#145 Special Episode: 2024 Updates to CAL-OSHA COVID-19 Prevention

On January 9, 2024, CAL-OSHA updated the non-emergency COVID-19 standard. Tune in to find out what employers and dental teams need to know about the changes, and what dental teams must do if they have COVID-19 symptoms or test positive for COVID-19.

Resources:

• CAL-OSHA Fact Sheet: Update:  COVID-19 Prevention - Non-Emergency Regulation What Employers Need to Know   https://www.dir.ca.gov/dosh/coronavirus/Non-Emergency-regs-summary.pdf
• CAL-OSHA COVID-19 Prevention Non-Emergency Regulations FAQ   https://www.dir.ca.gov/DOSH/Coronavirus/Covid-19-NE-Reg-FAQs.html
• CA Dept. of Public Health Isolation Q&A https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/Isolation-QA.aspx#
• CDC Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2 Updated Sept. 23, 2022 https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html
• Directory of Local Health Departments  https://www.naccho.org/membership/lhd-directory?searchType=standard&lhd-state
• National Law Review - COVID in California in 2024? https://www.natlawreview.com/article/covid-california-2024-isolation-guidance-and-caloshas-regulations

                                                 https://www.thecompliancedivas.com

Transcript

Copy Transcript Copied

SPEAKER_00 0:04

Welcome. I'm Leslie Cannon. I'm Mary Gavoni. I'm Linda Harvey. I'm Olivia Lon, and together we are the Compliance Divas. Welcome to the Compliance Divas podcast. I'm Mary Gavoni and I will be the moderator for this special episode on new compliance guidance that we have from the state of California, and our compliance diva California expert, Leslie Cannem, will be helping us to understand this new information. The Compliance Divas bring clarity and simplicity to compliance by navigating the regulatory world to keep you on course. You can subscribe to the Compliance Divas podcast through your favorite podcast channel or on our website, thecompliancedevas.com. All the resources we mentioned during our podcast can be found in the show notes on your podcast app. Please submit any questions to support at thecompliancedivas.com. And we also ask that when you're finished listening to the episode, you scroll to the end of your podcast app and leave us a review or give us some comments. I mentioned previously that this is a special edition podcast. So what has happened is Kalosha adopted the non-emergency COVID-19 prevention regulations in 2022. These regulations include some of the same requirements found in the COVID-19 prevention emergency temporary standards, as well as new provisions aimed at making it easier for employers to provide consistent protections to workers and allow for flexibility if changes are made to guidance in the future from the California Department of Public Health. Leslie, our California Compliance Diva, is going to help us to understand what these changes are. So, Leslie, please help us and the dentists and dental teams in California know what it is they need to do.

SPEAKER_01 2:15

Well, Mary, on January 9th, this notice went out called What Employers Need to Know. And we've included that in the show notes. I encourage our listeners to download a copy of that. But the important changes start out with the changes to definitions. Now, the definition of infectious period for the purpose of cases in Cal OSHA's COVID-19 prevention standards are now defined as for COVID-19 cases with symptoms, it's a minimum of 24 hours from the day of symptom onset. So that's an interesting thing that now we have a little bit closer understanding of what the infectious period is of a person, because we hear that word, close contact with someone during their infectious period, a lot in this standard. And so when we have someone who has COVID-19 in the workplace, according to CalOSHA, they can return to work if 24 hours have passed with no fever and without the use of fever-reducing medications. And their symptoms are mild and improving. Now that differs a little bit from the CDC guidelines, which we'll talk about in a little bit, but I'd like to continue on with some of the important changes that our listeners need to know about in California. There's also the opportunity to talk a little bit about infectious period when someone has no symptoms. And Cal OSHA says for COVID-19 cases with no symptoms, there is no infectious period for the purpose of isolation or exclusion. And if symptoms develop, of course, the criteria above return to work 24 hours after have passed after no fever without the use of fever-reducing medication, and symptoms are mild and improving. So those are the main parts about the changes, the important changes. There's also changes to testing. And this is where I want to caution our listeners to be especially careful when interpreting what CalOSHA says versus what CDC says. CalOSHA is covering all employees in California. And they're not discriminating between a healthcare worker, a dental worker, an office worker, factory worker, grocery store worker, bowling alley worker. So they're looking at this is the guidance for what employers need to know that have employees in California, as CalOSHA does. So we need to keep into consideration when we hear what it is that's recommended on testing, that we have a little bit different setting and we're working with patients. We're working with, you know, anywhere from sometimes we have as few as five patients in a day. Orthodontic practices may have as many as 90 or 100 patients in a day. And so we have multiple exposures to individuals who are not masks in our work setting with our patients in our chair. So keep that in mind as you listen to the note on changes for testing recommendations. California Public Health Department no longer recommends testing for all close contacts. So if you've had contact with someone who has COVID-19 and they say instead recommends testing only for people who have new COVID symptoms. So if you've had close contact and now you have symptoms, testing and close contacts who are at higher risk for severe disease. So if you have underlying health conditions that would put you at greater risk, of course, testing would be recommended or indicated. Or if you have contact with people who are at higher risk of severe disease. Now, let me just give you a little tip on what's the same, because I know that's going to be your next question of what's the same. California requires employers to continue to make COVID-19 testing available at no cost. I want to get into that in just a little bit, but I wanted to give you a pretty good idea of what the changes are.

