1

2

Pandemic Influenza: Workplace Exposure Risks & Prevention

Name

Event

Date

3

What This Presentation Will Cover

• The current status of the 2009 H1N1 Influenza Pandemic• The potential impact of an influenza pandemic on

workers, the community, and businesses• What OSHA expects that employers will do to plan for

worker safety and health during a pandemic– Assess the exposure risk of their workers– Take steps to reduce the risk– Communicate with workers– Train for workers

• Resources to support preparedness planning and keep plans up to date

4

PanFlu: It’s Not New

5

• Emergence of a novel influenza A virus

• People have little, if any, immunity

• Vaccine is not available• Usually causes disease

more serious than seasonal flu

• Passes readily and sustainably from human-to-human

• 2-3 waves of disease each up to 12 weeks, over a 12- 18 month period

• At risk populations may differ from seasonal influenza

Characteristics of an “Influenza Pandemic”

Can vary in severity from mild to very severe – the 1918 Influenza Pandemic resulted in 675,000 or more deaths in the U.S.

6

What Is It?

• A worldwide outbreak of influenza caused by the 2009 H1N1 virus.

• Virus comprised of novel combination of genetic elements from swine, bird, and human influenza viruses

What Happened?

• April 15, 2009 - First cases reported in Mexico

• June 11, 2009 - WHO elevated 2009 H1N1 influenza to pandemic status

• August 30, 2009 – Cases in 184 countries and territories

The 2009 H1N1 Influenza Pandemic

7

Data as of August 30, 2009*

• Confirmed cases in U.S. in all states and territories

• Hospitalized cases in U.S.: 9,079

• Deaths in U.S.: 593

• Basic symptoms similar to seasonal influenza

• Mild, short duration, acute upper respiratory illness

• Recovery aided by current anti-viral medications

• Deaths worldwide: ≥ 2,837

Concerns: Could be the first of a 2-3 waves Virus could mutate or reassort

with other viruses to become more virulent

Development and testing of new vaccine will take up to 4-6 months

Disease currently mild, could become more severe

H1N1 (continued)

*Sources: CDC updates and WHO updates

8

Why the WHO Declared the 2009 H1N1 Influenza as a “Pandemic”

• Pandemic: Human-to-human transmission causing sustained community level outbreaks of illness in ≥ 2 countries in 1 WHO region plus ≥ 1 country in another WHO region

• WHO declared a Pandemic on June 11, 2009 because of sustained outbreaks in North America (one WHO region) and South America (another WHO region)

• NOT BASED on the SEVERITY of the ILLNESS

9

• Thought to be spread primarily by relatively large droplets traveling less than 6 feet (droplet transmission).

• Touching contaminated objects can also be a factor (fomite transmission).

• May also be spread via very small particles traveling across longer distances (airborne/aerosol transmission).

How Does Influenza Spread?

Contact of infectious material with nose, mouth, and eyes

10

Impact on Employees

• Symptoms of 2009 H1N1 influenza may include– Fever– Chills– Headache– Upper respiratory symptoms

(cough, sore throat, runny nose, shortness of breath)– Muscle and joint pain– Fatigue– Vomiting – Diarrhea

• As of August 30, 593 persons have died in the U.S.

11

Impact on the Community

Potential Impact of an Influenza Pandemic in the United Potential Impact of an Influenza Pandemic in the United StatesStates

(Estimates based on U.S. population of 300,000,000; infection rate of 30%)

CHARACTERISTICMODERATE (1958/68-like)

SEVERE (1918-like)

Illness 90 million 90 million

Outpatient Medical Care

45 million (50%) 45 million (50%)

Hospitalization 865,000 (~1%) 9,900,000 (~11%)

ICU care 128,750 1,485,000

Mechanical ventilation 64,875 745,500

Deaths 209,000 (~0.23%) 1,903,000 (~2.1%)Numbers in parentheses = Percentages of ill persons

12

In 2006:

• Just over 947,000 beds in all U.S. hospitals

• ~ 69% occupancy rate without a pandemic

Source: DHHS, CDC, National Center for Health Statistics Health, United States, 2008. Table 116

www.cdc.gov/nchs/hus.htm

Hospital Capacity Dilemma

13

Impact on Businesses

• Absenteeism – up to 40% of workers affected– Sick workers– Caring for sick family members– Child care problems– Afraid to come to work

• Changes in Patterns of Commerce– Increased demand for some goods/services– Decreased demand for other goods/services– Increased demand for home delivery, drive-through windows, expanded

hours • Interrupted Supply/Delivery Chain

How a Severe Pandemic Could Affect Workplaces:

14

Who Should Plan for a Pandemic?

