Workplace hazard controls for COVID-19

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Nuvola apps kaboodle.svg COVID-19 and the Hierarchy of Controls

Hazard controls for COVID-19 in workplaces are the application of occupational safety and health methodologies for hazard controls to the prevention of coronavirus disease 2019 (COVID-19). Vaccination is the most effective way to protect against severe illness or death from COVID-19. Multiple layers of controls are recommended, including measures such as telework and flexible schedules, increased ventilation, personal protective equipment (PPE) and face coverings, physical distancing, and enhanced cleaning programs.

Contents

Hazard controls

Vaccination is the most effective way to protect against severe illness or death from COVID-19. Infections in fully vaccinated people happen in only a small proportion of people who are fully vaccinated, even with the Delta variant. [1]

The U.S. Occupational Safety and Health Administration (OSHA) continues to recommend implementing multiple layers of controls, including measures such as telework and flexible schedules, engineering controls (especially increased ventilation), administrative policies such as vaccination policies, personal protective equipment (PPE), face coverings, physical distancing, and enhanced cleaning programs with a focus on high-touch surfaces. [1]

Preliminary evidence suggests that the small number of fully vaccinated people who do become infected with the Delta variant can be infectious and can spread the virus to others. The U.S. Centers for Disease Control and Prevention (CDC) recommends that fully vaccinated people can reduce their risk of becoming infected with the Delta variant and potentially spreading it to others by: [1]

Along with vaccination, key controls to help protect unvaccinated and other at-risk workers include removing from the workplace all infected people, all people experiencing COVID symptoms, and any people who are not fully vaccinated who have had close contact with someone with COVID-19 and have not tested negative for COVID-19 immediately if symptoms develop and again at least 5 days after the contact (in which case they may return 7 days after contact). Fully vaccinated people who have had close contact should get tested for COVID-19 3–5 days after exposure and be required to wear face coverings for 14 days after their contact unless they test negative for COVID-19. [1]

Additional fundamental controls that protect unvaccinated and other at-risk workers include maintaining ventilation systems, implementing physical distancing, and properly using face coverings, and proper cleaning. Fully vaccinated people in areas of substantial or high transmission should be required to wear face coverings inside as well. Employees may request reasonable accommodations, absent an undue hardship, if they are unable to comply with safety requirements due to a disability. [1]

Randomized controlled trials and simulation studies are needed to determine the most effective types of PPE for preventing the transmission of infectious diseases to healthcare workers. There is low quality evidence that supports making improvements or modifications to personal protective equipment in order to help decrease contamination. Examples of modifications include adding tabs to masks or gloves to ease removal and designing protective gowns so that gloves are removed at the same time. In addition, there is weak evidence that the following PPE approaches or techniques may lead to reduced contamination and improved compliance with PPE protocols: Wearing double gloves, following specific doffing (removal) procedures such as those from the CDC, and providing people with spoken instructions while removing PPE. [2]

Return to work

A COVID-19 health checkpoint outside of an office COVID19OfficeCheckpoint.jpg
A COVID-19 health checkpoint outside of an office

As business reopen across the world, measures are being developed to re-integrate workers in a manner that minimizes risks of transmission of COVID-19. Tools and publications with approaches to be taken to help with a safe and healthy return to work have been published by several health agencies and professional organizations. Examples include tool kits with fact sheets for workers and employers, infographics, and checklists for readiness to return to work.

Employers may require workers entering the workplace to be vaccinated against the coronavirus. Federal law does not prevent companies from requiring employees to provide documentation or discriminating against employees who fail to document vaccination status. Employers can also distribute information to employees and their family members on the benefits of vaccination, as well as offer incentives to encourage employees to get vaccinated, as long as the incentives are not coercive.

