Recommend that presenter be familiar with the websites and resources identified at the end of the document. If possible, provide one of the following publications as a handout – whichever one is more applicable to your audience: Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare Employers (OSHA 3328-05R 2009) Guidance on Preparing Workplaces for an Influenza Pandemic (OSHA 3327-05R 2009)
These are the topics that we will cover in this presentation. Many people still refer to the 2009 H1N1 influenza as “Swine Flu.”
Four pandemics occurred in the 20th century: Spanish flu in 1918, Asian flu in 1957, Hong Kong flu in 1968 No one knows exactly how many people died during the 1918-1919 influenza pandemic. During the 1920s, researchers estimated that 21.5 million people died as a result of the 1918-1919 pandemic. More recent publications estimate that between 30 and 50 million died. An estimated 675,000 Americans were among the dead. Source: http://1918.pandemicflu.gov/the_pandemic/index.htm And what about “bird flu”? The highly pathogenic avian influenza (HPAI) H5N1 virus that first produced disease in humans in Hong Kong in 1997, re-emerged in Asia in 2003 and continues to evolve. It has caused disease in humans in 15 countries in Asia, Africa, and the Middle East. As many as 60% of the confirmed human infections have resulted in death. The greatest number of deaths have thus far been reported in Indonesia. The fear remains that one of the H5N1 viruses may mutate or reassort with another influenza virus (perhaps even with the 2009 H1N1 virus) and cause another influenza pandemic. Although the HPAI H5N1 virus continues to be monitored, it has not yet developed the ability to pass readily from human-to-human. It has also not yet made its way to the Western Hemisphere.
The term “pandemic” literally means a worldwide epidemic; it refers to the worldwide distribution of the disease, NOT to its severity. The term “pandemic influenza” or “pandemic flu” refers to influenza that is caused by a type A influenza virus for which humans have little immunity; begins to cause serious disease and is readily and sustainably transmitted from human-to-human. Once it has adapted to humans, it rapidly spreads around the world. The term “pandemic flu” does not uniquely identify the organism involved; the specific virus also needs to be specified to identify the pandemic. Sometimes the year, or years, in which the pandemic occurred is used as shorthand to identify the virus (for example the 1918 Spanish flu). For the World Health Organization to declare a pandemic, sustained human-to-human transmissions of a newly emerged influenza virus must be confirmed in 2 or more regions of the world. Additional info for: Bullet #1 – The novel virus may be derived directly from an animal (*bird or swine) influenza virus via mutation or via reassortment of an animal influenza virus and a human influenza virus. The latter can happen during a co-infection of an animal or human with two different influenza viruses. The possibility of a reassortment event is one reason that workers should be encouraged to receive a seasonal flu vaccination. Bullet #2 - Average attack rate for flu pandemics = 30%; average attack rate for seasonal flu is 10-15%. Bullet #3 - Vaccine must be developed and mass-produced after the virus emerges; there may be shortages of antiviral drugs Symptoms are discussed later on in the presentation.
Be sure to update this slide before your presentation. See WHO link in slide 7 notes. As of August 30, 2009, 184 countries and overseas territories/communities have reported at least one laboratory confirmed case of the 2009 pandemic H1N1 influenza. All continents are affected by the pandemic. *Given that countries are no longer required to test and report individual cases, the number of reported cases is an underestimate of the actual number of cases. Source: http://www.who.int/csr/don/2009_08_04/en/index.html
NOTE to presenter: Be sure to update the statistics on this slide as close as possible to your presentation date. CDC updates URL: http://www.cdc.gov/h1n1flu/updates WHO updates URL: http://www.who.int/csr/don/en/index.html Statistics on this slide represent hospitalized cases and deaths only. The WHO discontinued a requirement that countries report confirmed cases after July 6. As of August 30, the CDC began aggregating reports of deaths and hospitalizations from all types of influenza, not just 2009 H1N1. Since the virus has reached worldwide pandemic distribution, the health organizations are concentrating on providing assistance with coping with the disease and on tracking any unusual cases, symptoms, or reactions. As of early September, about 97% of all influenza in the US was due to the 2009 H1N1 virus. 2009 H1N1 outbreaks are ongoing in parts of the US, in some cases with intense activity. NOTE to presenter: Be sure to check this as you give talks into the fall. Although it is not certain, there is an expectation that H1N1 will replace or supplant seasonal influenza based on what has been observed in the Southern Hemisphere. 2009 H1N1 infection has been reported to cause a wide range of symptoms, including fever, cough, sore throat, body aches, headache, chills and fatigue. In addition, a significant number of people also have reported nausea, vomiting or diarrhea. Some data indicate this virus may cause more frequent, or more severe, pneumonia than does seasonal influenza. People with underlying medical conditions are thought to be more susceptible to severe disease. Some groups that appear to be more susceptible include pregnant women, people who have asthma, and people who are severely obese. The virus may mutate or “reassort” and turn up as a more virulent strain in the fall. That is why it is essential that preparations begin now!
WHO Pandemic Phases (Phase 6, a full pandemic, was declared on June 11, 2009, for the 2009 Novel H1N1 Influenza) Phase 1 . An influenza virus subtype that has caused human infection may be present in animals but the risk of human infection is considered to be low. Phase 2 . A circulating animal influenza virus subtype poses a major risk of human disease. Phase 3 . No human-to-human spread or at most rare instances of spread to a close contact Phase 4 . Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans. Phase 5 . Larger cluster(s) but human-to-human spread still localized, suggesting that the virus is becoming better adapted to humans but may not yet be fully transmissible. Phase 6 . Increased and sustained transmission in the general population.
Droplet Transmission - Contact of the mucous membranes of the nose, mouth or eyes of a susceptible person with large droplets containing infectious viral particles that are generated by an infected person during coughing, sneezing, talking and even breathing. Thought to be the primary route of flu transmission Droplets > 50 – 100 µm Most settle from air within 3 feet (sometimes up to 5-6 feet) from source. Contact Transmission - Occurs when a susceptible person touches a contaminated surface (an infected person’s skin or inanimate objects) and subsequently touches the mucus membranes of their nose, mouth or eyes. *Fomite - an inanimate object (e.g., doorknobs, phones, desks, tools) that is able to harbor infectious organisms and therefore may serve as a agent of transmission Airborne/Aerosol Transmission – Concern exists about the possibility of short-range aerosol transmission as a possible route of spread although data are limited Localized airborne transmission might occur over short distances (i.e., within 6 feet) via droplet nuclei or particles that are small enough to be inhaled Relative contribution of short-range airborne transmission to influenza outbreaks is unknown Additional Information: Transmission Issue - “…the proportional contribution and clinical importance of the possible modes of transmission of influenza (i.e., droplet, airborne, and contact) remains unclear and may depend on the strain of virus ultimately responsible for a pandemic.” - HHS. Interim Guidance on Planning for the Use of Surgical Masks And Respirators in Health Care Settings during an Influenza Pandemic . October 2006.