• All business and organizations should develop a plan for dealing with pandemic influenza NOW

• Lack of planning can result in a cascade of failure as employers attempt to address the challenges of a pandemic when it reaches their community

• Critical infrastructure/key resource (CI/KR) industries have a special responsibility to plan for a pandemic

15

OSHA’s Focus

To Reduce the Pandemic Influenza Exposure Risk in Workplaces

• What OSHA expects that employers will do– Include worker safety and health in pandemic

influenza planning– Perform task-/activity-based exposure risk

assessments– Use exposure control methods appropriate for the

work tasks and levels of risk– Communicate with workers about the risks and plans– Train workers on the steps being taken to lessen the

impact of the influenza outbreaks– Keep up-to-date on changes in the severity of the

pandemic in order to modify the plan as needed

16

OSHA’s Occupational Risk Pyramid for Pandemic Influenza

Basic considerations • Evaluate the tasks and

activities performed by workers and determine the exposure risk level associated with the tasks– This assessment permits

the tasks to be categorized into the four levels of the pyramid

17

Which Workers Are at Higher Exposure Risk?

• Those whose job tasks or activities require them to be within 6 feet of sources of the pandemic virus (exposure risk proximity)

• Those whose job tasks or activities require them to have frequent or prolonged exposures to sources of the pandemic virus (exposure risk frequency and duration)

18

Occupational Risk Pyramid

Exposure Risk

Nature of Job Tasks or Activities

Very HighThose with high potential exposure to high concentrations of confirmed, probable, or suspected sources of pandemic influenza virus during specific medical or laboratory procedures

HighThose with high potential for frequent, close contact* with confirmed, probable, or suspected pandemic patients

Medium

Those that require frequent, close contact with co-workers and the general public (school children, high population density work environments, and some high volume retail)

LowerThose that have minimal close contact with co-workers and the general public

“Guidance on Preparing Workplaces for an Influenza Pandemic,” U.S. Department of Labor, Occupational Safety and Health Administration, OSHA 3327-05R, 2009.

* Close contact = within 6 feet

19

Occupational Risk Pyramid

Exposure Risk

Examples of Job Tasks or Activities (workers involved)

Very High

• Performing aerosol-generating procedures for confirmed, probable, or suspected pandemic patients (healthcare employees)

• Collecting or handling specimens from confirmed, probable, or suspected pandemic patients (laboratory healthcare personnel)

High

• Working with confirmed, probable, or suspected pandemic patients (healthcare delivery and support staff)

• Transporting confirmed, probable, or suspected pandemic patients in enclosed vehicles (Emergency Medical Technicians—EMTs)

• Performing autopsies on confirmed, probable, or suspected pandemic patients (medical examiners)

Medium• Classroom instruction (teachers), bank teller operations (bank

tellers), work in high population density work environments (call centers), and some high volume retail work (cashiers)

Lower• General office work that does not require frequent close contact,

within 6 feet, with coworkers or the general public (office employees)“Guidance on Preparing Workplaces for an Influenza Pandemic,” U.S. Department of Labor, Occupational Safety and Health Administration, OSHA 3327-05R, 2009.

20

Steps Every Employer Can Take

• Get the seasonal flu vaccine and when available, get the pandemic flu vaccine

• If sick, stay home

• Frequently wash hands with soap and water or, if not available, use alcohol-based hand sanitizer

• Follow good “cough etiquette”

Encourage workers to do the following:

21

Steps Every Employer Can Take continued

• Plan for and use social distancing to limit close contact with co-workers and the public

• Provide customers and the public with hand washing facilities, tissues, and no-touch trash receptacles

• Keep work surfaces, telephones, computers, and other equipment clean

• Discourage use of other workers’ equipment• Minimize informal gatherings and group meetings

by using telephone conferences and e-mail

22

Steps Every Employer Can Take continued

• Reduce or eliminate workplace visits by the public or family members to the extent possible

• Promote healthy lifestyles to improve your workers’ immune systems: good nutrition, stress reduction, adequate rest, exercise

• Evaluate your workplace and your workers’ job tasks or activities to determine their exposure risk level and whether other controls are needed– Engineering and Work Practice controls– Administrative controls– Personal protective equipment

23

Engineering and Work Practice Control Examples

• Providing resources and a work environment that promotes personal hygiene and encourages workers to clean their work surfaces

• Encouraging workers to obtain seasonal influenza vaccine and the 2009 H1N1 influenza vaccine, when available

• Developing policies to minimize contacts between workers and between workers and clients or customers

• Installing physical barriers (e.g., clear plastic sneeze guards)

• Installing a drive-through window for customer service

• In some limited healthcare settings, for aerosol-generating procedures, specialized negative pressure ventilation

may be indicated

24

Administrative Control Examples

• Implementing policies that encourage ill workers to stay at home without fear of any reprisals

• Discontinuing nonessential travel to locations with high illness trans-mission rates

• Minimizing face-to-face contact between workers using e-mail, websites and teleconferences

• Allowing flexible work arrangements such as telecommuting or flexible work hours to reduce the number of workers who must be at work at one time or in one specific location

• Offering home delivery of goods and services to reduce the number of clients or customers who must visit your workplace

• Developing emergency communications plans. Maintaining a forum for answering workers' concerns. Developing internet-based communications if feasible

25

PPE must be:

