18/07/2020
PREPARING WORKPLACES FOR COVID-19
Course Introduction
The Occupational Safety and Health Administration (OSHA) developed planning guidance on prevention of exposure to infectious diseases based on traditional infection prevention and industrial hygiene practices. It focuses on the need for employers to implement engineering, administrative, and work practice controls and personal protective equipment (PPE).
The course introduces the student to the Infectious Disease Prevention and Response (IDPR) Plan for controlling COVID-19 and other infectious diseases in the workplace.
The course provides a general awareness of COVID-19 preventive measures, OSHA's COVID-19 Webpage, and the CDC's COVID-19 Information Website.
For who?
Employers Managers, supervisors, employees, all members of the public.
Both private and public sectors.
Infectious Disease Prevention and Planning
As a result of infectious disease outbreaks and pandemics throughout the recent past, OSHA has developed infectious disease preparedness and response planning guidance.
The guidance is based on traditional infection prevention and industrial hygiene practices and focuses on the design, development, and deployment of an Infectious Disease Prevention and Response (IDPR) Plan.
Recent Events Involving Infectious Diseases
Ebola Virus Disease (EVD) - One of the deadliest viral diseases, Ebola was discovered in 1976
when two consecutive outbreaks of fatal hemorrhagic fever occurred in different parts of Central Africa. The first outbreak occurred in the Democratic Republic of Congo (formerly Zaire) in a village near the Ebola River, which gave the virus its name. The second outbreak occurred in what is now South Sudan, approximately 500 miles (850 km) away.
More information on Ebola.
Middle East Respiratory Syndrome (MERS) -
Middle East Respiratory Syndrome (MERS) is an illness caused by a virus (more specifically, a coronavirus) called Middle East Respiratory
Syndrome Coronavirus (MERS-CoV). Most MERS patients developed severe respiratory illness with symptoms of fever, cough and shortness of breath. About 3 or 4 out of every 10 patients reported with MERS have died.
More information on MERS.
Norovirus Illness - Norovirus is the leading cause of foodborne illness in the United States. It causes 58% of foodborne illnesses and is the leading cause of vomiting and diarrhea from acute gastroenteritis (inflammation of the stomach and intestines) among people of all ages. It is the leading cause of acute gastroenteritis among U.S. children less than 5 years of age who seek medical care. Norovirus is responsible for nearly 1 million pediatric medical care visits annually.
More information on Norovirus Norovirus Toolkit.
Severe Acute Respiratory Syndrome (SARS) -
Severe acute respiratory syndrome (SARS) is an emerging, sometimes fatal, respiratory illness. The first identified cases occurred in China in late 2002, and the disease has now spread throughout the world. Although SARS is believed to be caused by a virus, the specific agent has not been identified, and there is not yet any laboratory or other test that can definitively identify cases. Suspected SARS cases in the United States have involved individuals returning from travel to Asia and health care workers and other contacts of
those patients.
More information on SARS
Swine Influenza - Swine Flu is a respiratory disease of pigs caused by type A influenza viruses that regularly cause outbreaks of influenza in pigs. Influenza viruses that commonly circulate in swine are called “swine influenza viruses” or “swine flu viruses.” Like human influenza viruses, there are
different subtypes and strains of swine influenza viruses. The main swine influenza viruses circulating in U.S. pigs in recent years have been, swine triple reassortant (tr) H1N1 influenza virus, trH3N2 virus, and trH1N2 virus.
More information on Swine Influenza. Information on Past
Influenza Pandemics.
Tuberculosis (TB) - According to the Centers for Disease Control and Prevention (CDC) in 2008, nearly one-third of the world's population is infected with Tuberculosis (TB), which kills almost 1.6 million people per year. TB is now the second most common cause of death from infectious disease in the world after human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS).
More information on Tuberculosis.
COVID-19 Pandemic
Note: Although we are emphasizing preparedness and response to the COVID-19 pandemic, the information in this course may also be valuable in preparing and responding to other infectious disease outbreaks, epidemics, and pandemics.What Employers Must Do
To reduce the long-term impact of infectious disease outbreak conditions on businesses, workers, customers, and the public, it is important for all employers to implement an Infectious Disease Preparedness and Response (IDPR) Plan.
