OSHA Regulation of Infectious Disease in Long Term Care

OSHA; Programs and Resources; Regulations; Infection Prevention/Control; Safety

While the Occupational Safety and Health Administration (OSHA) does not currently have a specific infection prevention standard tailored for long term care facilities, it regulates employee exposure to infectious disease through the OSHA General Duty Clause and existing standards, like the Bloodborne Pathogen Standard. OSHA is also drafting and expected to issue a more comprehensive infectious disease standard.  
Current Regulation Status 
Traditionally, OSHA has focused on disease transfer through blood or other potentially infectious fluids because the Bloodborne Pathogen Standard narrowly addressed those modes of transmission. Years before the emergence of COVID-19, however, OSHA began to look at the spread of infectious disease more broadly, and it continued those efforts throughout the pandemic.  
Currently, OSHA requires health care providers to continue following the Bloodborne Pathogen Standard and also implement known and feasible methods of preventing the spread of infection through contact, droplet, and airborne transmission. OSHA has published guidelines on infection control, many of which may already be used by health care providers to address patient or resident safety. OSHA enforces compliance with those guidelines through the General Duty Clause as discussed previously in Ergonomics 201: Controls, State Regulations, and Resources and Workplace Violence in LTC. Within those standards and guidelines, providers should also be mindful of related OSHA standards, like the Respiratory Protection Standard 1910.134 which is triggered when addressing airborne hazards, or the 1910.132 - PPE General Requirements which includes other precautions, like gloves, gowns, and eye protection.  

State OSHA Standards

Some states have their own Occupational Safety and Health (OSH) programs as identified in the Roadmap to OSHA Requirements, which may introduce additional regulations or standards surpassing federal OSHA requirements. For example, California's Cal/OSHA program has implemented specific regulations under the Aerosol Transmissible Diseases (ATD) standard, mandating stringent measures to prevent the transmission of infectious diseases in health care settings, including long term care facilities. 

Temporary Standards

During public health crises, like the COVID-19 pandemic, OSHA may also issue temporary standards and specific guidance to address the evolving safety concerns in workplaces, including long term care centers.  
These guidelines offer tailored recommendations to protect workers from exposure to infectious diseases and ensure their safety amidst challenging circumstances. These precautions are enforced either through an Emergency Temporary Standard, as was used with COVID-19, or through the General Duty Clause. 

Proposed Infectious Disease Standard 
While there is no broad infectious disease standard for long term care centers currently, OSHA is developing more comprehensive regulations. The new standard is likely to address critical aspects, such as airborne and droplet precautions, engineering control measures, personal protective equipment (PPE), respiratory protection, hazard assessment and control, training and education, recordkeeping, and reporting. As with other OSHA standards, many of the requirements for the new infectious disease standard may already be addressed in providers’ resident or patient care policies, but there will almost certainly be new documentation and similar requirements. 
Resources, such as regulatory agenda items, Requests for Information (RFI), stakeholder summary reports, and Small Business Advocacy Review Panel (SBAR Panel) Final Reports, serve as valuable references in understanding OSHA's initiatives on infectious diseases in the workplace: 

With infectious disease, regardless of the method of transmission, employee safety is tied closely with the safety of residents and patients. OSHA’s current standards and guidelines certainly place an additional regulatory burden on health care providers, but the basic principles of infection control remain the same.  
In an upcoming blog, AHCA/NCAL will provide additional insight and best practices to help long term care providers comply with OSHA’s employee-centric infection control regulation.