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William A. Levinson

Health Care

Preparing for the HEROES Act

Businesses can start planning on how to meet or exceed whatever is forthcoming from OSHA

Published: Monday, June 29, 2020 - 12:03

The U.S. House of Representatives has passed the HEROES Act (Health and Economic Recovery Omnibus Emergency Solutions Act)1 which will, if approved by the Senate and president, require OSHA to develop a standard for workplace protection against Covid-19.

Under section 120302 the legislation says specifically (emphasis is mine):

“(a) EMERGENCY TEMPORARY STANDARD

(1) In general—in consideration of the grave danger presented by COVID-19 and the need to strengthen protections for employees, notwithstanding the provisions of law and the Executive orders listed in paragraph (7), not later than 7 days after the date of enactment of this Act, the Secretary of Labor shall promulgate an emergency temporary standard to protect from occupational exposure to SARS-CoV-2

(A) employees of health care sector employers;
(B) employees of employers in the paramedic and emergency medical services, including such services provided by firefighters and other emergency responders; and
(C) other employees at occupational risk of such exposure. ...

... “(b) PERMANENT STANDARD—Not later than 24 months after the date of enactment of this Act, the Secretary of Labor shall, pursuant to section 6 of the Occupational Safety and Health Act (29 U.S.C. 655), promulgate a final standard(1) to protect employees in the occupations and sectors described in subparagraphs (A) through (C) of subsection (a)(1) from occupational exposure to infectious pathogens, including novel pathogens....”

The good news is that OSHA will develop a standard, and hopefully regardless of whether the HEROES Act is enacted into law. OSHA is very good at what it does, and this includes anticipation of risks that would not necessarily be obvious to most people. OSHA has already provided “Guidance on Preparing Workplaces for COVID-19,” which is a good starting point.2

The bad news is that a permanent standard might not be ready until 2022, and businesses must meanwhile find ways to reopen safely to restart the U.S. economy and get people back to work. “Wait for a vaccine” is not an option because, first, clinical trials could take months and, second, the disease might mutate, as the seasonal flu does, to render the vaccine ineffective.

We can, however, use quality management approaches, including risk, to develop and deploy actions to suppress workplace contagion. This means that, should Covid-19 ever return, even in a mutated form, we should never again have to shut down most of our economy to protect human lives.

Don’t wait for OSHA

Businesses that start to plan and act now will meanwhile be in an excellent position to meet or even exceed whatever is forthcoming from OSHA. We don’t need to know what will be in a standard or regulation that has yet to be developed to get this head start, any more than manufacturers needed to know in 1986 the contents of ISO 9001:1987. A manufacturer with a good quality management system, including anticipation of foreseeable risks to quality, would have probably had 90 percent of the requirements in place when the standard was issued. It would also have almost certainly had processes in place that could have been easily modified to meet any remaining requirements.

We can similarly start now to implement changes to “harden” workplaces against contagious diseases, which will protect our stakeholders and also (quite likely) meet most if not all of the forthcoming OSHA requirements. Proactive organizations will not need to scramble to meet the OSHA requirements; they should at most have to make minor changes.

Approach to planning

The good news is that planning needs to consider, as far as I can tell, exactly two failure modes. Contagion from a cough is the primary failure mode, which is what we will consider here. (Countermeasures against a cough will also cover ordinary respiration, but not necessarily the other way around.) Contagion from contaminated surfaces is the secondary one.

A good planning process might consist of first creating a risk register of locations and activities that involve contagion risks. We should then, for each risk, ask what (if any) controls or countermeasures exist to suppress and prevent contagion. If there are no answers to questions like, “How do we...?” or “What do we...?” then we need to provide them. In addition, the standard control hierarchy, from most to least effective, is:
1. Engineering or technical controls that do not rely on vigilance or compliance, such as partitions and air-handling systems
2. Administrative or behavioral controls that require vigilance and compliance, such as “Don’t forget to wash your hands”
3. Personal protective equipment (PPE) such as face masks and respirators are a last line of defense.

We will now look at some engineering controls, administrative controls, and PPE considerations.