For employers who have already planned for influenza pandemics, planning for COVID-19 may involve updating plans to address the specific exposure risks, sources of exposure, routes of transmission, and other unique characteristics of SARS-CoV-2.
Employers who have not prepared for pandemic events should prepare themselves and their
workers as far in advance as possible of potentially worsening outbreak conditions.
Lack of continuity planning can result in a cascade of failures as employers attempt to address challenges of COVID-19 with insufficient resources and workers who might not be adequately trained for jobs they may have to perform under pandemic conditions.
WHAT EMPLOYERS MUST DO
1. To mitigate the long-term negative impact of an infectious disease outbreak, employers
should _____.
a. send workers home if they get sick
b. move the company to a rural location
c. develop and deploy an IDPR Plan
d. close the business until the outbreak is over
What is COVID-19?
"COVID-19" is shorthand for COronaVIrus Disease 2019. It is a respiratory disease caused by the SARS-CoV-2 virus. It has spread from China to many other countries around the world, including the United States. Because COVID-19 has reached the level of world-wide pandemic, it can affect all aspects of daily life, including travel, trade, tourism, food supplies, and financial markets.
Symptoms of COVID-19
Infection with SARS-CoV-2, the virus that causes COVID-19, can cause illness ranging from mild to severe and, in some cases, can be fatal.
• Most people experience symptoms such as fever (the most common symptom), dry cough, shortness of breath, and general aches and pains.
• Others may also experience sputum production, headache, spitting up blood, or diarrhea.
Some people infected with the virus have reported experiencing other non-respiratory symptoms. Other people, referred to as asymptomatic cases, have experienced no symptoms at all.
According to the CDC, symptoms of COVID-19 may appear in as few as 2 days or as long as 14 days after exposure.
How COVID-19 Spreads
Basically, COVID-19 spreads like the flu. Although the first human cases of COVID-19 likely resulted from exposure to infected animals, infected people can spread SARS-CoV-2 to other people.
The virus is thought to spread mainly from person- to-person, including:
• Between people who are in close physical contact with one another (within about 6 feet).
• Through respiratory droplets produced when an infected person coughs or sneezes. These
droplets can land in the mouths or noses of people who are nearby or possibly be inhaled
into the lungs.
It may be possible that a person can get COVID-19 by touching a surface or object infected with SARS-CoV-2 and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the primary way the virus spreads.
People are thought to be most contagious when they are most symptomatic (i.e., experiencing fever, cough, and/or shortness of breath). Some spread might be possible before people show symptoms; there have been reports of this type of asymptomatic transmission with this new coronavirus, but this is also not thought to be the main way the virus spreads.
Although the United States has implemented public health measures to limit the spread of the virus, it is likely that some person-to-person transmission will continue to occur.
This CDC.website provides the latest information about COVID-19.
How COVID-19 Affects the Workplace
Similar to viral infections, COVID-19 has the potential to cause extensive outbreaks. Under
conditions associated with widespread person-to- person spread, multiple areas of the United
States and other countries may see impacts at the same time. In the absence of a vaccine, an
outbreak may also be an extended event. As a result, workplaces may experience:
• Absenteeism:
Workers could be absent because they are sick; are caregivers for sick family members; are caregivers for children if schools or daycare centers are closed; have at-risk people at home, such as immunocompromised family members; or are afraid to come to work because of fear of possible exposure.
• Change in patterns of commerce:
Consumer demand for items related to infection prevention (e.g., respirators) is likely to increase significantly, while consumer interest in other goods may decline. Consumers may also change shopping patterns because of a COVID-19 outbreak. Consumers may try to shop at off-peak hours to reduce contact with other people, show increased interest in home delivery services, or prefer other options, such as drive- through service, to reduce person-to-person contact.
• Interrupted supply/delivery:
Shipments of items from geographic areas severely affected by COVID-19 may be delayed or canceled with or without notification.
Infectious Disease Preparedness and Response Plan
This section describes basic steps that every employer can take to reduce the risk of worker
exposure to SARS-CoV-2, the virus that causes COVID-19, in their workplace. Later sections of this guidance—including those focusing on jobs classified as having low, medium, high, and very high exposure risks— provide specific recommendations for employers and workers within specific risk categories.
