By Karen O’Hara
With the spotlight in recent months on Ebola, occupational health professionals are experiencing a halo effect in the form of opportunities to educate employers about preventing and controlling the spread of all types of infectious diseases in the workplace.
The far-reaching impacts of the Ebola Virus Disease (EVD) outbreak in West Africa have prompted many U.S. employers to seek advice on best clinical practices, the use of personal protective equipment (PPE), travel restrictions, quarantines, and other precautions.
With preparation and a sound response, infectious disease experts say the likelihood of a worker in the U.S. contracting Ebola is relatively low. However, more commonly occurring infectious diseases including influenza, pertussis, tuberculosis (infecting one-third of the world’s population), Methicillin-resistant Staphylococcus Aureus (MRSA), some strains of hepatitis, rhinovirus, and norovirus afflict millions of people each year around the globe, though they are all largely preventable. Occupational medicine physicians with academic training in infectious disease management who work collaboratively with employers and workers have invaluable insights to share on these threats.
Meanwhile, researchers at the Centers for Disease Control and Prevention (CDC), the National Institute for Occupational Safety and Health (NIOSH), and numerous academic institutions are investigating epidemics and pandemics as well as new and emerging infectious diseases like Middle East Respiratory Syndrome (MERS).
It Starts With A Plan
An effective infectious disease prevention and control plan typically features:
- an explanation of fundamental infectious disease management principles
- before, during, and after scenarios
- comprehensive education and training
- medical surveillance
- elements of the federal Occupational Health and Safety Administration’s (OSHA) bloodborne pathogens standard (29 CFR 1910.1030), including the adoption of standard and universal precautions (www.osha.gov, enter search for bloodborne pathogens standard) In the workplace, simple messages are often the optimal way to reach a large, diverse audience. Recommended messages include:
- Hand hygiene: Frequently washing hands with soap and water for at least 20 seconds (or using a waterless,alcohol-based hand sanitizer) is one of the most effective ways to prevent the spread of disease.
- Vaccines: When a certain percentage of the population is immunized against a contagious disease, everyone benefits from the herd or community immunity, including those who are not candidates for immunization.
- Respiratory hygiene:
- Covering one’s mouth and nose when coughing or sneezing and promptly disposing of soiled tissues
- Keeping a distance of at least three feet from a symptomatic individual
- Surgical masks and PPE such as face pieces and respirators used in certain circumstances to reduce the spread of disease via airborne or droplet contamination.
ADDITIONAL PRACTICES:
- frequently disinfect surfaces such as countertops, phones, and door handles
- stay home from work when ill
- practice donning and doffing personal protective equipment UNIVERSAL PRECAUTIONS
OSHA’s bloodborne pathogens standard requires employees to observe universal precautions to prevent contact with blood or other potentially infectious materials (OPIM). In addition to hand hygiene and respiratory protection, universal precautions include:
- flushing mucous membranes immediately after contact with blood or OPIM or PPE removal
- not eating, drinking, smoking, applying cosmetics or lip balm, or handling contact lenses in areas where there is a reasonable likelihood of occupational exposure to blood or OPIM
- placing all needles and sharp objects in puncture-resistant, labeled, leak-proof containers
- disposing of any potentially contaminated waste in sealable bio-hazardous waste bags and containers
Standard Precautions
Standard precautions are based on the principle that all blood, body fluids, secretions and excretions (except sweat), non-intact skin, and mucous membranes may contain transmissible infectious agents. Similar to universal precautions, standard precautions include hand hygiene, gloves, gown, mask, eye protection, total face shield, and/or safe injection practices.
