active workers; collected colorimetric wipe samples from the active workers’ hands before and after each water line replacement job; and took surface samples from the insides of active workers’ gloves, within work trucks, and at the main pump station.
During the evaluation, all nine workers underwent blood testing through their employer’s health program, and one of the workers was found to have a BLL of 5.7 μg/dL. NIOSH considers an elevated BLL for adults to be 5 μg/dL.
The NIOSH team also found lead present on employees’ hands, inside work gloves, and on surfaces in work trucks and the locker rooms of the pump station. Although some workers wore respirators incorrectly, no air samples were found to be above 50 μg/m3, OSHA’s permissible exposure limit, NIOSH’s recommended exposure limit, and ACGIH’s threshold limit value for lead in air.
NIOSH’s report recommends that the employer improve surveillance, training, and work practices. As the lead service line replacement process sometimes requires the use of compressed air to blow a string or rope through the pipe, which is then used to pull the pipe from the ground, these recommendations include ensuring that no workers are in the pipe trench while this procedure takes place to prevent them from inhaling lead particulate. Recommendations to improve personal protective equipment use include allowing workers to change gloves more frequently and to wear nitrile gloves beneath their work gloves. The report also recommends that lead removal wipes and soap be stocked in trucks and locker rooms so that workers may thoroughly clean themselves and their tools after work is completed. For more information, see the full report (PDF).
Due to an editing error in the June/July 2021 Synergist, the biographical information provided in the "Contributors" section on page 4 for Richard M. Newton is in fact that of his coauthor, Edgar Y. Reed. Newton and Reed are the authors of "A Standard to Protect Miners: The AIHA Mining Working Group's Collaboration with the ISO Mining Technical Committee." The correct biographical information for both authors appears on page 33 of the print version and in the digital version of the article.