Develop an Infectious Disease Preparedness and Response (IDPR) Plan
The IDPR Plan is an important component of a company's Business Continuity Plan. If your
company does not yet have an IDPR Plan, don't wait: develop a plan that can help guide
protective actions against COVID-19 and other infectious diseases.
Stay abreast of guidance from federal, state, local, tribal, and/or territorial health agencies, and consider how to incorporate those recommendations and resources into workplace-specific plans.
Plans should consider and address the level(s) of risk associated with various worksites and job tasks workers perform at those sites.
Considerations When Developing IDPR Plan
1. Where, how, and to what sources of SARS-CoV-2 might workers be exposed, including:
• The general public, customers, and coworkers; and
• Sick individuals or those at particularly high risk of infection (e.g., international
travelers who have visited locations with widespread sustained (ongoing) COVID-19
transmission, healthcare workers who have had unprotected exposures to people known to have, or suspected of having, COVID-19).
2. Non-occupational risk factors at home and in community settings.
3. Workers' individual risk factors (e.g., older age; presence of chronic medical conditions,
including immunocompromising conditions; pregnancy).
4. Controls necessary to address those risks.
Follow federal and state, local, tribal, and/or territorial (SLTT) recommendations regarding
development of contingency plans for situations that may arise as a result of outbreaks, such as:
• Increased rates of worker absenteeism.
• The need for social distancing, staggered work shifts, downsizing operations, delivering
services remotely, and other exposure-reducing measures.
• Options for conducting essential operations with a reduced workforce, including cross-
training workers across different jobs in order to continue operations or deliver surge
services.
• Interrupted supply chains or delayed deliveries.
Plans should also consider and address the other steps that employers can take to reduce the risk of worker exposure to SARS-CoV-2 in their workplace, described in the following sections.
5. Infectious Disease Preparedness & Response Plans should consider and address _____.
a. warning signage to identify infected employees
b. scheduling consolidated work shifts
c. the costs associated with control measures
d. the levels of risk associated with worksites and task
Prepare to Implement Basic Infection Prevention Measures
When developing the IDPR Plan, develop policies and procedures that emphasize basic infection
prevention measures. As appropriate, all employers should give information and training on good hygiene and infection control practices, including:
• Personal Hygiene:
Promote frequent and thorough hand washing, including by providing workers, customers, and worksite visitors with a place to wash their hands. If soap and running water are not immediately available, provide alcohol-based hand rubs containing at least 60% alcohol.
• Flexible work scheduling:
Employers should explore establishing policies and practices, such as flexible worksites (e.g., telecommuting) and flexible work hours (e.g., staggered shifts).
Require workers to stay home if they are sick. Encourage work at home when possible.
• Respiratory etiquette:
Encourage properly covering coughs and sneezes.
• Waste containment: Provide customers and the public with tissues and trash receptacles.
• Social distancing:
This measure and hand washing are the two most effective measures to prevent infection. Increase the physical distance to at least 6 feet among employees and between employees and others, both on and off work, and do not shake hands.
• Sharing items:
Discourage workers from using other workers' phones, desks, offices, or other work tools and equipment, when possible.
• Housekeeping:
Maintain good housekeeping practices, including routine cleaning and disinfecting of surfaces, equipment, and other elements of the work environment. When choosing cleaning chemicals, employers should consult information on Environmental
Protection Agency (EPA) -approved disinfectant labels with claims against emerging viral
pathogens. Products with EPA-approved emerging viral pathogens claims are expected to be effective against SARS-CoV-2 based on data for harder to kill viruses.
Develop effective policies and procures to identify and isolate employees and others who may be infected and showing symptoms.
Policies and procedures include the following:
• Identification:
Prompt identification and isolation of potentially infectious individuals is a
critical step in protecting workers, customers, visitors, and others at a worksite.
• Self-monitoring:
Employers should inform and encourage employees to self-monitor for signs and symptoms of COVID-19 if they suspect possible exposure.
• Reporting symptoms:
Employers should develop policies and procedures for employees to report when they are sick or experiencing symptoms of COVID-19.
• Isolation:
Where appropriate, employers should immediately isolate people who have
signs and/or symptoms of COVID-19. Move potentially infectious people to a location away from workers, customers, and other visitors to prevent further transmission—particularly in worksites where medical screening, triage, or healthcare activities occur, using either permanent (e.g., wall/different room) or temporary barrier (e.g., plastic sheeting).
