Episode #54 Special Podcast: California Edition: CAL/OSHA’s Newly Revised Emergency Temporary Standard and Dentistry

The California OSHA Emergency Temporary Standard for COVID-19 prevention has been revised AGAIN! Dental offices are considered high risk settings and must comply with both the May 6, 2022 revision of the  CAL/OSHA Emergency Temporary Standard and  California Department of Public Health orders.  The Divas review how to comply with the updates to keep  your team safe. 

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SPEAKER_00 0:04

Welcome. I'm Leslie Cannon. I'm Mary Gavoni.

SPEAKER_01 0:09

I'm Linda Harvey. I'm Olivia Juan, and together we are the Compliance Divas. Welcome to the Compliance Divas podcast. My name is Olivia Wan. In today's discussion, I have the honor and privilege of interviewing Leslie Canham to talk to us about California OSHA Emergency Temporary Standard Revision that took place May 6th. Federal OSHA Healthcare Emergency Temporary Standard came to an end on December 21st last year. In California, the OSHA Emergency Temporary Standard remains in effect and was revised on May 6th. As the Compliance Divas, we bring clarity and simplicity to compliance by navigating regulatory compliance to keep you on course. Please subscribe to the Compliance Divas podcast through your favorite podcast channel or on our website, thecompliancedevas.com. Any resources we mentioned during the podcast can be found at thecompliancedivas.com. Also, please submit your questions to support at thecompliancedivas.com. Leslie, I'm so excited for you to share this information that was just recently published so that our California listeners can be up to date and current. So, Leslie, what are the important changes in the revised ETS and how do those changes affect dental practices in California?

SPEAKER_00 1:54

Well, Livia, many people think that the emergency temporary standard doesn't apply to them. But in California, OSHA is much more strict. And we have had not only one revision to the emergency temporary standard, but it's been readopted three times. So this is the fourth iteration of that standard. And the important changes really include the definitions. And there's definitions of close contact and infectious period are now defined so their meeting will change if the California Public Health Department changes its definition of that term within either a regulation or an order. And with the ever-changing data and science and new emerging information that we have regarding COVID-19, that's important for OSHA to be able to flex with the most current health information. So the definition has will be changing. And then also the definition of COVID-19 test. Previously, in the last uh version of the ETS, employees had to be uh tested in front of either a healthcare provider or in front of the employer so that it was validated. Now it's going to be easier to self-administer a test with self-read results. And instead of having a video observation of the entire test or having a healthcare provider, now just a date and timestamp photo of the test result will be sufficient. And that's something that can easily be done with someone's own cell phone. They also changed the definition of fully vaccinated. It's been actually deleted because there's several different versions of fully vaccinated. Does that mean uh one Johnson and Johnson? Does that mean two, Moderna and Pfizer? Does that mean boosted? Does that mean second booster? So as things evolve with uh maybe perhaps third and fourth boosters, fully vaccinated is deleted as a term. And another thing that employers in California need to be aware of is that COVID-19 testing must be made available to all employees with COVID symptoms. This means regardless of vaccination status, where previously it only applied to unvaccinated employees. Employers are now required to offer that testing at no cost to employees and during time that they're being paid. So this is an on the clock type of testing as opposed to on their own time. There are other uh points that to be considered. One must read the emergency temporary standard to be aware of what other triggers there are. There's also information on exclusion of employees who have had close contact. And uh today, employers have to review whatever California Public Health Department guidelines are for employees who had close contact and implement what's called quarantine and other measures in the workplace to prevent COVID-19 transmission in the workplace. We'll talk a little bit about isolation and quarantine a little bit later. And uh, there's another requirement for exclusion of employees with COVID-19. And the requirement for employees who test positive for COVID-19 has been updated to reflect the most current isolation and quarantine guidance. One other thing that's kind of interesting is that uh for all businesses in California, which is what this emergency temporary standard applies to, partitions and barriers have also been deleted and are no longer required. But I would encourage dental practices to continue to keep those partitions and barriers up because many patients aren't aware of that at this time, they still need to wear face coverings when they enter a healthcare setting. And dentistry is considered a healthcare setting. So uh if the barriers and partitions are already there, it's it doesn't make sense to take them down when we may have a hazard from a patient who's unmasked, who comes into the reception room and sneezes or coughs. Now, uh there are a few parts of the previous standard that are going to stay in place. And of course, I think that everybody is familiar with uh uh the establishment of implementing and maintaining a written COVID-19 prevention plan. Um, also making sure that they notify public health departments of outbreaks. That means three or more employees have uh COVID-19 within the practice. Uh, also providing employees notification if they've been exposed or had a close contact. So uh again, there's no physical distancing requirements, but during in a healthcare setting, we should still be mindful of keeping patients in the reception room distanced from other patients. I think they kind of expect that, expect us to keep them safe while they're in our care. And if we do have an outbreak or even a major outbreak, which is 20 or more employees with an exposed group, then physical distancing would go right back into place. Uh, something else that we'll discuss a little later is the requirement for employers to do an ongoing assessment of workplace hazards and make sure they prevent uh transmission of a disease. So that will be something that would be uh appropriate to do at all times to continue beyond COVID to continue to look for workplace hazards. And while uh base covering requirements for the general public when they're going to, let's say, a restaurant or a movie theater or a grocery store, uh, that they're no longer mandated in workspace settings. They were at one time mandated for unvaccinated workers in all indoor places. But now uh California Public Health Department has issued guidance that in healthcare settings, face coverings are required regardless of vaccination status. So in dentistry, this means both patients and dental health care workers.