• Selected based upon the hazard to the worker

• Of proper size and fit. Respirators must be fit tested initially and periodically (at least annually)

• Conscientiously & properly worn• Regularly maintained and

replaced, as necessary• Properly removed and disposed

of to avoid contamination of self, others or the environment

PPE examples:

• Gloves• Goggles• Faceshields• Facemasks (e.g.,

surgical masks)• Respirators (e.g., N95

filtering facepieces)

Personal Protective Equipment (PPE)

26

When selecting PPE, employers will also consider factors such as function, fit, ability to be decontaminated, disposal, and cost

PPE Selection Guidelines

• Each employer should select the combination of PPE that protects workers against the exposure hazards they encounter when performing their job tasks

• When a piece of PPE is intended for repeated use over an extended time period, a more expensive and durable piece of PPE may be less expensive in the long run than a disposable piece of PPE (e.g., elastomeric vs. filtering facepiece respirators or face shields vs. surgical masks)

• Wearing PPE may be physically burdensome to workers, particularly when the use of PPE is not common practice for the work task

27

And a Little Bit About Respirators

Facemasks or Respirators Not Recommended

Occupational Risk Pyramid for Pandemic Influenza

Facemasks Recommended

Respirators Recommended

Respirators Recommended;Consider higher level respirator (e.g., PAPR)

28

• Designed to reduce worker’s exposure to small airborne contaminants

• Both disposable and reusable respirators are available

• Certified by NIOSH

Respirators

29

• Not tight fitting• Worn by healthcare workers to:

− Prevent contamination of patient’s wounds;

− Provide a physical barrier to protect against splashes of large droplets of blood or bodily fluids; and

− Protect against droplet transmission of an infectious disease, but not airborne transmission.

• Placed on sick people to limit the spread of disease

• Cleared by FDA

Facemasks (e.g., surgical masks)

30

Health Care Particulate Respirator and Surgical Mask

“NIOSH” Manufacturer’s name

and part number An abbreviation to

indicate filter type (e.g., N95, P100, etc.)

Surgical N95 Respirator

31

• N95 respirators are recommended for performing High and Very High exposure risk tasks or activities– Consider use of respirators with a higher level of protection

(e.g., PAPRs) for aerosol-generating procedures

• If supplies of N95 respirators are limited:– Prioritize use by highest exposure risk– Consider reusable powered air-purifying respirators

(PAPRs), or elastomeric respirators

Respiratory Protection Guidelines

Remember: If employees are required to use respirators, a full written respiratory protection program in compliance with 29 CFR 1910.134 must be implemented.

32

Communicate with Employees

• Communication with employees is essential to the success of the plan– Consult with employees when assessing the levels of

exposure risk– Acknowledge the health risks and explain plans for

controlling/lessening the risks– Explain workplace policies regarding sick leave, flexible

work arrangements, and other policies and how these will impact the risk of exposure

– Solicit, acknowledge, and respond to employees’ concerns in order to increase their feelings of ownership and “buy-in” to the plan

– Develop a plan for emergency communications

33

Train Employees

• Appropriate training can be a part of the employer’s overall risk communication strategy

• Training for an emergency such as an influenza pandemic should include:– Hazards– Health effects– Anticipated exposures– Control measures

34

Resources Available: OSHA Print Publications

Both are also available online at www.osha.gov

OSHA 3327 2009 OSHA 3328 2009

35

“In Focus” section:• Pandemic Influenza

page• Resources (e.g. Fact

Sheets, QuickCards®,) are available in HTML or PDF formats as well as English or Spanish versions

• e-Tool: Coming soon!

Online at: www.osha.gov

36

• Managed by the Department of Health and Human Services;

• Tag line reads: One-stop access to U.S. Government H1N1, avian and pandemic flu information.

Online at: www.flu.gov

37

• The home page links you to comprehensive coverage of the global situation for H1N1

– Guidance documents

– Frequently asked questions

– Situation updates– Regional

information

Online at: www.who.int

38

Other Online Resources

• Centers for Disease Control and Prevention (CDC):

www.cdc.gov• National Institute for Occupational Safety and

Health (NIOSH):

www.cdc.gov/niosh/topics/h1n1flu/• Food and Drug Administration (FDA):

www.fda.gov/cdrh/ppe/fluoutbreaks.html

39

More Resources

• “Proposed Guidance on Workplace Stockpiling of Respirators and Facemasks for Pandemic Influenza;” public comments requested in the Federal Register on May 9, 2008. Available on www.osha.gov

• Course #7210: Pandemic Influenza Workplace Preparedness. Available at the OSHA Training Institute Education Centers beginning in fall 2009.

40

Why Be Prepared? Protect Workers

Protect the Community

Continue Business Operations

Continue To Be Prepared: Develop, reassess and update

a disaster/business continuity plan that addresses an influenza pandemic

Strongly encourage and facilitate seasonal flu and pandemic influenza vaccinations when available

Monitor and promote good hygiene practices

Evaluate worker risk levels and provide appropriate controls

In Conclusion

41