The Role of the Pandemic · The Role of the Industrial Hygienist in a. AIHA Guideline 7 – 2006...

Provided resources, information, and tools to advise and assist general workers, health care workers, and management to protect workers in the case of a flu pandemic.

By the AIHA Biosafety and Environmental Microbiology Committee

A Publication by American Industrial Hygiene Association

PandemicThe Role of the Industrial Hygienist in a

AIHA Guideline 7 – 2006

The Role of the Industrial Hygienist in a Pandemic

Approval Date: May 4, 2006American Industrial Hygiene Association

Copyright AIHA® For personal use only. Do not distribute.

DisclaimerThis document is neither a comprehensive treatment of issues concerning a pandemic nor a stand-alone resource. Scientific and practical knowledge in this area are rapidly

accumulating and evolving. It is intended to complement policies and procedures put intopractice by other disciplines within a healthcare environment and should be used by the

industrial hygienist in conjunction with existing information.

AIHA and the authors disclaim any liability, loss, or risk resulting directly or indirectly from the use of the practices and/or theories discussed in this guideline. Moreover, it is

the reader’s responsibility to stay informed of policies adopted specifically in the reader’s workplace.

Specific mention of manufacturers, membership organizations, and products in this guideline does not represent an endorsement by AIHA.

Copyright 2006, by the American Industrial Hygiene Association.All rights reserved. No part of this publication may be reproduced in any form, by

Photostat, microfilm, retrieval system, or any other means, without prior permission fromthe publisher.

Stock Number: SEPG06-711ISBN: 1-931504-70-9

American Industrial Hygiene Association2700 Prosperity Avenue, Suite 250

Fairfax, VA 22031Tel: (703) 849-8888Fax: (703) 207-3561

E-mail: [email protected]://www.aiha.org

Printed in the United States of America


Table of Contents

Contributing Authors ...........................................................................................i

I. Background........................................................................................................1a. Overview.......................................................................................................1b. Purpose.........................................................................................................1

II. Roles and Responsibilities. ..................................................................................1

III. Hazards .............................................................................................................1

IV. Recommended Controls......................................................................................2a. Administrative/Work Practices ........................................................................2b. Engineering Controls .....................................................................................4c. Personal Protective Equipment .......................................................................4

V. Communication/Coordination ............................................................................6a. Coordination with Infection and Prevention Control Specialists ......................6b. Emergency Responders / Emergency Preparedness Personnel.........................6c. Communications Planning .............................................................................7d. Plan for the impact of a pandemic on the organization and its mission ..........8e. Plan for the impact of a pandemic on staff ....................................................8f. Set up policies to follow during a pandemic...................................................8g. Allocate resources to protect staff ..................................................................9h. Communicate with and educate staff members, and persons in the

communities served.......................................................................................9i. Coordinate with external organizations and help community .........................9j. Communication/Coordination with Workforce

(includes Business Continuity Plan) ................................................................9

VI. Communication/Coordination with the Public ...................................................10

VII. Resources.........................................................................................................10

VIII. References........................................................................................................11

Appendix 1: Industrial Hygiene Planning Checklist......................................................13Appendix 2: Standard Precautions ..............................................................................15Appendix 3: Pandemic Planning Template...................................................................17


i

Contributing Authors

This guideline is sponsored and maintained by the American Industrial Hygiene Association Biosafety and Environmental Microbiology Committee Project Team comprised of members from several

AIHA volunteer groups, and other occupational health and safety agencies and professional associations.

Members who authored this document include the following:Robert C. Adams, CIH, CSP, Emergency Response Task ForceMichael T. Brandt, DrPH, CIH, PMP, AIHA Board of Directors

Camille J. Carraway, CIH, Biosafety and Environmental Microbiology CommitteeDavid N. Easton, MPH, CIH, Biosafety and Environmental Microbiology Committee

Janice K. Flesher, Biosafety and Environmental Microbiology CommitteeThomas P. Fuller, ScD, CIH, MSPH, MBA, Healthcare Working Group, and Nonionizing Radiation Committee

Fred Fung, MD, Biosafety and Environmental Microbiology CommitteeNatalie A. Gaydos, CIH, Respiratory Protection Committee

Roger D. Lewis, PhD, CIH, Biosafety and Environmental Microbiology CommitteeDina M. Sassone, CIH, CSP, Biosafety and Environmental Microbiology Committee

James A. Scott, Biosafety and Environmental Microbiology CommitteeJack P. Springston, CIH, CSP, Biosafety and Environmental Microbiology Committee

Andy J. Streifel, Biosafety and Environmental Microbiology CommitteeRobert D. Strode, CIH, Biosafety and Environmental Microbiology Committee

Victor M. Toy, CIH, CSP, Past President, AIHA AcademyDonald M. Weekes, CIH, CSP, Indoor Environmental Quality Committee

P. Brock Williams, PhD, Biosafety and Environmental Microbiology CommitteeZiqing Zhuang, PhD, Respiratory Protection Committee

AIHA Staff Author

Aimée O’Grady, Project Coordinator, Scientific and Technical Initiatives

Acknowledgement

AIHA would like to thank those employers who allowed their employees to devote time and resources toward the development of this document.


