Blog Entry

International recommendations for COVID-19 workplace safety

Introduction

A new ISO standard has been issued, looking at the impact of maintaining business operations in the context of the coronavirus pandemic. The reference for the standard is ISO/PAS 45005:2020, and it is titled ‘Occupational health and safety management — General guidelines for safe working during the COVID-19 pandemic’ (1). The standard is multi-industry and the focus is with providing guidance to firms for taking effective action to protect workers and other relevant interested parties from the risks related to the novel coronavirus.

There are two key principles to the document:

  1. Reasonable measures must be undertaken by employers to manage the risks arising from COVID-19 are, or will be, implemented to protect the health and safety of workers and visitors;
  2. Workers should not be required to work unless appropriate measures have been implemented.

Central to these principles is with protecting the physical and mental health of workers (2), be they at the workplace facility, on the road, or working remotely at home.

Purpose

The focus of the document is with addressing the current coronavirus pandemic and businesses that have either been open during the pandemic, which are planning to open or where the idea for opening a new business are being considered.

There are times within the standard where COVID-19 is used where reference to the coronavirus (SARS-CoV-2, with SARS standing for ‘severe acute respiratory syndrome’) should be made (the symptomatic disease in human is ‘COVID-19’, for ‘coronavirus disease 2019’), but this is not synonymous for the name of the virus. However, the intent is invariably clear throughout the normative document.

Risk considerations

The novel coronavirus SARS-CoV-2, at global pandemic status at the time of writing, presents a transmissibility risk through different vectors (3):

  • Direct or indirect contact between an infected and a susceptible person, usually resulting in contamination of a susceptible person's hands followed by hand to respiratory mucosa contact;
  • Direct or indirect contact with an infected item (fomite) or surface;
  • Large droplet spray wherein droplets of respiratory fluid greater than approximately 100 µm in diameter are expelled with sufficient momentum to deliver a direct hit on the respiratory mucosa;
  • Aerosols generated by release of smaller, virus-containing droplets, as may occur during tidal breathing and coughing, which can evaporate into residual particles (droplet nuclei), which are inhaled and deposited in the respiratory tract.

The new ISO standard looks at these risks from the perspective of the workplace.

In terms of the workplace risks presented by the coronavirus, the standard divides the risk assessment approach into external and internal factors. External risk factors include the prevalence of COVID-19 cases within the local community together with any local, regional, national and international levels of the virus. A second external factor are the legal requirements, as dictated by central government. A third consideration is with the level of health service provision, including   the availability of clinical services, testing, treatments and vaccines. In terms of the supply chain and having sufficient resource to protect workers, the standard recommends consideration of the personal protective equipment and disinfectants, thermometers, and cleaning materials).

The standard also advises that the employer understands how its employees will travel to work, such as by public transport or by private car, together with the feasibility of the employee attending work, such as the availability of childcare and schooling.

The risk-based approach also requires the employer to consider whether the employee can actually work at home and produce work at an equivalent level. This requires an understanding of the employee’s job and whether the employee has the facilities for home working. Also for consideration, in terms of whether the employee should attend the workplace, is consideration of the workers’ domestic situation (such as if they are living with someone who is considered to be at higher risk of contracting COVID-19 or getting severe illness from the coronavirus. Cultural factors can also play a part in deciding if, and then how, employees might be encouraged to attend the workplace is necessary.

Motivations for the business itself to open can be triggered by factors relating to the supply chain or the type of service that the business provides. Other external considerations include whether the necessary services and utilities will be available. One utilities consideration is with any enhanced risk in relation to Legionella bacteria in the event of air conditioning systems or showers not being used for a period of time.

In terms of internal factors for the employer to weigh up, these considerations include the prevalence of COVID-19 in the organization; the number and types of workplaces (ranging from offices to factories; and from retail to traveling salespersons).

The organization also needs to consider whether any cultural values within the organization will affect risk control measures. The types of workers employed or working on the site may also be a factor, such as differences between full-time employed and short-term contractors. Given contractors are often brought in for additional projects, it is prudent to consider whether they are needed under the circumstances of a pandemic.

Further within the extent to which the company can put in place physical distancing measures and whether any specific workers are at higher risk of contracting the coronavirus or who are at a risk of developing a severe illness from COVID-19. This could be based on demographic factors, for example. Employers should expect increased worker absence, either due to sickness, self-isolation or quarantine requirements. For accommodating employees onto site, the employer needs to consider resource availability, such as toilet and handwashing facilities. The employer is encouraged to communicate these factors to the workforce and the risk outcomes, and to be open to engaging with the workforce about safety matters.