Note to presenters: update the data from http://www.cdc.gov/h1n1flu/updates. Symptoms for 2009 H1N1 flu in people are similar to the symptoms of seasonal flu and include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. A significant number of people who have been infected with this virus also have reported diarrhea and vomiting. Also, like seasonal flu, severe illnesses and death has occurred as a result of illness associated with this virus. For H1N1: The time from exposure to disease onset is usually 1-4 days, with an average of 2 days, but can be up to 9 days. Most patients recover within 3-7 days. Recent research (presented by Gaston De Serres of the Institute of Public Health in Quebec at the American Society for Microbiology conference on September 14) indicates it is possible that patients may remain infectious for some time after their fever has subsided. In adults, emergency warning signs that need urgent medical attention include: Difficulty breathing or shortness of breath Pain or pressure in the chest or abdomen Sudden dizziness Confusion Severe or persistent vomiting Flu-like symptoms improve but then return with fever and worse cough FOR COMPARISON: Characteristics and Symptoms of Seasonal Influenza: abrupt onset fever, chills, fatigue, muscle aches, headache, dry cough, upper respiratory congestion, sore throat time from exposure to onset: 1-4 days adults are infectious from 1-5 days after onset children are infectious much longer: + 10 days usual recovery time: 3-7 days cough and weakness/aches: up to 2-3 weeks Characteristics and Symptoms of H5N1 Highly Pathogenic Avian Influenza : primarily in children and young adults/high fever and cough/lower respiratory tract symptoms/shortness of breath development of viral pneumonia/diarrhea, abdominal pain, and vomiting frequently reported/in many cases, death follows quickly after signs & symptoms noticed
Whether it is a MODERATE or SEVERE Pandemic, the number of people infected and receiving outpatient care will be the same. It’s the difference in the number of people hospitalized and the percentage of people who die (the case fatality rate) that mark the difference between MOD and SEV. The above is based on a US Population = 300 million. Evidence to date suggests that population immunity to this virus is low, particularly among the young. Thus far, most cases of illness, hospitalization and death associated with the 2009 H1N1 influenza have occurred among persons less than 65 years of age. Groups at increased risk of influenza-related complications include pregnant women, those with asthma, COPD, diabetes, chronic cardiovascular disease, and immuno-compromised persons. These are the same groups as previously recognized as having an increased risk of severe illness from seasonal influenza. In addition, morbid obesity may represent an additional risk factor for severe illness. Unlike seasonal influenza where persons 65 years and older are most likely to be hospitalized or die from influenza-related complications, this age group has been substantially less affected by 2009 H1N1 virus than younger age groups. It is not known at this time whether older groups are less affected because they have fewer opportunities to be exposed (as compared to school children) or whether they may have some limited residual immunity from exposure to similar viruses many years ago.
In the case of an outbreak of a SEVERE illness, how will we squeeze the extra 10 million ill people (9,900,000 – see the previous slide) into the fewer than 300,000 ( ~0.69 x 947,000) hospital beds not occupied by patients with other problems? BOTTOM LINE - There could be crippling shortages of hospital beds, medical devices such as ventilators, doctors, nurses, medicine and even caskets! In 1918, hospitals hired armed guards to protect doctors and nurses from people trying to force their way in.
Just as there will be an increase in demand for some services, such as health care, there will also be a decrease in demand for others. For example, during the global SARS outbreak in 2003, air travel, tourism and retail industries throughout Asia and later Toronto, Canada, experienced a tremendous decrease. How will the demand for your products or services change during a flu pandemic and how will you prepare for that change? Staff absenteeism (some sources estimate that half of all workers could be sick, at home caring for loved ones, or staying home to avoid getting sick); higher or lower demand for products and services; an inability to deliver products and services; and even a lack of funding from global economic disruption could affect the functioning of organizations. That’s why all workplaces need to prepare.
Lack of staff may cause severe hardship for businesses, causing many to reduce output and some to close on either a temporary or a permanent basis. By developing continuity plans now , businesses can help reduce the economic impact of a pandemic. Most large public and private sector organizations have formal business continuity plans in place to ensure that they will survive and thrive during a disruption, such as a snowstorm or hurricane. However, most of these plans are for short term events and do not address what to do in a communicable disease emergency such as a flu pandemic. Also, since a flu pandemic will last a long time, organizations need plans that enable them to continue their most important functions for a period of two to three months, with fewer staff available. They should also remember that these two or three month periods may occur a few times over 18 to 24 months. DHS’s 84-page guide entitled: Pandemic Influenza Preparedness, Response, and Recovery Guide for critical infrastructure and key resources can be downloaded from: http://www.flu.gov/plan/pdf/cikrpandemicinfluenzaguide.pdf As part of the U.S. Government’s pandemic preparedness strategy, the Department of Homeland Security (DHS) supports the efforts of the public and private sector Critical Infrastructure and Key Resources (CI/KR) community and their businesses to develop and execute their essential pandemic contingency plans and preparedness actions. The Pandemic Influenza Preparedness, Response, and Recovery Guide is one of the practical tools DHS has developed for business owner-operators and their contingency planners to enhance pandemic planning. This guide assembles the primary government and pandemic influenza-specific background material, references, and contacts all in one place. It introduces an enhanced contingency planning process for a pandemic and provides business planners with numerous sector-specific c and common pandemic influenza planning variables keyed to escalating disaster phases. This Guide will complement and enhance, not replace, extensive private sector contingency planning already in place Critical Infrastructure: Food & Agriculture-Public Health and Healthcare-Banking & Finance-Chemical & Hazardous Materials-Defense Industrial Base-Water-Energy-Emergency Services-Information Technology-Telecommunications-Postal & Shipping-Transportation-National Monuments & Icons Key Resources: Government Facilities-Dams-Commercial Facilities-Nuclear Power Plants
Employers need to have policies that will help reduce the spread of influenza in the workplace. They may start by educating workers and encouraging healthy habits today to avoid illness and absenteeism caused by common illnesses such as the seasonal flu. This includes promoting the techniques such as frequent handwashing, covering coughs and sneezes, and cleaning and disinfecting surfaces that are frequently touched by many people.
OSHA has developed a way to classify the level of risk of exposure to the virus for workers. NOTE: be sure to discuss close contact, frequency, etc.
As we go through this process, remember it’s the job tasks that a worker does and who he/she is exposed to and for how long-- not only the type of facility or business-- that determines the exposure risk.
JOB Exposure Risk Levels.