I. Backgrounda. Overview

As industrial hygienists today, we arefaced with a myriad of issues that haveexpanded our role. This includes new tech-nologies, terrorism, emergency prepared-ness and response, and emerging infectiousdiseases such as SARS, plague, and influen-za. Of particular concern to many govern-ments, public health officials, and medicalproviders, is the possibility of a pandemic. A pandemic is a global outbreak that occurswhen, for example, a new influenza viruscauses serious human illness and spreadseasily from person to person1.

A pandemic is, by definition, an out-break of a disease that initiates simultane-ous infections of humans throughout theworld. The disease occurs simultaneouslybecause populations share some commonsusceptibility. Health officials currently fearthat the H5N1 subtype of the avian influen-za virus is the agent that will initiate thepandemic if it mutates to acquire the abilityto spread from human to human. Seehttp://www.cdc.gov/flu/avian/index.htmand/or http://www.who.int/csr/disease/avian_influenza/en/index.html.

The primary reason this subtype of virusis so widely feared is because the world’spopulation is immunologically vulnerable.This is a new strain and humans have noresidual antibodies from previous seasonalinfluenza outbreaks. Also, cases wherehumans have been infected following closecontact with infected birds indicate that it isan extremely virulent agent of disease.Estimates of 52–55% mortality rates havebeen quoted. See http://www.who.int/csr/disease/avian_influenza/en/index.html.

There is no readily available referenceor guidance that addresses the industrialhygienist’s role in planning for a pandemic,or provides an industrial hygienist with spe-cific actions for prompt and effectiveresponse to a pandemic. AIHA recognizesthat the working industrial hygiene profes-sional, regardless of employer or back-ground, needs ready access to specificresources, information and tools, in order toplan for and provide assistance in the eventof a pandemic. This guideline provides back-

ground, roles and responsibilities, an intro-duction to infection control and a discussionof the hazards and controls, critical commu-nication strategies, planning, and additionalresources. This guideline also includes achecklist that an IH may use for planningpurposes (Appendix 1).

This guideline represents a consensusstatement by a group of experts aboutimportant aspects of the “state of the sci-ence.” The guidance offered is practicalinformation and does not claim to be adefinitive or comprehensive position state-ment. Because it is not comprehensive, itshould always be used with newly emergingguidance in addition to existing guidancedocuments, as well as professional judgment.

b. Purpose

The purpose of this guideline is to pro-vide industrial hygienists with resources,information, and tools to advise and providerecommendations to general workers, healthcare workers, and management, in order toprotect workers. This guideline was devel-oped in cooperation with several AIHA vol-unteer groups and other occupational healthand safety agencies and professional associ-ations. It should be considered complemen-tary to the many excellent resources avail-able, which are references at the end of thisguideline.

II. Roles and ResponsibilitiesThe role and responsibility of the indus-

trial hygienist is to provide advice and rec-ommendations on control measures for theworkplace and community. (i.e., administra-tive controls, personal protective equipment,and engineering), in coordination with theinfection prevention and control specialist,based on the best available information.

III. HazardsThe identification of hazards and assess-

ment of risks differ when evaluating biologi-cal agents versus chemical and physicalagents. Chemicals and physical agents arenormally evaluated on a quantitative basis(e.g., measured concentrations that arecompared to occupational exposure limits).The risk of exposure to biological agents

1

1 CDC pandemic influenza web page http://www.cdc.gov/flu/pandemic/


must be determined qualitatively with signifi-cant variations based upon factors such ashost susceptibility, agent pathogenicity (i.e.,it’s capability to cause disease, agent stabili-ty in the environment, the availability oftherapeutic interventions (e.g., treatment orvaccinations). See, http://bmbl.od.nih.gov/risk.htm. The National Institutes of Health in“Guidelines for Research InvolvingRecombinant DNA Molecules,” (see,http://www4.od.nih.gov/oba/rac/guidelines_02/APPENDIX_B.htm), list humandisease agents according to the followingrisk criteria:

Table 1: Biological Agents by Risk Group (RG)

Qualitative Grouping Definition

Risk Group 1 (RG1) Agents that are not associated with disease in healthy adult humans

Risk Group 2 (RG2) Agents that are associated with human disease which is rarely serious; preventive or therapeutic interventions are often available

Risk Group 3 (RG3) Agents that are associated with serious or lethal human disease for which preventive or therapeutic interventions may be available (high individual risk but low community risk)

Risk Group 4 (RG4) Agents that are likely to cause serious or lethal human disease for which preventive or therapeutic interventions are not usually available (high individual risk and high community risk)

Application of these risk groupings forthe H5N1 avian flu subtype that hasacquired human to human transmissioncapability indicates these agents fall into riskgroup 3 or 4. Clearly, the stakes are highand there is strong evidence that a conser-vative approach is required to protect thebroad spectrum of workers addressed in thisdocument.

