A process is now underway for the Occupational Health and Safety Administration to issue a new set of standards. Public health experts fear that the CDC’s newest guidelines on masking––which no longer recommend universal masking in healthcare settings––may weaken OSHA standards.

JORDAN BARAB; confinedspaced2017@gmail.com, @jbarab
    Barab was deputy assistant secretary of labor for OSHA from 2009 to 2017 and senior labor policy advisor to the House of Representatives Committee on Education and Labor from 2019 to 2021. He writes the Confined Space newsletter on workplace safety and labor issues. 

Barab told the Institute for Public Accuracy: “OSHA had six to nine months, starting in January, to deliver its next set of regulations to OIRA,” the Office of Information and Regulatory Affairs. “OIRA can then take up to three months to review the regulations. At this point, interest groups can meet with OIRA about what they want––but OIRA is not required to take any of that into account.” 

“It’s unclear,” Barab said, “how much warning OSHA had [about the new CDC recommendations on masking].” The changes to the CDC guidelines “aren’t major,” Barab said. But they “will require some adjustment on the part of OSHA… The recommendations might send OSHA back to the drawing board screaming. [The agency] can’t be inconsistent with CDC recommendations.” Generally, Barab said, OSHA will “defer to the CDC. But it’s hard when their recommendations are changing.” Last week, Barab published a blog post on the guidance, and on hospital industry and Republican opposition to the standard so far. 

     “The other complicating factor,” Barab said, “is the upcoming midterm elections. White Houses are sometimes hesitant to publish major standards right before the elections.” 

    He added: “The goal of the standards, more or less, is to make CDC guidance enforceable. The new standards will add some things like training––to what extent workers need to be trained about Covid-19 and precautions––and hopefully some kind of enhanced non-discrimination language, to keep employers from retaliating against workers who are exercising their health and safety rights. In past Democratic administrations, OSHA has included more explicit language about retaliation.”

Barab recently published an article called “Ensuring Your Safety: How OSHA Can Better Protect Healthcare Workers” on the American Federation of Teachers website. The article offers an explainer history of OSHA, starting in the 1980s, when healthcare worker unions first began addressing the risk of bloodborne pathogens to healthcare workers amid the AIDS epidemic. In subsequent years, OSHA focused on protecting healthcare workers from back injuries and workplace violence. 

Barab writes that during the H1N1 outbreak, “OSHA realized that it did not have the enforcement tools to address a major disease outbreak and began work on a comprehensive infectious disease standard that would supplement the Bloodborne Pathogens Standard… OSHA also became aware in 2009 of a potential critical shortage of N95 respirators.”

Barab offers three lessons about the protection of healthcare workers from the last fifty years:

• “Progress on worker protection only happens as a result of pressure from labor unions and public health advocates. From the earliest days of OSHA, unions representing healthcare workers pressured OSHA through lawsuits, petitions, and congressional lobbying to protect healthcare workers from hazardous chemicals, infectious diseases, musculoskeletal injuries, and workplace violence. While progress has been slow, it would have been nonexistent without union activity.

• “Hazards to healthcare workers are not well covered by OSHA. Adequate health and safety coverage continues to be a struggle because of the agency’s initial and continuing focus on manufacturing and construction, the glacially slow pace of rulemaking, OSHA’s small budget, the strength of employer organizations like the AHA, and the persistent belief that healthcare workers somehow voluntarily assume hazards in their jobs (almost all of which are preventable with appropriate investments in engineering controls, staffing, personal protective equipment, and other protections).
• “OSHA is severely underfunded and understaffed, and the agency has few standards that address healthcare worker hazards. This means that while OSHA serves as an important backstop to prevent healthcare worker injuries, illnesses, and deaths, workers have to take action on their own—through forming unions, writing protections into contract language, and enforcing those contracts.”