Author: Debbi Waters

OSHA Reopens Comment Period on Occupational Exposure to COVID-19 through April 22

  

This Capitol Beat article was guest-written by Debbi Waters, MSN, RN, MJ, CHC, who was a student in the McKendree University Doctor of Nursing Practice (DNP) in Ethical Leadership Program. Ms. Waters completed her leadership practicum in partnership with ANA’s Department of Policy and Government Affairs and successfully completed all requirements as a DNP candidate on April 12, 2022. She will be awarded her degree on May 13, 2022.

The COVID-19 Healthcare Emergency Temporary Standard (ETS) issued by OSHA on June 21, 2021, although late in coming, was a very important step forward in providing workplace protections for all healthcare workers. There was an expectation, based upon statute and OSHA’s representations, that the ETS would be replaced with a permanent standard within six months of being issued. Thus, it was somewhat surprising on December 27, 2021, when OSHA announced they would step away from enforcement of the most protective provisions of the ETS and do so in the absence of a permanent standard. OSHA did provide assurances that a permanent standard would be forthcoming.  

On March 23, 2022, OSHA issued a notice stating the agency would again accept comments on the interim final rule that established the COVID-19 ETS. Specifically, OSHA is requesting comments on proposed changes for a final rule that would broaden the scope of the ETS while increasing flexibility for employers.

 As a Doctor of Nursing Practice candidate, I spent the past year thoroughly and carefully researching policies to safeguard healthcare personnel throughout the COVID-19 pandemic. The suggestion that OSHA is set to weaken many provisions of the ETS as OSHA transitions to a permanent standard was surprising.

The COVID-19 pandemic demonstrated the lack of readiness of the U.S. healthcare system to rapidly respond to the threat of an airborne infectious disease. As of March 30, 2022, there have been 1,071,214 cases of COVID-19 and 4,102 deaths reported among healthcare workers, a number significantly underestimated due to limitations of COVID-19 surveillance and tracking systems to accurately identify cases by occupation. This, combined with an astonishing 249 percent increase in reported workplace illnesses and injuries within the healthcare industry in 2020, an industry that led all other industries prior to COVID-19, would suggest that a permanent standard should incorporate relevant  guidance and existing ETS provisions to create a strong workplace airborne infectious disease standard.  

While it may appear that the most dangerous period of the COVID-19 pandemic is now in the rearview mirror, an extended view must be taken.  The threat of new variants of COVID-19, continued infections among healthcare workers, and the threat of the next airborne infectious disease are very real dangers that must be addressed. Some of the key provisions that should be included in a permanent standard include:

  • Provision of an N95 or higher respirator when caring for any patient with a novel or unknown respiratory virus, including pandemic influenza, until it is unequivocally confirmed to be droplet transmission rather than airborne;
  • Workplace hazard assessment;
  • Easily accessible, written airborne infectious disease plan;
  • PPE stockpile, particularly N95 or higher respirators;
  • Engineering controls to rapidly convert additional patient rooms into negative airflow;
  • Process for tracking and reporting disease transmission, including notification and surveillance of those who may have been exposed regardless of occupational class or department;
  • Access to vaccinations for disease pathogens, based upon vaccine availability, at no cost to employees;
  • Employee training on the infectious disease plan, and all policies and procedures related to protection of health and safety;
  • Mini Respiratory Program to provide rapid access to respirators for precautions deemed necessary outside of the scope of a known diagnosis or suspected case of an airborne infectious disease; and
  • Triggers for crisis standard use and termination.

While the significant increase in workplace morbidity and mortality within the healthcare industry is in large part attributed to COVID-19, it is also reflective of the weaknesses in the healthcare system to rapidly deploy lifesaving protections based on years of voluntary guidance rather than enforceable standards.  The OSHA rulemaking process for a permanent infectious disease standard began shortly after the H1N1 pandemic of 2009; yet, more than a decade later, healthcare workers continue to provide care without a federal workplace standard to protect them from the workplace threat of airborne infectious diseases.

This is not the time for nurse safety to backslide, but rather a time for nurses to advocate for prompt action on a permanent workplace airborne infectious disease standard. This is the time to call upon OSHA to focus on the fundamental responsibility to establish the workplace protections we deserve now and to build sustainable capacity to rapidly adapt to the next threat.

Next Steps
There is still time to act by reviewing the proposed changes to the ETS as it is considered for a permanent COVID-19 standard. OSHA will be accepting public comments through April 22, 2022, ahead of public hearings that will begin on April 27, 2022. To submit your comments and encourage OSHA to strengthen rather than weaken the ETS provisions, visit regulations.gov and select the comment button. Now is the time for the voice of nursing professionals to be heard.  

H.R. 3635 Promises to Strengthen PPE Stockpile for Future Emergencies

  

This Capitol Beat article was guest-written by Debbi Waters, MSN, RN, MJ, CHC, a student in the McKendree University Doctor of Nursing Practice (DNP) in Ethical Leadership Program, who is completing her leadership practicum in partnership with ANA Senior Policy Advisor Lisa Stand.

This month, Congress took a positive step in preventing a repeat of the catastrophic shortages of personal protective equipment (PPE) experienced by nurses at the outset of the COVID-19 pandemic. With bipartisan support, the House of Representatives passed H.R. 3635, the Strengthening America’s Strategic National Stockpile Act of 2021.