As a matter of practicality, it would beutterly impossible to apply the isolation, con-tainment, and administrative controls seenroutinely in laboratory settings with RG 3and RG 4 agents in the event of a pandemicwherein thousands of individuals may bepotentially infected. Practical guidelines havebeen developed by infection prevention and

control professionals to minimize transmis-sion and the spread of disease in healthcare facilities. They are listed in Supplement4 of the Health and Human Services (HHS)“Pandemic Influenza Plan”(http://www.hhs.gov/pandemicflu/plan/pdf/HHSPandemicInfluenzaPlan.pdf ).

The plan adopts the common InfectionControl approach of rating influenza trans-mission potential according to three modes:

• Droplet Transmission: contact of theconjunctivae or the mucous membranesof the nose or mouth

• Contact Transmission: skin-to-skincontact or indirect contact with virus inthe environment

• Airborne Transmission: disseminationof either airborne droplet nuclei or smallparticles in the respirable size rangecontaining the infectious agent.

IV. Recommended Controlsa. Administrative/Work Practices

The ability of industrial hygienists toensure the protection of worker health andsafety in the setting of a pandemic influenzaoutbreak requires the consideration of cer-tain administrative controls. Industrialhygienists participating in the emergencyresponse planning process or tasked withthe management of workers during an out-break should be aware of the principalareas of administrative control available.

Education and TrainingIndustrial hygienists should be closely

involved in training and providing up-to-dateguidance/interpretation on recommendedsafe work practices and PPE use. During apandemic, industrial hygienists are well posi-tioned to ensure that workers properly followhealth and safety procedures and complywith PPE requirements. In the early planningstages, industrial hygienists should engagethe participation of all workplace parties:

• To establish mandatory policy on PPE usebased on available current guidelines,including procedures to address non-compliance;

• Tto develop policies limiting use ofshared equipment;

2


• To develop guidelines on the disinfection,including chemical use, of generalsurfaces including where the sharing ofequipment is absolutely necessary;

• To provide on-going worker training andeducation; and

• To support safe work practices and PPEuse during the course of an outbreak,providing leadership by example andencouragement for continuing workercompliance.

Workplace Access and SecurityThe movement of workers to and from

the workplace presents a pathway wherebyinfectious agents may be acquired andtransmitted between the community andworkers. The careful control of access to theworkplace together with the use of a "fit-for-work" screening tool, can help to protectworkers and maintain productivity. A suitable"fit-for-work" screening tool should evaluateworkers against relevant, conspicuous clini-cal features of early-stage infection, such asfever and cough, in order to provide ameans to screen out high risk workers priorto their entry into the workplace.

Appropriate questionnaires may beobtained from the U.S. Centers for DiseaseControl or local health authorities. Effectiveadministration of the tool may require thedesignation a single or few workplaceentrances and exits to which dedicatedscreening staff can be assigned. Industrialhygienists should participate in the develop-ment of policies:

• To restrict and monitor workplace access; • To provide for follow-up evaluation for

tool failure criteria, such as a qualifiedhealthcare assessment or emergencyintervention; and

• To establish criteria for refusal of accessand isolation of unfit workers, and “casecontacts” and return-to-work.

The concept of “social distancing” is themost important feature of a pandemic man-agement plan. The underlying idea of thisplan is the limitation of human-to-humancontacts that might risk the transmission ofinfectious disease. No other controls alone,including use of respirators and other pro-tective equipment, has shown to be moreeffective. Several strategies of social distanc-ing industrial hygienists may consider in the

event of a pandemic influenza outbreakinclude:

• Implementing telework capabilitieswhere feasible;

• Developing infrastructure to managemeetings by conference call orvideoconferencing;

• Encouraging job rotation or staggeredshifts to reduce workplace capacity aswell as worker exposure risks related totraveling on public transit during peaktimes;

• Segregating/ isolating critical workclusters;

• Reducing or eliminating work in low-ventilated areas;

• Minimizing the use of shared facilitiesfor eating/ smoking by staggeringmeals/ breaks or designating multiplesites;

• Reducing or eliminating work travel tohigh-risk regions and encourage workersengaged in travel to stay away in theevent of a local outbreak; and

• Initiating an administrative leave policyfor non-essential workers.

Cleaning, Disinfection and SterilizationCleaning, disinfection and sterilization

are commonly assigned by infection andprevention control specialists to ensurepatient safety. Disinfection and sterilizationare not often prescribed to ensure workerhealth and safety. Therefore there is a needfor industrial hygienists to obtain a basicunderstanding of concepts and terminologyand apply them to the protection of workers.

Cleaning is the removal of all foreignmaterial (e.g. soil, organic material) fromobjects. It is normally accomplished withwater, mechanical action, and detergents orenzymatic products. Meticulous cleaningmust precede disinfection and sterilizationprocedures.

