Protecting Workers from Infectious Disease

In the wake of the recent Ebola scare in the United States, employers may want to assess their infection control programs to ensure workers’ health and stay compliant with safety regulations.

“Rest assured, the vast majority of people will never come into contact with [Ebola], but the concern engendered by the news is a good reminder that there are many other common infectious diseases prevalent throughout our country and the world,” said Langdon Dement, an environmental health and safety advisor with UL Workplace Health & Safety. More-common diseases such as influenza, pertussis (whooping cough), tuberculosis, various strains of hepatitis, rhinovirus and norovirus affect millions of people every year and could spread throughout an organization in a relatively short time, he said.

Transmission

Understanding the modes of transmission enables employers and employees to better understand how to prevent the spread of infections. According to the Occupational Safety and Health Administration (OSHA), the primary routes through which infectious diseases travel in the workplace are contact (direct and indirect), droplet and airborne. Direct contact involves the infectious agent being transmitted person-to-person, whereas indirect contact occurs when the infectious agent is transferred to an object or surface, which is then touched by an employee. Droplet-borne transmission occurs when infectious agents are released when a person coughs, sneezes or talks, and then those droplets come into direct contact with the eyes, nose or mouth of another susceptible individual. Airborne transmission occurs when aerosolized particles that contain infectious agents are inhaled.

OSHA was in the incipient stages of a rulemaking on infectious diseases before Ebola made landfall in the U.S. in October, but don’t expect to see that rule for some time, according to experts.

“This is not a speedy process,” said Eric Conn, founding partner of Conn Maciel Carey and chair of the firm’s national OSHA Workplace Safety Practice Group. “But the process is likely to be informed by what we saw with the Ebola outbreak in Dallas and other parts of the country.”

In the meantime, OSHA currently has a bevy of standards that are implicated by worker exposure to infectious diseases, Conn said.

Protecting Against Bloodborne Pathogens

Exposure to infectious blood and other bodily fluids represents a major area of contagious disease risk for employers and occurs across a wide variety of occupations.

Bloodborne pathogens are infectious micro-organisms in human blood that can cause disease. These pathogens include, but are not limited to, hepatitis B, hepatitis C and human immunodeficiency virus (HIV). Needlesticks and other sharps-related injuries may expose workers to these hazards.

OSHA’s bloodborne pathogen standard imposes a range of requirements on employers whose workers can be reasonably anticipated to come into contact with blood or other potentially infectious materials. “It is a performance-based standard, so employers can implement the practices and control measures that best suit their workplace,” said Mike Pannell, a senior industrial hygienist at OSHA. “OSHA’s bloodborne pathogens standard prevents an estimated 200 fatalities and 9,000 disease exposures each year,” he added. While hospitals account for 75 percent of exposures, 11 other industries, including nursing homes and residential care facilities, continue to have a substantial number of exposures, according to OSHA.

“The standard doesn’t just apply to health care workers, but any employer where there is reasonable foreseeable exposures,” stressed Conn. For example, emergency response and public safety personnel, schools, hotel housekeeping, airlines and janitorial services must be aware of the rules.

OSHA requires employers to implement an exposure control plan for their worksite with details on worker protection measures. The plan must describe how an employer will use a combination of engineering and work practice controls, ensure the use of personal protective clothing and equipment, provide training, conduct medical surveillance, administer hepatitis B vaccinations, and post hazard signs and labels, among other provisions.

“Where engineering solutions exist to eliminate or minimize a hazard, they must be used,” said Pannell. Engineering controls include using safer medical instruments, such as needleless devices, shielded needle devices, and alternate cutting methods like electrosurgery and cautery.

Employers must also offer medical evaluations, blood tests and follow-up evaluations after any worker is exposed to blood or other infectious materials. The standard contains many other nuanced requirements, including the careful documentation of compliance measures.

OSHA also encourages “universal precautions,” that is, treating all bodily fluids as if infectious, regardless of the health of the patient, said Conn.

Exposure Control Plan Key to Safety, Compliance

Pannell characterized the requirement to implement, maintain and update an exposure control plan as the biggest obstacle for employers. From 2001-2011, the most frequently cited bloodborne pathogen standard citations were the failure to have an exposure control plan, followed by the failure to update it annually, he said.

“The exposure control plan is so significant. It’s the key requirement because the employer is required to make an exposure determination,” said Sheila Arbury, a health scientist at OSHA. The exposure determination identifies job classifications, tasks and procedures with occupational exposure.

Exposure control plans must be written, and specific to your workplace, because OSHA will ask to see it during an inspection, said Arbury. OSHA publication 3186, which provides a model plan, will help you write it, she offered.

Employers should continually evaluate engineering controls to reduce the potential for exposure, like using retractable needle technologies or blunted devices, and document those evaluations, said Pannell.

If an employer is required to maintain the OSHA 300 log of occupational injuries and illnesses, it must also establish and maintain a sharps injury log for recording injuries from contaminated sharps. The sharps injury log must contain, at a minimum, the type and brand of device involved in the injury (if known), the department or work area where the exposure incident occurred, and an explanation of how the incident occurred. Employee confidentiality is a critical component of this recordkeeping, and the log must be recorded and maintained in a manner that removes all personal identifiers.