This chart gives some examples of work tasks that put the workers who perform them in the various occupational risk levels. Very high risk exposure tasks : aerosol-generating procedures such as cough induction, aerosolized or nebulizer medication administration, airway suctioning, sputum induction, or certain dental procedures. High risk exposure tasks : entering of rooms occupied by suspected, probable, or confirmed pandemic patients, by doctors, nurses, home health aids or other staff; medical transport of suspected, probable, or confirmed pandemic patients in enclosed vehicles; performing autopsies on known or suspected pandemic patients Medium exposure risk tasks: Examples of tasks that could require workers to have frequent close contact (less than 6 feet) with co-workers or the general public: Classroom instruction, bank teller operations, work in a high population density work environment such as a call center where employee work stations are close together, and cashiering in some high volume retail (e.g., grocery store). Consideration of Elevated Protections for Employees in Certain Situations Consider the use of elevated protections IF the task/activity is being performed by essential critical infrastructure/key resource personnel OR if there is an expectation that the task will require infrequent but close contact with people who have influenza-like illness or extended close contact with these people in enclosed spaces. Note: A billing clerk in a doctor’s office or even in a hospital may have only a lower exposure risk. It’s the job tasks that a worker does and who he/she is exposed to and for how long, not only the type of facility or business, that determines the exposure risk.
The measures on these 3 slides are ones that every employer could and should take to minimize the risk of occupational exposure to the H1N1 influenza A virus. Note the “old” and “new” posters for cough etiquette. For the latest information on vaccine, go to: http://www.cdc.gov/h1n1flu/ With the new H1N1 virus continuing to cause illness, hospitalizations and deaths in the US during the normally flu-free summer months and some uncertainty about what the upcoming flu season might bring, CDC's Advisory Committee on Immunization Practices (ACIP) has taken an important step in preparations for a voluntary 2009 H1N1 vaccination effort to counter a possibly severe upcoming flu season. On July 29, ACIP met to consider who should receive H1N1 vaccine when it becomes available. The seasonal flu vaccine is unlikely to provide protection against 2009 H1N1 influenza. However a 2009 H1N1 vaccine is currently in production and may be ready for the public in the fall. The novel H1N1 vaccine is not intended to replace the seasonal flu vaccine – it is intended to be used along-side seasonal flu vaccine. Treatment: If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious influenza complications. Influenza antiviral drugs work best when started soon after illness onset (within two  days), but treatment with antiviral drugs should still be considered after 48 hours of symptom onset, particularly for hospitalized patients or people at high risk for influenza-related complications. Prevention: Influenza antiviral drugs also can be used to prevent influenza when they are given to a person who is not ill, but who has been or may be near a person with swine influenza. When used to prevent the flu, antiviral drugs are about 70% to 90% effective. When used for prevention, the number of days that they should be used will vary depending on a person’s particular situation. There are four influenza antiviral drugs approved for use in the United States (oseltamivir, zanamivir, amantadine and rimantadine). The swine influenza A (H1N1) viruses that have been detected in humans in the United States and Mexico are resistant to amantadine and rimantadine so these drugs will not work against these swine influenza viruses. Laboratory testing on these swine influenza A (H1N1) viruses so far indicate that they are susceptible (sensitive) to oseltamivir and zanamivir. The number one infection control measure you can take is washing your hands- To properly wash your hands you should use warm water and soap, scrub all surfaces of your hands for at least 20 seconds (enough time to sing “Happy Birthday” twice), and rinse thoroughly. Use a paper towel to dry your hands and that same paper towel to turn off the faucet and open the door. At a minimum, you should wash your hands after using the restroom, after coughing or sneezing, and before eating or preparing food. If soap and water is not available, hand sanitizing gels are an effective alternative when your hands are not visibly soiled. Watch the video for more information: http://www.cdc.gov/CDCTV/HandsTogether/
The following recommendations should be followed when possible for work activities that involve contact with people who have Influenza-like Illness (ILI), such as escorting a person with ILI, interviewing a person with ILI, and providing assistance to an individual with ILI: maintain a distance of 6 feet or more from the ill person (i.e., social distancing); keep interactions with ill persons as brief as possible; ask the ill person to follow good cough etiquette and hand hygiene and to wear a facemask, if able, and one is available; workers at increased risk of severe illness from influenza infection should avoid people with ILI (possibly by temporary reassignment); and, where workers cannot avoid close contact with persons with ILI, wearing a facemask or N95 respirator on a voluntary basis could be considered. Requirements for the voluntary use of respirators in the workplace can be found on the OSHA website (http://www.osha.gov/SLTC/etools/respiratory/voluntaryuses.html). What kills influenza virus? Influenza virus is destroyed by heat (167-212°F [75-100°C]). In addition, several chemical germicides, including chlorine, hydrogen peroxide, detergents (soap), iodophors (iodine-based antiseptics), and alcohols are effective against human influenza viruses if used in proper concentration for a sufficient length of time. For example, wipes or gels with alcohol in them can be used to clean hands. The gels should be rubbed into hands until they are dry. What surfaces are most likely to be sources of contamination? Droplets generated when an infected person coughs, sneezes, talks or even breathes contain germs that move through the air. These respiratory droplets land on various surfaces and when a susceptible person touches them and then touches their own eyes, mouth or nose before washing their hands, they may become infected.
There are various levels of control that can be used to protect employees, including engineering controls, work practices, administrative controls, and PPE. Some examples of these controls are barriers/sneeze guards, promoting personal hygiene measures, minimizing face-to-face contact, and use of gloves/respirators. A combination of these controls is likely to be used by most employers. Signage in common areas around the workplace encouraging and explaining how to use these controls may increase awareness and good hygiene behavior. Employers should also educate their workers about good hygiene and infection control practices. Definitions of Control types: Engineering controls involve making changes to the work environment to reduce work-related hazards. Administrative controls include controlling employees' exposure by scheduling their work tasks in ways that minimize their exposure levels. Work practices are procedures for safe and proper work that are used to reduce the duration, frequency or intensity of exposure to a hazard. Personal Protective Equipment (PPE) is specialized clothing and equipment worn by an employee for protection against a hazard. Frequently Asked Questions can be found at: http://www.pandemicflu.gov/faq/index.html FAQ: Can employers close their place of business to employees or customers known to have contracted or to have been exposed to pandemic influenza? Yes. An employer may close its facilities to employees or customers known to have contracted or have been exposed to pandemic influenza. Source: http://www.pandemicflu.gov/faq/workplace_questions/human_resource_policies/v3.html Remember that any employment decision mandating that certain employees stay home must comply with federal laws prohibiting discrimination in the workplace on the basis of race, sex, age (40 and over), color, religion, national origin, disability, or veteran status.” Note: Although federal, state, and local laws and regulations are binding, employers may also be guided in their relationship with their workers by their own employee handbooks, manuals, and contracts (including bargaining agreements).
