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Thursday, August 13, 2020

The Michigan Occupational Safety and Health Administration (MIOSHA) is Michigan’s government regulatory agency responsible for enforcing workplace safety laws, rules, and policies. They recently launched a state emphasis program (SEP) to “ensure front-line hospital workers caring for and treating COVID-19 patients are receiving the appropriate personal protective equipment (PPE) from their employer.” Although SEP is currently focused on hospital compliance with existing MIOSHA standards, the Governor’s Executive Orders, and Centers for Disease Control and Prevention (CDC) and federal OSHA guidance as they pertain to PPE, physician medical practices should ensure they, too, are in compliance with PPE policies that safeguard their employees from contracting COVID-19.

MIOSHA has created and posted updated guidance for outpatient health care facilities (including clinics, physician medical practices, and dental offices) on the Michigan Department of Labor and Economic Opportunity’s COVID-19 website. Like employers in other professions and industries, physicians must establish a COVID-19 Preparedness and Response plan in place (see MSMS Safe Return to Practice Toolkit for a sample plan), train ALL employees on this plan, and conduct an assessment of each employees risk of exposure (see OSHA’s Examples of healthcare work tasks associated with exposure risk levels). According to OSHA, “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.”

Examples of health care work tasks associated with exposure risk levels (per OSHA):

Also, under Michigan’s current Executive Order on workplace safeguards (EO 2020-161), businesses and other operations must require face covering to be worn when employees cannot consistently maintain six feet of separation from other individuals in the workplace and “consider” face shields when employees cannot consistently maintain three feet of separation from other individuals in the workplace. For outpatient health care facilities, facilities must “require employees to make proper used of personal protective equipment in accordance with guidance from the CDC and OSHA.” 

Determining what type of PPE each health care team member needs to utilize as a required safeguard during the current pandemic will require an assessment of the individual's risk exposure, both with respect to the individual's work tasks and the level of community transmission where the facility is located. Below is the text from the CDC’s Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic.

  • Healthcare personnel (HCP) working in facilities located in areas with moderate to substantial community transmission are more likely to encounter asymptomatic or pre-symptomatic patients with SARS-CoV-2 infection. If SARS-CoV-2 infection is not suspected in a patient presenting for care (based on symptom and exposure history), HCP should follow Standard Precautions (and Transmission-Based Precautions if required based on the suspected diagnosis). They should also:
    • Wear eye protection in addition to their facemask to ensure the eyes, nose, and mouth are all protected from exposure to respiratory secretions during patient care encounters.
    • Wear an N95 or equivalent or higher-level respirator, instead of a facemask, for:
    • Respirators with exhalation valves are not recommended for source control and should not be used during surgical procedures as unfiltered exhaled breath would compromise the sterile field.
  • For HCP working in areas with minimal to no community transmission, HCP should continue to adhere to Standard and Transmission-Based Precautions, including use of eye protection and/or an N95 or equivalent or higher-level respirator based on anticipated exposures and suspected or confirmed diagnoses. Universal use of a facemask for source control is recommended for HCP.

For additional information on community transmissions:

It is critical that physicians, as employers, take the steps necessary to provide an adequately safe work environment and comply with applicable regulations as enforced by MIOSHA and OSHA. The development, implementation, and documentation of written policies, risk assessments, and employee trainings are essential should any employees report concerns with these regulatory agencies. Also, it is important to note - while an employee’s concerns, by themselves, do not necessarily mean that an employer is not providing adequate workplace safeguards, they can trigger whistleblower/anti-retaliation protections for the employee under MIOSHA and OSHA.