SPEAKER_00 6:19

Thanks, Leslie. And I just wanted to add one thing in because, and you made that very good differentiation, we are not necessarily the general public. We are healthcare workers. And so we may need to take some extra precautions for patient safety and also for the safety of our coworkers. And the really important thing to remember is just, I think, sort of a common sense thing. If you have respiratory symptoms, do a COVID test so that you know whether you have COVID or not. So now let's focus Leslie on what stays the same in the California regs, because that, of course, is just as important as the changes.

SPEAKER_01 7:03

Well, as I mentioned, testing is provided by the employer at no charge and during paid time for employees who have to go and get a test if they've had a close contact. And the only time that they would not have to have this testing would be asymptomatic employees who have recently recovered for COVID-19 because the testing is likely to show that they have a positive when they when they have recovered. So this is required. And then testing is also required in workplace outbreaks. And workplace outbreak, you know, major outbreaks, that's you know, pretty substantial, but a lot of times we don't recognize that a workplace outbreak is if we have three COVID cases in our work setting in a seven-day period. And those workplace outbreaks in an exposed group, then we need to make sure, of course, that we provide testing. And employees who refuse testing and have symptoms have to be excluded for at least 24 hours from symptom onset and can return only when they've been fever-free for at least 24 hours without the use of fever-reducing medication, and their symptoms are mild and improving. And let's talk a little bit more about what else is the same. Employers must have identified COVID-19 as a workplace hazard. That is required now, just like bloodborne pathogens and hazard communication, COVID-19 now has earned its place as a workplace hazard. So that means there has to be written plans in what's called an injury and illness prevention program and include their COVID-19 procedures to prevent this health hazard in those written plans. They can either have that in their OSHA manual or they can have a separate COVID-19 document. Fortunately, in dentistry, we have a lot of experience with infection control. So we don't have to be have extra training on disinfecting surfaces and cough etiquette and some of the other personal protective equipment and hand hygiene that other businesses who don't have a lot of experience with infection control need with training. However, we still need to have a document that identifies those things as being precautions. The other part that stayed the same is that employers still have to provide face coverings and ensure that they're worn by employees whenever California Public Health Department requires their use. And I have to caution Californians that we have public health departments that vary from county to county on what they are requiring. Some will require all healthcare workers to wear masks in healthcare settings, whatever patients are present. Patients don't need to wear them, they're not mandated, but healthcare workers do in certain counties. So please check with your own county public health department because the guidance might be drastically different than what the California Public Health Department is guiding and advising. So that's part of what's new. And then the other part is about COVID cases who return to work. If this is a part that I think is oftentimes overlooked, Mary, that if you've had COVID and you return to work, you have to wear a face covering if you work indoors for 10 days from the start of symptoms, or if someone was asymptomatic for 10 days from the date of their first positive COVID test. It's not like coming back to work after you've had a cold or the flu. This is very important for everyone to know. This is a state of California Cal OSHA requirement. And then what else is stayed the same is that employees still have the right to wear face coverings at work and to request and receive respirators from the employer when working indoors and, of course, during outbreaks. Employers must report information about employee deaths, serious illness, serious injury to CalOSHA consistent with the existing CalOSHA regulations. And the other part of this that is kind of COVID-specific is employers must notify all employees, independent contractors, and employers with an employee who've had close contact with a COVID-19 case. So if a patient has COVID-19 and is in the office and you find out the next day, oh, they call and they say that I want regret to inform you, but now I have COVID, I test positive, everybody in that practice needs to be notified, whether they're an employee, an independent contractor, which is, you know, hopefully not the situation of independent contractors with any dental office unless they're from an outside agency. And uh any employers in that practice with an employee. So if there's an associate and they have their own employee in the practice, everyone needs to be notified that they were exposed to a COVID-19 case. And OSHA says that employers must exclude COVID cases during their infectious period from the workplace. And I just gave you the definition of infectious period. That was for the purposes of the standard COVID-19 cases with symptoms. It's a minimum of 24 hours from the day of symptom onset. So infectious cases could be anybody that even has a mild case of COVID. So those are the requirements, and then there's a few more that we're going to talk about, but I'd like to just spend a couple of minutes talking about the CDC guidelines and how they differ from Cal OSHA non-emergency regulations for all. Mary?