Examples of personal hygiene resources include: tissues, no-touch trash cans, hand soap, hand sanitizer, disinfectants and disposable towels Why is it a good idea to encourage workers to obtain a seasonal influenza vaccine? It lessens the possibility that they will become ill from seasonal flu If they don’t become ill from seasonal flu, it lessens the burden on the health care system It lessens the possibility that the seasonal flu and the 2009 H1N1 influenza virus will “reassort” in the human body and cause either of them to become more severe. Vaccine Getting a flu shot every year is the best action you can take to prevent seasonal influenza. Because a pandemic strain of influenza will be a new emerging virus, a vaccine may not be available for three to six months after the pandemic begins. Utilize the hygiene and social distancing techniques mentioned previously to protect yourself until one becomes available. Antivirals Antivirals, such as Tamiflu and Relenza, are medications that can be used for the treatment of influenza or as prophylaxis to prevent infection during an outbreak or after exposure to the virus. Antivirals may be in short supply during a pandemic and some influenza viruses have been found to be resistant to such pharmaceuticals. The appropriateness of specific engineering controls depends on the type of exposure anticipated (e.g., contact, droplet, airborne) for a particular task or activity and the exposure risk associated with the task or activity (e.g., aerosol-generating procedures).
The appropriateness of specific administrative controls depends on the type of exposure anticipated (e.g., contact, droplet, airborne) for a particular task or activity and the exposure risk associated with the task or activity (e.g., aerosol-generating procedures).
The appropriateness of specific personal protective equipment depends on the type of exposure anticipated (e.g., contact, droplet, airborne) for a particular task or activity and the exposure risk associated with the task or activity (e.g., aerosol-generating procedures). Personal protective equipment (PPE) is specialized clothing and equipment worn by an employee for protection against a hazard. This includes respirators, facemasks, gloves, goggles, and gowns. In general, PPE provides protection against hazards, such as infectious materials, contacting the skin, respiratory tract, and mucous membranes of the mouth, nose, or eyes. When used properly, PPE can help prevent the spread of infection from one person to another. Gloves, goggles, and faceshields are not usually recommended for employees in lower and medium exposure risk categories. Eye protection is generally not recommended to prevent influenza infection although there are limited examples where other strains of influenza have caused eye infection (conjunctivitis caused by some highly pathogenic avian influenza H7 viruses). Exposure through non-intact skin (cuts and scrapes) is not a route of transmission for influenza. The exposure of concern is touching the mouth and nose with a contaminated hand. There is no difference between unintentional touching of the mouth, nose, or eyes with either contaminated hands or contaminated gloves. If employees wear gloves, they must be sure to wash their hands with soap and water immediately after removing the gloves. If soap and water are not available they should use an alcohol-based hand sanitizer.. Workers in the healthcare field will utilize gloves and eye protection as control measures for bloodborne pathogens, not just for influenza. These workers generally fall into the high or very high exposure risk levels.
During an influenza pandemic, government agencies may recommend that workers use a facemask, N95 respirator, or other type of equipment as protection against infection. Differences between a facemask and N95 respirator will be discussed in a few minutes. FAQ: Are employers required to provide employees with infection control supplies and personal protective equipment (PPE) to prevent or slow the transmission of influenza? Answer: Workplace safety law requires employers to provide a workplace free from recognized hazards likely to cause death or physical harm. The Department of Labor’s Occupational Safety and Health Administration has provided detailed guidance (Guidance on Preparing Workplaces for an Influenza Pandemic) on how to prepare the workplace for pandemic flu. It is recommended that you provide sufficient and accessible infection control supplies and, if needed, PPE to control the spread of disease among your employees. (Where the employer has evaluated the work site and determined that PPE is required to be worn by employees, it is the employer’s responsibility to assure that PPE is provided at that site. For guidance on selecting PPE, employers can consult the Guidance referenced above.) Source: http://www.pandemicflu.gov/faq/workplace_questions/workplace_safety/m4.html
What is a respirator? Respirators are devices that fit over the nose and mouth and are designed to reduce a worker’s exposure to airborne contaminants. Respirators come in various sizes and must be individually selected to fit the wearer’s face and to provide a tight seal. A proper seal between the user’s face and the respirator forces inhaled air to be pulled through the respirator’s filter material and not through gaps between the face and respirator. Respirators offer the best protection for workers who must work closely (either in contact with or within 6 feet) with people suspected or confirmed to have pandemic influenza. Where workers are required by employers to wear respirators, they must be NIOSH-certified, selected and used in the context of a comprehensive respiratory protection program (see OSHA standard 29 CFR 1910.134, the OSHA Respiratory Protection Standard). It is important to medically evaluate workers to ensure that they can perform work tasks while wearing a respirator. For many workers, medical evaluation may be accomplished by having a physician or other licensed healthcare provider review a respiratory questionnaire completed by the worker (see Appendix C of the OSHA Respiratory Protection Standard). Employers who have never before needed to consider a respiratory protection plan should note that it can take time to choose an appropriate respirator to provide to workers; arrange for and provide training, fit testing and medical evaluations for their workers. If employers wait until an influenza pandemic occurs, they may be unable to implement an adequate respiratory protection program in a timely manner. Note: Tight fitting respirators must be fit tested. Loose-fitting PAPRs (powered air supplied respirators) do not require a fit test.
Respirators are devices that cover the nose and mouth and are designed to prevent contaminants from entering a worker’s respiratory tract. Respirators that may be legally used in workplaces in the United States are certified by the National Institute for Occupational Safety and Health (NIOSH). One of the most common types of respirators is the N95 filtering facepiece respirator/dust mask. This type of respirator is disposable and NIOSH-certified as effective at removing 95% of the most penetrating size of small particulates (0.3 µm) from the air. Higher filtering efficiency respirators remove a greater percentage of particulates. There are also non-disposable N-95 respirators that have elastomeric facepieces that may be cleaned and disinfected for re-use. Most NIOSH-certified filtering facepiece respirators have 2 straps, one to be placed at or near the crown of the head and the other around the neck. However, there are a few NIOSH-certified respirators that have one strap as shown in the bottom photo.