Disinfection describes the process thateliminates many or all pathogenic microor-ganisms, but not necessarily all microbialforms (e.g., bacterial/fungal spores) andother resistant forms, from inanimateobjects. The efficacy of disinfection is affect-ed by a number of factors including; previ-ous cleaning, organic load, type and level ofmicrobial contamination, concentration ofand exposure time to the disinfectant, physi-cal configuration of the object, and the tem-

3


perature and pH of the disinfection process.Disinfection is broken into three categories;high, intermediate, and low based upon theeffectiveness of killing or neutralizing biolog-ical agents.

Sterilization is the complete eliminationor destruction of all forms of microbial life. Itcan be accomplished by either physical orchemical processes.

In the event of an outbreak of agentswith unknown characteristics the industrialhygienist will need to keep abreast of cur-rent recommendations for cleaning, disinfec-tion and sterilization to ensure a safe work-place. The Center for Disease Control(www.cdc.gov), Food and Drug administra-tion (www.FDA.gov ), World HealthOrganization (www.who.org) and theEnvironmental Protection Agency(http://www.epa.gov/oppad001/chemregindex.htm ) are all repositories of informationand expertise on the most effective productsand techniques.

Labor RelationsDuring a pandemic influenza outbreak,

industrial hygienists will play an essentialrole both in ensuring worker health andsafety and maintaining adequate workforceto accommodate event-related changes inworkflow/production. It should also beexpected that workplaces will experience anincrease in grievances and work refusalsalong with an increase in union involvementwith respect to workplace health and safetyissues. In anticipation of these outcomes,industrial hygienists should participateproactively in the development and imple-mentation of a planning process to:

• Provide input to the business inidentifying critical production needs andreduce non-essential production;

• Compile priority requirements for keyworkers with respect to PPE and training;

• Engage management and workers/union parties in discussions on safe workpractices, grievance procedures, andcontingencies available for workforce,supply chain and production;

• Maintain effective communicationsbetween all workplace parties;

• Address dispute resolution regardinghealth and safety/safe work issues; and

• Identify and mitigate unique exposurerisks posed by multiple jobs/shifts by

part-time/ occasional workers (e.g.health care workers working shifts atmultiple hospitals).

• Identify and help secure critical suppliessuch as personal protective equipmentand disinfectants.

CommunicationsIndustrial hygienists should participate

closely with all parties in the development ofa critical path for communications prior toand during a pandemic event. Robust com-munication pathways will be critical to keepworkers current of evolving procedures andpractices, changing production needs,emerging events, and other time-critical oressential information. Depending on thescale of the workplace, particular informa-tional requirements, potential externalimpacts (e.g., limited phone service, poweravailability), methods to consider include theimplementation of one or more of the fol-lowing, based on worker accessibility andworkplace needs:

• Call-in hotline;• Up-to-the-minute web splash-page; and• Dedicated "grapevine".

b. Engineering Controls

The following examples of engineeringcontrols may be used. The industrial hygien-ist should work closely with the infection andprevention control personnel in terms ofapplication of any of these controls.

• Negative pressure rooms should haveestablished minimum differentials inaccordance with accepted practice. Referto http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm?s_cid=rr5417a1_e for specific details.

• General ventilation that ensures the flowof non-contaminated to potentiallycontaminated air throughout the facility.

• Temporary structures adjacent to usualtreatment facilities such as air-conditioned and heated tents can beuseful areas to triage and screen suspectpatients prior to allowing entry into thefacility.

• Develop O&M procedures to clean,maintain, and operate HVAC and roomventilation including protection formaintenance staff.

4


c. Personal Protective Equipment

The industrial hygiene approach to per-sonal protective equipment is based on pro-tection of the worker, and stems from anevaluation of the hazard, primarily the physi-cal form of the hazard, whether it be chemi-cal, biological, or a physical agent. Infectioncontrol measures focus primarily on patientsafety and aim at reducing the spread of dis-ease. These two approaches can be comple-mentary, resulting in a more comprehensiveapproach to pandemics. Because of the pur-pose and history of these two approaches tohealth protection, infection control measuresand industrial hygiene concepts and

approaches can differ. It is essential thatindustrial hygienists and infection control andprevention specialists work collaboratively todevise the best protective scheme for the par-ticular situation in compliance with OSHA’srespiratory protection standard, 1910.134.

The tables shown below show twoapproaches: Infection Control Measurementsand Industrial Hygiene Control Measures.Since approaches to PPE such as respiratoryprotection and gloves are different, theindustrial hygienist should work closely withinfection and prevention control specialiststo ensure the best approach, based on thespecific situation.