An exposure control plan must be reviewed and updated at least annually, and also whenever necessary to reflect new or modified tasks and procedures which affect occupational exposure and to reflect new or revised employee positions with exposure.

All employees at risk of exposure need to be trained on compliance with the standard before their assignment begins and at least annually thereafter, said Arbury. Additional training is required if procedures or tasks that affect exposure to workers change. It also needs to be in a language and at the level for all employees to understand, and it must be interactive, she said. “The training cannot just be online. OSHA is insistent about this.”

Training records need to be kept for three years, and medical records kept for the duration of employment plus 30 years, said Arbury.

OSHA will determine compliance with the bloodborne pathogens standard through review of employers’ injury and sharps logs, exposure control plan, and interviews with employees.

PPE, Respiratory Protection

Beyond the bloodborne pathogens standard, OSHA reminds employers that precautions for contact-transmissible diseases and aerosolized infectious agents must comply with OSHA’s respiratory protection standard if respirators are used on the job and personal protective equipment (PPE) standard wherever PPE is used.

PPE is worn to minimize the possibility of serious workplace injuries and illnesses and may include items such as gloves, safety glasses and shoes, earplugs or muffs, hard hats, respirators, coveralls, vests and full body suits.

If PPE is used, a PPE program must be implemented, according to OSHA. This program requires employers to:

• Evaluate the workplace with a hazard assessment, and identify any PPE that may be needed to safeguard workers from hazards.
• Select, maintain, store and care for the PPE. “Appropriate PPE must fit employees of all sizes, and employers are responsible for making sure that PPE is clean, maintained and used by workers, which can be difficult at times,” said Arbury.
• Train each worker on when to use PPE, what type is necessary, and how to don, doff, adjust, maintain, care for, store and dispose of it. Workers also need to know the limitations of their PPE, said Conn. “Employees may think a certain glove or dust mask may be sufficient to address a hazard, but there are limitations for each PPE, and you must communicate the limitations, to make sure they understand they’re not protected from all hazards,” said Conn.
• Monitor the effectiveness of the program. This includes evaluating the useful life of any PPE.

OSHA’s respiratory protection standard requires employers to identify airborne hazards, including aerosolized infectious diseases, and implement a program if it is reasonably foreseeable that airborne hazards may exist.

According to OSHA’s respiratory protection standard, employers must provide:

• Appropriate respirators.
• Procedures for use, donning, doffing, storage, cleaning and maintenance.
• Training, fit-testing (creating an effective seal), and medical evaluations to ensure that employees are medically able to wear a respirator.

OSHA and the National Institute for Occupational Safety and Health (NIOSH) recommend the N-95 filtering face-piece particulate respirator or “dust mask” to protect against infectious agents, said Conn. Particulate respirators are the simplest, least expensive and least protective of the respirator types available. These respirators clean particles out of the air as you breathe but do not protect against chemicals, gases or vapors, and are intended only for low hazard levels. They’re usually disposable and must be replaced when they become discolored, damaged or clogged.

A key issue for non-health care employers is when employees request to wear a respirator voluntarily. “Employers think if employees want to wear it, go right ahead, I’ve got no responsibilities here,” said Conn. “That’s not true. If you allow workers to wear a respirator voluntarily, you must comply with certain regulations.”

According to OSHA, if employees want to voluntarily use simple filtering dust masks like the N-95 respirator, employers must determine that such use will not in itself create a hazard and provide users with the information contained in 29 CFR 1910.134 Appendix D.

If workers are allowed to voluntarily use more-robust respirators, employers must establish and implement the elements of a written respiratory protection program necessary to ensure that employees are medically evaluated for respirator use, and that the respirator is cleaned, stored and maintained so that it is not hazardous to the user.



Prevention and Control

Finally, OSHA may issue citations against employers under the general duty clause of the Occupational Safety and Health Act, the catchall provision which is used if no other regulation applies when an employer allegedly fails to keep its workplace free of recognized hazards. “OSHA will often point to consensus guidance documents and enforce them as though it was the law, through the general duty clause,” warned Conn. “Pay attention to notices and guidance from NIOSH, the Centers for Disease Control and Prevention, and the World Health Organization. OSHA may point to them and say that even though it’s not required by any standard, the [hazard and prevention] was well recognized, everyone knew about it, you should have known about it, and therefore it’s a violation of the general duty clause.”

In addition to complying with these regulations, businesses need to reinforce the importance of sick employees staying home to further prevent spreading infections, said Dement. Companies have the ability to protect their employees through education, allowance for sick days and vaccination programs, he said.

“With an effective infection control plan in place, including steps such as fundamental principles, education and training, surveillance, standard precautions, and [complying with OSHA’s standards], businesses can be assured that their employees are better guarded and they have greatly reduced the possibility of further infections.”

Roy Maurer is an online editor/manager for SHRM.

Follow him @SHRMRoy​