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Federal Register / Vol. 86, No. 116 / Monday, June 21, 2021 / Rules and Regulations food service, environmental services, security, and patient access/registration Wilkins et al., 2021. A meta-analysis published in the American Journal of Epidemiologists compared data from 97
separate studies and found evidence that COVID19 infections were both common 11% of the tested cohort of healthcare employees and spread among different healthcare worker occupations. In this study, however, nurses had the highest rate of seroprevalence while most of the COVID19-positive medical personnel were working in hospital nonemergency wards during screening Gomez-Ochoa et al., January 2021.
Healthcare employees who provide direct patient care are at high risk of exposure to SARSCoV2 because they have close and sometimes prolonged contact with patients who are infected or potentially infected with SARSCoV
2. This contact occurs when conducting physical examinations and providing treatment and medical support. The risk can be amplified when examining or treating a COVID19 patient who has symptoms such as coughing and difficulty breathing leading to more forceful inhalation and exhalation, both of which can result in the release of more droplets that can be propelled further. Healthcare employees who conduct, or provide support during, aerosol-generating procedures on persons with suspected or confirmed COVID19 also face a greater risk of infection Heinzerling et al., April 17, 2020. Examples of procedures that can produce aerosols include intubation, suctioning airways, use of high-speed tools during dental work, and use of power saws during autopsies. A
complete list of aerosol-generating procedures, as defined by this ETS, is included in 29 CFR 1910.502b.
Employees in healthcare are also at risk of exposure to SARSCoV2 if they have close contact with co-workers while providing patient care or performing other duties in enclosed areas such as a nursing station, laundry room, or kitchen. Based on the biological mechanisms of SARSCoV2
transmission, there is no doubt that some employees in healthcare are at risk of exposure to SARSCoV2. Healthcare employees are performing some job tasks that create an expectation of exposure to people or human remains infected with COVID19. The nature of caring for a patient known to have COVID19 or performing on autopsy on someone who had COVID19 increases the risk to employees performing that task.
This section summarizes recent studies about U.S. employees in
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healthcare that illustrate the impact of COVID19 in several types of settings.
Because the pandemic is recent and the evidence generated is on the frontiers of science, studies are not available for every type of employee in every type of healthcare setting. The peer-reviewed scientific journal articles, government reports, and journal pre-print articles described below establish the widespread prevalence of COVID19
among healthcare employees. OSHAs findings are based primarily on the evidence from peer-reviewed scientific journal articles and government reports.
However, peer review for scientific journal articles and the assembly of information for government reports and other official sources of information take time, and therefore those sources do not always reflect the most up-to-date information Chan et al, December 14, 2010. This is critical in the context of the COVID19 pandemic, where new information is emerging daily.
Therefore, OSHA has supplemented peer-reviewed data and government reports with additional information on occupational outbreaks contained in other sources of media e.g., newspapers. The reported information from newspapers can provide further evidence of the impact of an emerging and changing disease, especially for certain workers in healthcare and associated occupations e.g., laundry workers, janitors that are not well represented in the peer-reviewed scientific literature, and assist OSHA in protecting these employees from the grave danger posed by transmission of SARSCoV2. OSHA did not make findings based solely on non-peerreviewed sources such as pre-prints and news articles, but the agency found that those sources sometimes provided useful information when considered in context with more robust sources.
Together, these sources of information represent the best available evidence of the impact on employees of the pandemic thus far.
The peer-reviewed literature, government reports and, in a limited number of cases, non-peer-reviewed articles illustrate a significant number of infections among healthcare employees, but the types of workplaces or conditions described are not the only ones in which a grave danger exists.
However, the studies add to the evidence that any healthcare employee is at risk of exposure if they have close contact with others who are suspected or confirmed to have COVID19. The studies also provide evidence that once SARSCoV2 is introduced into the healthcare workplace e.g., through an
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infected patient, other member of the public, or employee, unvaccinated employees in that workplace are at risk of exposure.
a. General Investigations of Workers or Workplaces The Washington State Department of Health and the Washington State Department of Labor and Industries collaborated on a report evaluating COVID19 cases and their occupational history WSDH and WLNI, November 10, 2020. They identified 30,895
confirmed cases of COVID19 in Washington State with occupational data, including healthcare settings, through September 13, 2020. They reported infection rates for 22
occupational groups, and reported that healthcare and social assistance were among the industry sectors with the highest incidence of infections WSDH
and WLNI, November 10, 2020. The report states that some occupations increase the risk to workers of exposure to SARSCoV2, but the data does not demonstrate that all the cases reported resulted from occupational exposure.
These data were also used to determine how work activities were related to COVID19. Zhang used information from a previous Washington State report with an earlier cutoff date through June 11, 2020;
10,850 cases and cross-referenced it with information available from ONET
a Department of Labor database that contains detailed occupational information for more than 900
occupations across the U.S. to determine occupation-specific COVID
19 risks Zhang, November 18, 2020.
Zhang created a model using the ONET
descriptors and correlated it to the case reports from Washington State to develop a predictive model for COVID
19 cases. The model found that among ONETs 57 physical and social factors related to work, the two predictive variables of COVID19 risk were frequency of exposure to diseases and physical proximity to other people. The author found that healthcare professions in general had the highest predicted risk for COVID19. This finding provides additional evidence that during an active pandemic, healthcare employees can be exposed to a grave danger during sustained periods in workspaces where they are working in proximity to others, including patients with COVID19.
The Oregon Health Authority OHA
publishes a weekly report detailing outbreaks directly related to work settings. OHA epidemiologists consider cases to be part of a workplace outbreak when clusters form with respect to space and time unless their
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