• Limiting the spread:
Take steps to limit spread of the respiratory secretions of a person who may have COVID-19. Provide a face mask, if feasible and available, and ask the person to wear it, if tolerated. Note: A face mask (also called a surgical mask, procedure mask, or
other similar terms) on a patient or other sick person should not be confused with PPE for
a worker; the mask acts to contain potentially infectious respiratory secretions at the
source (i.e., the person’s nose and mouth).
• Restricted entry:
Restrict the number of personnel entering isolation areas.
• Exposure controls:
Protect workers in close contact with (i.e., within 6 feet) a sick person
or who have prolonged/repeated contact with such persons by using additional engineering and administrative controls, safe work practices, and PPE. Workers whose activities involve close or prolonged/ repeated contact with sick people are addressed further in later sections covering workplaces classified at medium and very high or high
exposure risk.
Develop Flexibility in the Plan
Develop flexible IDPR Plan policies for employees. Include the following:
• During an outbreak, require sick employees to stay at home.
• Ensure that sick leave policies are flexible and that employees are aware of these policies.
• Talk with temporary employee providers about the importance of sick employees staying
home and encourage them to develop non-punitive leave policies.
• Do not require a healthcare provider's note for employees who are sick with acute
respiratory illness to validate their illness or to return to work.
• Maintain flexible policies that permit employees to stay home to care for a sick family
member.
• Recognize that workers with ill family members may need to stay home to care for them.
• Be aware of workers' concerns about pay, leave, safety, health, and other issues. Provide
adequate information and training about business-essential job functions, proper hygiene
practices, and the use of any exposure controls.
• Work with insurance companies and public health agencies to provide information to
workers and customers about medical care in the event of an outbreak.
Once the Plan is Developed
After the IDPR Plan has been developed, the work is not yet done. You can help make sure the
plan is effective by taking the following actions:
• Ensure the plan is flexible and involve your employees in developing and reviewing your
plan.
• Conduct an exercise to discover ahead of time if the plan has gaps or problems that need
to be corrected.
• Prepare a checklist containing all essential steps, actions, and responsible persons.
• Tell employees what human resources policies, workplace and leave flexibilities, and pay
and benefits will be available to them.
• Share best practices with other businesses in your communities (especially those in your
supply chain), chambers of commerce, and associations to improve community response
efforts.
Exposure Control Strategies
The Hierarchy of Controls
Occupational safety and health professionals use a framework called the "hierarchy of controls" to select ways of controlling workplace hazards. In other words,
the best way to control a hazard is to systematically remove it from the workplace, rather than relying on workers to reduce their exposure. During a COVID-19 outbreak, when it may not be possible to eliminate the hazard, the most effective protection measures are
(listed from most effective to least effective):
engineering controls, administrative controls, safe work practices (a type of administrative control), and PPE.There are several models for the hierarchy of controls by safety professionals and training providers. Our training uses the hierarchy of controls model detailed in ANSI/ASSP Z10, Occupational & Safety Management Systems.
Here is a short summary of the hierarchy of controls:
• Elimination or substitution eliminating or substituting a hazard to reduce risk.
• Engineering controls includes isolating the exposure source or using other engineering
methods, such as local exhaust ventilation, to minimize exposure.
• Warnings such as signs, barrier tape, and alarms help employees become aware of
hazards.
• Administrative controls usually involve logistic or workforce actions such as limiting the
amount of time a worker performs work involving potential exposure. Good housekeeping practices to prevent surface contamination and hygiene facilities and practice to protect workers from exposure.
• Personal Protective Equipment is used when exposure to hazards cannot be engineered
completely out of normal operations or maintenance work, and when safe work practices and other forms of administrative controls cannot provide sufficient additional protection. PPE includes wearing the proper respiratory protection and clothing.
It's very important to understand that no one control measure may be totally effective against exposure. The most effective strategy to protect employees and the public is to use a combination of the hierarchy of control measures to best protect against exposure to infectious diseases. We will discuss each of the control measures in the next several sections.
Engineering Controls
Engineering controls to reduce exposure to infectious diseases through the design of equipment. The advantage of using engineering controls is that they reduce exposure to hazards without relying on worker behavior and can be the most cost-effective solution to implement. Engineering
controls for SARS-CoV-2 and other viruses include:
• Installing high-efficiency air filters.