Gloves should be worn whenever there is a likelihood of contact with blood, non-intact skin, mucous membranes, or OPIM, and when handling or touching contaminated items or surfaces. Disposable gloves and mouthpieces should not be washed or decontaminated for reuse. OSHA’s model Exposure Control Plan includes all elements required by the bloodborne pathogens standard. The intent is to provide employers with a template to develop a written exposure-control plan that can be adapted to their specific work environment. Exposure control plan elements include:
- determination of employee exposure
- implementation of various methods of exposure control such as universal precautions, engineering and work practice controls, PPE, and housekeeping
- hepatitis B vaccination
- post-exposure evaluation and follow-up
- communication of hazards to employees and training
- recordkeeping
- procedures for evaluating circumstances surrounding exposure incidents
PANDEMIC PREPAREDNESS
Many companies consider pandemic illness as a potentially serious threat to operations. A severe influenza pandemic, for example, could affect a significant percentage of the population in the U.S. and other countries. During a pandemic, illness outbreaks typically occur in waves that can last from six to eight weeks and continue for a year or more. In a pandemic, OSHA reports that employers should expect to experience:
- Absenteeism – estimated up to 40 percent of the workforce is absent during peak periods
- Changes in patterns of commerce – consumers dictate supply and demand
- Interrupted supply/delivery – delays or cancellations in supply and product shipments in affected geographic areas
According to OSHA, a lack of pandemic preparedness can result in a “cascade of failures.” However occupational health programs can help create a surge of success by assisting with the development and implementation of a comprehensive preparedness plan that will help employers better protect workers and the enterprise as a whole. Officials say occupational health professionals interested in developing competencies in this area should be able to identify disease outbreaks and pandemic threats and provide recommendations to prevent the spread of disease (e.g., administrative and engineering controls, PPE) at specific worksites. The Department of Health and Human Services and the CDC have published a pandemic preparedness checklist that contains numerous recommendations for business owners including the following:
- Identify a pandemic coordinator and/or team with defined roles and responsibilities for preparedness and response planning.
- Identify essential employees and other critical inputs (e.g. raw materials, suppliers, sub-contractor services/products, and logistics) required to maintain operations by location and function during a pandemic.
- Train and prepare an ancillary workforce (e.g. contractors, employees in other job titles/descriptions, retirees).
- Develop and plan for scenarios likely to result in a pandemic situation, including an increase or decrease in demand for products and/or services (e.g., increased need for employee health personnel). materials, suppliers, subcontractor services/products, and logistics) required to maintain operations by location and function during a pandemic.
- Train and prepare an ancillary workforce (e.g. contractors, employees in other job titles/descriptions, retirees).
- Develop and plan for scenarios likely to result in a pandemic situation, including an increase or decrease in demand for products and/or services (e.g., increased need for employee health personnel).
EBOLA IN THE WORKPLACE
“Let’s face it, Ebola is a scary disease,” said Peter Swann, M.D., an occupational medicine physician and associate medical director with WorkCare, Inc., a national occupational health services company specializing in medical surveillance, on-site clinics, physician consulting, and 24/7 injury management. “However, despite its example offices and manufacturing facilities, most employees are likely to be in the “no known exposure” risk category. However, certain infection prevention and control guidelines are recommended for workers and visitors at companies in impacted regions.
Recommended practices include:
- Supply workplaces with personal hygiene items including tissues, hand soap, surgical masks, disinfectants, disposable paper towels and sponges, and effective waterless hand sanitizer.
- Train employees designated to respond to first aid events in first aid procedures and universal precautions. Fully supply first aid and universal precaution kits in offices and project sites in potentially affected locations.
- Encourage employees to report signs and symptoms of illness to their immediate supervisor or project manager so treatment and other arrangements can be made, as appropriate. Many other diseases, including malaria, have symptoms in common with EVD. For instance, malaria is present in West Africa and is a far more common illness.
- Employees who assist someone exhibiting Ebola-like symptoms must wear protective equipment, including surgical mask and gloves, and take the following precautions:
- wash hands and face after contact
- immediately notify their supervisor
- monitor their health for 21 days. Watch for fever, severe headaches, muscle aches, diarrhea, vomiting, rash, and other symptoms consistent with Ebola
- In cases with symptomatic employees, any body fluid should be treated as though it is infectious and all necessary precautions must be taken.
- All affected employees should be notified of potential exposure events. A company designee should be responsible for notifying client contacts or public health authorities, as required. Patient confidentiality must be protected to the greatest degree possible.
ABOUT THE AUTHOR:
Karen O’Hara is the Director of Marketing and Communications for WorkCare, Inc.,(www.workcare.com), and the former SeniorVice President of RYAN Associates and Editor-in-Chief of VISIONS.
