Enforcement Procedures for Exposure Risk to H1N1
On November 20, 2009, OSHA released CPL-02-02-075, Enforcement Procedures for High to Very High Occupational Exposure Risk to 2009 H1N1 Influenza. The purpose of the document is to establish enforcement policies and to ensure uniform inspections when conducting inspections to minimize exposure to 2009 H1N1 influenza for workers that have contact with patients or contaminated material in healthcare or clinical laboratories. The document also provides instructions for inspector safety and patient confidentiality. OSHA uses CDC guidance for assessing potential workplace hazards and hazard controls. According to OSHA and the CDC, aerosol-generating procedures increase the likelihood of exposure to the H1N1 virus as well as other airborne infections. These procedures are consider to hold a higher risk of exposure than coughing, sneezing, talking, or breathing. They are listed here.
Bronchoscopy
Sputum induction
Endotracheal intubation and extubation
Open suctioning of airways
CPR
Autopsies
Employee risk for exposure is based on the employee’s job task and proximity to the infected patient.
Very High Exposure Risk: Job activity involving a medical or laboratory procedure with a potential of exposure to high concentrations of suspected or confirmed H1N1 virus. This would include employees performing or present during the performance of the aerosol-generating procedures listed on page 4 and workers involved in collecting or handling specimens from known or suspected pandemic patients.
High Exposure Risk: Job activity involving a high potential for exposure to suspected or confirmed H1N1 virus. This includes workers who are in close contact (within 6 feet) to patients or who enter a small enclosed airspace shared with the patient, and workers involved in transporting or performing autopsies on suspected or confirmed pandemic patients. (The “small enclosed airspace” would be about the size of an average patient room.)
Medium Exposure Risk: Job activity that requires frequent, close contact (within 6 feet) with others, including coworkers and the general public. This group includes anyone with frequent contact with the general population, such as teachers, bank tellers, and cashiers in high-volume retail settings.
Low Exposure Risk: Job activity that does not require close contact (within 6 feet) with others (coworkers or general public). The directive addresses only high and very high risk exposures. Information on medium and low risk is for information only. Settings that will typically be inspected by OSHA for compliance with this directive are hospitals, emergency medical centers, physician and dental offices, and clinics. For home health agencies, only the employer’s
office will be inspected; OSHA will not inspect private residences. Inspections will be triggered by complaints, catastrophes, or fatalities. OSHA will first determine the potential for very high or high risks for exposure to 2009 H1N1.
Did the workplace handle specimens or evaluate, care for, or treat suspected or confirmed 2009 H1N1 influenza patients within the past 6 months?
Does the employer have any hazard assessment or exposure risk assessment performed at the facility to determine the presence of the hazards, the need for respiratory protection, and employees’ risk categories?
Do the employer’s injury and illness records show that any employee has or has had occupationally acquired 2009 H1N1? This applies only to confirmed, work-related cases.
If the inspector does not find any violations of OSHA standards, regulations, or the general duty clause, he or she will terminate the inspection and leave the facility.
If the inspector determines that there is a high or very high risk for exposure, he or she will evaluate the exposure control plan to ensure its compliance with the directive. This includes an initial hazard assessment, training for workers, and respiratory protection that includes fit testing.
In cases where employers have experienced a shortage of respirators that are at least as effective as N95 respirators, the employer must show documentation of a good faith effort to find suitable alternatives. (N99 and N100 respirators are acceptable.) Employers may be cited for failure to comply with any of the above requirements (hazard assessment, training, respiratory protection). During the course of the inspection, other hazards may be observed and may be cited as well.
