Respiratory Infectious Diseases / COVID-19 – Tips

The first element is the act of identifying and assessing the risk of infection in a setting. Once identified, proper controls can be applied to minimize the risk. Trained and experienced workers are better able to identify and assess high risk work activities. Assessments should involve the health and safety committee or representative, workers and supervisors. Workers can also continually assess work processes and procedures by asking themselves:

• Is this a high-touch surface or a potential source of an infectious agent?
• Is this job task high risk (e.g., cleaning up blood or spit, assisting a co-worker or client who is ill)?
• Is there a potential for exposure to hazardous products or chemicals (e.g., bleach)? Or infectious agents? (e.g., handshaking, caring for a sick person, tattooing)?
• Are people around me showing signs of illness?
• Are the proper control measures in place to perform the task safely?

Risk of infection is often based on the tasks workers are performing and local community disease outbreak conditions. Job task risks can be categorized as:

• Low risk
  • Working alone or in a physically distanced cohort
  • Little or no interaction with others
  • Well-ventilated workspace
  • Setting has many layered occupational health and safety controls and public health measures in place
  • High vaccination uptake for common diseases in the community and workplace
• High risk
  • Interaction with people who are ill or infected (e.g., COVID-19, flu, or hepatitis)
  • Frequent contact with many people
  • Poorly ventilated workspace
  • Crowded workspaces and working closely to others
  • Setting has no layered occupational health and safety controls and public health measures in place
  • Low vaccination uptake for common diseases in the community

A COVID-19-specific assessment tool is available from the Public Health Agency of Canada.

Good hand hygiene is considered by public health experts to be the most important and effective IPC measure to prevent the spread of diseases. Many diseases are spread by hand contact with contaminated surfaces followed by the touching of eyes, mouth, or nose with unwashed hands. Common contaminated surfaces include:

• Handles (e.g., doorknobs, handrails, tools, or equipment)
• Controls (e.g., buttons, levers, or switches)
• Other people (e.g., handshakes, caring for others, performing personal services)

The risk of disease transmission is lowered when all people in a setting, including workers and visitors, perform effective hand hygiene.

Effective hand hygiene includes following the proper procedures at the correct times, such as:

• Following personal hygiene activities (e.g., after using the bathroom, after coughing or sneezing into your hand)
• After handling waste (e.g., used tissues, waste collection and removal)
• Before and after smoking, taking oral medication, eating, and drinking
• Before putting on and after removing gloves
• After contact with blood or other body fluids, mucous membranes, or non-intact skin
• Before and after using high-touch or contaminated equipment, instruments, or surfaces
• Before and after touching your mask

Two methods for hand hygiene:

• Water and soap (preferably liquid or foam soap)
  • Provides very thorough cleaning
  • Effective at removing germs and dirt if performed for at least 20 seconds
  • Preferred method if hands are contaminated or visibly soiled
• Alcohol-based hand rub (ABHR)
  • Must have at least 60% alcohol content
  • Convenient
  • Portable
  • Dispensers can be installed wherever needed
  • Preferred for certain settings

Many infectious diseases spread from person-to-person by respiratory droplets and airborne particles. When diseases are prevalent in a community, workplaces should emphasize good respiratory etiquette. When people in a setting have good respiratory etiquette, the risk of disease spread is lowered. Respiratory etiquette involves:

• Covering up sneezes and coughs with tissue or elbow to avoid releasing germs into the air.
• Properly disposing of tissues after each use, preferably in a no-touch plastic lined waste container.
• Providing masks to individuals who are coughing or sneezing.

Control of the environment includes the physical or mechanical measures that are built into a setting such as barriers or ventilation. Ensuring optimal ventilation can help reduce the concentration of potentially infectious droplets or aerosols in the air. This can be achieved by natural ventilation (opening windows or doors) or through mechanical ventilation (e.g., Heating, Ventilation, and Air Conditioning systems).