Many businesses are encouraging workers to get the jab rather than requiring them to do so. [3]

Workers' rights

In the United States, under the General Duty Clause of the Occupational Safety and Health Act of 1970, employers are responsible for providing a safe and healthy workplace free from recognized hazards likely to cause death or serious physical harm, which includes COVID-19. [1] In addition, OSHA's Emergency Temporary Standard applies required measures to most settings where any employee provides healthcare services or healthcare support services. [4] Section 11(c) of the OSH prohibits employers from retaliating against workers for raising concerns about safety and health conditions, and OSHA encourages workers who suffer such retaliation to submit a complaint to OSHA's Whistleblower Protection Program within the legal time limits. [5] [6]

On July 15, 2020, Virginia adopted binding safety regulations on COVID-19, the first such regulations in the United States. The regulations includes mandates about control measures and prohibits retaliation against workers for expressing concern about infection risk, and provides for fines of up to US$130,000 for companies found in violation. [7] [8] As of July 2020, Oregon adopted a timeline that targets the establishment of COVID-19 regulations for September 1. [9]

Historical guidance before availability of COVID-19 vaccines

COVID-19 outbreaks have been responsible for several effects within the workplace. Workers may be absent from work due to becoming sick, needing to care for others, or from fear of possible exposure. Patterns of commerce may change, both in terms of what goods are demanded, and the means of acquiring these goods (such as shopping at off-peak hours or through delivery or drive-through services). Lastly, shipments of items from geographic areas severely affected by COVID-19 may be interrupted. [10] :6

An infectious disease preparedness and response plan can be used to guide protective actions. Such plans address the levels of risk associated with various worksites and job tasks, including sources of exposure, risk factors arising from home and community settings, and risk factors of individual workers such as old age or chronic medical conditions. They also outline controls necessary to address those risks, and contingency plans for situations that may arise as a result of outbreaks. Infectious disease preparedness and response plans may be subject to national or subnational recommendations. [10] :7–8 Objectives for response to an outbreak include reducing transmission among staff, protecting people who are at higher risk for adverse health complications, maintaining business operations, and minimizing adverse effects on other entities in their supply chains. The disease severity in the community where the business is located affects the responses taken. [11]

It has been suggested that improving ventilation and managing exposure duration can reduce transmission. [12] [13]

All workplaces

Door handle that need not be touched by a hand B&H forearm door pull 2021 jeh.jpg
Door handle that need not be touched by a hand

In many workplaces, groups share many hours of the day indoors. These conditions can facilitate the transmission of disease, [14] but also control it through workplace practices and policies. [15] Identifying industries or particular jobs that have the highest potential exposure to a specific risk can help in the development of interventions to control or prevent the spread of diseases such as COVID-19. [16] [17] [18]

According to the U.S. Occupational Safety and Health Administration (OSHA), lower exposure risk jobs have minimal occupational contact with the public and other coworkers. [10] :18–20 Basic infection prevention measures recommended for all workplaces include frequent and thorough hand washing, encouraging workers to stay home if they are sick, respiratory etiquette including covering coughs and sneezes, providing tissues and trash receptacles, preparing for telecommuting or staggered shifts if needed, discouraging workers from using others' tools and equipment, and maintaining routine cleaning and disinfecting of the work environment. Prompt identification and isolation of potentially infectious individuals is a critical step in protecting workers, customers, visitors, and others at a worksite. [10] :8–9 The U.S. Centers for Disease Control and Prevention (CDC) recommends that employees who have symptoms of acute respiratory illness are to stay home until they are free of fever, signs of a fever, and any other symptoms for at least 24 hours without the use of fever-reducing or other symptom-altering medicines, and that sick leave policies are flexible, permit employees to stay home to care for a sick family member, and that employees are aware of these policies. [11]

There are also psychosocial hazards arising from anxiety or stress from worries about contracting COVID-19, the illness or death of a relative or friend, changes in work patterns, and financial or interpersonal difficulties arising from the pandemic. Social distancing measures may prevent typical coping mechanisms such as personal space or sharing problems with others. Controls for these hazards include managers checking on workers to ask how they are, facilitating worker interactions, and formal services for employee assistance, coaching, or occupational health. [19]

It has been suggested that improving ventilation and managing exposure duration can reduce transmission. [12] [13]

Medium-risk workplaces

According to OSHA, medium exposure risk jobs include those that require frequent or close contact within six feet (1.8 m) of people who are not known or suspected COVID-19 patients, but may be infected with SARS-CoV-2 due to ongoing community transmission around the business location, or because the individual has recent international travel to a location with widespread COVID-19 transmission. These include workers who have contact with the general public such as in schools, high-population-density work environments, and some high-volume retail settings. [10] :18–20