5

Table 2: Infection Control Measures

Scenario Transmission Mode Hazard Level Prescribed Infection Control Measures

Outside the potentially infectious None None None Recommendedpatient’s room or containment Recommended

Entering the potentially infectious Airborne, Contact Low Surgical mask, vinyl or nitrilepatient’s room or containment gloves, Standard Precautions*

Close contact with potentially Airborne, Contact Moderate N95 respirator, PPE (Splash Protection, vinyl or infectious patient Droplet Spray nitrile gloves, Gowns, Head /Shoe Covers),

Standard Precautions*

Patient undergoing endotracheal Airborne, Contact High N95 respirator (minimum), PPE (as listed in intubation, suctioning or Droplet Spray Contact Section Above), Negative Pressure aerosolized nebulizer treatments Isolation Room, and Standard Precautions*

Table 3: Industrial Hygiene Control Measures

Scenario Minimum Industrial Hygiene PPE Control Measures

Outside the potentially infectious patient’s room or containment None Recommended

Entering the potentially infectious patient’s room or containment N95 respirator, Standard Precautions*

Close contact with potentially infectious patient N95 respirator, (splash protection, nitrile gloves, surgical gown with long cuffed sleeves), Standard Precautions*

Patient undergoing endotracheal intubation, suctioning or N95 respirator, nitrile gloves, protective clothing (preferablyaerosolized nebulizer treatments disposable outer garments or coveralls), an impermeable apron or

surgical gown with long cuffed sleeves, impermeable apron, disposable protective shoe covers or boots that can be disinfected, safety goggles.†

Workers having the potential to come into close contact with N95 respirator, nitrile gloves, protective clothing (preferablypotentially infected live or dead animals, or tissues disposable outer garments or coveralls), an impermeable apron or

surgical gown with long cuffed sleeves, impermeable apron, disposable protective shoe covers or boots that can be disinfected, safety goggles

* See Appendix 2 of this guideline for Standard (Universal) Precautions Guidelines described in the OSHA Bloodborne PathogensStandard. (29 CFR 1910.1030) can be found at ww.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051.† Safety goggles should offer splash protection, specifically indirect vented or nonvented goggles.

Tables updated 8/23/2006.


V. Communication/Coordination a. Coordination with Infection and

Prevention Control Specialists

Hospital infection and prevention controlteams are typically comprised of medicaldoctors, microbiologists, nurses and epi-demiologists. Their goal is to develop andimplement procedures for the evaluation,identification, prevention, and control ofinfections. They also provide training andoversight to staff, and communicate withgovernment agencies.

Industrial hygiene has evolved into adiscrete sophisticated science. Infection andprevention control personnel may beunaware of the capabilities and tools avail-able to them to assist with infection control.Expertise in aerosol science, respiratory pro-tection, protective equipment, chemical safe-ty, ventilation, contamination control, airmonitoring, and surface sampling can helpinfection and prevention control specialists.It can be a challenging task, but it is theindustrial hygienists' job to make theirexpertise and services available to the infec-tion and prevention control team. Theirunderstanding and implementation of indus-trial hygiene concepts such as ventilationmay provide valuable assistance to theinfection and prevention control team. It isimportant for the industrial hygienists tomeet regularly with the infection and pre-vention control specialist at their site, or intheir community, in order to communicatewith management and employees, and todevelop control strategies as information onthe agents becomes available.

b. Emergency Responders/Emergency Preparedness Personnel

Industrial hygienists can serve a crucialand essential role in the emergency commu-nications network of organizations that areinvolved in planning for, or response to, thewidespread outbreak of an infectious dis-ease. The industrial hygienist will become avery important source of health, safety andenvironmental information for municipal,state, or federal governmental agencies,local emergency planning committees,healthcare professionals, public and privateemergency response organizations, businessleaders and incident commanders (collec-tively the “emergency planning and

response community”). With their back-ground in anticipation, recognition, evalua-tion and control, industrial hygienists canprovide a wide range of expertise to advisethe emergency response community on themeans to effectively identify, manage, andultimately, control health, safety and envi-ronmental risks associated with an infectiousdisease outbreak.

While the industrial hygienist has therequisite skills to effectively communicaterisks based upon complex scientific data andfield information, it is understood that manymay not have direct experience with emer-gency response and preparedness or experi-ence with a pandemic. However, the skill setof the industrial hygienist would include theability to ascertain, characterize, and evalu-ate various hazards in a pandemic.Industrial hygienists have a strong under-standing of personal protective equipment,respiratory protection, contamination con-trol, decontamination principles, samplingand analytical methods and other relatedareas. Whether in emergency planning orduring an actual pandemic response, indus-trial hygienists can provide a vital role inhelping the emergency planning andresponse community deal with issues of risk,exposure and protection, and can help inthe challenging communications betweenvarious parties such as the incident com-mander, healthcare providers, private sectorresponse teams, the general public andbusiness leaders.