FDA-cleared facemasks (e.g., surgical masks) are a fluid resistant physical barrier used to prevent the transmission of splashes and splatters of bodily fluids. Surgical masks do not seal tightly to the face, do not filter small particles, and do not protect against airborne transmission. Uses for surgical masks: Placed on sick people to limit the spread of disease. Worn by healthcare workers to prevent contamination of patients’ wounds. Worn by employees as a physical barrier to protect against splashes of large droplets of blood or bodily fluids. What is a facemask? Facemasks are loose-fitting, disposable masks that cover the nose and mouth. FDA-cleared facemasks are labeled as:● surgical mask● dental mask● medical procedure mask● isolation mask● laser mask Facemasks help stop droplets from being spread by the person wearing them. They also keep splashes or sprays from reaching the mouth and nose of the person wearing the facemask. They are not designed to protect the wearer against breathing in very small particles. Surgical masks are used as a physical barrier to protect workers from hazards such as splashes of large droplets of blood or body fluids. Surgical masks also prevent contamination by trapping large particles of body fluids that may contain bacteria or viruses when they are expelled by the wearer, thus protecting other people against infection from the person wearing the surgical mask. Facemasks are not designed to seal tightly against the user’s face. During inhalation, much of the potentially contaminated air passes through gaps between the face and the surgical mask, thus avoiding being pulled through the material of the mask and losing any filtration that it may provide. Their ability to filter small particles varies significantly based upon the type of material used, and so they cannot be relied upon to protect workers against airborne infectious agents. Only surgical masks that are cleared by the U.S. Food and Drug Administration (FDA) to be legally marketed in the United States have been tested for their ability to resist blood and bodily fluids.
Filtering facepieces that are cleared by the Food and Drug Administration (FDA) and certified by the National Institute for Occupational Safety and Health (NIOSH) provide the benefits of both surgical masks and respirators, respectively They are cleared by FDA and certified by NIOSH If it’s certified by NIOSH, you should find the above 3 items identified somewhere on respirator (e.g., on the filter, or filter straps).
Only NIOSH-certified N95 particulate respirators (or filtering facepieces with a higher filtering efficiency, such as N99 or P100) are permitted by OSHA where protection from small airborne particles is needed. Types of respirators other than a filtering facepiece respirator are considered to prevent a greater proportion of contaminants from entering the respiratory tract. Powered-air purifying respirators (PAPRs) are one such type. They are NIOSH-certified to provide a higher level of protection, or a “higher protection factor”. There are also elastomeric facepiece respirators with N95 (or higher) filtering efficiency. The advantage of elastomeric respirators is that the facepieces may be cleaned and disinfected and therefore may be reused. If N95 Respirators Not Available: “If N-95 or other types of respirators are not available, surgical masks provide benefit against large-droplet exposure and should be worn for all health care activities involving patients with confirmed or suspected pandemic influenza.” HHS. Interim Guidance on Planning for the Use of Surgical - Masks And Respirators in Health Care Settings during an Influenza Pandemic. October 2006. OSHA requirements in 29 CFR 1910.134, the respiratory protection standard: Selection Medical evaluation Fit testing Use Maintenance and care Breathing air quality and use Training Program evaluation Recordkeeping requirements If filtering facepiece respirators are used voluntarily (for example, by employees performing job tasks at lower exposure risk according to OSHA’s pyramid classification scheme), the employer must verify that the respirators are clean and will not present an additional hazard to the employees and also provide the employees with Appendix D of 1910.134.
Steps in developing and implementing an effective training program include Conducting a needs assessment Developing the training program (including objectives)] Implementing the training program Evaluating the training program Improving the training program
Publication: “Guidance on Preparing Workplaces for an Influenza Pandemic”: Joint DOL/HHS document OSHA 3327-05R 2009 First released: February 6, 2007 Available at: www.flu.gov www.OSHA.gov This publication is an excellent document that will assist all employers in preparation for an influenza pandemic. Publication: “Pandemic Influenza preparedness and Response Guidance for Healthcare Workers and Healthcare Employers”. OSHA 3328-02N 2009 First published June 2007. Available at www.OSHA.gov This publication focuses on employers of healthcare workers, many of which will have high exposure risk job tasks or activities during an influenza pandemic. Some will also have very high exposure risk job tasks of activities. Remember—the exposure risk depends more on the job tasks or activities that a worker performs and who they are exposed to than the type of facility or industry they work at. HHS = Department of Health and Human Services
NOTE: This website, as all of the others that deal with H1N1 flu and/or pandemic flu, is constantly changing. Be sure to review all of these websites before you make a presentation. It is best if you have an Internet hookup during your presentation and can navigate around the pages as you talk. OSHA’s home page has an “In Focus” section that directs the user to important announcements about influenza and to the Pandemic Influenza special topics page. OSHA’s Pandemic Influenza page offers concise information and includes its own “In Focus” area with links to the list of publications from the OSHA home page as well as other credible resources. Publications Guidance on Preparing Workplaces for an Influenza Pandemic . OSHA Publication 3327-05R, (2009). Also available as a 371 KB PDF , 47 pages. [ en Espa ñ ol ] Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare Employers . OSHA Publication 3328-05R, (2009). Also available as a 405 KB PDF , 104 pages. How to Protect Yourself in the Workplace during a Pandemic . OSHA Quick Card, 3365-05N-09. [27 KB PDF ] What Employers Can Do to Protect Workers from Pandemic Influenza . OSHA Fact Sheet, (2009, May). [47 KB PDF ] Healthcare Workplaces Classified as Very High or High Exposure Risk for Pandemic Influenza What to do to protect workers (Healthcare) OSHA Fact Sheet, (2009, May). [54 KB PDF ] Protect Yourself: Pandemic Flu Respiratory Protection . OSHA Quick Card, 3366-05N-09. [26 KB PDF ] Respiratory Infection Control: Respirators vs. Surgical Masks . OSHA Fact Sheet, (2009, May). [2 MB PDF ] Other Resources Frequently Asked Questions on Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare Employers . OSHA, Office of Occupational Health Nursing (OOHN). Proposed Guidance on Workplace Stockpiling of Respirators and Facemasks for Pandemic Influenza . OSHA. Workplace Preparation . Flu.gov.
Flu at: www.flu.gov (Managed by the Department of Health and Human Services; offers one-stop access, including toll-free phone numbers, to U.S. government seasonal, novel H1N1 flu, avian flu, and pandemic flu information.) Access any of the many links from the left navigation pane. Explore: General Information; Frequently Asked Questions (FAQs); Monitoring Outbreaks; Health & Safety; Tests, Vaccines, Medications, & Masks; Travel; Business, Community, and School Planning; and more. “Stay Informed” with the Latest News, CDC Press Briefings, US Map, Subscribe to RSS Updates (Help with RSS is available too); Email Updates; Twitter (online discussion site) Planning and preparation help is available whether you are interested as Families & Individuals, Workplace, Schools, Community, Hospitals, or State & Local. Planning checklists provided are intended to aid preparation for a pandemic in a coordinated and consistent manner across all segments of society. Catch up on the latest news from other sources such as the CDC and WHO. Receive email updates: enter you email address here or click the link from the “Stay Informed” section (2 in graphic - explain email registration process).