Engineering controls for this and higher risk groups include installing high-efficiency air filters, increasing ventilation rates, installing physical barriers such as clear plastic sneeze guards, and installing a drive-through window for customer service. [10] :12–13

Administrative controls for this and higher risk groups include encouraging sick workers to stay at home, replacing face-to-face meetings with virtual communications, establishing staggered shifts, discontinuing nonessential travel to locations with ongoing COVID-19 outbreaks, developing emergency communications plans including a forum for answering workers’ concerns, providing workers with up-to-date education and training on COVID-19 risk factors and protective behaviors, training workers who need to use protecting clothing and equipment how to use it, providing resources and a work environment that promotes personal hygiene, requiring regular hand washing, limiting customers' and the public's access to the worksite, and posting signage about hand washing and other COVID-19 protective measures. [10] :13–14,21–22

Depending on the work task, workers with at least medium exposure risk may need to wear personal protective equipment including some combination of gloves, a gown, a face shield or face mask, or goggles. Workers in this risk group rarely require use of respirators. [10] :22

Food service and processing

For retail workers in food and grocery businesses, CDC and OSHA recommend specific COVID-19 hazard controls above the general workplace practices. For employees, these include encouraging touchless payment options and minimizing handling of cash and credit cards, placing cash on the counter rather than passing it directly by hand, and routinely disinfecting frequently touched surfaces such as workstations, cash registers, payment terminals, door handles, tables, and countertops. Employers may place sneeze guards with a pass-through opening at the bottom of the barrier in checkout and customer service locations, use every other check-out lane, move the electronic payment terminal farther from the cashier, place visual cues such as floor decals to indicate where customers should stand during check out, provide remote shopping alternatives, and limit the maximum customer capacity at the door. [20]

An infographic on ways to control COVID-19 hazards in meat processing facilities How to align meatpacking and meat processing workstations (English).png
An infographic on ways to control COVID-19 hazards in meat processing facilities

Meat and poultry processing facilities are considered critical infrastructure workers, and CDC advises that they may be permitted to continue work following potential exposure to COVID-19, provided they remain asymptomatic and additional precautions are implemented to protect them and the community. However, their work environments may contribute substantially to their potential exposures, as they often work close to one another on processing lines during prolonged work shifts. For engineering controls, CDC and OSHA recommend configuring communal work environments so that workers are spaced at least six feet apart including along processing lines, using physical barriers such as strip curtains or plexiglass to separate workers from each other, and ensuring adequate ventilation that minimizes air from fans blowing from one worker directly at another worker. For administrative controls, they recommend staggering workers' arrival, break, and departure times, cohorting workers so they are always assigned to the same shifts with the same coworkers, encouraging single-file movement through the facility, avoiding carpooling to and from work, and considering a program of screening workers before entry into the workplace and setting criteria for return to work of recovered workers and for exclusion of sick workers. For personal protective equipment, they recommend face shields and considering allowing voluntary use of filtering facepiece respirators such as N95 masks. They also recommend wearing cloth face masks that should be replaced if they become wet, soiled, or otherwise visibly contaminated during the work shift, although cloth face masks are not considered to be personal protective equipment. [5]

Transportation

If a person becomes sick on an airplane, proper controls to protect workers and other passengers include separating the sick person from others by a distance of 6 feet, designating one crew member to serve the sick person, and offering a face mask to the sick person or asking the sick person to cover their mouth and nose with tissues when coughing or sneezing. Cabin crew should wear disposable medical gloves when tending to a sick traveler or touching body fluids or potentially contaminated surfaces, and possibly additional personal protective equipment if the sick traveler has fever, persistent cough, or difficulty breathing. Gloves and other disposable items should be disposed of in a biohazard bag, and contaminated surfaces should be cleaned and disinfected afterwards. [21]

For commercial shipping, including cruise ships and other passenger vessels, hazard controls include postponing travel when sick, and self-isolating and informing the onboard medical center immediately if one develops a fever or other symptoms while on board. Ideally, medical follow-up should occur in the isolated person's cabin. [22]

Other sectors

For schools and childcare facilities, CDC recommends short-term closure to clean or disinfect if an infected person has been in a school building regardless of community spread. When there is minimal to moderate community transmission, social distancing strategies can be implemented such as canceling field trips, assemblies, and other large gatherings such as physical education or choir classes or meals in a cafeteria, increasing the space between desks, staggering arrival and dismissal times, limiting nonessential visitors, and using a separate health office location for children with flu-like symptoms. When there is substantial transmission in the local community, in addition to social distancing strategies, extended school dismissals may be considered. [23]