In the preparedness phase, industrialhygienists can provide valuable informationon the types of hazards that might beexpected during a pandemic outbreak.Industrial hygienists can advise the emer-gency planning and response community onhazard control methods, such as ways tosubstitute or eliminate hazards that mayarise from an incident. The industrialhygienist can provide important informationabout the types of PPE, including assistancewith selection, limitations and care andmaintenance of equipment. During anevent, the IH can assist response personnelwith information on the:

• proper donning and doffing of PPE; • risks of wearing PPE, such as heat stress,

lack of visibility or increased accident risks;• fit testing and fit checking of respiratory

protection; and

6


• proper methods for decontaminationand disposal of equipment and clothing.

Industrial hygienists can also helpexplain, particularly to the healthcare com-munity, the value of using respiratory protec-tion when dealing with airborne infectiousdiseases.

Industrial hygienists are in a good posi-tion to communicate the capabilities and lim-itations of sampling data and analyticalmethods. Industrial hygienists understand thepotential complexities of various samplingand analytical methods and can help explainnon-detect readings, false-positive readings,below detection limits results or cross-reactiv-ity with similarly structured biological agents.In addition, industrial hygienists can explainhow sampling results can be affected by tem-perature, humidity, and moisture presence,and other factors that might exist.

The industrial hygienist can further assistthe emergency planning and response com-munity by:

• raising awareness of health and safetyissues that will have to be addressed,including explaining how varioussituations may have an impact on theresponse worker and community healthand safety; communicating procedures,policies, positions and activities to assurethe protection of workers and the public;

• assisting with the production of factualinformational materials (bulletins,pamphlets, notices, alerts or advisories),as needed, to further understanding ofkey environmental, health and safetyissues; and

• encouraging preparedness and responsecollaboration among business,government, healthcare professionals,responders, workers and the generalpublic.

The industrial hygienist can serve a criti-cal role in providing on-site safety andhealth training. The industrial hygienist cancommunicate incident specific informationon hazards and required controls to allimpacted workers and response personnelinvolved. Industrial hygienists are greatassets to train current or new response per-sonnel, prior to commencing work, on haz-ards and ways to control them. This includesconducting "tail-gate" safety briefings to vari-ous groups, as needed.

c. Communications Planning

• Assess readiness to meetcommunications needs in preparationfor an influenza pandemic, includingregular review, testing, and updating ofcommunications plans.

• Develop a dissemination orcommunication plan with employees,students, and families, including leadspokespersons and links to othercommunication networks. Ensurelanguage, culture and reading levelappropriateness in communications.

• Anticipate and plan communications toaddress the potential fear and anxiety ofemployees, students, and families thatmay result from rumors ormisinformation.

• Develop and test platform (e.g., hotlines,telephone trees, dedicated websites,local radio or television) response andactions to employees, students, andfamilies.

• Assure the provision of redundantcommunication systems/channels thatallow for the expedited transmission andreceipt of information.

• Advise employees and students where tofind up-to-date reliable pandemicinformation from federal, state and localpublic health sources.

• Disseminate information aboutpandemic preparedness and responseplan. This should include the potentialimpact of a pandemic on housingclosures, and contingency plans, e.g., forstudents who depend on studenthousing and campus food service,including how student safety for thosewho remain in student housing will bemaintained.

• Disseminate information from publichealth sources covering routine infectioncontrol (e.g., hand hygiene,coughing/sneezing etiquette), pandemicinfluenza fundamentals (e.g., signs andsymptoms of influenza, modes oftransmission), personal and familyprotection and response strategies, andthe at-home care of ill students oremployees and their family members.

7


d. Plan for the impact of a pandemic on the organization and its mission

• Identify key staff with the authority todevelop, maintain and act upon apandemic preparedness and responseplan. The plan should be written,reviewed as a “table top” exercise, andexecuted as a drill (where possible andfeasible) to familiarize each person withtheir respective role and improved withlessons learned from a critique of thedrill.

• Determine the potential impact of apandemic on the organization’s usualactivities and services. Plan for situationslikely to require increasing, decreasingor altering the services the organizationdelivers.

• Determine the potential impact of apandemic on outside resources that theorganization depends on to deliver itsservices (e.g., supplies, travel, “waves” ofinfection, etc.).

• Outline what the organizationalstructure will be during an emergencyand revise periodically. The outlineshould identify key contacts with multipleback-ups, role and responsibilities, andwho is supposed to report to whom.

• Identify and train essential staff(including full-time, part-time andunpaid or volunteer staff) needed tocarry on the organization’s work duringa pandemic. Include backup plans,cross-train staff in other jobs so that ifstaff are sick, others are ready to comein to carry on the work.

• Find up-to-date, reliable pandemicinformation from state and local healthdepartments, emergency managementagencies, and the CDC.

• Test response and preparedness planusing an exercise or drill, and reviewand revise the plan as needed.

e. Plan for the impact of a pandemic on staff

• Plan for extended staff absences (weeksor perhaps months) during a pandemicdue to personal and/or family illnesses,quarantines, and school, business, andpublic transportation closures. Staff mayinclude full-time, part-time andvolunteer personnel.