Risk outcomes

While risk outcomes will be workplace specific, they will include the provision of personal face masks and clear instructions as to where they are to be used; hand sanitization stations; and increased cleaning and disinfection of work areas, with a focus on ‘hot touch’ items. Other items to include under an increased cleaning regime are showers and toilet handles. To this can be added water taps and drinks dispensers, which need to be disinfected by the user after use. The preference is for paper towels only in toilets, rather than air dryers (especially the type that requires a person to place their hands inside). The bins for disposing of paper waste should preferably be foot operated.

Consideration should be given to room design and airflow patterns. This includes maximizing the amount of outdoor air and room air changes through ventilation systems (with appropriate filtration and duration of operation), turning off air recirculation systems, and keeping doors and windows open. The standard recommends that those at work remain in ‘social bubbles’ and limit the interactions with other group of staff, in order to reduce the chances of spreading infections. This can be supported by one-way systems and by having defined routes for personnel to follow. To further enhance protection,  the standard recommends revising work instructions to enable safe operation of activities (e.g. keeping activity times as short as possible, using screens or barriers to separate people, using back-to-back or side-to-side working instead of face-to-face). The orientation that people adopt when seated can enhance or decrease the possibility of viral transmission through aerosols.

Areas that need attention are with the demarcation of spaces, to encourage putting in place signs and floor and/or wall markings to indicate recommended physical distancing, ensuring markings are simple, clear and large enough to be seen by visually impaired people; putting in place physical barriers to enforce physical distancing to the extent possible.

In terms of arrival and departure times and the extent that personnel mix, the standard makes the useful point that times should be varied in order to minimize points of personnel contact. One-way systems can assist with maintaining segregation, especially where staggered start and finish times cannot be easily accommodated.

Day-to-day assessments and general measures

There are number of general measures that will need to be accounted for in any risk assessment, such as the necessity of minimizing the number of workers in a physical workplace, and in provide enhanced protection, such as face masks. Also of importance is hand sanitization, preferably by washing with clean and hot water and soap for between 20 and 40 seconds. Alternatively, a hand sanitizer  containing a minimum of 60 % ethanol or 70 % isopropyl alcohol can be used for situations when hand washing is not possible. It is very important that hands are clean before hand sanitizer is applied, otherwise the is disinfectant will not penetrate the soil effectively.

Controls will be required for visitors coming into a site. It is recommended that businesses establish arrangements to prevent potentially infectious people from entering the workplace. This includes ensuring all visits have been agreed in advance and requesting that visitors undertake an assessment for COVID-19 symptoms prior to travelling to the site.

Once risk assessments have been put in place, the standard makes the recommendation that the employer should continue to engage with the workforce and listen to any recommendations made. In terms of oversight, controls should extend to the employer knowing who is in, when and where, so that should an incident occur (or a later positive result be notified), appropriate track-and-trace can be instigated.

In the event of a COVID-19 incident in the workplace, the standard provides a proforma for addressing the response. This includes measures like isolating the affected person until transportation can be arranged, asking the affected person to wear a mask, and initiating a cleaning and disinfection regime for the areas visited by the person with a suspect infection. This includes tracing any other workers who may have undertaken activities alongside the affected person and asking these other workers to self-isolate.

To ensure that the risk assessment is current and that the recommendations are being followed, the standard recommends that periodic audits are conducted. This will include assessing how effectively safety measures and controls are protecting the workers. Such audits can also assess the extent that personnel are maintaining compliance with safety measures in the workplace. The questioning approach inherent within the audit process can also be useful when reviewing COVID-19 incidences and deciding how good a response was. From such inquiries, the organization can determine opportunities for improving how it manages risks related to COVID-19 and implement necessary improvements.

Points of unclarity

With face masks, the term ‘face covering’ is used quite often. The standard indicates that ‘face covering is equivalent to the terms community masks, hygiene mask, barrier masks, and comfort masks and other local terms. This is somewhat confusing, given that many face coverings are of poor filtration efficacy in terms of minimizing the exhalation of particles containing virions. The better recommendation is towards using personal protective equipment.

The standard does, however, state that face coverings need to fit correctly and that they need to be disposed of safely. The good point is made that the employer should always provide face coverings free of charge and ensure there is sufficient stock. Face coverings must be changed a soon as they become wet and most can only be worn for up to 4 hours, after which they need to be disposed of.

Summary

Overall the new ISO standard contains useful advice. No set of general guidelines can be sufficiently specific to capture the finer aspects of every industrial sector, and there will be specific concerns within pharmaceuticals and healthcare to consider such as viral removal strategies and with the avoidance of cross-contamination (some suggestions here are discussed in a Journal of Validation Technology article) (4). With this in mind, the standard provides a good starting point for generating a workplace assessment and it contains points for consideration against which an existing workplace COVD-19 risk assessment can be compared.

References




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