In the early 1990s, at the height of the HIV/AIDS epidemic, OSHA issued a bloodborne-pathogen standard that required establishments where workers could be exposed to contaminated blood or other bodily fluids to implement protective measures. This standard is the reason why every hospital room has a container for sharps disposal, and why every hospital offers its employees free hepatitis-B vaccination.
OSHA’s efforts in this area were opposed at the time by many in the health-care community. Dentists, for example, complained that if they had to wear masks and gloves, they would not be able to practice dentistry. But once the standard was issued, the industry found that its provisions were effective and relatively easy to implement. The results have been enormously positive. The rate of needlesticks among health-care workers has decreased dramatically and the number of hospital workers who develop work-related hepatitis B has decreased: Cases dropped from about 12,000 annually to a mere handful each year.
The continued value of the OSHA bloodborne-pathogen standard was demonstrated again in 2014, when several U.S. health-care workers were infected with the Ebola virus. Since the standard covered Ebola exposure, OSHA officials were able to ensure that hospitals that might receive Ebola patients followed required safety precautions.
Creating a standard that would protect workers exposed to airborne infectious diseases has long been an OSHA priority. In 2010, following the H1N1 influenza pandemic, the agency started working on a rule that would apply to health-care facilities and other establishments where workers might be exposed to the flu, tuberculosis, or other airborne diseases, as well as other dangerous hospital-transmitted infections such as methicillin-resistant Staphylococcus aureus (MRSA). The standard would require employers to develop and implement an infection-control plan to protect health-care and related workers with occupational exposure. It would include provisions for worker training and distribution of masks and other personal protective equipment.
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Rules that require employers to plan for an epidemic may seem like common sense, and many employers voluntarily already do everything they would be required to do. But many is not enough. An OSHA standard would provide much-needed guidance, and the prospect of inspections and civil penalties would no doubt motivate some employers to do the right thing. Such a standard would, in essence, make following CDC guidance an enforceable requirement.
Health-care workers aren’t the only people who need protection, of course, and employers must also begin planning to continue operating under pandemic conditions. There are large numbers of workers whose activities are vital to society’s function, especially during a disease outbreak. What would happen if bus drivers were too sick to drive, or pharmacists stopped coming to work? These workers are at increased risk of infection because they have regular contact with the public. They need to be trained and prepared to control their exposure, but for the most part their employers have little experience in addressing these issues. There are other workers, such as truck drivers and utility workers, who may not be at elevated risk, but whose functions are vital to the economy. How will we make sure they remain healthy and able to do their jobs?