• Work with local health authorities toencourage yearly influenza vaccinationfor staff, members, and persons in thecommunities served.

• Evaluate access to mental health andsocial services during a pandemic forstaff members, and persons in thecommunities served; improve access tothese services as needed.

• Identify persons with special needs (e.g.elderly, disabled, limited Englishspeakers) and include their needs inresponse and preparedness plan.Establish relationships with them inadvance to foster trust during a crisis.

f. Set up policies to follow during a pandemic

• Set up policies for non-penalized leavefor personal illness or care for sickfamily members during a pandemic.

• Set up mandatory sick-leave policies forstaff suspected to be ill, exposed (casecontact), or who become ill at theworksite. Employees should remain athome until their symptoms resolve andthey are physically ready to return toduty (Know how to check up-to-dateCDC recommendations).

• Set up policies for flexible work hoursand working from home.

• Set up policies to prevent the spread ofpandemic influenza during theorganization’s usual activities andservices, including guidance forrespiratory hygiene and cough etiquette,and instructions for persons withinfluenza symptoms to stay home andphone the organization rather than visitin person. Think in advance about howto adapt the activities in ways thatprotect the community at large,especially those at most risk.

• Follow CDC travel recommendationsduring an influenza pandemic.Recommendations may includerestricting travel to affected domesticand international sites, recalling non-essential staff working in or near anaffected site when an outbreak begins,and distributing health information topersons who are returning from affectedareas.

• Set procedures for activating theorganization’s response plan when an

8


influenza pandemic is declared by publichealth authorities and altering theorganization’s operations accordingly.

g. Allocate resources to protect staff

• Determine the amount of suppliesneeded to promote respiratory hygieneand cough etiquette (e.g., tissues andreceptacles for their disposal, alcohol-based hand sanitizers where soap andwater not readily available, etc.) andhow they will be obtained.

• Consider focusing the organization’sefforts during a pandemic to providingservices that are most needed during theemergency (e.g. mental/spiritual healthor social services).

h. Communicate with and educate staff members, and persons in the communities served

• Distribute materials with basicinformation about pandemic influenza:signs and symptoms, how it is spread,ways to protect individuals and theirfamilies (e.g., respiratory hygiene andcough etiquette), family preparednessplans, and how to care for ill persons athome.

• When appropriate, include basicinformation about pandemic influenza inpublic meetings (e.g. classes, trainings,small group meetings andannouncements).

• Develop tools to communicate to staffabout pandemic status and theorganization’s actions. This mightinclude websites, flyers, local newspaperannouncements, pre-recorded widelydistributed phone messages, etc.

• Consider the organization’s uniquecontribution to addressing rumors,misinformation, fear and anxiety.

• Share information about the pandemicpreparedness and response plan withstaff members, and persons in thecommunities served.

• Advise staff members, and persons inthe communities you serve to followinformation provided by public healthauthorities—state and local healthdepartments, emergency managementagencies, and CDC.

• Ensure that what you communicate isappropriate for the cultures, languagesand reading levels of staff members,and persons in the communities served.

i. Coordinate with external organizations and help community

• Understand the roles of federal, state,and local public health agencies andemergency responders and what toexpect and what not to expect from eachin the event of a pandemic.

• Work with local and/or state public healthagencies, emergency responders, localhealthcare facilities and insurers tounderstand their plans and what they canprovide. Share preparedness and responseplan details and what the organization isable to contribute, and take part in theirplanning. Appoint a point of contact tomaximize communication between yourorganization and state and local publichealth systems.

• Coordinate with emergency respondersand local healthcare facilities to improveavailability of medical advice and timely/urgent healthcare services for staffmembers, and persons in thecommunities served.

• Share lessons learned from developingyour preparedness and response planwith other companies to improvecommunity response efforts.

• Work together with communityorganizations in the local area andthrough networks (e.g. denominations,associations, etc) to help communitiesprepare for pandemic.

j. Communication/Coordination with Workforce (includes Business Continuity Plan)

It is likely that the industrial hygienistmay take a lead role in planning and imple-menting the communication and continuityplan for your workplace. While the planningmay be similar to other emergency and dis-aster planning, there are key differences inthe effect of a pandemic. Some of these dif-ferences include:

Widespread Impact: Because theimpact of a pandemic may be nation-wide,there may be little outside assistance avail-able to your business.

9


Duration and Notice: A pandemicwould not be a short, limited event like aphysical disaster that would lead immediate-ly to a recovery phase. Also, it is likely thatthere will be advance warning, although thiscould be very short.

Primary Effect on Staffing: Unlike nat-ural disasters, where business disruption islargely hardware related, the disruption tobusiness services during a pandemic is antic-ipated to be human resource related.Businesses should plan for 50% staffabsences for at least two weeks at theheight of a severe pandemic and lower lev-els of staff absence for a few weeks oneither side. Staff absences can be expectedfor many reasons: illness, caring for ill familymembers, schools may be closed, or simplybecause people may feel safer at home.

