Healthcare Workers and Employers
This guidance is not a standard or regulation, and it creates no new legal obligations. It contains recommendations as well as descriptions of mandatory safety and health standards. The recommendations are advisory in nature, informational in content, and are intended to assist employers in providing a safe and healthful workplace. The Occupational Safety and Health Act requires employers to comply with safety and health standards and regulations promulgated by OSHA or by a state with an OSHA-approved state plan. In addition, the Act's General Duty Clause, Section 5(a)(1), requires employers to provide their employees with a workplace free from recognized hazards likely to cause death or serious physical harm.
This section provides guidance for healthcare workers and employers. This guidance supplements the general interim guidance for workers and employers of workers at increased risk of occupational exposure to SARS-CoV-2.
Employers should remain alert of changing outbreak conditions, including as they relate to community spread of the virus and testing availability, and implement infection prevention measures accordingly. As states or regions satisfy the gating criteria to progress through the phases of the guidelines for Opening up America Again, employers will likely be able to adapt this guidance to better suit evolving risk levels and necessary control measures in their workplaces.
Employers should assess the hazards to which their workers may be exposed; evaluate the risk of exposure; and select, implement, and ensure workers use controls to prevent exposure. The table below provides examples of healthcare work tasks associated with the exposure risk levels in OSHA's occupational exposure risk pyramid, which may serve as a guide to employers in this sector.
Examples of healthcare work tasks associated with exposure risk levels
Note: For activities in the lower (caution) risk category, OSHA's Interim Guidance for Workers and Employers of Workers at Lower Risk of Exposure may be most appropriate.
Until more is known about how COVID-19 spreads, OSHA recommends using a combination of standard precautions, contact precautions, airborne precautions, and eye protection (e.g., goggles, face shields) to protect healthcare workers with exposure to the virus.
The CDC provides the most updated infection prevention and control recommendations for healthcare workers managing suspected or confirmed cases of COVID-19.
Employers of healthcare workers are responsible for following applicable OSHA requirements, including OSHA's Bloodborne Pathogens (29 CFR 1910.1030), Personal Protective Equipment (29 CFR 1910.132), and Respiratory Protection (29 CFR 1910.134) standards. See the Standards page for additional information on OSHA requirements.
Use engineering controls to shield healthcare workers, patients, and visitors from individuals with suspected or confirmed COVID-19. This includes physical barriers or partitions in triage areas to guide patients, curtains separating patients in semi-private areas, and airborne infection isolation rooms (AIIRs) with proper ventilation. AIIRs are single-patient rooms with negative pressure that provide a minimum of 6 air exchanges (existing structures) or 12 air exchanges (new construction or renovation) per hour.
Is OSHA infection prevention guidance for healthcare the same as CDC recommendations?
- With regard to healthcare worker infection prevention, CDC guidance may appear to differ from OSHA guidance.
- CDC information reflects infection control recommendations that are based in part on PPE supply chain considerations.
- OSHA's recommended infection prevention methods, including for PPE ensembles, help employers to remain in compliance with the agency's standards for respiratory protection (29 CFR 1910.134) and other PPE (29 CFR 1910 Subpart I).
- OSHA is addressing supply chain considerations, including respirator shortages, through enforcement flexibilities, as discussed in the Enforcement Memoranda section of the Standards page.
If an AIIR is:
- Available: Place patients with suspected or confirmed COVID-19 in an AIIR if available at the healthcare facility. Perform aerosol-generating procedures on patients with suspected or confirmed COVID-19 in an AIIR. Ensure that the room air exhausts directly to unoccupied areas outside of the building (i.e., not into walkways, break areas, or other areas where workers or visitors could congregate or pass through), or passes through a high-efficiency particulate arrestance (HEPA) filter, if recirculated.
- Not available: Isolate the patient in a private room. If available, negative-pressure rooms (i.e., rooms under negative pressure that may not meet all of the specifications of an ideal AIIR) are preferable to ordinary exam or patient rooms. Keep the room door closed. Isolation tents or other portable containment structures may serve as alternative patient-placement facilities when AIIRs are not available and/or examination room space is limited. Ensure that the room air exhausts directly to unoccupied areas outside of the building, or passes through a HEPA filter, if recirculated.
The CDC/Healthcare Infection Control Practices Advisory Committee (HICPAC) Guidelines for Environmental Infection Control in Healthcare Facilities contain additional information on negative-pressure room control for airborne infection isolation.
Consistent with the general interim guidance, isolate patients with suspected or confirmed COVID-19 to prevent transmission of the disease to other individuals. If possible, isolating suspected cases separately from confirmed cases may also help prevent transmission.
