Summary of Outreach Efforts for a Potential Standard Addressing
Occupational Exposure to Infectious Diseases 

OSHA’s first public step in developing a standard to address
occupational exposure to infectious diseases was to issue a Request for
Information (“RFI”) on May 6, 2010.  OSHA received more than 220
comments in response to the RFI.  The comments came from representatives
of a wide range of healthcare workplaces, including:  private,
not-for-profit, and university hospitals; ambulatory care centers;
long-term, home health, and hospice care facilities; and emergency
response, laboratory and animal facilities.  The Agency also received
comments from representatives of healthcare unions and healthcare
associations.  

Following the RFI, OSHA conducted two stakeholder meetings at the
Department of Labor in Washington, DC. The meetings were held on July
29, 2011; one in the morning and the other in the afternoon.  There were
37 participants and 23 observers at the morning meeting, and 16
participants and 20 observers at the afternoon meeting.  The meetings
were attended by healthcare professionals and other interested parties
representing private industry, labor unions, government entities, and
trade associations. 

During the stakeholder meetings, OSHA received feedback regarding the
advantages and disadvantages of a possible infectious diseases program
standard.  OSHA stated at the stakeholder meetings that it was
considering a “vertical” program standard that would apply only to
workers that provide direct patient care and/or perform other ancillary
tasks in healthcare and related work places.  Some stakeholders
commented that OSHA should develop a broader “horizontal” standard
that would cover all workplaces where workers could be exposed to
infectious agents.      

Some stakeholders questioned whether it was necessary for OSHA to
develop a new standard specific to infectious diseases, and urged OSHA
to consider that many healthcare facilities are already heavily
regulated in this area.  Other stakeholders countered that a new
standard is necessary, particularly for those settings that are not
heavily regulated.  Many stakeholders stated that there is a need for
consistency given the various guidance materials currently published by
government agencies and private organizations.  And some stakeholders
also emphasized that CMS regulations, and many infection control
guidelines, focus on protecting patients from exposure to infectious
agents, not specifically on protecting workers from infectious agents,
and that it was important for OSHA to develop a rule that focuses on the
protection of workers. 

Some participants stated that healthcare facilities must currently
comply with OSHA’s existing Bloodborne Pathogens (BBP) standard, and
that a new standard would overlap significantly with the BBP standard. 
According to these participants, because healthcare facilities are
already in compliance with the BBP standard, a new standard would
require duplicative efforts and result in facilities incurring
unnecessary costs.  Some stakeholders also suggested that OSHA should
consider incorporating infectious agents into the BBP standard.  

Other participants stated that if facilities are already in compliance
with overlapping guidelines and standards, then additional
implementation costs would be minimal.  Also, as outlined by OSHA during
the stakeholder meetings, an infectious diseases program standard would
be flexible and allow each affected employer to develop a worker
infection control plan tailored to its specific workplace.  Additional
participants stated that a new standard would give workers an additional
incentive to follow CMS regulations, TJC standards, and CDC guidelines. 


The complete notes for the two stakeholder meetings are available for
review at   HYPERLINK "http://www.regulations.gov"  www.regulations.gov 
under docket number OSHA-2010-0003. 

In addition to the stakeholder meetings, OSHA conducted other outreach
activities. Between November 2011 and March 2012, OSHA conducted site
visits to a non-profit clinic, a specialty care clinic, a clinical
laboratory, a private dental practice, and a long-term care facility. 
The purpose of these five site visits was to explore the feasibility of
implementing certain elements of a potential Infectious Diseases
standard.  Each of these healthcare facilities had an infection control
program in place.  Further, in August of 2012, OSHA sent a Conceptual
Framework for an Infectious Diseases standard to CDC, the National
Institute of Occupational Safety and Health, the Department of Health
and Human Services, and the Department of Veterans Affairs.  Comments
from these other agencies were supportive.  

