The U.S. Department of Labor published an Emergency Temporary Standard (ETS) which became effective in June 2021, with some provisions applying in July, to address occupational exposure to COVID-19 that requires several significant changes to protect employees in healthcare settings. To help independent pediatric employers comply with the standard, in this post we’ll cover an overview of the most pediatric-specific requirements. We’ll also cover concerns expressed by the AAP and answer some common questions about the standard in pediatric practice.
COVID-19 Emergency Temporary Standard: An Overview
The ETS aims to protect healthcare workers from exposure to COVID-19. Here are the requirements that apply to pediatric practices, defined as a non-hospital ambulatory care setting, and how your practice can get a start on compliance and keep employees and patients safe. The ETS applies to pediatric practices of any size, although there are a couple of requirements that do not apply to smaller practices, such as having to reduce your COVID-19 plan to writing.
This overview is to help you better understand this rule and isn’t intended to instruct your practice’s specific needs to comply with the OSHA COVID-19 rule. We encourage you to review the entire final rule before enacting any changes at your practice.
The AAP’s Section on Administration and Practice Management (SOAPM) has provided a COVID-19 plan template for practices to tailor to their own needs. Find it here to determine which requirements will affect your practice, create your COVID-19 plan, adhere to documentation requirements, and more.
COVID-19 Safety Plan
Employers with a staff of over 10 members must create a written COVID-19 plan. Practices with a staff of under 10 members must also have a plan, but it is not required to be in writing. For practices with multiple locations, the same plan may apply for each office as long as site-specific information is included. The practice must also designate a COVID-19 safety coordinator(s) with authority to enforce the plan where necessary and knowledge in infection control principles and practices as they apply to the workplace and employee job operations. The plan must be developed with the input of both managerial and non-managerial staff.
Hazard Assessment
Prior to completing the COVID-19 plan, practices must complete a hazard assessment. Per the ETS, a hazard assessment should be worksite-specific to “identify potential workplace hazards related to COVID-19.” After the assessment is complete, the hazard plan can be drafted, and the plan must include the feedback and input of both managers and non-management staff. It may also include requirements beyond the ETS, such as guidelines from the CDC, AAP, or state and local authorities.
The rule notes that “Although the employer’s COVID-19 plan must account for the potential COVID-19 exposures to each employee, the plan can do so generally and need not address each employee individually.” The rule also applies to delivery people or persons required to be in the office only to pick up or drop off items -- that is, all non-employee visitors, including patients, families, and personnel.
On Exemptions: Any fully vaccinated employee may be exempt from certain requirements like physical distancing, wearing of face masks, and protecting themselves behind physical barriers under certain circumstances. This exception applies only in places such as break rooms, labs, and employee restrooms where no person suspected or confirmed to have COVID-19 is reasonably likely to be present. Employee vaccination status must also be documented to be exempt from these requirements in designated areas.
Operations: Patient Management, Mini-Aerosol Program, & PPE
There are several operations tasks required of employers by the rule to promote employee safety. While the official federal register dictates the details of each requirement, such as how to clean a practice when a person who is COVID-positive has been present, in general, employers must:
- Provide appropriate access to PPE for all employees (masks, face shields, gloves, gowns), including appropriate cleaning and storage. The specific use of each will depend on certain circumstances.
- Screen employees each day and before each shift, and log instances of fever or other potential COVID symptoms. Some practices have found a daily log book useful for logging temperatures and symptoms.
- Screen and triage every patient, caregiver, and visitors before entering the building. Many practices already log temperatures and offer patients a pre-appointment COVID-19 screening before the day of their appointment.
- In certain situations defined by OSHA, employers should provide employees with a respirator instead of the use of a face mask. This typically applies to situations where there is exposure to a patient with suspected or confirmed COVID. Employees may also elect to wear a respirator in certain situations instead of a face mask.
- Require and enforce physical distancing of 6 feet between employees except during activities such as clinical care where this distance isn’t feasible.
