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Federal Register / Vol. 86, No. 116 / Monday, June 21, 2021 / Rules and Regulations
the workplace by helping to ensure that all effective measures are implemented as part of a multi-layered strategy to minimize employee exposure to COVID19.
References
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American National Standards Institute ANSI/American Society of Safety Professionals ASSP. 2019. ANSI/
ASSP Z10.02019. Occupational Health and Safety Management Systems. ANSI/
ASSP, 2019.
International Organization for Standardization ISO. 2018.
Occupational health and safety. ISO
45001. ISO, 2018.
National Institute for Occupational Safety and Health NIOSH. 2016, December.
Fundamentals of total worker health approaches: essential elements for advancing worker safety, health, and well-being. Publication no. 2017112.
https www.cdc.gov/niosh/docs/2017112/pdfs/2017_112.pdf. NIOSH, December 2016.
Occupational Safety and Health Administration OSHA. 2005. Small Business Handbook. Small Business Safety and Health Management Series.
OSHA 2209 02R 2005. https
www.osha.gov/sites/default/files/
publications/small-business.pdf. OSHA, 2005.
Occupational Safety and Health Administration OSHA. 2012, January.
Injury and Illness Prevention Programs.
White Paper. https www.osha.gov/dsg/
InjuryIllnessPreventionPrograms WhitePaper.html. OSHA, January 2012.
Occupational Safety and Health Administration OSHA. 2016, October 18. Recommended Practices for Safety and Health Programs. OSHA 3885.
https www.osha.gov/sites/default/files/
publications/OSHA3885.pdf. OSHA, October 18, 2016.

C. Patient Screening and Management Limited contact with potentially infectious persons is a cornerstone of COVID19 pandemic management. For example, screening and triage of everyone entering a healthcare setting is an essential means of identifying those individuals who have symptoms that could indicate infection with the SARS
CoV2 virus CDC, February 23, 2021.
Persons with such symptoms can then be triaged appropriately to minimize exposure risk to employees. CDC
guidance provides a number of approaches for screening and triage, including screening at entry, separate triage areas for patients desiring evaluation for COVID19 concerns, and electronic pre-screening prior to arrival CDC, February 23, 2021. Once identified, potentially infected individuals can then be isolated for evaluation, testing, and treatment.
Triage increases the likelihood of implementation of the appropriate level
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of personal protective equipment for employees and other protections required for exposure to potentially infectious patients. Patient segregation in healthcare settings also reduces nosocomial healthcare-acquired infections for employees. Inpatients continue to require regular re-evaluation for COVID19 symptoms.20
Symptoms-based screening is a standard component of infection control. This approach was recommended during the 2003 SARS
epidemic caused by SARSCoV1, a different strain of SARS and is routinely recommended for airborne infections such as M. tuberculosis and measles, and as a general practice in infection control programs Siegel et al., 2007. Because SARSCoV2 can be transmitted by individuals who are infected but do not have symptoms asymptomatic and presymptomatic transmission, symptombased screening will not identify all infectious individuals Viswanathan et al., September 15, 2020. However, persons with symptoms early in their SARS
CoV2 infection are among the most infectious Cevik et al., November 19, 2020. Therefore, symptombased screening will identify some of the highestrisk individuals for SARS
CoV2 transmission and thereby reduce the risk to workers.
References Centers for Disease Control and Prevention CDC. 2021, February 23. Interim infection prevention and control recommendations for healthcare personnel during the Coronavirus Disease 2019 COVID19 pandemic.
https www.cdc.gov/coronavirus/2019ncov/hcp/infection-controlrecommendations.html. CDC, February 23, 2021.
Cevik, M. et al., 2020, November. SARS
CoV2, SARSCoV, and MERSCoV
viral load dynamics, duration of viral shedding, and infectiousness: A
systematic review and meta-analysis.
Lancet Microbe 2021; 2: e1322. https
doi.org/10.1016/S2666-52472030172-5.
Cevik et al., November 19, 2020.
Siegel, J., Rhinehart, E., Jackson, M., Jackson, M., Chiarello, L. 2007. Guideline for isolation precautions: Preventing transmission of infectious agents in healthcare settings. https www.cdc.gov/
infectioncontrol/pdf/guidelines/
isolation-guidelines-H.pdf. Siegel et al., 2007.
Viswanathan, M. et al., 2020, September 15.
Universal screening for SARSCoV2
infection: A rapid review. Cochrane 20 Limiting and monitoring points of entry to the setting will also help limit contact with potentially infectious persons. For further discussion, see the Need for Specific Provisions for Physical Distancing.

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Database of Systematic Reviews, Issue 9.
Art. No.: CD013718. DOI: 10.1002/
14651858.CD013718. Viswanathan et al., September 15, 2020.

D. Standard and Transmission-Based Precautions Standard and Transmission-Based Precautions are well-accepted as important to controlling disease transmission HICPAC, December 27, 2018; CDC, January 7, 2016. It should be noted that during times of significant transmission, such as during this pandemic, additional protections are needed to supplement the basic level of recommended precautions and practices in these guidelines. For instance, wearing at least a facemask regardless of interaction with known or suspected infectious patients is needed during the pandemic CDC, February 23, 2021.
Standard Precautions refers to infection prevention practices, implemented in healthcare settings, where the presence of an infectious agent is assumed i.e., without the suspicion or confirmation of exposure.
The use of Standard Precautions thus relies on the assumption that all patients, patient samples, potentially contaminated materials e.g., patient laundry, medical waste, and human remains in healthcare settings are potentially infected or colonized with an infectious agents. For example, Standard Precautions would include appropriate hand hygiene and use of personal protective equipment as well as practices to ensure respiratory hygiene, sharps safety, safe injection practices, and sterilization and disinfection of equipment and surfaces CDC, February 23, 2021.
Transmission-Based Precautions add an additional layer of protection to Standard Precautions. TransmissionBased Precautions refers to those good infection prevention practices, used in tandem with Standard Precautions that are based on the way an infectious agents may be transmitted. These precautions are needed, for example, when treating a patient where it is suspected or confirmed that the patient may be infected or colonized with agents that are infectious through specific routes of exposure Siegel et al., 2007. For example, handwashing and safe handling of sharps needles, etc.
are routine Standard Precautions. An infectious agent capable of airborne transmission through aerosols would require patient care in an airborne infection isolation room AIIR, if available, under Transmission-Based Precautions.
Even before a patient is treated, certain Transmission-Based Precautions
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