SPEAKER_00 12:39

Leslie, you are such a wealth of information and our interpreter for all this information. I think it just bears saying that for those out there listening that think, why are we still talking about this? Why are we still fussing about work restrictions and wearing face coverings as source control and all that? And the reason is, of course, that COVID is here to stay. It's still spreading. People are still being hospitalized in pretty high numbers throughout the country, and people are still dying from COVID. And COVID isn't on the same wavelength, so to speak, as the flu. A lot of people are suffering from long COVID symptoms, and we don't even know all of the repercussions of that. So we need to take these extra precautions for our safety, for our family's safety, for our patient's safety. And you're right, Leslie, that there is some variance, and you need to work closely with your county health department to know what their requirements are. So I'm going to let you lead off, Leslie, with talking about the CDC guidance for workers who may have been exposed to or who do have COVID symptoms.

SPEAKER_01 13:58

Well, yes, Mary, and this is where it is very confusing. We have CalOSHA who have regulations that cover all employees in California. And then we have CDC guidelines where there's specific return-to-work criteria for healthcare providers with SARS-CoV-2 infection. And this most recent one is from September 23rd, 2022. So we look at a document that's from 2022. Here we are in 2024. What's a dentist to do when they try to understand how they can bring their employees back to work? And Mary, I know you and I always defer back to the CDC guidelines as the best practices for healthcare workers, for dental settings when it comes to infection control. And again, we have to remember that people who are working in other work settings aren't working on a patient in a healthcare setting with close contact as we are. So let me give you some information of CDC's guidelines, and we'll include this in the show notes as well, that the following are criteria to determine when healthcare providers with SARS-CoV-2 infection could return to work. And they're influenced by a severity of symptoms and the presence of immunocompromising conditions. So after returning to work, a healthcare provider should monitor for symptoms and seek reevaluation from their healthcare provider if symptoms reoccur or worsen. If symptoms reoccur or rebound, healthcare workers should be restricted from work and should follow the recommended practices to prevent transmission to others. And that includes a well-fitting source control until they again meet the healthcare criteria to return to work, unless an alternative diagnosis is identified. So, in getting right down to it, here's the brass tacks of it. Healthcare workers with mild to moderate illness who are not moderately to severely immunocompromised could return to work after the following criteria are met. At least seven days have passed since symptoms first appeared, if a negative viral test is obtained within 48 hours prior to returning to work. Or 10 days if testing is not performed, or if there's a positive test at day five or seven. And at least 24 hours have passed since the last fever without the use of fever-reducing medication, and symptoms, meaning cough or shortness of breath, have improved. So that's the guidance that dental workers should follow, is the same guidance that healthcare workers should follow, and not necessarily what CalOSHA is telling everyone that they can do as every employer how they can guide their employees following COVID infection or exposure in that case. And just want to remind everyone the public health department in your locality may have different guidance. So please pay close attention to what your local public health department is recommending. Mary, could you give us a little bit of information on indoor air quality? That's something else that has remained the same for California, is that we are looking at indoor air spaces. And just for our listeners, uh just to give them a little idea of what indoor spaces look like. When Cal OSA talks about a close contact with a person during their infectious period, close contact means an indoor airspace of 400,000 or fewer cubic feet per floor. And a close contact is defined as sharing the same indoor airspace with a COVID-19 case for a cumulative total of 15 minutes or more over a 24-hour period during the COVID-19 case's infectious period. Most dental offices are going to be within that range of uh 400,000 or fewer cubic feet. And it's pretty interesting to think, well, gee, if we have a either a coworker who tests positive for COVID who's was on the in the office during their infectious period or a patient, then how do we address the best practices in maintaining good indoor air quality?