SPEAKER_01 7:50

Leslie, that's such great information to get practices up to date. And I would like to mention to supplement what you've said, that when respirators are required by the employer, OSHA requires certain things to be accomplished. One is anyone that is going to wear a respirator must complete training on respiratory protection. Fit testing is required to make sure that the mask is properly, the respirator is properly making a seal over the nose and mouth of the user. And I want to mention, Leslie, that, and this is often overlooked and it's a violation of OSHA. If someone is required to wear respirators in the workplace, they must have medical evaluation first to make sure that they are physically and physiologically cleared to wear a respirator. So training, fit testing, medical evaluation, and let's not look overlook that they must have a written respiratory protection program. The divas put together a video that will actually walk people through on how to do fit testing. The fit testing video may be purchased on our website. Is that right, Leslie?

SPEAKER_00 9:20

You can find the fit testing video, and that's a great place to purchase that.

SPEAKER_01 9:25

Leslie, can you talk to us about voluntary use?

SPEAKER_00 9:30

Well, Olivia, when voluntary use is in place, that means that the employer has uh conducted an assessment, hopefully, and determined that the requirement is not there to provide uh respirators uh on a required basis for employees, but employees still feel that they want to wear the respirators for their own protection. And that would require that the employer, number one, um, oblige the employees. So they met the respirators must be provided at no charge. And then also, employees still need to have that medical evaluation and have that clearance for voluntary use. They need to know how to uh clean, store, and maintain a respirator if they're using perhaps a PAPR or a uh elapsomeric respirator. If it's a disposable respirator, then training on appropriate donning and doffing of that respirator so that they don't damage it, donning it, learning how to do a seal check, as you mentioned, that's so important. Fit testing is important in the first time you wear a respirator or a brand, but every single time you don't, you need to make sure that it is fully protecting you. So training on how to don it, training on how to doff it without contaminating yourself is important. And then there's one other piece of the puzzle called Appendix D, and that must be provided to employees. We're gonna uh have that resource on our resources page for this podcast so that anyone who wants to download that can. And so those are really the four components uh medical evaluation, uh procedures for training, uh, storing and maintaining respirators if they're reusable, training on how to don and doff, uh, and then also, of course, making sure that employees have that appendix D.

SPEAKER_01 11:13

That's helpful, Leslie. Thank you. And what kind of reminders can you provide dental employers that relates to screening patients and face masks?

SPEAKER_00 11:24

Well, it's been a regulation since 2009. In California, we have what's called an aerosol transmissible disease standard. According to the ATD standard, all patients must be screened. And I think we probably didn't bring that to light until COVID said we need to screen patients. And uh so now, just reminder to employers the just because some of the levels of COVID have dropped off, it doesn't excuse healthcare providers from screening patients. Unless a dental practice wants to be subject to the aerosol transmissible disease standard, they must screen patients. So screening patients is still required. As I mentioned before, in healthcare settings, face masks are still required, face coverings for all people in a dental setting. That's both patients and employees, and employees who may not be clinical, who may be working at the administrative area. And one other thing that Cal OSHA tells me is that respirators should be worn by employees who are performing aerosol generating procedures. And this is in place because we can't always screen out COVID. There may be either an asymptomatic or pre-symptomatic patient who passes right through our screening process, and they can be infectious and transmissible to us. And as we know today, with vaccination, sometimes vaccination and boosted doesn't always mean that you have full protection. It means that you're likely to have less severe illness or be hospitalized. So it is still transmissible. And I think sometimes we forget that that uh being vaccinated does still mean that employees could be subject to infection. So while we're seeing rates of COVID go down in some areas in our country and maintain on that downward trend, we still need to follow the aerosol transmissible disease requirements of screening patients, wearing face masks, and using uh respiratory protection when we could be exposed to a hazard. But being exposed to a hazard, now, Olivia, I know that you have mentioned many times in a previous podcast how to perform a hazard assessment and why that's important. Can you tell us a little bit more about that? Sure.