It has been nearly two years since the COVID-19 pandemic began to rapidly spread across the United States (U.S.), triggering the worst public health emergency the nation has witnessed in more than a century. From the beginning of the pandemic in 2020, nurses quickly found themselves fearing for their personal safety, as well as the safety of their patients and families, as PPE supplies were being depleted at an extraordinarily fast pace. Nurses on the frontlines were directed to abandon evidence-based infection prevention standards, for instance, by being required to wear the same PPE for extended periods of time, and to reuse PPE across multiple shifts. In an American Nurses Association (ANA) survey in May of 2020, 45 percent of nurses reported experiencing PPE shortages, with 79 percent of nurses reporting being encouraged or required to reuse PPE, of those 59 percent felt unsafe in doing so. The ANA completed a second survey, ending on August 14, 2020, with 47 percent of nurses reporting intermittent to occasional PPE shortages. Forty-two percent of participating nurses reported an increase in PPE availability, as compared to 36 percent reporting no change; however, 68 percent continued to report being required by their facility to reuse single-use PPE, with 62 percent reporting feeling somewhat to very unsafe. The enormity of the impact of COVID-19 on healthcare workers is yet to be determined; however, the failure to provide basic PPE to frontline nurses and healthcare workers was profound and consequential to physical and mental well-being of our nation’s nursing workforce.

Why is H.R. 3635 Important?
H.R. 3635 would address key vulnerabilities within the federal government’s ability to adequately respond to such large-scale public health emergency, particularly with the medical supply chain.

The U.S., as with most other countries around the globe, utilized unprecedented amounts of PPE during the COVID-19 pandemic. At times, the PPE burn rate was nearly a 100 percent increase over historical levels. Very early in the pandemic as hospitals exhausted PPE supplies and began experiencing challenges in purchasing supplies through the usual “just in time” supply chain channels, and as local and state supplies became depleted, states called up the federal government for assistance through the Strategic National Stockpile (SNS)

The SNS, long considered to be the contingency plan for public health emergencies, was ill-prepared to respond to a threat the size and scope of this pandemic, certainly not for a threat simultaneously affecting all 56 states, territories, and the District of Columbia. The SNS endured years of underfunding and budget cuts by Congress that, compounded by a failure to replenish and rotate stock, led not only to inadequate amounts of PPE, but also to the delivery of PPE that was expired, rotting, and inappropriate for safe use in protecting nurses from the dangers of COVID-19.

Maintaining the Stockpile
H.R. 3635 would address the issue of expired and unsafe supplies by allowing the U.S. Department of Health and Human Services (HHS) to distribute supplies from the SNS to any federal department or agency, on a reimbursable basis, if the supplies are within one year of expiration and can be replenished within the SNS. In addition, HHS would be required to ensure that supplies and equipment within the SNS are in working order.

Domestic Production
The COVID-19 pandemic also exposed the risks associated with U.S. dependence on foreign sources for nearly 60 percent of the nation’s medical supplies. This dependence created cataclysmic sourcing and price challenges for American hospitals and healthcare providers, caused by stockpiling of supplies and price gouging, at one point upwards of 1,000 percent the customary cost, for supplies that were of poor quality and at times counterfeit. The inability of domestic manufacturing proved to be detrimental to nurses who were providing care to COVID-19 patients. H.R. 3635 calls for the creation of a pilot program designed to strengthen the U.S. supply chain by increasing domestic manufacturing. Specifically, the pilot requires HHS to establish and maintain geographically dispersed domestic reserves of critical medical supplies, including PPE, and increased emergency stock of those critical supplies through cooperative agreements or partnerships with manufacturers to produce and maintain supplies. Additionally, the bill provides temporary authorization for HHS to disperse grants to states for use in maintaining or expanding state strategic stockpiles of critical supplies that are deemed essential by the State in preparation for future public health emergencies.

Transparency and Tracking
Strengthening America’s Strategic National Stockpile Act of 2021 would require HHS to develop a transparent process for distribution and use of supplies from the SNS by January 1, 2022. This would include a process for states, localities, tribes, and territories (SLTT) to request supplies; the decision-making process HHS will follow when determining if the request will be fulfilled or denied; and the process for the prioritization of distribution to the SLTT. In addition, the bill would require a monthly report to be provided detailing the requests submitted by SLTT, including the amount of materials and supplies requested, along with the outcomes of those requests. In the event a supply request is only partially filled or denied, the rationale for those outcomes must be included.

Our nation must begin building upon the lessons learned during the COVID-19 pandemic by planning and preparing a response to future public health emergencies. We must remain vigilant, as COVID-19 will not be an isolated incident, if we are going to prevent a repeat of the catastrophic failures experienced during the COVID-19 response. H.R. 3635 is a positive step towards ensuring the U.S. response to upcoming public health emergencies will be more efficient and effective, while protecting the health and safety of our frontline healthcare workers and we thank Representative Elissa Slotkin for her leadership in addressing this critical issue.

Next Steps
There is still work to be done to ensure the Strengthening America’s Strategic National Stockpile Act of 2021 is signed into law. This legislation now moves to the Senate where a companion bill S.1974 was introduced in June 2021. As you know, things tend to move slowly in the Senate and they need a groundswell of support from their constituents to pass legislation. Without action, nurses will be no more protected in future pandemics, than we were in March of 2020. Please visit our Latest News page for updates on the legislation and a chance for every nurse and health care advocate to take action and message their members of Congress soon.