Distance is our friend

Any engineering or administrative control that increases the distance between people’s respiratory tracts reduces the chance of contagion, and “respiratory tracts” is important. New York State, for example, ordered restaurants to take out half their tables,3 thus putting roughly half the servers and probably the cooks out of work while reducing the restaurant’s business volume by half. The installation of partitions between tables4 increases distance without the need for more floor space, and one restaurant uses shower curtains for this purpose.5 Yet another restaurant installed greenhouse-like booths for diners to effectively isolate groups from one another.6 All these solutions are far more cost effective, and quite likely more effective in preventing contagion, than removal of half the tables. Open offices are likely to be on their way out7 with enclosed cubicles, or at least partitions between workstations, increasing distance without the need for more floor space. Figure 1 illustrates the general principle that we can have more distance without more floor space.


Figure 1: Distance is our friend

Five feet is of course not the recommended six feet, but it is more than three feet, and contagion drops off rapidly with distance.

Heating, ventilation, and air conditioning (HVAC)

HVAC can play a significant role in the suppression of contagion by removing and killing airborne pathogens. The ultimate example involves laminar flow (figure 2), in which there is no turbulence (mixing) between fluid elements as they pass from ceiling to floor. This is how semiconductor clean rooms achieve nearly particle-free environments, and operating rooms achieve high sterility.


Figure 2: Laminar flow

Laminar flow can also be horizontal and can achieve 480 exchanges of the room air per hour.8 The reference adds that clean rooms can “markedly” reduce airborne bacterial concentrations, and presumably viral concentrations as well. The air can, for example, be recirculated through HEPA (high-efficiency particle air) filters whose performance is comparable to that of N95 respirators, or through ducts where the air is exposed to ultraviolet light. While this solution may not be cost-effective, or even practical, for many business places, the takeaway is that air-handling and disinfection suppress contagion. Figure 3 shows the general principle; air is withdrawn from the room, sterilized, and returned.


Figure 3: General principle, air-handling system

ASHRAE (American Society of Heating, Refrigerating and Air-Conditioning Engineers) offers considerable guidance for systems that are both practical and reasonably priced.9 Ultraviolet germicidal irradiation (UVGA) is highly effective, although it is important to avoid skin and eye contact with ultraviolet light. This can be achieved in air ducts, or even by UV-C upper-air disinfection (figure 4); UV-C is the same wavelength used in barbershops to sterilize instruments between customers. The ultraviolet light is well above head level for safety purposes. The Illuminating Engineering Society (IES) Photobiology Committee published a FAQ on germicidal ultraviolet (GUV) for more information, including safety considerations.10


Figure 4: Ultraviolet upper-air disinfection

Telecommuting

Organizations have already been forced to use telecommuting, distance education, and remote conferencing in response to the coronavirus threat. Although computer viruses can of course propagate over the internet, Covid-19 cannot. More to the point is that telecommuting eliminates the cost of office space as well as physical commuting costs and there is no physical business location that will need to comply with the new OSHA regulations. An office, conference venue, or classroom can be regarded as a form of hidden plant that adds cost without additional value if the same job can be accomplished without it.

Administrative controls

Administrative controls (or behavioral controls) rely on vigilance and compliance, such as telling people to stay more than six feet from one another. Administrative controls also include staggered shifts, or even staggered starting and quitting times, that reduce the number of people present in a workplace at any given time. This is mentioned in OSHA’s “Guidance on Preparing Workplaces for COVID-19,” and it was also used more than 100 years ago for two purposes. Henry Ford had workers start and quit at 30-minute intervals so there were no specific shifts and therefore no rush hours. It was also used as a countermeasure against the 1918 flu epidemic, as shown in figure 5.11


Figure 5: Staggered opening and closing times reduce contagion

Staggered lunch breaks are already recommended as an adjunct to Goldratt’s theory of constraints to avoid having everybody go to lunch at the same time and leave the capacity-constraining resource idle. This also has the effect of reducing the number of people in the dining area at any given time. One-way aisles in supermarkets meanwhile reduce the number of people who must pass one another at close quarters, and therefore opportunities for contagion.12 Boarding airplanes back-to-front also reduces the number of passengers who come into close contact with one another.13

Administrative controls, in the form of company attendance policies, should also encourage potentially contagious employees to stay home rather than discourage them by, for example, requiring them to stay home without pay or use sick days. OSHA’s “Guidance on Preparing Workplaces for COVID-19” also mentions hygiene, which requires not only vigilance and compliance but also availability of soap, water, and sanitizers.