SPEAKER_01 13:50

So we are required, even prior to COVID, let's say COVID didn't exist, we are still required to perform, conduct a hazard assessment. And that allows us to identify the types of hazards in the workplace, what types of appropriate personal protective equipment must be utilized, and also the types of work practice and engineering controls that are in place. Now, with COVID, we are required to conduct a hazard assessment that relates to COVID-19. And in doing so, we would outline the PPE that's being utilized. So please include respirators. Also, what are we doing to minimize aerosol? Now, in the example that I ran into, there was an employer that there was a complaint against the employer because the dentist was not providing respirators. When OSHA came in and conducted an inspection, they discovered that the dentist was providing engineering controls to minimize aerosol. And therefore, the dentist was not cited for not requiring N95 respirators in the workplace. Now, with that being said, the OSHA inspector did advise the dentist to make N95s voluntary use. And I think you gave a beautiful explanation of that, Leslie. And so just to remind listeners to conduct the hazard assessment and really pay attention to the types of engineering controls that's in place. And a good example would be HEPA filtration. And we do have a podcast that we focused on minimizing aerosols, the types of engineering controls that could be implemented. Leslie, at this time, could you speak to us a bit more about isolation and quarantine updates?

SPEAKER_00 16:03

So Olivia, what we have seen in our uh changes with this, if trying to keep up with this virus, is that uh the information changes frequently on how long one would need to isolate or quarantine if they have either had a close contact or have been diagnosed with COVID-19. So our public health department in California changed their isolation and quarantine periods in April of this year, 2022. And they also, what that information was reflected in Cal OSHA's emergency temporary standard, which was effective again, May 6 of 2022. And so in the first table, it describes what the exclusion requirements are for employees who test positive for COVID-19. And this applies whether anyone has been vaccinated or they have not. This is all employees, regardless of vaccination status, previous infection, or lack of symptoms. So any employee who tests positive must be excluded from the workplace for at least five days after the start of symptoms or after the first positive test, if no symptoms. Now, there's some more information that uh goes through when an employee can come back to work regarding testing and if they have testing available to them. And that includes the same standard that we have heard of uh not returning to work until 24 hours after the fever has resolved without the use of fever-reducing medications. If an employee is unable to access testing, uh, they can return to the workplace after uh day 10 again if they're fever-free and without the use of fever-reducing medication. So that's for employees who test positive for COVID-19. And the table goes into quite an explanation of that. I want to remind California dentists that the second table, and by the way, we will make this uh resource available on our compliance diva's website so that you can download this document and make it easy to review. Table two really applies to all employees except for in high-risk settings. And I want to remind dentists that the California Public Health Department has dubbed healthcare settings, including dentistry, as a high-risk setting. So we have to skip the part about what all employers do for all employees who have had an exposure to someone with COVID-19 and jump to table three, which is guidance for close contacts to COVID-19 in specified healthcare settings, which would be in dental practices as well. So, what it says is that this applies to all employees who are either not fully vaccinated or have not had infection with SARS-CoV-2 within the prior 90 days. That's kind of interesting because uh people who have been infected with SARS-CoV-2 seem to have some kind of a natural immunity for about 90 days, according to the science. So uh that's why they've included that in this particular statement. They say exposed employees must be exposed, excluded from work for at least five days after the last known close contact. And exclusion can end, and exposed employees can return to work after day five if symptoms are not present, and uh a diagnostic specimen has been collected on day five or later test negative. Now, if an employee is unable to test or chooses not to test, which they do have that choice, uh, they may return to work after day 10. Employees have to wear face coverings while indoors and while around others, along with the standard of the California Public Health Department Universal Masking Guidance for Healthcare settings. And of course, employees are strongly encouraged to get vaccinated or boost it. So remember again, unless the dental practice wants to be subject to the aerosol transmissible disease standard, they have to follow closely all the steps that are required by OSHA to be exempt from it and to follow all public health department orders. And again, we'll make those resources available to our listeners, along with a simple fact sheet called What Employers Need to Know About the Emergency Temporary Standards as of May 2022. And with that, I hope that provides our California listeners with enough information to know what they need to do to comply with OSHA, to protect their employees, and to be exempt from the aerosol transmissible disease standard.

SPEAKER_01 20:38

Leslie, thank you so much. You put uh a large amount of time into researching this for our listeners, and we so appreciate you. I do want to mention again for the listeners if they would like to learn how to do fit testing and save their practice money and time, we do have that video on our website. As the compliance divas, we bring clarity and simplicity to compliance by navigating regulatory compliance to keep you on course. Please submit your questions to support at the compliance divas.com. Any resources that we mentioned will be on the compliance divas website. Thanks for tuning in, and thank you again, Leslie.