For law enforcement personnel performing daily routine activities, the immediate health risk is considered low by CDC. Law enforcement officials who must make contact with individuals confirmed or suspected to have COVID-19 are recommended to follow the same guidelines as emergency medical technicians, including proper personal protective equipment. If close contact occurs during apprehension, workers should clean and disinfect their duty belt and gear prior to reuse using a household cleaning spray or wipe, and follow standard operating procedures for the containment and disposal of used PPE and for containing and laundering clothes. [24]

High-risk healthcare and mortuary workplaces

An infographic on the difference between surgical masks and N95 respirators Understanding the difference between surgical masks and N95 respirators.pdf
An infographic on the difference between surgical masks and N95 respirators

OSHA considers certain healthcare and mortuary workers to be at high or very high categories of exposure risk. High exposure risk jobs include healthcare delivery, support, laboratory, and medical transport workers who are exposed to known or suspected COVID-19 patients. These become very high exposure risk if workers perform aerosol-generating procedures on, or collect or handle specimens from, known or suspected COVID-19 patients. Aerosol-generating procedures include intubation, cough induction procedures, bronchoscopies, some dental procedures and exams, or invasive specimen collection. High exposure risk mortuary jobs include workers involved in preparing the bodies of people who had known or suspected cases of COVID-19 at the time of their death; these become very high exposure risk if they perform an autopsy. [10] :18–20

Additional engineering controls for these risk groups include isolation rooms for patients with known or suspected COVID-19, including when aerosol-generating procedures are performed. Specialized negative pressure ventilation may be appropriate in some healthcare and mortuary settings. Specimens should be handled with Biosafety Level 3 precautions. [10] :13,23–24 The World Health Organization (WHO) recommends that incoming patients be separated into distinct waiting areas depending on whether they are a suspected COVID-19 case. [25]

In addition to other PPE, OSHA recommends respirators for those who work within 6 feet of patients known to be, or suspected of being, infected with SARS-CoV-2, and those performing aerosol-generating procedures. In the United States, NIOSH-approved N95 filtering facepiece respirators or better must be used in the context of a comprehensive, written respiratory protection program that includes fit-testing, training, and medical exams. Other types of respirators can provide greater protection and improve worker comfort. [10] :14–16,25

The WHO does not recommend coveralls, as COVID-19 is a respiratory disease rather than being transmitted through bodily fluids. [25] [26] WHO recommends only a surgical mask for point-of-entry screening personnel. For those who are collecting respiratory specimens from, caring for, or transporting COVID-19 patients without any aerosol-generating procedures, WHO recommends a surgical mask, goggles, or face shield, gown, and gloves. If an aerosol-generating procedure is performed, the surgical mask is replaced with an N95 or FFP2 respirator. [25] Given that the global supply of PPE is insufficient, WHO recommends minimizing the need for PPE through telemedicine, physical barriers such as clear windows, allowing only those involved in direct care to enter a room with a COVID-19 patient, using only the PPE necessary for the specific task, continuing use of the same respirator without removing it while caring for multiple patients with the same diagnosis, monitoring and coordinating the PPE supply chain, and discouraging the use of masks for asymptomatic individuals. [26]

See also

SARS-CoV-2 (Wikimedia colors).svg   COVID-19portal

Related Research Articles

Personal protective equipment Equipment designed to help protect an individual from hazards

Personal protective equipment (PPE) is protective clothing, helmets, goggles, or other garments or equipment designed to protect the wearer's body from injury or infection. The hazards addressed by protective equipment include physical, electrical, heat, chemicals, biohazards, and airborne particulate matter. Protective equipment may be worn for job-related occupational safety and health purposes, as well as for sports and other recreational activities. Protective clothing is applied to traditional categories of clothing, and protective gear applies to items such as pads, guards, shields, or masks, and others. PPE suits can be similar in appearance to a cleanroom suit.