• Increasing ventilation rates in the work environment.
• Installing physical barriers, such as clear plastic sneeze guards.
• Installing a drive-through window for customer service.
• Specialized negative pressure ventilation in some settings, such as for aerosol generating
procedures (e.g., airborne infection isolation rooms in healthcare settings and specialized
autopsy suites in mortuary settings).
Warnings help raise general awareness about entering biohazard areas, but they do not prevent entry. Warnings work only as long as employees comply with them. Generally, warnings include signs, alarms, and labels.
All signs must be well lit and kept clean so that they are easily visible. Statements that contradict or detract from the signs' meaning are prohibited. Signs required by other statutes, regulations, or ordinances, however, may be posted in addition to, or in combination with, this sign.
Administrative Controls
Administrative controls require action by the worker or employer. Typically, administrative
controls are changes in work policies, programs, processes, and procedures to reduce or minimize exposure to a hazard. Examples of administrative controls for SARS-CoV-2 include:
• Encouraging sick workers to stay at home.
• Minimizing contact among workers, clients, and customers by replacing face-to-face
meetings with virtual communications and implementing telework if feasible.
• Establishing alternating days or extra shifts that reduce the total number of employees in a facility at a given time, allowing them to maintain distance from one another while maintaining a full onsite work week.
Discontinuing nonessential travel to locations with ongoing COVID-19 outbreaks. Regularly check CDC travel warning levels.
• Developing emergency communications plans, including a forum for answering workers' concerns and internet-based communications, if feasible.
• Providing workers with up-to-date information on COVID-19 risk factors and protective
behaviors.
• Providing hands-on training practices such as personal hygiene, cough etiquette, and use and care of PPE.
Safe Work Practices
Safe work practices are types of administrative controls that include procedures for safe and
proper work used to reduce the duration, frequency, or intensity of exposure to a hazard.
Examples of safe work practices for SARS-CoV-2 include:
• Providing resources and a work environment that promotes personal hygiene. For example, provide tissues, no-touch trash cans, hand soap, alcohol-based hand rubs containing at least 60 percent alcohol, disinfectants, and disposable towels for workers to clean their work surfaces.
• Requiring regular hand washing or use of alcohol-based hand rubs. Workers should always wash hands when they are visibly soiled and after removing any PPE. Post handwashing signs in restrooms.
• Cover a sneeze or cough with a tissue or sleeve.
Personal Protective Equipment (PPE)
While engineering and administrative controls are considered more effective in minimizing
exposure to viruses, PPE may also be needed to prevent certain exposures. While correctly using PPE can help prevent some exposures, it should not take the place of other prevention strategies.Examples of PPE include gloves, goggles, face shields, and respiratory facepieces. *Don't think of face masks as PPE because they are used to primarily protect others, not the user*. During an outbreak of an infectious disease, such as COVID-19, recommendations for PPE specific to
occupations or job tasks may change depending on:
• geographic location, updated risk assessments for workers, and
• information on PPE effectiveness in preventing the spread of COVID-19. Employers should check the OSHA and CDC websites regularly for updates about recommended PPE.
Employers are obligated to pay for and provide their workers with PPE needed to keep them safe while performing their jobs. The types of PPE required during an outbreak will be based on the risk of being infected while working and job tasks that may lead to exposure.
All types of PPE must be:
• Selected based upon the hazard to the worker.
• Properly fitted and periodically refitted, as applicable (e.g., respirators).
• Consistently and properly worn when required.
• Regularly inspected, maintained, and replaced, as necessary.
Properly removed, cleaned, and stored or disposed of, as applicable, to avoid
contamination of self, others, or the environment.
Respiratory Protection
Facemasks
Unlike NIOSH-approved N95s, facemasks are loose-fitting and provide only barrier protection against droplets, including large respiratory particles. No fit testing or seal check is necessary with facemasks. Most facemasks do not effectively filter small particles from the air and do not prevent
leakage around the edge of the mask when the user inhales.
The role of facemasks is for patient source control, to prevent contamination of the surrounding area when a person coughs or sneezes. Therefore, they do not perform the same function as a N95 filtering facepieces and should not be considered PPE. People with confirmed or suspected COVID-19 should wear a facemask until they are isolated in a hospital or at home. The person does not need to wear a facemask while isolated. See Understanding the Difference info graphic for more information.