Cleaning and disinfecting of environmental surfaces or specific tools and equipment is another form of control. Some germs can survive on surfaces for minutes to days, allowing them to spread from person-to-person. To prevent the spread of disease, clean and disinfect all high-touch surfaces (e.g., handles, switches, and controls) on a routine schedule, when visibly soiled or obviously contaminated. Perform additional cleaning and disinfection, when required. The number of times a surface should be cleaned depends on how often it is touched as well as by how many different people touch it.

It is also important to make sure that work activities are conducted in environments appropriate for the task. For example, a home-based hairdresser should not provide services in a room that is also used for cooking or eating.

When IPC practices are properly implemented and followed, a workplace can prevent or dramatically reduce the spread of diseases.

Workplace policies where IPC practices apply:

• Worker immunization
• Workplace wellness
• Workplace cleaning and disinfection
• Worker and visitor screening
• Worker and visitor illness
• Worker hygiene
• Other applicable occupational health and safety policies

For infection prevention and control practices to be effective, workers should be trained on:

• Good hand hygiene and respiratory etiquette
• The proper use and care of equipment (e.g., personal protective equipment, air purifiers)
• What to do if they or someone in the setting shows symptoms of illness
• Workplace orientation for new workers and refresher for existing workers

Other important factors necessary to maintain effective IPC:

• Review and adjust the IPC practices as needed and in response to local disease conditions.
• Review worker adherence to IPC policies, practices, and procedures. Retrain workers if necessary.
• Isolate people who are ill from healthy people.
• Implement systems to maintain adequate supplies of hand sanitizer, soap, and personal protective equipment.
• Post IPC educational materials prominently for workers and visitors.
• Make sure supervisors are trained and competent on IPC.

Infection prevention and control practices work best in settings where employers have a high degree of control (e.g., indoor facility, office, retail). These principles are more challenging to implement for employers of mobile workforces (e.g., police or service technicians) who have little control over the work settings. Consider focusing worker training on personal preventative practices and communication techniques to make sure clients understand company health measure.

Employers should assess the risk that diseases pose to their workers before implementing personal protective equipment (PPE) requirements. All PPE must be worn, handled, and disposed of properly to avoid self-contamination. PPE should only be used where appropriate and by workers who are properly trained and fit tested as required. The most common PPE used in IPC programs are:

• Eye protection (safety glasses, goggles, or face shields): physical barrier that prevents germs from entering the body through the moist membranes of the eyes, nose, and mouth.
• Medical masks: barrier to help prevent the spread of large respiratory droplets and spit.
• Respirators (e.g., N95): filter most germs from the air while breathing. Wearers should be medically able to use respirators and fit tested to make sure the respirator has a good seal.
• Gloves: made of materials that germs cannot penetrate. Best used for high risk activities and must be used in conjunction with hand hygiene.
• Gowns: made of materials that germs cannot penetrate. Often used when contact with infectious material is expected.

When renovating or designing new workspaces consider the following design elements to minimize the spread of disease:

• Floor and furniture surfaces that are easy to clean and do not degrade when frequently exposed to cleaning products.
• Choosing antibacterial surface materials for high-touch surfaces (e.g., zinc or copper alloys).
• Installing hand sanitizer dispensers in key locations such as building entrances, reception, food consumption areas, outside elevators.
• Reducing the number of high-touch points (e.g., washroom entrances without doors, motion activated faucets).
• Installing ventilation equipment with high air exchange rate and optimizing air flow patterns (i.e., not directing airflow from person-to-person).
• Installing in-ventilation or upper-room Ultraviolet Germicidal Irradiation (UVGI) units.

• Prevents or minimizes the spread and outbreak of diseases
• Preserves the health of workers, visitors, participants, and their families
• Reduces the risk of business slowdown or closure due to absenteeism or public health order
• Boosts company reputation
• Saves labour costs

• Requires organization leaders to monitor their workforce and community disease rates closely.
• May create tension with workforce, visitors, or participants who do not want to follow the routine practices.
• May increase operating costs for training, supplies and equipment.

In the event of an infectious disease outbreak, follow the advice of your local public health authority and occupational health and safety regulator, and adjust your workplace plans and procedures accordingly.