World Health Organization at: www.who.int /en The World Health Organization (WHO) provides up to the minute information regarding H1N1 around the world. WHO is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends.
H1N1 Flu is among the headline frames of the Centers for Disease Control and Prevention’s website Clicking “GO>>H1N1 Flu” when prompted, leads you to an area of consolidated information National Institute for Occupational Safety and Health (NIOSH) at: http://www.cdc.gov/niosh/topics/h1n1flu/ U.S. Food and Drug Administration (FDA) at: www.fda.gov/cdrh/ppe/fluoutbreaks.html
The stockpiling guidance Encourages employers to stockpile respirators and facemasks so they can protect workers during a pandemic. Discusses various types of respirators available for use. Discusses appropriate uses for facemasks. Provides estimates of the quantity of N95 respirators and/or facemasks employers should stockpile. The focus of Course #7210 is to provide private businesses within general industry with an opportunity to enhance their awareness and preparation for a pandemic. The objectives of the course are to Describe the potential impact of a pandemic influenza event on a business or company. Determine the elements of a pandemic influenza preparedness plan. Identify sound strategies for continuity of operations. List recommended measures to reduce the risk of employee exposure to influenza viruses. Recognize the key sources for accurate, current information and guidance on pandemic influenza preparedness and strategies. The locations of the OSHA Training Institute Education Centers may be found at https://www.osha.gov/fso/ote/training/edcenters/index.html
It is difficult to predict when the next influenza pandemic will occur or how severe it will be. Wherever and whenever a pandemic starts, everyone around the world is at risk. Countries might, through measures such as border closures and travel restrictions, delay arrival of the virus, but cannot stop it. A worldwide influenza pandemic could have a major effect on the global economy, including travel, trade, tourism, food, consumption and eventually, investment and financial markets. Planning now for pandemic influenza by business and industry is essential to minimize a pandemic's impact! This presentation was designed to give you the information necessary to help you plan for a pandemic influenza.
What This Presentation Will Cover <ul><li>The current status of the 2009 H1N1 Influenza Pandemic </li></ul><ul><li>The potential impact of an influenza pandemic on workers, the community, and businesses </li></ul><ul><li>What OSHA expects that employers will do to plan for worker safety and health during a pandemic </li></ul><ul><ul><li>Assess the exposure risk of their workers </li></ul></ul><ul><ul><li>Take steps to reduce the risk </li></ul></ul><ul><ul><li>Communicate with workers </li></ul></ul><ul><ul><li>Train for workers </li></ul></ul><ul><li>Resources to support preparedness planning and keep plans up to date </li></ul>
<ul><li>Emergence of a novel influenza A virus </li></ul><ul><li>People have little, if any, immunity </li></ul><ul><li>Vaccine is not available </li></ul><ul><li>Usually causes disease more serious than seasonal flu </li></ul><ul><li>Passes readily and sustainably from human-to-human </li></ul><ul><li>2-3 waves of disease each up to 12 weeks, over a 12- 18 month period </li></ul><ul><li>At risk populations may differ from seasonal influenza </li></ul>Characteristics of an “Influenza Pandemic” <ul><li>Can vary in severity from mild to very severe – </li></ul><ul><ul><ul><li>the 1918 Influenza Pandemic resulted in 675,000 or more deaths in the U.S. </li></ul></ul></ul>
<ul><li>What Is It? </li></ul><ul><li>A worldwide outbreak of influenza caused by the 2009 H1N1 virus. </li></ul><ul><li>Virus comprised of novel combination of genetic elements from swine, bird, and human influenza viruses </li></ul><ul><li>What Happened? </li></ul><ul><li>April 15, 2009 - First cases reported in Mexico </li></ul><ul><li>June 11, 2009 - WHO elevated 2009 H1N1 influenza to pandemic status </li></ul><ul><li>August 30, 2009 – Cases in 184 countries and territories </li></ul>The 2009 H1N1 Influenza Pandemic
<ul><li>Data as of August 30, 2009* </li></ul><ul><li>Confirmed cases in U.S. in all states and territories </li></ul><ul><li>Hospitalized cases in U.S.: 9,079 </li></ul><ul><li>Deaths in U.S.: 593 </li></ul><ul><li>Basic symptoms similar to seasonal influenza </li></ul><ul><li>Mild, short duration, acute upper respiratory illness </li></ul><ul><li>Recovery aided by current anti-viral medications </li></ul><ul><li>Deaths worldwide: ≥ 2,837 </li></ul><ul><li>Concerns: </li></ul><ul><li>Could be the first of a 2-3 waves </li></ul><ul><li>Virus could mutate or reassort with other viruses to become more virulent </li></ul><ul><li>Development and testing of new vaccine will take up to 4-6 months </li></ul><ul><li>Disease currently mild, could become more severe </li></ul>H1N1 (continued) *Sources: CDC updates and WHO updates
Why the WHO Declared the 2009 H1N1 Influenza as a “Pandemic” <ul><li>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 </li></ul><ul><li>WHO declared a Pandemic on June 11, 2009 because of sustained outbreaks in North America (one WHO region) and South America (another WHO region) </li></ul><ul><li>NOT BASED on the SEVERITY of the ILLNESS </li></ul>
<ul><li>Thought to be spread primarily by relatively large droplets traveling less than 6 feet (droplet transmission). </li></ul><ul><li>Touching contaminated objects can also be a factor (fomite transmission). </li></ul><ul><li>May also be spread via very small particles traveling across longer distances (airborne/aerosol transmission). </li></ul>How Does Influenza Spread? Contact of infectious material with nose, mouth, and eyes
Impact on Employees <ul><li>Symptoms of 2009 H1N1 influenza may include </li></ul><ul><ul><li>Fever </li></ul></ul><ul><ul><li>Chills </li></ul></ul><ul><ul><li>Headache </li></ul></ul><ul><ul><li>Upper respiratory symptoms </li></ul></ul><ul><ul><ul><li>(cough, sore throat, runny nose, shortness of breath) </li></ul></ul></ul><ul><ul><li>Muscle and joint pain </li></ul></ul><ul><ul><li>Fatigue </li></ul></ul><ul><ul><li>Vomiting </li></ul></ul><ul><ul><li>Diarrhea </li></ul></ul><ul><li>As of August 30, 593 persons have died in the </li></ul><ul><li>U.S. </li></ul>
Impact on the Community Numbers in parentheses = Percentages of ill persons Potential Impact of an Influenza Pandemic in the United States (Estimates based on U.S. population of 300,000,000; infection rate of 30%) CHARACTERISTIC MODERATE (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%)