The CDC does not recommend that the general public routinely wear N95 respirators to protect themselves from respiratory diseases, including coronavirus (COVID-19). The best way to prevent illness is to avoid being exposed to this virus. However, as a reminder, CDC always recommends everyday preventive actions, such as hand washing, to help prevent the spread of respiratory diseases.
N95 Filtering Facepiece Respirators (FFR)
Filtering facepieces are the primary respirator being used for COVID-19. An N95 FFR is a type of respirator which removes particles from the air that are breathed through it. These respirators filter out at least 95% of very small (0.3 micron) particles. N95 FFRs are capable of filtering out all types of particles, including bacteria and viruses. See approved manufacturers.
For a list of N95 and other approved respirator models see the NIOSH-Approved Particulate
Filtering Facepiece webpage.
The appropriate form of respirator will depend on the type of exposure and on the transmission pattern of COVID-19. See the NIOSH "Respirator Selection Logic" or the OSHA "Respiratory Protection eTool."
Fit Testing
Fit testing is a procedure used to determine how well a respirator "fits"—that is, whether the respirator forms a seal on the user's face. Before any employee first starts wearing a respirator in the work environment, the employer must perform a respirator fit test. For all employees wearing negative or positive pressure tight-fitting facepiece respirators, the employer must perform either qualitative or quantitative fit tests using an OSHA-accepted fit testing protocol. In addition, employees must be fit tested whenever a different respirator facepiece is used, and at least annually thereafter.
If an employee has difficulty breathing during a fit test or while using a respirator, the employer
must make a medical examination available to that employee to determine whether he or she can wear a respirator safely.
Respirator Inspection Requirements
Respiratory protection is no better than the respirator in use, even though it is worn correctly. Frequent random inspections must be conducted by a qualified individual to make sure respirators are properly selected, used, cleaned, and maintained.
All respirators:
For all respirators, inspections must include a check of respirator function,
tightness of connections, and the condition of the various parts including, but not limited to the:
• facepiece
• head straps
• valves
• connecting tube
• cartridges, canisters, or filters
It's especially important to evaluate elastic parts for pliability and signs of deterioration.
Respiratory Protection Training
Respirator training is an important part of the respiratory protection program. As you learned
earlier, initial and annual respirator education should include three components: instruction,
training, and evaluation to ensure employees have the necessary knowledge, skills, and abilities
(KSAs) required to use respirators on the job.
Retraining must be done annually and under some conditions, additional retraining might be
required. Circumstances which would require retraining include situations where:
changes in the type of respirator assigned to the employee render previous training
obsolete;
• when the employee has not retained the requisite understanding or skill to use the
respirator properly; or
• any other situation in which retraining appears necessary to ensure safe respirator use.
Note: If an employee has adequate KSAs but is intentionally violating safety rules covering
respiratory protection program, policies, and rules, retraining may not be the most appropriate
response. More appropriately, the intentional violation of an OSHA or employer safety rule may require progressive disciplinary action, if justified.
Respiratory protection training should address selection, use (including donning and doffing),
proper disposal or disinfection, inspection for damage, maintenance, and the limitations of respiratory protection equipment. Learn more at OSHA's Respiratory Protection Overview.
For more information on OSHA training requirements see OSHA Pub 2254, Training Requirements in OSHA Standards, and OSHAcademy Course 703, Introduction to OSHA Training.
Risk Levels and Respiratory ProtectionRisk levels
Worker risk of occupational exposure to SARS-CoV-2, the virus that causes COVID-19, during an outbreak may vary from very high to high, medium, or lower (caution) risk. The level of risk depends in part on the:
• occupations with each industry type
• frequency of contact within 6 feet of people at work known to be, or suspected of being, infected with SARS-CoV-2
• requirement for repeated or extended contact with persons at work known to be, or suspected of being, infected with SARS-CoV-2
To help employers determine appropriate precautions, OSHA has divided job tasks into four risk exposure levels:
very high, high, medium, and lower risk. The Occupational Risk Pyramid shows
the four exposure risk levels in the shape of a pyramid to represent probable distribution of risk. Most American workers will likely fall in the lower exposure risk (caution) or medium exposure risk levels.
