September 17, 2020

As companies across the United States continue to reopen following COVID-19 shutdowns, prioritizing the health and safety of workplace employees will be paramount.  In our previous posts (which can be found here and here), we discussed the CDC’s guidance for healthcare professionals exposed to COVID-19 and CMS’s recommendations for re-starting clinically necessary care, respectively.  The U.S. Department of Labor’s Occupational Safety and Health Administration (“OSHA”) also released Guidance on Preparing Workplaces for COVID-19 and offered COVID-19 control and prevention tips for healthcare workers and employers.  These tools can be used to identify workplace risk and implement control measures. 

Create an infectious disease preparedness and response plan

If your company does not already have an infectious disease preparedness and response plan in place, a plan should be developed immediately.  This plan should consider: (i) where, how and to what sources of COVID-19 workers could be exposed; (ii) non-occupational risk factors; (iii) workers’ individual risk factors (e.g., older age, presence of chronic medical conditions, and pregnancy); and (iv) controls necessary to address the foregoing risks.  The plan should also address infection prevention measures, the identification and isolation of sick people, and the implementation of workplace controls, flexibilities and protections, as further discussed below. 

Develop COVID-19 prevention practices

Employers should implement good hygiene and infection control practices in the workplace, including:

• Promoting frequent and thorough hand washing.  If soap and running water are not readily available, employers should provide alcohol-based hand rubs containing at least 60% alcohol to workers;
• Encouraging workers to stay home when sick;
• Encouraging respiratory etiquette, such as covering coughs and sneezes;
• Providing customers and the public with tissues and trash receptacles;
• Establishing policies and procedures to increase the physical distance among employees and between employees and others;
• Discouraging workers from using phones, desks, offices, or work tools and equipment which are not theirs, when possible; and
• Maintaining regular housekeeping practices.  For example, employers can implement routine cleaning and disinfecting of the work environment with EPA-approved cleaning chemicals.  Additionally, medical devices contaminated with COVID-19 should be disinfected and sterilized, according to the CDC’s Guideline for Disinfection and Sterilization in Healthcare Facilities.     

Identify and isolate those who are sick

Employers should encourage employees to self-monitor for signs and symptoms of COVID-19 if exposure is suspected.  When appropriate, individuals who show signs and/or symptoms of COVID-19 should be isolated.  For example, potentially infectious people can be moved to a location away from workers, customers, and other workplace visitors who are not infectious.  If possible, those suspected of having COVID-19 should further be separated from those confirmed to have COVID-19. 

• Encouraging sick employees to stay home.  Employers may also talk with companies that provide contract or temporary employees about the importance of sick employees staying home;
• Not requiring a healthcare provider’s note for employees who are sick with acute respiratory illness to validate the illness or return to work;
• Ensuring that sick leave policies are flexible and consistent with public health guidance; and
• Maintaining flexible policies that permit employees to stay home to care for a sick family member. 

Implement appropriate workplace controls

According to OSHA, when it is not possible to eliminate the hazard of exposure to COVID-19, the most effective protection measures are engineering controls, administrative controls, safe work practices, and PPE.  Such protective measures take into account the worker risk of occupational exposure to COVID-19.  Healthcare employers should assess the hazards to which their workers may be exposed, evaluate the risk of exposure, and ensure workers use controls to prevent exposure.  OSHA recommends using a combination of CDC’s standard precautions, contact precautions, airborne precautions, and eye protection to protect healthcare workers exposed to COVID-19.  OSHA also offers examples of workplace controls that healthcare employers may implement. 

Engineering controls shield healthcare workers, patients, and visitors from those with suspected or confirmed COVID-19.   Examples include:

• Installing physical barriers or partitions to guide patients in triage areas;
• Using curtains to separate patients in semi-private areas; and
• Utilizing airborne infection isolation rooms (“AIIRs”) with proper ventilation to treat patients with suspected or confirmed COVID-19.  If AIIRs are unavailable, the patient should be isolated in a private room, preferably a negative-pressure room, with the room door closed.  If AIIRs are unavailable and room space is limited, portable containment structures may be used.        

Administrative controls, including certain safe work practices, may also help reduce the risk of exposure to COVID-19.  Examples include:

• Implementing restrictions on the number of personnel entering a room of a patient with suspected or confirmed COVID-19;
• Performing as many tasks as possible in places away from the patient with suspected or confirmed COVID-19;
• Minimizing the number of staff present while performing aerosol-generating procedures;
• Working “from clean to dirty” and limiting touch contamination.  It may help to differentiate clean areas from potentially contaminated areas; and
• Encouraging workers to avoid touching their eyes, noses, and mouths.      

Employers are obligated to provide workers with the appropriate PPE needed to keep workers safe while performing their jobs.  OSHA recommends healthcare workers exposed to those with suspected or confirmed COVID-19 wear: (i) gloves; (ii) gowns; (iii) eye/face protection; and (v) NIOSH-certified, disposable N95 filter face-piece respirators or better.  Gloves should be worn while removing potentially contaminated PPE, so the outside of the respirator is not touched. 

For additional information on OSHA requirements, please refer to OSHA’s Standards page.