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Workplace Safety for Healthcare Workers


Cal/OSHA Interim Guidance for Protecting Hospital Workers from Exposure to Coronavirus Disease (COVID-19) – May 22, 2020

Cal/OSHA’s regulations, in particular the Aersol Transmissible Disease Standard,  require protection for workers in healthcare settings exposed to airborne infectious diseases such as the 2019 novel coronavirus disease (COVID-19). This guidance highlights some of the main protections and below are key highlights specific to the Aersol Transmissible Disease Standard.


Cal/OSHA’s Aerosol Transmissible Diseases (ATD) Standard

Cal/OSHA’s ATD Standard

Cal/OSHA requires employers covered by the Aerosol Transmissible Diseases (ATD) Standard (California Code of Regulations, title 8, section 5199) to protect employees from airborne infectious diseases such as COVID-19 and pathogens transmitted by aerosols. The ATD Standard applies to:

  • Hospitals, skilled nursing facilities, clinics, medical offices, outpatient medical facilities, home health care, long-term health care facilities, hospices, medical outreach services, medical transport, and emergency medical services
  • Certain laboratories, public health services, and police services that are reasonably anticipated to expose employees to an aerosol transmissible disease.
  • Correctional facilities, homeless shelters, and drug treatment programs.
  • Any other locations when Cal/OSHA informs employers in writing that they must comply with the ATD Standard.


Personal Protective Equipment

Cal/OSHA Interim Guidance for Healthcare Facilities: Respirators – August 06, 2020

In situations where there is no critical shortage, healthcare employers must provide and ensure the use of NIOSH certified particulate respirators by all employees occupationally exposed to novel pathogens such as SARS-CoV-2, the virus that causes COVID-19.

Respirators must always be immediately available to health care workers who may be called upon to perform emergency aerosol generating procedures on suspected or confirmed COVID-19 patients.

With some exceptions, employers must provide a powered air-purifying respirator (PAPR) with high efficiency particulate air filters to employees who perform high hazard procedures on COVID-19 cases or suspected cases. Such procedures include but are not limited to intubation, caring for patients on positive-pressure ventilation, and suctioning of the airway.


Laboratory Operation Requirements

In California, Laboratory operations capable of aerosolizing infectious pathogens must have a biosafety plan and a qualified biosafety officer. Additionally, employers with laboratory operations in which employees have direct contact with cases or suspected cases must comply with all other applicable parts of the ATD Standard.

In addition to California’s regulation on Aerosol Transmissible Diseases which addresses Laboratory health and safety, the CDC has issued guidelines, which include, but is not limited to the following:

  • Wear appropriate personal protective equipment including disposable gloves, laboratory coat/gown, respiratory, and eye protection.
  • Perform procedures that may generate fine-particulate aerosols (e.g., vortexing or sonication of specimens in an open tube) in a Class II Biological Safety Cabinet (see title 8 section 5154.2 for further information on biological safety cabinets).
  • Use appropriate physical containment devices (e.g., centrifuge safety buckets; sealed rotors) for centrifugation.
  • Use work practices that minimize the risk of exposure for procedures done outside a biological safety cabinet.
  • Decontaminate work surfaces and equipment with appropriate disinfectants after specimens are processed.
  • Autoclave disposable waste.

Virus isolation in cell culture and initial characterization of viral agents recovered in cultures of COVID-19 specimens are NOT recommended at this time, except at a biosafety level 3 facility.