Personal protective equipment (PPE)

Respiratory protection should become more widely available as U.S. factories ramp up production, and the hospital caseload of Covid-19 patients declines. It is absolutely vital to select effective and reliable PPE, and this means from reputable manufacturers. Canada, for example, rejected a shipment of Chinese-made KN95 respirators that were supposed to be equal to N95 respirators but weren’t.14

Respirators must meet the requirements of 42 CFR (Code of Federal Regulations) Part 84 in terms of their ability to filter out particles 0.3 microns and larger. Look for NIOSH (National Institute of Occupational Health and Safety) approval. NIOSH maintains a list15 of approved respirators which will help buyers avoid counterfeit and substandard PPE. NIOSH’s “Respirator Awareness: Your Health May Depend On It”16 explicitly warns about counterfeit PPE and cites not only the manufacturers and model numbers, but also user instructions. Surgical face masks must meet the requirements of ASTM F2100-19e1 in terms of bacterial filtration efficiency (BFE) and 0.1 micron particulate filtration efficiency. Dirk Dusharme provides additional, and very valuable, information on how to avoid counterfeit and substandard respirators.17

It is not, however, enough to just purchase the PPE and ensure its availability to workers. It must fit correctly, and workers must know how to put it on and remove it properly to ensure good protection and also avoid contagion (e.g., from touching the front of the mask or respirator) while removing it. As an example, respirator users must ensure an airtight seal around the nose and mouth, and an OSHA-approved fit-testing protocol is required. If respiratory protection is mandatory, then so is a written respiratory protection program that meets the requirements of 29 CFR 1910.134.18 “Guidance on Preparing Workplaces for COVID-19” says, however, that jobs classified as medium risk, i.e., most ordinary jobs, will rarely require the use of respirators.

An action plan

It is not too early to begin to plan for safe resumption of operations, and also to ensure that a Covid-19 resurgence or a new incarnation of the disease in a mutated form can never again compel a shutdown in operations. SAI Global19 offers a 15-minute self-assessment tool that looks extremely useful. It cites explicitly the need for a Covid-19 risk assessment, assignment of responsibility, workforce training, other considerations, and, very important, contingency plans for another Covid-19 outbreak.

I would meanwhile encourage organizations to take the following steps to reopen their businesses, and keep them open.

1. Create a risk register, and probably by location rather than job assignment. Even if the job requires a worker to move from one place to another, e.g., between restaurant tables and a kitchen, or the stockroom to the factory floor, the location is likely to be the primary focus, although there may of course be exceptions.

2. Involve the workforce. Worker involvement is also required by ISO 45001:2018, and with good reason. The people who do the jobs are often in the best position to identify risks.

3. Ask “How?” or “What?” for each risk venue and, if no answer is available, develop one. Here are a few examples of questions to ask.

Workplace organization including layout and partitions
• How does the workplace organization increase the distance between people’s respiratory tracts?
• How do partitions and dividers suppress contagion? (Example: “We installed partitions between the restaurant tables or workstations,” or, “We replaced our open office with private cubicles.”)

HVAC
• How does the air-handling system provide contagion-free air to this room?
• What is our capability for upper-air ultraviolet disinfection?

Maintenance, including sanitizing surfaces
• What processes do we have in place for periodic sanitizing of surfaces in this room?
• How often does this happen?

Flow and density of workers and/or customers
• How do we minimize the number of people in this room at any given time? (Example: “Staggered shifts and corresponding lunch breaks result in roughly 50-percent lower occupancy.”)
• How do we minimize the frequency with which people must pass in close proximity to one another? (Example: “We have designated one-way aisles in our supermarket.”)

Relevant administrative controls
• How do we make it clear to our workers that they should not come to work if they exhibit symptoms of Covid-19?
• How do we make sure people use proper hand hygiene after using the rest room?

PPE
• What is our written respiratory protection program (or process)? How does it define explicit responsibilities for the required activities and ensure that they happen?
• How do we select PPE such as respirators or surgical masks? (Example: “We assess each job in the context of OSHA requirements for NIOSH-compliant respirators, and keep a record of the review.” Example: “OSHA does not require customers to use NIOSH-compliant respirators in our store, but we provide ASTM Level 2 surgical masks at the entrance and ask customers to wear them.”)
• How do we train workers to wear PPE properly?

These are but examples of questions we can ask and again, if there is no answer to a relevant question, we need to develop and deploy one.