<ul><li>In 2006: </li></ul><ul><li>Just over 947,000 beds in all U.S. hospitals </li></ul><ul><li>~ 69% occupancy rate without a pandemic </li></ul><ul><li>Source: DHHS, CDC, National Center for Health Statistics Health, United States, 2008. Table 116 </li></ul><ul><li>www.cdc.gov/nchs/hus.htm </li></ul>Hospital Capacity Dilemma
Impact on Businesses <ul><li>Absenteeism – up to 40% of workers affected </li></ul><ul><ul><li>Sick workers </li></ul></ul><ul><ul><li>Caring for sick family members </li></ul></ul><ul><ul><li>Child care problems </li></ul></ul><ul><ul><li>Afraid to come to work </li></ul></ul><ul><li>Changes in Patterns of Commerce </li></ul><ul><ul><li>Increased demand for some goods/services </li></ul></ul><ul><ul><li>Decreased demand for other goods/services </li></ul></ul><ul><ul><li>Increased demand for home delivery, drive-through windows, expanded hours </li></ul></ul><ul><li>Interrupted Supply/Delivery Chain </li></ul>How a Severe Pandemic Could Affect Workplaces:
Who Should Plan for a Pandemic? <ul><li>All business and organizations should develop a plan for dealing with pandemic influenza NOW </li></ul><ul><li>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 </li></ul><ul><li>Critical infrastructure/key resource (CI/KR) industries have a special responsibility to plan for a pandemic </li></ul>
OSHA’s Focus <ul><li>What OSHA expects that employers will do </li></ul><ul><ul><li>Include worker safety and health in pandemic influenza planning </li></ul></ul><ul><ul><li>Perform task-/activity-based exposure risk assessments </li></ul></ul><ul><ul><li>Use exposure control methods appropriate for the work tasks and levels of risk </li></ul></ul><ul><ul><li>Communicate with workers about the risks and plans </li></ul></ul><ul><ul><li>Train workers on the steps being taken to lessen the impact of the influenza outbreaks </li></ul></ul><ul><ul><li>Keep up-to-date on changes in the severity of the pandemic in order to modify the plan as needed </li></ul></ul>To Reduce the Pandemic Influenza Exposure Risk in Workplaces
OSHA’s Occupational Risk Pyramid for Pandemic Influenza <ul><li>Basic considerations </li></ul><ul><li>Evaluate the tasks and activities performed by workers and determine the exposure risk level associated with the tasks </li></ul><ul><ul><li>This assessment permits the tasks to be categorized into the four levels of the pyramid </li></ul></ul>
Which Workers Are at Higher Exposure Risk? <ul><li>Those whose job tasks or activities require them to be within 6 feet of sources of the pandemic virus (exposure risk proximity) </li></ul><ul><li>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) </li></ul>
Occupational Risk Pyramid “ 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 Nature of Job Tasks or Activities Exposure Risk Those that have minimal close contact with co-workers and the general public Lower 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) Medium Those with high potential for frequent, close contact* with confirmed, probable, or suspected pandemic patients High Those with high potential exposure to high concentrations of confirmed, probable, or suspected sources of pandemic influenza virus during specific medical or laboratory procedures Very High
Occupational Risk Pyramid “ Guidance on Preparing Workplaces for an Influenza Pandemic,” U.S. Department of Labor, Occupational Safety and Health Administration, OSHA 3327-05R, 2009. Examples of Job Tasks or Activities (workers involved) Exposure Risk • General office work that does not require frequent close contact, within 6 feet, with coworkers or the general public (office employees) Lower • Classroom instruction (teachers), bank teller operations (bank tellers), work in high population density work environments (call centers), and some high volume retail work (cashiers) Medium <ul><li>Working with confirmed, probable, or suspected pandemic patients (healthcare delivery and support staff) </li></ul><ul><li>Transporting confirmed, probable, or suspected pandemic patients in enclosed vehicles (Emergency Medical Technicians—EMTs) </li></ul><ul><li>Performing autopsies on confirmed, probable, or suspected pandemic patients (medical examiners) </li></ul>High <ul><li>Performing aerosol-generating procedures for confirmed, probable, or suspected pandemic patients (healthcare employees) </li></ul><ul><li>Collecting or handling specimens from confirmed, probable, or suspected pandemic patients (laboratory healthcare personnel) </li></ul>Very High
Steps Every Employer Can Take <ul><li>Get the seasonal flu vaccine and when available, get the pandemic flu vaccine </li></ul><ul><li>If sick, stay home </li></ul><ul><li>Frequently wash hands with soap and water or, if not available, use alcohol-based hand sanitizer </li></ul><ul><li>Follow good “cough etiquette” </li></ul>Encourage workers to do the following:
Steps Every Employer Can Take continued <ul><li>Plan for and use social distancing to limit close contact with co-workers and the public </li></ul><ul><li>Provide customers and the public with hand washing facilities, tissues, and no-touch trash receptacles </li></ul><ul><li>Keep work surfaces, telephones, computers, and other equipment clean </li></ul><ul><li>Discourage use of other workers’ equipment </li></ul><ul><li>Minimize informal gatherings and group meetings by using telephone conferences and e-mail </li></ul>
Steps Every Employer Can Take continued <ul><li>Reduce or eliminate workplace visits by the public or family members to the extent possible </li></ul><ul><li>Promote healthy lifestyles to improve your workers’ immune systems: good nutrition, stress reduction, adequate rest, exercise </li></ul><ul><li>Evaluate your workplace and your workers’ job tasks or activities to determine their exposure risk level and whether other controls are needed </li></ul><ul><ul><li>Engineering and Work Practice controls </li></ul></ul><ul><ul><li>Administrative controls </li></ul></ul><ul><ul><li>Personal protective equipment </li></ul></ul>
Engineering and Work Practice Control Examples <ul><li>Providing resources and a work environment that promotes personal hygiene and encourages workers to clean their work surfaces </li></ul><ul><li>Encouraging workers to obtain seasonal influenza vaccine and the 2009 H1N1 influenza vaccine, when available </li></ul><ul><li>Developing policies to minimize contacts between workers and between workers and clients or customers </li></ul><ul><li>Installing physical barriers (e.g., clear plastic sneeze guards) </li></ul><ul><li>Installing a drive-through window for customer service </li></ul><ul><li>In some limited healthcare settings, for aerosol-generating procedures, specialized negative pressure ventilation </li></ul><ul><li>may be indicated </li></ul>
