OSHA Poker: I'll See Your ATD Standard and Raise You One

When Cal/OSHSA raised the healthcare workplace safety stakes by enforcing its aerosol transmissible disease standard (ATD) last year, many OSHA watchers expected the agency to follow suit with a similar standard. Now it seems the feds are raising the stakes by two transmission modes.

Last fall, OSHA said it would consider adding an ATD standard, similar to the one enacted in California, to its spring 2010 regulatory agenda. OSHA did publish a request for information in the May 6 Federal Register, but expanded on the scope to include transmission by all infectious modes.

David Michaels, assistant secretary for OSHA, previewed the change in scope during a regulatory Web chat on April 26. Such a standard could protect 16.5 million healthcare and social service workers from infectious diseases via contact, droplet, and airborne transmission routes, according to a fact sheet accompanying Michaels' remarks. 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.

Here is what OSHA is interested in:

• 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

The announcement generated visceral comments, mostly opposing a new standard, on OSHA Healthcare Advisor blog posts here and here. A poll on the same website corroborated reader input, 34% in favor of a standard, with 66% opposing it.

The naysayers mostly follow the theme that the CDC already has guidelines in place to protect healthcare workers from infectious disease exposures, and that the enforcement of these guidelines through the carrot-and-stick incentive of The Joint Commission accreditation is sufficient.

Those favoring the standard explain that voluntary CDC guidelines cannot carry the weight of federal law as an OSHA standard would. In addition, say pro-standard commenters, not all healthcare is provided in accredited facilities. Why should healthcare workers in a non-accredited physician practice have less protection from the law than colleagues in larger, accreditation-abiding, healthcare systems?

You can follow or contribute to the official, and more-measured, public input by searching for docket number OSHA-2010-0003 at www.regulations.gov.

Stakeholders have until August 4, when the RFI comment period closes, to decide if they are going to be all in or fold on this regulatory hand.