Restrict the number of personnel entering the room of a patient with suspected or confirmed COVID-19. This may involve training healthcare workers in the appropriate use of PPE so they can perform tasks such as housekeeping and meal service to reduce the need for environmental and food service workers to enter areas where suspected or confirmed COVID-19 patients are isolated.
Follow CDC guidelines for signs for and labeling of patient room doors when transmission-based precautions (i.e., contact and airborne precautions) are in place.
Minimize the number of staff present when performing aerosol-generating procedures.
Safe Work Practices
Perform as many tasks as possible in areas away from a patient with suspected or confirmed COVID-19 (e.g., do not remain in an isolation area to perform charting; use closed-circuit television systems to communicate with patients in an isolation area when a worker does not need to be physically present).
Work from clean to dirty (i.e., touching clean body sites or surfaces before touching dirty or heavily contaminated areas) and limit opportunities for touch contamination (e.g., adjusting glasses, rubbing the nose, or touching face with gloves that have been in contact with suspected or confirmed COVID-19 patients or contaminated/potentially contaminated surfaces). Also, prevent touch contamination by avoiding unnecessary touching of environmental surfaces (such as light switches and door handles) with contaminated gloves.
Ensure that there are systems in place to:
- Differentiate clean areas (e.g., where PPE is put on) from potentially contaminated areas (e.g., where PPE is removed);
- Handle waste and other potentially infectious materials; and
- Clean, disinfect, and maintain reusable equipment and PPE.
Use caution when handling needles or other sharps, and dispose of contaminated sharps in puncture-proof, labeled, closable sharps containers.
Workers should avoid touching their faces, including their eyes, noses, and mouths, particularly until after they have thoroughly washed their hands upon completing work and/or removing PPE.
Train and retrain workers on how to follow established protocols.
Personal Protective Equipment
Flexibilities Regarding OSHA’s PPE Requirements and Prioritization of PPE During COVID-19
Some healthcare facilities and systems are experiencing shortages of PPE, including gowns, face shields, face masks, and respirators, as a result of the COVID-19 pandemic.
See information on PPE flexibilities and prioritization in the Personal Protective Equipment Considerations section within the Interim Guidance for U.S. Workers and Employers of Workers with Potential Occupational Exposures to SARS-CoV-2.
Healthcare workers must use proper PPE when exposed to a patient with suspected or confirmed COVID-19 or other sources of SARS-CoV-2 (See OSHA's PPE standards at 29 CFR 1910 Subpart I).
OSHA recommends that healthcare workers with exposure to suspected or confirmed COVID-19 patients wear:
- Eye/face protection (e.g., goggles, face shield)
- NIOSH-certified, disposable N95 filter facepiece respirators or better
Use respiratory protection as part of a comprehensive respiratory protection program that meets the requirements of OSHA's Respiratory Protection standard (29 CFR 1910.134) and includes medical exams, fit testing, and training.
When removing potentially contaminated PPE such as an N95 respirator, do not touch the outside of the respirator without wearing gloves.
In addition to the PPE considerations for all workers and employers of workers at increased risk of occupational exposure, CDC has developed strategies for optimizing the supply of PPE, including specifically for:
CDC has developed interim guidance for healthcare providers who are coordinating the home care and isolation or quarantine of people confirmed or suspected to have COVID-19.
Cleaning and disinfection in healthcare:
Routine cleaning and disinfection procedures (e.g., using cleaners and water to pre-clean surfaces before applying an EPA-registered, hospital-grade disinfectant to frequently touched surfaces or objects for appropriate contact times as indicated on the product’s label) are appropriate for SARS-CoV-2 in healthcare settings, including those patient-care areas in which aerosol-generating procedures are performed.
Refer to List N on the EPA website for EPA-registered disinfectants that have qualified under EPA's emerging viral pathogens program for use against SARS-CoV-2.
Follow standard practices for disinfection and sterilization of medical devices contaminated with COVID-19, as described in the CDC Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008.
Note that workers who perform cleaning and disinfection in healthcare may require PPE and/or other controls to protect them simultaneously from chemical hazards posed by disinfectants and from human blood, body fluids, and other potentially infectious materials to which they have occupational exposure in the healthcare environment. Employers may need to adapt guidance from this Healthcare Workers and Employers section, the Environmental Services Workers and Employers section, and the interim guidance for workers and employers of workers at increased risk of occupational exposure, to fully protect workers performing cleaning and disinfection activities in healthcare workplaces.