May 21, 2007 (CIDRAP News) – Experts predict that an influenza pandemic will place a long and heavy burden on the medical community, which prompted the US Department of Labor (DOL) to develop guidance for healthcare worker safety that it released today at a press conference.
The guidelines, released on the Occupational Safety and Health Administration (OSHA) Web site today, cover a range of healthcare settings, from emergency departments to ambulances to temporary patient care facilities. The 100-page document is a follow-up to guidelines released by OSHA in February that provided general guidance for all types of workplaces.
Edwin G. Foulke Jr, assistant secretary of labor for OSHA, told reporters today that the guidance for the healthcare workers and other employee groups is part of the Bush administration's national pandemic strategy. "We have to ensure that essential public services will continue, and only by protecting healthcare workers can we weather a pandemic," he said.
The OSHA guidelines are based on traditional infection control and occupational hygiene principles but may need to be modified or supplemented as more details become known about the transmission once a pandemic strain emerges, Foulke said.
The guidance for healthcare workers is divided into four sections that cover clinical information on influenza, infection control, pandemic influenza preparedness, and specific OSHA standards. Donald Wright, director of OSHA's office of occupational medicine, said he anticipates that healthcare workers will be most interested in the infection control section.
A focus of the infection control section is the "weak links" in hospital infection control, such as hand hygiene and respiratory protection compliance. The section stresses that it's not enough to question employees about hygiene practices; institutions need to observe employee behavior, implement strategies to promote the recommended practices, and cultivate a safety climate that promotes good infection control behaviors.
In reviewing several possible patient care scenarios, the OSHA guidance, for example, suggests what to do when a hospital runs out of single rooms for patients: Patients with suspected pandemic influenza could be grouped in cohorts in areas of the facility where they receive care from experienced staff and are isolated from main thoroughfares.
OSHA suggests several surveillance activities that would be helpful for hospitals in a pandemic, such as tracking employees who have cared for patients with suspected or confirmed influenza or screening workers each day for influenzalike symptoms.
Guidance on personal protective equipment is consistent with other OSHA and US Department of Health and Human Services (HHS) advisories, Wright said. Though the HHS pandemic influenza plan does not recommend goggles and face shields for routine care of patients with pandemic influenza, OSHA advises that workers who are within 3 feet of a coughing patient should wear those items.
OSHA strongly urges healthcare institutions to stockpile N-95 respirators and other protective equipment, warning that the items will be scarce once a pandemic strikes. "Employers and employees should not count on obtaining any additional protective equipment not already purchased and stockpiled," the report said. "Therefore, it is important for healthcare facilities to consider respiratory protection for essential personnel to assure that employees are ready, willing, and able to care for the general population."
The guidelines recognized that when supplies are scarce, employees may need to consider reusing their respirators. Reuse of disposable respirators should be limited to a single wearer, be labeled with the employee's name, and include clear instruction about how to avoid spreading contamination from the outside of the respirator. Wearing a face shield over the respirator may help keep the exterior of the device clean, the OSHA guidance suggests.
Several other institutional issues are addressed, such as cleaning patient care equipment, disinfecting patient rooms, and disposing of solid waste.
Extensive appendices include several resources for healthcare institutions, such as communication tools for promoting employee infection control practices, strategies for planning respiratory protections programs, triage algorithms, supply and pandemic planning checklists, and even a crisis communication guide for handling questions from the media.
OSHA pandemic preparedness and response guidance for healthcare workers and employers
May 21 OSHA press release
Feb 8 CIDRAP News article "New OSHA guidance targets pandemic flu"