Administrative Control Examples <ul><li>Implementing policies that encourage ill workers to stay at home without fear of any reprisals </li></ul><ul><li>Discontinuing nonessential travel to locations with high illness trans-mission rates </li></ul><ul><li>Minimizing face-to-face contact between workers using e-mail, websites and teleconferences </li></ul><ul><li>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 </li></ul><ul><li>Offering home delivery of goods and services to reduce the number of clients or customers who must visit your workplace </li></ul><ul><li>Developing emergency communications plans. Maintaining a forum for answering workers' concerns. Developing internet-based communications if feasible </li></ul>
<ul><li>PPE must be: </li></ul><ul><ul><li>Selected based upon the hazard to the worker </li></ul></ul><ul><ul><li>Of proper size and fit. Respirators must be fit tested initially and periodically (at least annually) </li></ul></ul><ul><ul><li>Conscientiously & properly worn </li></ul></ul><ul><ul><li>Regularly maintained and replaced, as necessary </li></ul></ul><ul><ul><li>Properly removed and disposed of to avoid contamination of self, others or the environment </li></ul></ul><ul><li>PPE examples: </li></ul><ul><li>Gloves </li></ul><ul><li>Goggles </li></ul><ul><li>Faceshields </li></ul><ul><li>Facemasks (e.g., surgical masks) </li></ul><ul><li>Respirators (e.g., N95 filtering facepieces) </li></ul>Personal Protective Equipment (PPE)
PPE Selection Guidelines <ul><li>Each employer should select the combination of PPE that protects workers against the exposure hazards they encounter when performing their job tasks </li></ul><ul><li>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) </li></ul><ul><li>Wearing PPE may be physically burdensome to workers, particularly when the use of PPE is not common practice for the work task </li></ul>When selecting PPE, employers will also consider factors such as function, fit, ability to be decontaminated, disposal, and cost
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)
<ul><li>Designed to reduce worker’s exposure to small airborne contaminants </li></ul><ul><li>Both disposable and reusable respirators are available </li></ul><ul><li>Certified by NIOSH </li></ul>Respirators
<ul><ul><li>Not tight fitting </li></ul></ul><ul><ul><li>Worn by healthcare workers to: </li></ul></ul><ul><ul><ul><li>Prevent contamination of patient’s wounds; </li></ul></ul></ul><ul><ul><ul><li>Provide a physical barrier to protect against splashes of large droplets of blood or bodily fluids; and </li></ul></ul></ul><ul><ul><ul><li>Protect against droplet transmission of an infectious disease, but not airborne transmission. </li></ul></ul></ul><ul><ul><li>Placed on sick people to limit the spread of disease </li></ul></ul><ul><ul><li>Cleared by FDA </li></ul></ul>Facemasks (e.g., surgical masks)
<ul><li>Health Care Particulate Respirator and Surgical Mask </li></ul><ul><li>“ NIOSH” </li></ul><ul><li>Manufacturer’s name and part number </li></ul><ul><li>An abbreviation to indicate filter type (e.g., N95, P100, etc.) </li></ul>Surgical N95 Respirator
<ul><li>N95 respirators are recommended for performing High and Very High exposure risk tasks or activities </li></ul><ul><ul><li>Consider use of respirators with a higher level of protection (e.g., PAPRs) for aerosol-generating procedures </li></ul></ul><ul><li>If supplies of N95 respirators are limited: </li></ul><ul><ul><li>Prioritize use by highest exposure risk </li></ul></ul><ul><ul><li>Consider reusable powered air-purifying respirators (PAPRs), or elastomeric respirators </li></ul></ul>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.
Communicate with Employees <ul><li>Communication with employees is essential to the success of the plan </li></ul><ul><ul><li>Consult with employees when assessing the levels of exposure risk </li></ul></ul><ul><ul><li>Acknowledge the health risks and explain plans for controlling/lessening the risks </li></ul></ul><ul><ul><li>Explain workplace policies regarding sick leave, flexible work arrangements, and other policies and how these will impact the risk of exposure </li></ul></ul><ul><ul><li>Solicit, acknowledge, and respond to employees’ concerns in order to increase their feelings of ownership and “buy-in” to the plan </li></ul></ul><ul><ul><li>Develop a plan for emergency communications </li></ul></ul>
Train Employees <ul><li>Appropriate training can be a part of the employer’s overall risk communication strategy </li></ul><ul><li>Training for an emergency such as an influenza pandemic should include: </li></ul><ul><ul><li>Hazards </li></ul></ul><ul><ul><li>Health effects </li></ul></ul><ul><ul><li>Anticipated exposures </li></ul></ul><ul><ul><li>Control measures </li></ul></ul>
Resources Available: OSHA Print Publications Both are also available online at www.osha.gov OSHA 3327 2009 OSHA 3328 2009
<ul><li>“ In Focus” section: </li></ul><ul><li>Pandemic Influenza page </li></ul><ul><li>Resources (e.g. Fact Sheets, QuickCards ® ,) are available in HTML or PDF formats as well as English or Spanish versions </li></ul><ul><li>e-Tool: Coming soon! </li></ul>Online at: www.osha.gov
<ul><li>Managed by the Department of Health and Human Services; </li></ul><ul><li>Tag line reads: One-stop access to U.S. Government H1N1, avian and pandemic flu information. </li></ul>Online at: www.flu.gov
<ul><li>The home page links you to comprehensive coverage of the global situation for H1N1 </li></ul><ul><ul><li>Guidance documents </li></ul></ul><ul><ul><li>Frequently asked questions </li></ul></ul><ul><ul><li>Situation updates </li></ul></ul><ul><ul><li>Regional information </li></ul></ul>Online at: www.who.int
Other Online Resources <ul><li>Centers for Disease Control and Prevention (CDC): </li></ul><ul><li>www.cdc.gov </li></ul><ul><li>National Institute for Occupational Safety and Health (NIOSH): </li></ul><ul><li>www.cdc.gov/niosh/topics/h1n1flu/ </li></ul><ul><li>Food and Drug Administration (FDA): </li></ul><ul><li>www.fda.gov/cdrh/ppe/fluoutbreaks.html </li></ul>
More Resources <ul><li>“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 </li></ul><ul><li>Course #7210: Pandemic Influenza Workplace Preparedness. Available at the OSHA Training Institute Education Centers beginning in fall 2009. </li></ul>
<ul><li>Why Be Prepared? </li></ul><ul><li>Protect Workers </li></ul><ul><li>Protect the Community </li></ul><ul><li>Continue Business Operations </li></ul><ul><li>Continue To Be Prepared: </li></ul><ul><li>Develop, reassess and update a disaster/business continuity plan that addresses an influenza pandemic </li></ul><ul><li>Strongly encourage and facilitate seasonal flu and pandemic influenza vaccinations when available </li></ul><ul><li>Monitor and promote good hygiene practices </li></ul><ul><li>Evaluate worker risk levels and provide appropriate controls </li></ul>In Conclusion