The Occupational Safety and Health Administration is a large regulatory agency of the United States Department of Labor that originally had federal visitorial powers to inspect and examine workplaces. Congress established the agency under the Occupational Safety and Health Act, which President Richard M. Nixon signed into law on December 29, 1970. OSHA's mission is to "assure safe and healthy working conditions for working men and women by setting and enforcing standards and by providing training, outreach, education and assistance". The agency is also charged with enforcing a variety of whistleblower statutes and regulations. OSHA's workplace safety inspections have been shown to reduce injury rates and injury costs without adverse effects to employment, sales, credit ratings, or firm survival.

A blood-borne disease is a disease that can be spread through contamination by blood and other body fluids. Blood can contain pathogens of various types, chief among which are microorganisms, like bacteria and parasites, and non-living infectious agents such as viruses. Three bloodborne pathogens in particular, all viruses, are cited as of primary concern to health workers by the CDC-NIOSH: HIV, hepatitis B (HVB), & hepatitis C (HVC).

Construction site safety is an aspect of construction-related activities concerned with protecting construction site workers and others from death, injury, disease or other health-related risks. Construction is an often hazardous, predominantly land-based activity where site workers may be exposed to various risks. Site risks can include working at height, moving machinery and materials, power tools and electrical equipment, hazardous substances, plus the effects of excessive noise, dust and vibration. The leading causes of construction site fatalities are falls, electrocutions, crush injuries, and caught-between injuries.

Chemical hazard Non-biological substance that has the potential to cause harm to life or health

A chemical hazard is a (non-biological) substance that has the potential to cause harm to life or health. Chemicals are widely used in the home and in many other places. Exposure to chemicals can cause acute or long-term detrimental health effects. There are many types of hazardous chemicals, including neurotoxins, immune agents, dermatologic agents, carcinogens, reproductive toxins, systemic toxins, asthmagens, pneumoconiotic agents, and sensitizers. In the workplace, exposure to chemical hazards is a type of occupational hazard. The use of protective personal equipment(PPE) may substantially reduce the risk of damage from contact with hazardous materials.

Occupational hazard Hazard experienced in the workplace

An occupational hazard is a hazard experienced in the workplace. Occupational hazards can encompass many types of hazards, including chemical hazards, biological hazards (biohazards), psychosocial hazards, and physical hazards. In the United States, the National Institute for Occupational Safety and Health (NIOSH) conduct workplace investigations and research addressing workplace health and safety hazards resulting in guidelines. The Occupational Safety and Health Administration (OSHA) establishes enforceable standards to prevent workplace injuries and illnesses. In the EU a similar role is taken by EU-OSHA.

Workplace health surveillance or occupational health surveillance (U.S.) is the ongoing systematic collection, analysis, and dissemination of exposure and health data on groups of workers. The Joint ILO/WHO Committee on Occupational Health at its 12th Session in 1995 defined an occupational health surveillance system as “a system which includes a functional capacity for data collection, analysis and dissemination linked to occupational health programmes”.

Isolation (health care) Measure taken to prevent contagious diseases from being spread

In health care facilities, isolation represents one of several measures that can be taken to implement in infection control: the prevention of communicable diseases from being transmitted from a patient to other patients, health care workers, and visitors, or from outsiders to a particular patient. Various forms of isolation exist, in some of which contact procedures are modified, and others in which the patient is kept away from all other people. In a system devised, and periodically revised, by the U.S. Centers for Disease Control and Prevention (CDC), various levels of patient isolation comprise application of one or more formally described "precaution".

An occupational fatality is a death that occurs while a person is at work or performing work related tasks. Occupational fatalities are also commonly called “occupational deaths” or “work-related deaths/fatalities” and can occur in any industry or occupation.

Physical hazard Hazard due to a physical agent

A physical hazard is an agent, factor or circumstance that can cause harm with contact. They can be classified as type of occupational hazard or environmental hazard. Physical hazards include ergonomic hazards, radiation, heat and cold stress, vibration hazards, and noise hazards. Engineering controls are often used to mitigate physical hazards.

Influenza prevention involves taking steps that one can use to decrease their chances of contracting flu viruses, such as the Pandemic H1N1/09 virus, responsible for the 2009 flu pandemic.