1. The designation of an occupational risk level of exposure to the SARS-CoV-2 virus at work
Very High Exposure Risk
Very high exposure risk jobs are those with high potential for exposure to known or suspected
sources of COVID-19 during specific medical, postmortem, or laboratory procedures.
• Healthcare workers (e.g., doctors, nurses, dentists, paramedics, emergency medical
technicians) performing aerosol-generating procedures (e.g., intubation, cough induction
procedures, bronchoscopies, some dental procedures and exams, or invasive specimen
collection) on known or suspected COVID-19 patients.
• Healthcare or laboratory personnel collecting or handling specimens from known or
suspected COVID-19 patients (e.g., manipulating cultures from known or suspected COVID-
19 patients).
• Morgue workers performing autopsies, which generally involve aerosol-generating
procedures, on the bodies of people who are known to have, or suspected of having,
COVID-19 at the time of their death.
High Exposure Risk
High exposure risk jobs are those with high potential for exposure to known or suspected sources of COVID-19.
• Healthcare delivery and support staff (e.g., doctors, nurses, and other hospital staff who
must enter patients’ rooms) exposed to known or suspected COVID-19 patients. (Note:
when such workers perform aerosol-generating procedures, their exposure risk level
becomes very high.)
• Medical transport workers (e.g., ambulance vehicle operators) moving known or suspected
COVID-19 patients in enclosed vehicles.
• Mortuary workers involved in preparing (e.g., for burial or cremation) the bodies of people
who are known to have, or suspected of having, COVID-19 at the time of their death.
*Medium Exposure Risk*
Medium exposure risk jobs include those that require frequent and/or close contact with (i.e., within 6 feet of) people who may be infected with SARS-CoV-2, but who are not known or suspected COVID-19 patients.
• In areas without ongoing community transmission, workers in this risk group may have frequent contact with travelers who may return from international locations with
widespread COVID-19 transmission.
In areas where there is ongoing community transmission, workers in this category may
have contact be with the general public (e.g., in schools, high-population-density work
environments, and some high-volume retail settings).Lower Exposure Risk (Caution)
Lower exposure risk (caution) jobs are those that do not require contact with people known to be, or suspected of being, infected with SARS-CoV-2 nor frequent close contact with (i.e., within 6 feet of) the general public. Workers in this category have minimal occupational contact with the
public and other coworkers.
*High and Very High Risk*
Jobs Classified at High or Very High Exposure Risk: What to Do to Protect Workers In workplaces
where workers have high or very high exposure risk, employers should follow guidance and
implement control measures described in this section.
*Engineering Controls*
• Ensure appropriate air-handling systems are installed and maintained in healthcare
facilities. See "Guidelines for Environmental Infection Control in Healthcare Facilities" for
more recommendations on air handling systems.
• CDC recommends that patients with known or suspected COVID-19 (i.e., person under
investigation) should be placed in an airborne infection isolation room (AIIR), if available.
• Use isolation rooms when available for performing aerosol-generating procedures on patients with known or suspected COVID-19. For postmortem activities, use autopsy suites or other similar isolation facilities when performing aerosol-generating procedures on the bodies of people who are known to have, or suspected of having, COVID-19 at the time of their death. See the CDC postmortem guidance. OSHA also provides guidance for postmortem activities on its COVID-19 webpage.
• Use special precautions associated with Biosafety Level 3 when handling specimens from known or suspected COVID-19 patients. For more information about biosafety levels, consult the U.S. Department of Health and Human Services (HHS) "Biosafety in Microbiological and Biomedical Laboratories.
Administrative Controls
If working in a healthcare facility, follow existing guidelines and facility standards of practice for identifying and isolating infected individuals and for protecting workers.
• Develop and implement policies that reduce exposure, such as cohorting (i.e., grouping) COVID-19 patients when single rooms are not available.
• Post signs requesting patients and family members to immediately report symptoms of
respiratory illness on arrival at the healthcare facility and use disposable face masks.
• Consider offering enhanced medical monitoring of workers during COVID-19 outbreaks.
• Provide all workers with job-specific education and training on preventing transmission of
COVID-19, including initial and routine/refresher training.
• Ensure that psychological and behavioral support is available to address employee stress.