Disclaimer

No part of this article constitutes formal engineering or occupational health and safety advice. Its purpose is to provide a general, high-level overview of what to consider and what authoritative off-the-shelf resources (e.g., OSHA, NIOSH, CDC, ASHRAE) are available. Readers are encouraged to consult these resources for specific guidance, and to engage the appropriate professionals (e.g., OH&S, HVAC) as appropriate for their workplace.

References
1. U.S. Congress. H.R. 6800—The Heroes Act. (As of May 24, 2020.)
2. OSHA. "Guidance on Preparing Workplaces for COVID-19.” March 2020.
3. Kim Severson, Kim, and Moskin, Julia. “Restaurants Across the Country Struggle to Respond to Coronavirus,” The New York Times, March 12, 2020.
4. del Castillo, Amanda. “Coronavirus: Partitions, paper menus and more as Bay Area restaurant prepares for post-COVID-19 business.” ABC 7 News, May 1, 2020.
5. Horn, Austin. “Shower Curtains—And Rubber Duckies—Help One Restaurant Reopen.” NPR, May 15, 2020.
6. Cost, Ben. “Restaurant enforces social distancing with private ‘greenhouses’ for diners.” New York Post, May 6, 2020.
7. Gibbens, Sarah. “Goodbye to open office spaces? How experts are rethinking the workplace.National Geographic, April 30, 2020.
8. Nelson, J. Phillip; Glassburn, Alba, R., Jr.; Talbott, Richard, D.; McElhinney, James, P. “The Effect of Previous Surgery, Operating Room Environment, and Preventive Antibiotics on Postoperative Infection Following Total Hip Arthroplasty.” Clinical Orthopaedics and Related Research: March–April 1980, vol. 147, p. 167–169.
9. ASHRAE. “ASHRAE Resources Available to Address COVID-19 Concerns.” Feb. 27, 2020.
10. “IES Committee Report: Germicidal Ultraviolet (GUV)—Frequently Asked Questions.”
11. Journal of the American Medical Association, vol. 71, No. 26, 1918.
12. Mazzoni, Alana. “Calls for Australian supermarket giants Coles, Aldi, and Woolworths to enforce one-way aisles and limit the amount of shoppers in each store.Daily Mail, March 23, 2020.
13. Dinges, Gary. “New Delta Air Lines boarding procedures aimed at preventing spread of coronavirus.” USA Today, April 11, 2020.
14. Miller, Joshua Rhett. 2020. “Canada rejects 1 million ‘non-compliant’ masks from China.New York Post, April 24, 2020.
15. Centers for Disease Control and Prevention. NIOSH-Approved Particulate Filtering Facepiece Respirators
16. Centers for Disease Control and Prevention. “Respirator Awareness: Your Health May Depend On It.”
17. Dusharme, Dirk. “Fake PPE on the Rise: Don’t Get Fooled.Quality Digest, May 28, 2020.
18. OSHA. Regulations (Standards—29 CFR).
19. SAI Global. Assess your readiness to a safe return to work post COVID-19.

Discuss

About The Author

William A. Levinson’s picture

William A. Levinson

William A. Levinson, P.E., FASQ, CQE, CMQOE is the principal of Levinson Productivity Systems P.C. and the author of the book The Expanded and Annotated My Life and Work: Henry Ford’s Universal Code for World-Class Success (Productivity Press, 2013).

Comments

Another virus may be on the way

I just saw this news item today, but everything we are doing against COVID-19 should work against this one as well if it becomes a problem.

https://www.reuters.com/article/us-health-coronavirus-china-pigs/chinese...

"SHANGHAI (Reuters) - A new flu virus found in Chinese pigs has become more infectious to humans and needs to be watched closely in case it becomes a potential “pandemic virus”, a study said, although experts said there is no imminent threat."

Article

Surprisingly astute article.  Faced with continuing to run a life sustaining business. This summary is relevant and puts a method to many of the practices we have taken. Lines on the floor around work stations Trying to isolate people by five feet. Staggering break times. Giving out masks. Banning all external visitors. as ever Bill is clear and concise. Pity it may take Congress two years to enact the legislation  

Preparing for the HEROES Act

Bill,

Great article.  It's wonderful to see common sense at work.  Too bad there isn't very much in Washington.  How easy it is to deal with this pandemic using some logical thinking.