SACRAMENTO (CBS SF) — California has become the first state in the nation to require all workers in health care settings to be fully vaccinated against COVID.

The new public health order from the state Department of Public Health (CDPH) requires workers in health care settings to be fully vaccinated or receive their second dose by September 30.

The CDPH said the order applies to workers in hospitals, skilled nursing facilities and in most other health care settings.

A second public health order directs hospitals, skilled nursing facilities and intermediate-care facilities to verify that visitors are fully vaccinated or have tested negative for COVID-19 in the prior 72 hours before indoor visits.

“Many of the large health care systems have already done it including UCSF and Kaiser a few days ago but I think it’s appropriate for all of the health care workers in the state to be vaccinated. They shouldn’t be able to come near vulnerable patients unless they are,” said Dr. Robert Wachter, chair of the UCSF Department of Medicine.

On Thursday, the number of hospitalizations due to confirmed and suspected COVID-19 cases in California reached a total of 5,551, an increase of 269 from the prior day total, according to the state’s COVID dashboard. The number of ICU patients due to confirmed and suspected COVID-19 rose to 1,153, an increase of 18 from the prior day total.

“As we continue to see an increase in cases and hospitalizations due to the Delta variant of COVID-19, it’s important that we protect the vulnerable patients in these settings,” said CDPH Director Dr. Tomás J. Aragón in a prepared statement. “Today’s action will also ensure that health care workers themselves are protected. Vaccines are how we end this pandemic.”

CDPH said updates to guidance for visitors to other long-term care facilities is expected in the near future.

The order coming down from the State and not a private employer eliminates one key challenge according to Prof. Dorit Reiss of UC Hastings in San Francisco.

“The employer has to negotiate with a union, the state doesn’t have to negotiate with the union because it’s not directly the employer,” she told KPIX.

The California Nurses Association issued a statement, reading in part: “We strongly believe all eligible people should be vaccinated, while respecting the need for medical and religious accommodations.”

The order does allow exemptions with a caveat.

“The state allows people who are exempt to keep working as long as they get tested and wear masks so the accommodation is that you don’t have to vaccinate but you do have to test or wear a mask and yes, it’s probably legal,” Reiss said.

Wachter says it’s time. “I am all in favor of it. I think from the very beginning it’s appropriate who take an oath to do no harm — to keep themselves safe for their patients.”

Last week, Governor Gavin Newsom announced state workers and workers in health care and high-risk congregate settings would need to either demonstrate proof of full vaccination or be tested at least once per week. Other businesses and local governments have implemented similar measures for their employees.

Earlier this week, Kaiser Permanente also announced it would make COVID-19 vaccination mandatory for all its employees, including physicians. On Wednesday, Sutter Health announced a similar policy, requiring its workforce to be fully vaccinated against COVID-19 by Sept. 30.

KPIX 5’s Andria Borba contributed to this report