Requirement for Protection Against COVID-19 for Health Care Workers in Licensed Health Care Facilities


216-RICR-20-15-9 ACTIVE RULE EMERGENCY RULE

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9.1Authority

9.2Definitions

9.3General Requirements

9.4Violations

9.5Severability


Title 216 Department of Health
Chapter 20 Community Health
Subchapter 15 Information for Health Care Professionals
Part 9 Requirement for Protection Against COVID-19 for Health Care Workers in Licensed Health Care Facilities
Type of Filing Adoption
Regulation Status Active
Effective 03/11/2022 to 07/09/2022

Regulation Authority:

R.I. Gen. Laws § 23-1-1
R.I. Gen. Laws § 23-1-17

Purpose and Reason:

This emergency regulation requires health care workers in licensed health care facilities to either be up to date with a SARS-CoV-2 (COVID-19) vaccine or wear an N95 mask when the prevalence rate in the State is greater than or equal to fifty (50 cases) per one hundred thousand (100,000) people per week.

Brief statement of Reason for Finding Imminent Peril:

Since October 1, 2021, an Emergency Regulation (216-RICR-20-15-8) has been in place mandating that all health care workers and providers be vaccinated against the novel coronavirus SARS-CoV-2, also known as COVID-19 (the “Emergency Regulation”). Two highly contagious strains of the virus, the Delta and Omicron variants, spread through Rhode Island between October1, 2021 and March 9, 2022, with transmission rates ranging from a low of 94 cases per 100,000 people in the prior seven days, on March 8, 2022, to a high of more than 3,400 cases per 100,000 people in the seven days prior to January 9, 2022.  Among the purposes of 216-RICR-20-15-8 has been to limit transmission of COVID-19 and protect public health. 

The Emergency Regulation will expire on March 12, 2022 and the COVID-19 transmission rate is at its lowest point since 216-RICR-20-15-8 went into effect, allowing restrictions to now be eased.  The Rhode Island Department of Health (“RIDOH”) is currently in the process of promulgating permanent rules to ensure that suitable protections regarding health care workers and COVID-19 will continue to be enforceable for the health, safety, and welfare of Rhode Islanders, but those rules will not be finalized when the Emergency Regulation expires. While COVID-19 transmission rates and number of persons hospitalized with COVID-19 is decreasing, a need remains to protect vulnerable patients from the spread of respiratory droplets containing COVID-19 by ensuring that mitigation measures continue to be in place in locations where COVID-19 represents an especially high risk to public health, such as facilities in which health care workers are treating the most vulnerable patients, especially in a congregate setting. 

There is significant evidence that masking is effective in reducing transmission of SARS-CoV-2, including variants. See e.g., cdc.gov/coronavirus/2019-ncov/science/science-briefs/masking-science-sars-cov2.html#anchor_1619457210222 (last updated Dec. 6, 2021); cdc.gov/mmwr/volumes/70/wr/mm7010e3.htm (published March 12, 2021); cdc.gov/mmwr/volumes/70/wr/mm7036a3.htm  (published September 10, 2021); cdc.gov/mmwr/volumes/70/wr/mm7007e1.htm  (published February 19, 2021); cdc.gov/mmwr/volumes/70/wr/mm7035e2.htm  (published September 3, 2021).   Research also supports that mask-wearing has no significant adverse health effects for wearers. cdc.gov/coronavirus/2019-ncov/science/science-briefs/masking-science-sars-cov2.html#anchor_1619457210222 (last updated Dec. 6, 2021). The reason masks are effective in limiting the spread of SARS-CoV-2 is because the disease is transmitted predominately by inhalation of respiratory droplets generated when people exhale in any manner (i.e., through coughing, talking, or breathing). Masks are primarily intended to reduce the emission of virus-laden droplets from someone who is infected with SARS-CoV-2. This includes people who may be asymptomatic or pre-symptomatic and may be unaware of their infectiousness to others—more than 50% of transmissions are estimated to result from asymptomatic or pre-symptomatic transfers. Masks also help reduce inhalation of these droplets by the mask wearer.  Please see here for the source and a summary of the available data, which are extensive, from the CDC:
cdc.gov/coronavirus/2019-ncov/science/science-briefs/masking-science-sars-cov2.html.  Additionally, there is significant evidence that vaccination is effective in reducing transmission of SARS-CoV-2, including variants.  See https://www.cdc.gov/mmwr/volumes/70/wr/mm7034e4.htm.; https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html#Contraindications.

The risk of inadvertent transmission by COVID-19 positive health care workers, who are often asymptomatic or pre-symptomatic, will be ongoing. Health care workers interact with individuals who are immunocompromised and individuals with co-morbidities, who remain at risk for adverse health outcomes from COVID-19. A lapse in regulation during the pendency of permanent rules for COVID-19 protections would allow health care workers to interact with patients without any COVID-19 mitigation measures and place these vulnerable populations, and the public health at large, in imminent peril. Under these circumstances, it is imperative to public health that the Department immediately promulgate emergency regulations to ‘bridge the gap’ between the expiration of the Emergency Regulation and the finalization of pertinent permanent rules.