SPEAKER_00 18:19

That is such a great question. And I just wanted to make a comment on what you have been saying to us, which is such good advice, that always be in contact with your county health department to know what their recommendations are. And some people may wonder well, why do they vary from county to county? Well, those county health departments are basing their recommendations primarily on the incidence of disease. So if a particular county is having a high incidence of test positivity for COVID or a high number of hospitalizations or deaths, then they're going to increase their recommendations. So that's the difference. And I heard from many people over the time of the pandemic, and you have too, that why doesn't the CDC, why doesn't Calosha, why don't they make up their minds about this? And I think we all have to keep in mind that this still is a new virus, relatively new virus now. And we don't have all the answers to everything. But we do have some good answers to the questions on ventilation. So Calosha has specific requirements on ventilation. We have that resource in your show notes. The CDC in May of 2023 updated their guidance for ventilation with specific recommendations for dental settings. And Ashray, the American Society for Heating, Refrigeration, Cooling Engineers, I probably botched that name, but Ashray, as we call them, developed some specific guidance for us during COVID-19. And many people think, well, the pandemic is over, so we don't have to pay attention to that. But we do still have to pay attention to all this advice because COVID is still here. We're not in a state of pandemic, but we are still dealing with COVID. So there's a couple of really critical things in these ashray guidelines, which are referred to by Cal OSHA. One is the concept of air exchanges. So how often is the air in your facility vented to the outside of your facility and fresh air brought in? Because that is one way to remove air contaminants. And so the minimum number of air exchanges in a facility should be five per hour. If you can achieve more than that, that is even better. Then the other concept of improving the filtration. So in your heating cooling system in your facility, do you have appropriate filtration? And there again is a minimum recommendation, and that is the value called MERV. And you should have at least MERV 13 for your filtration from your practice. Again, if you can achieve higher than that through the system you have, awesome. That's so much better. It improves your air quality. And then using freestanding air purification systems. And I've heard from so many practices that have said, well, the pandemic's over, we just put those in the closet, or some people have sold them or let employees take them home, get them back. You should not stop using those air purification systems. HEPA filtration units. But you also need to follow the guidance on where to place those. So some practices, because There hasn't been a lot of space in the treatment rooms, they were positioned behind the head of the patient and behind the team, which is not the correct place because what you're doing then is drawing air from the patient past the dental team members into the air purification unit. When what you really want to do is draw it away, and so you can place it either in a corner of the treatment room at the foot of the chair or right near the foot of the chair, so that again you're drawing that air away from the patient, away from the team, and into that filtration unit. But filtration units as well as um HVAC system filters need to be maintained. They need to be changed when necessary. So you can't just do a set it and forget it and think everything is working just beautifully for you. And then there's some even higher level technology that some practices have introduced upper room UV, air, essentially disinfection to make it a very non-technical description. And there are systems that literally are used in operating rooms and hospitals that can be utilized in dental practices that actually disinfect the air before it's recirculated back into the room. So we've listed these resources for ventilation in your show notes. So you can refer to them if you have questions. And Miss Leslie, do you have anything that you would add to that?