- Where 6 feet distance isn’t possible between employees, employers should install disposable or cleanable barriers at locations such as the front desk -- they must be situated to “block face-to-face contact based on where individuals would normally stand or sit.” Barriers aren’t required in exam rooms.
- Provide training -- OSHA states in their FAQ that training provided on COVID-19 transmission and other elements of the required training can rely on previous training.
We recommend reviewing the entire ETS rule, available from the Federal Register. FAQs from OSHA are also available.
The COVID-19 ETS for Employers
Questions on practice owners’ minds are likely to focus on how to handle exposure to COVID-19 by employees. It’s important to be aware of both employees’ and employers’ rights when considering actions such as medical removal and whether to pay an employee paid leave.
Employees
Employees must promptly report concerns potential exposure to COVID-19 to their employers -- OSHA defines these concerns as COVID that is “suspected” or “confirmed positive.”
Employees can work remotely if medically removed from the office, but whether they work or not, they must be paid their usual wages and benefits. According to OSHA, “employers with 500 or more employees must pay the employee’s salary up to $1400 per week during the entire period of removal, until the employee meets the return to work criteria.”
Employers
The physician-owner or practice owner has the responsibility to notify other employees in close contact with a person who is COVID-19 positive within 24 hours, without providing information on that person’s identity. In many practices, this requirement may extend to all staff, while in larger practices or those in multiple locations, the requirement may only extend to a particular area, floor, or building.
Employers are also responsible for beginning a medical removal process to protect an exposed employee and the workplace. Note that removal is warranted if the employee is COVID-19 positive or suspects COVID-19, and also if they have high fever or loss of taste or smell without other explanation.
After medical removal, employers of over 10 employees are required to provide employees their normal pay and benefits as if they had never left the office, and are required to maintain their position. Employees may be required to work remotely if they are well enough to do so. The ETS also has an anti-retaliation policy included to protect workers, because “a workplace free from the threat of retaliation promotes collaboration between employers and employees in the effort to minimize the risk of transmission of COVID-19.”
The AAP’s Stance on the COVID-19 Emergency Temporary Standard
On July 2nd, 2021, the American Academy of Pediatrics (AAP) delivered a letter to the Secretary of the U.S. Department of Labor (DoL) expressing concerns over that department’s Occupational Safety and Health Administration (OSHA) COVID-19 healthcare emergency temporary standard (ETS). The AAP’s concerns include:
- The limited timeframe for pediatric practices to adhere to the ETS (with compliance dates of July 6th and July 21st, 2021).
- The possibility that practices unable to meet the standards would have to refer patients with COVID-19 symptoms to urgent care centers in order not to qualify as a location requiring the ETS compliance standards.
- The complications of separation between vaccinated and unvaccinated employees and providing safe working conditions (e.g., telemedicine or physical barriers).
- Concerns over access to appropriate PPE for all employees.
The DoL’s definition of COVID-19 symptoms are similar to symptoms of many common childhood illnesses, which include “fever or chills; cough; shortness of breath or difficulty breathing; fatigue; muscle or body aches; headache; new loss of taste or smell; sore throat; congestion or runny nose; nausea or vomiting; diarrhea.” The AAP has expressed concerns that practices unable to comply with the ETS rule may refer all patients to other providers with such symptoms in order to be an employer not covered by the rule, even if the symptoms are not COVID-19-related and could be safely treated by that patient’s pediatrician.
Fortunately, many practices already have several components of the ETS’s requirements in place, and meeting compliance can help pediatricians stay open for sick kids. PCC is here to help pediatricians comply with these additional standards to keep staff and children safe from exposure to COVID-19. Is your practice meeting the ETS requirements? For more information and a visual guide to OSHA’s ETS requirements, be sure to check out this video series hosted by Dr. Suzanne Berman, chair of the AAP’s Section on Administration and Practice Management (SOAPM) as she answers this question in part 1 of a video series available to all pediatricians.