Occupational safety and health Field concerned with the safety, health and welfare of people at work

Occupational safety and health (OSH), also commonly referred to as occupational health and safety (OHS), occupational health, or occupational safety, is a multidisciplinary field concerned with the safety, health, and welfare of people at occupation. These terms also refer to the goals of this field, so their use in the sense of this article was originally an abbreviation of occupational safety and health program/department etc.

Occupational hearing loss

Occupational hearing loss (OHL) is hearing loss that occurs as a result of occupational hazards, such as excessive noise and ototoxic chemicals. Noise is a common workplace hazard, and recognized as the risk factor for noise-induced hearing loss and tinnitus, but it is not the only risk factor that can result in a work-related hearing loss. Also, noise-induced hearing loss can result from exposures that are not restricted to the occupational setting.

Occupational heat stress is the net load to which a worker is exposed from the combined contributions of metabolic heat, environmental factors, and clothing worn which results in an increase in heat storage in the body. Heat stress can result in heat-related illnesses, such as heat stroke, hyperthermia, heat exhaustion, heat cramps or heat rashes. Although heat exhaustion is less severe, hyperthermia is a medical emergency and requires emergency treatment, which if not provided can even lead to death.

Engineering controls are strategies designed to protect workers from hazardous conditions by placing a barrier between the worker and the hazard or by removing a hazardous substance through air ventilation. Engineering controls involve a physical change to the workplace itself, rather than relying on workers' behavior or requiring workers to wear protective clothing.

N95 respirator Particulate respirator meeting the N95 standard

An N95 filtering facepiece respirator, commonly abbreviated N95 respirator, is a particulate-filtering facepiece respirator that meets the U.S. National Institute for Occupational Safety and Health (NIOSH) N95 classification of air filtration, meaning that it filters at least 95% of airborne particles. This standard does not require that the respirator be resistant to oil; another standard, P95, adds that requirement. The N95 type is the most common particulate-filtering facepiece respirator. It is an example of a mechanical filter respirator, which provides protection against particulates but not against gases or vapors. An authentic N95 respirator is marked with the text "NIOSH" or the NIOSH logo, the filter class ("N95"), a "TC" approval number of the form XXX-XXXX, the approval number must be listed on the NIOSH Certified Equipment List (CEL) or the NIOSH Trusted-Source page, and it must have headbands instead of ear loops.

Cloth face mask mask made of common textiles worn over the mouth and nose

A cloth face mask is a mask made of common textiles, usually cotton, worn over the mouth and nose. When more effective masks are not available, and when physical distancing is impossible, cloth face masks are recommended by public health agencies for disease "source control" in epidemic situations to protect others from virus laden droplets in infected mask wearers' breath, coughs, and sneezes. Because they are less effective than N95 masks, surgical masks, or physical distancing in protecting the wearer against viruses, they are not considered to be personal protective equipment by public health agencies. They are used by the general public in household and community settings as protection against both infectious diseases and particulate air pollution.

Face masks during the COVID-19 pandemic Health control procedure against COVID-19

During the COVID-19 pandemic, face masks, such as surgical masks and cloth masks, have been employed as a public and personal health control measure against the spread of SARS-CoV-2. In both community and healthcare settings, their use is intended as source control to limit transmission of the virus and personal protection to prevent infection. Their function for source control is emphasized in community settings.

Source control (respiratory disease) Strategy for reducing disease transmission

Source control is a strategy for reducing disease transmission by blocking respiratory secretions produced through speaking, coughing, sneezing or singing. Surgical masks are commonly used for this purpose, with cloth face masks recommended for use by the public only in epidemic situations when there are shortages of surgical masks. In addition, respiratory etiquette such as covering the mouth and nose with a tissue when coughing can be considered source control. In diseases transmitted by droplets or aerosols, understanding air flow, particle and aerosol transport may lead to rational infrastructural source control measures that minimize exposure of susceptible persons.

Elastomeric respirator Respirator with a rubber face seal

Elastomeric respirators, also called reusable air-purifying respirators, are a type of respirator that seals to the face using a mask made of an elastomeric material, which may be a natural or synthetic rubber. They are generally reusable. Full-face versions of elastomeric respirators seal better and protect the eyes.

References

PD-icon.svg This article incorporates  public domain material from websites or documents ofthe Occupational Safety and Health Administration . PD-icon.svg This article incorporates  public domain material from websites or documents ofthe Centers for Disease Control and Prevention .

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