SBREFA Panel: No Infection-Control Rule Needed

Posted January 30, 2015 at 12:40 pm

A recent issue that TRSA has worked closely on is a proposed OSHA rule on occupational exposure to infectious diseases in healthcare and other related work settings. TRSA member Rick Kislia of Crescent Laundry in Davenport, IA, participated in the Small Business Advocacy Review (SBAR) panel (also known as a “SBREFA” panel) addressing the possible rule.

The Occupational Safety and Health Administration (OSHA) is considering a rule that would impact employers, including numerous small businesses, whose employees provide direct patient care or potentially come into contact with infectious materials.

The panel’s report was transmitted to Assistant Secretary of Labor for Occupational Safety and Health David Michaels.

OSHA’s rule reportedly would address worker exposure to infectious diseases by nonbloodborne routes – that is by contact, droplet, or airborne transmission – as OSHA already has a rule on bloodborne pathogens. Also, OSHA is considering what it calls a “vertical” standard (i.e., a rule that only applies to certain categories of employees) rather than a “horizontal” standard (which would cover any place of employment where the hazard is present). As such, the rule would only cover employees who perform direct patient care (e.g., hospitals, clinics, doctors and dentist’s offices, etc.) or potentially come into contact with infectious materials (e.g., textile services, janitorial services that clean patient-care areas, laboratories, medical waste transporters etc.).

OSHA was required to convene the SBAR panel by the Small Business Regulatory Enforcement Fairness Act (SBREFA) of 1996. SBREFA requires OSHA to convene a small business panel for any rule that is expected to “have a significant economic impact on a substantial number of small entities” before it can publish a proposed rule. The panel itself consisted of OSHA, the SBA Office of Advocacy, and the Office of Information and Regulatory Affairs within the Office of Management and Budget. The panel included more than 50 small-entity representatives (SERs) from the range of potentially regulated entities. As noted, Rick Kislia represented the textile services industry.

OSHA’s rule, as contemplated, would mandate what OSHA calls its preferred “regulatory framework,” which would essentially require regulated employers to follow the Centers for Disease Control and Prevention guidelines on infection-disease control (CDC guidelines) or similar best practices and protocols. This would likely require:

  • Employers to prepare a written worker infection-control plan
  • Develop standard operating procedures for each occupation and task
  • Provide medical screening and surveillance
  • Provide training and vaccinations
  • Maintain records

The panel was asked to review OSHA’s background documents and other materials, including OSHA’s preferred regulatory framework and to provide advice and recommendations.

The majority of the panel were critical of OSHA’s plan because they said they already do what OSHA would mandate and because they have not seen their employees contract infectious diseases at work.

Many on the panel also noted that they are already subject to rigorous licensing, certification and accreditation requirements. Furthermore, the panel is skeptical about OSHA’s plan to require paid medical removal for any employee who contracts an infectious disease at work.

In its report, the panel’s nonbinding recommendation is that OSHA not proceed with a proposed rule unless it has risk data to justify a new regulation. OSHA also should consider other regulatory and nonregulatory alternatives to the proposed rule. The panel also recommends that OSHA assess each particular work setting to determine the level of risk associated with it.