SPEAKER_01 23:32

I think that we found the aromas of a dental office are greatly improved when there's the HEPA filtration system. I know that it's kind of a funny thing. I would remark sometimes that I could smell disinfectants from the parking lot before I get into a dental office. And when I get into the reception room, I can identify the disinfectant that they're using by the smell. So sometimes those dental materials that we use do have quite an aroma and make our practices smell medicinal. But also sometimes we have people who have allergies, whether it's the us who work in a dental office or our patients, and boy, do they improve the air quality and reduce the spores and other sometimes other things that float in the air that set our allergies off. So there's a lot of good reasons to keep those air purifiers in the practice, as well as patient perception, and patient perception that we're doing everything we can to implement strategies to make that dental workspace a safe place for employees, a safe place for patients to receive care.

SPEAKER_00 24:37

You are so right, Leslie. And I just was mentioning to some groups I was lecturing to this past weekend that you know you used to be able to smell it almost in the parking lot, and you'd walk into a dental office and you're like, hmm, eugenol, hmm, methylmethacrylate, and like, oh, okay, it feels like home, it smells like home, but that isn't exactly a safe home to be smelling those particular fumes. And so one of the things I think we've learned from COVID is that number one, we have always had risks of exposure to infectious or potentially infectious aerosols. And what about this indoor air quality issue? My favorite example is going into an enclosed shopping mall. And if there's a nail salon, when you walked into the mall, you used to be able to smell the methylmethacrylate, which was used so often maybe five or 10 years ago, and then OSHA really cracked down on the nail salons, making sure that they had PEPA filtration. And now you walk in and you don't smell it, it's not used as much anymore, but you also don't smell it because of the air filtration. So that's kind of um kind of interesting. So, Leslie, as we wrap up this special episode, are there any other special tips that you have for our folks in California?

SPEAKER_01 26:00

Yes, actually, there is a guidance from the California Public Health Department, and this was from uh it turns out to be from July of 2023 regarding source control for healthcare providers following exposure to someone with COVID. And the California Public Health Department says that all healthcare workers and healthcare facilities that they should be required when they have had exposure to someone with COVID-19 infection, and they're working during their post-exposure testing period to wear an N95 respirator for source control at all times when they're in the healthcare facility until they've had a negative test or on day five. So I'd like us to think for a moment about exposure where we may have symptoms or we may be asymptomatic, and we are continuing to work on patients. Our patients are unprotected next to us. We're 18 inches or so away from their face and we're providing dental treatment. Our surgical face mask has a leakage rate. According to studies that have been conducted, we have about a 50% inward and outward leakage rate, plus we breathe from around the size of a surgical face mask. And so we breathe in, but we also exhale. It's source control for droplets, but aerosols are tiny and pass right through a surgical face mask, aerosols that may be contain particles in the nanometer measurements. So bacteria and viruses that we exhale are being exhaled into the direct vicinity of a patient's open mouth where they're breathing in. So it makes sense that wearing an N95 respirator after you've had a close contact or after you have tested positive and have returned to work, CalOSA says to wear face coverings for 10 days for everybody else. But healthcare workers, in my opinion, if they're working on patients, would want to protect their patients by wearing an N95 respirator. So, in closing, I'd like to remind everyone that CalOSHA has regulations that have changed this this month that are in effect for another 13 months. And it pertains to all workers in California. But healthcare workers should, number one, defer to the CDC guidelines when it comes to testing and when it comes to return to work and to personal protective equipment and source control for ourselves. And we should also look at our local public health department to see what our local health officer is telling our county that we must do.

SPEAKER_00 28:40

Excellent job, Leslie. Thank you so much for this very important, late-breaking information. Thank you to our listeners for joining us for this special episode. Remember that the Compliance Divas bring clarity and simplicity to compliance by navigating the regulatory world to keep you on course. You can submit any questions that you may have to support at thecompliancedivas.com. Any of the resources that we mentioned will be in the show notes on your podcast app. And we also ask that you scroll down at the very end of your podcast app and leave us some comments or please leave us a review. Thank you for joining us. We hope to see you on a future episode.