Healthcare providers have been at the forefront of many changes to our healthcare systems and society during the pandemic, as they treat COVID-19 patients and face a constant threat of exposure. Personal protective equipment (PPE) has become the norm, and it has undoubtedly kept healthcare workers safer. Now, as the pandemic may be nearing its end in the U.S., the question becomes whether these measures, adopted out of necessity, will persist. Personally, I am worried they will not. Once the pandemic recedes from memory and the impetus for wearing PPE isn’t present on a daily basis, I fear these protections will no longer be universally provided to us.
So, how can we ensure that healthcare workers continue to have access to masks and other PPE? The Occupational Safety and Health Administration (OSHA) should create an airborne pathogen standard.
Throughout the pandemic, we worked to limit the toll this disease took on our country. This work came with significant risk: healthcare workers were three times more likely to be infected with COVID-19 compared to the general public. This high infectivity rate was likely exacerbated by PPE shortages during the initial phases of the pandemic, with many healthcare workers either having inadequate PPE or being forced to reuse their equipment well beyond its intended use. Early on, there were even alarming news stories of hospitals and other healthcare organizations that actually forbade their employees from wearing masks and other PPE.
However, it quickly became obvious that healthcare systems needed to implement new standards. With remarkable speed, wearing masks, eye protection, and gowns became standard practice. CDC developed COVID-19 recommendations for healthcare providers, which stated that providers “should wear well-fitting source control at all times while they are in the healthcare facility.” Masks and other protective equipment, while initially in short supply, undoubtedly helped prevent scores of healthcare providers from becoming ill — or worse — due to a COVID-19 infection.
Adequate PPE is absolutely necessary to protect healthcare workers from airborne infection. An OSHA airborne pathogen standard is an important step to ensure the PPE shortages and restrictions on mask wearing we witnessed during this pandemic never happen to us again. The CDC issues recommendations, but an OSHA regulation can have real consequences, including loss of certification and significant fines. An OSHA airborne pathogen standard would not only codify best practices for prevention and protection, but it would also place the onus on hospitals and other healthcare employers to ensure they adequately protect their employees in the future.
This wouldn’t be the first time OSHA produced workplace standards in response to a significant health event — precedent already exists. In the early 1990s, OSHA created the Bloodborne Pathogens standard in response to the AIDS epidemic. This standard laid out requirements for employers “to protect workers who are occupationally exposed to blood or other potentially infectious organisms.” Among other protections, it requires that gloves are provided to employees, disposable needles are used, and that post-exposure prophylaxis is made available to any employee who is potentially exposed to a bloodborne organism. These practices are now known as “universal precautions,” meaning they are used for all patients. Most physicians cannot imagine practicing medicine without them. Yet, if it were not for this OSHA standard, these basic protective measures might not have become universal. OSHA’s actions ensured that all employees would enjoy this level of protection.
It’s time for OSHA to take action on the important issue we’re facing today. At this point, it is not clear when or if COVID-19 is going to completely disappear. It’s also unlikely that COVID-19 is the last, or even the worst, airborne pathogen we will face. The coronavirus pandemic, for all of the suffering it has caused, has also helped advance our understanding of best practices for airborne contagion prevention. It has shown us how vulnerable we are to these pathogens when basic, protective measures are lacking. OSHA, please give us this standard; we cannot let all that we have learned from this pandemic go to waste.
Gregory Jasani, MD, is an emergency medicine physician at the University of Maryland Medical Center in Baltimore.