*Safe Work Practices*
If working in a healthcare facility, follow existing guidelines and facility standards of practice for identifying and isolating infected individuals and for protecting workers.
• Provide emergency responders and other essential personnel who may be exposed while working away from fixed facilities with alcohol-based hand rubs containing at least 60% alcohol for decontamination in the field.
*Personal Protective Equipment*
Most workers at high or very high exposure risk likely need to wear gloves, a gown, a face shield or goggles, and either a face mask or a respirator, depending on their job tasks and exposure risks.
Those who work closely with (either in contact with or within 6 feet of) patients known to be, or suspected of being, infected with SARS-CoV-2, the virus that causes COVID-19, should wear respirators. In these instances, see the PPE section beginning on page 14 of this booklet, which provides more details about respirators.
• PPE ensembles may vary, especially for workers in laboratories or morgue/mortuary facilities who may need additional protection against blood, body fluids, chemicals, and other materials to which they may be exposed. Additional PPE may include medical/surgical gowns, fluid-resistant coveralls, aprons, or other disposable or reusable protective clothing. Gowns should be large enough to cover the areas requiring protection.NOTE: Workers who dispose of PPE and other infectious waste must also be trained and provided with appropriate PPE.
*Workers Living Abroad or Traveling Internationally*
Employers with workers living abroad or traveling on international business should consult:
• the "Business Travelers" section of the OSHA COVID-19 webpage
• the CDC's Travel Health Notices webpage, CDC travel warnings
• the U.S. Department of State's travel advisoriesEmployers should communicate to workers that the Department of State (DOS) cannot provide Americans traveling or living abroad with medications or supplies, even in the event of a COVID-19 outbreak.
As COVID-19 outbreak conditions change, travel into or out of a country may not be possible, safe, or medically advisable. It is also likely that governments will respond to a COVID-19 outbreak by imposing public health measures that restrict domestic and international movement, further
limiting the U.S. government’s ability to assist Americans in these countries. It is important that employers and workers plan appropriately, as it is possible that these measures will be implemented very quickly in the event of worsening outbreak conditions in certain areas.
Follow Existing OSHA Standards
Existing OSHA standards may apply to protecting workers from exposure to infectious diseases.
While there is no specific OSHA standard covering COVID-19 exposure, some OSHA requirements may apply to preventing occupational exposure to infectious diseases. Among the most relevant are:
• OSHA's Personal Protective Equipment (PPE) standards (in general industry, 29 CFR 1910.132, PPE General Requirements), which require using gloves, eye and face protection, and respiratory protection.
• When respirators are necessary to protect workers or where employers require respirator
use, employers must implement a comprehensive respiratory protection program in accordance with the Respiratory Protection standard (29 CFR 1910.134). OSHA has issued temporary guidance related to enforcement of respirator annual fit-testing requirements for healthcare.
• The General Duty Clause, Section 5(a)(1) of the Occupational Safety and Health (OSH) Act of 1970, 29 USC 654(a)(1), which requires employers to furnish to each worker
"employment and a place of employment, which are free from recognized hazards that are causing or are likely to cause death or serious physical harm."
*Information and Training*
Educating employees about exposure to infectious diseases and the IDPR Plan is accomplished using three primary strategies: instruction, training, and evaluation. These strategies ensure employees have the necessary knowledge, skills, and abilities (KSAs) required to work safe on the job.
*1. Instruction:*
Employees must be instructed on OSHA regulations, hazards of exposure,
components of the IDPR Plan, and related company safety policies, programs, and
procedures.
*2. Training:*
Employees must receive training that includes hands-on demonstration and an
opportunity to practice performing procedures and using tools and equipment.
*3. Evaluation:*
Employee abilities to perform their responsibilities on the job must be
evaluated by a competent person, formally certified to train, and designated as qualified to use PPE, equipment, and perform response procedures.
*Employer Responsibilities*
Many OSHA regulations require employers to develop and deploy a suitable safety training program. Note: It's important to know that OSHA will ALWAYS inspect the safety training program during an OSHA inspection.
Your employer is required to provide an information and training program for all employees exposed to hazards in the workplace.
Information and training must inform employees of the specific hazards associated with their work environment, protective measures which can be taken, and their rights under the standard.
23/08/2020
18/08/2020