Business Continuity TeamsKeep in mind that while industrial

hygienists and medical staff are essential tomany elements of a business continuity andcommunication plan, additional resourceswill be necessary to maintain a business in atime of high anxiety and absences. A plan-ning team may include:

• Pandemic Flu Manager• Medical Advisor• Human Resources Professional• Communications Manager• Business Manager for each “essential

operation”• Information Management Manager• Internal and External Procurement

Managers

Continuity Planning for a pandemicshould include:

• Identification of essential businessactivities (and core people and skills tokeep them running).

• Mitigation of business/economicdisruptions, including possible shortagesof supplies.

• Minimizing illness in workers andcustomers.

Communication Plans Communicate frequently with your work-

force. You may want to begin your commu-nications right away to let them know thatplanning is underway. Avoid being alarmist

in communications and give people toolsthey can use to protect themselves and theirfamilies. It may be helpful to train peoplenow in ways they can prevent to spread ofseasonal colds and flu so that they candevelop good habits.

Additional Resources for BusinessTo assist in tailoring a plan to your busi-

ness, a Business Pandemic InfluenzaPlanning Checklist is available from the U.S.Centers for Disease Control and Preventionat http://www.cdc.gov/flu/pandemic/business.htm

In addition, the government of NewZealand has prepared extensive planningguidelines for business, available at:http://www.med.govt.nz/irdev/econ_dev/pandemic-planning/

VI. Communication/Coordination with the Public

Industrial hygienists can also play animportant role in communications with thegeneral public. Industrial hygienists can assistpublic information officers and their staff inthe transmission of vital information toemployees and their families, neighbors,public officials and business leaders. It isessential that there is accurate and timelydissemination of health and safety informa-tion to members of the public or the newsmedia during an emergency. The IH can alsoassist in the control of the spread of rumorsthat may develop during an outbreak. In aresponse situation, industrial hygienists canprovide necessary information to help publicinformation officers communicate the expo-sure risks to the community or to the media.This risk communication is extremely vital inorder to prevent unnecessary concern fromthe surrounding community, but also, toeffectively address the community's concerns.

VII. Resources• The American Industrial Hygiene Association

(AIHA): www.aiha.org• The American Biological Safety Association

(ABSA): www.absa.org• American Society of Heating, Refrigeration

and Air-Conditioning Engineers, Inc.(ASHRAE):http://membership.ashrae.org/template/AssetDetail?assetid=48387

10


• Association for Professionals in InfectionControl and Epidemiology (APIC):http://www.apic.org/AM/Template.cfm?Section=Home

• The Center for Disease Control andPrevention (CDC):http://www.cdc.gov/flu/avian/index.htm

• The Center for Disease Control andPrevention (CDC), Guidelines for Preventing theTransmission of Mycobacterium tuberculosis inHealth-Care Settings, 2005:http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm?s_cid=rr5417a1_e

• Environmental Protection Agency:http://www.epa.gov/oppad001/chemregindex.htm

• Infectious Diseases Society of America (IDSA):http://www.idsociety.org/Content/NavigationMenu/Resources/Avian_Pandemic_Flu/Avian_Pandemic_Flu.htm

• Health and Human Services (HHS), PandemicInfluenza Plan:http://www.hhs.gov/pandemicflu/plan/pdf/HHSPandemicInfluenzaPlan.pdf

• The National Institutes of Health, Biosafety inBiomedical and Microbiological Laboratories:http://bmbl.od.nih.gov/risk.htm

• The National Institutes of Health, Guidelinesfor Research Involving Recombinant DNAMolecules:http://www4.od.nih.gov/oba/rac/guidelines_02/APPENDIX_B.htm

• New Zealand Ministry of EconomicDevelopment:http://www.med.govt.nz/irdev/econ_dev/pandemic-planning/

• OSHA Bloodborne Pathogens Standard (29CFR 1910.1030):http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051

• World Health Organization (WHO):http://www.who.int/csr/disease/avian_influenza/en/

VIII. General ReferencesU.S. Department of Labor Occupational Safety

and Health Administration (OSHA): “Guidancefor Protecting Workers Against Avian Flu”http://www.osha.gov/dsg/guidance/avian-flu.html.Accessed on: April 26, 2006.

Centers for Disease Control and Prevention(CDC): “Prevention of Avian Flu”http://www.cdc.gov/flu/avian/professional/infect-control.htm. Accessed on: April 26, 2006.

World Health Organization (WHO):“Clarification: Use of masks by health-careworkers in pandemic settings” November 2005

Thorne, C., S. Khozin, M. McDiarmid: Using thehierarchy of control technologies to improvehealthcare facility infection control: lessons fromsevere acute respiratory syndrome. J. Occ. Env.Med. 46:7,613–622 (2004).

Centers for Disease Control and Prevention(CDC): Guidelines for preventing the transmissionof mycobacterium tuberculosis in health-carefacilities. MMWR 43:1–132 (1994).

Oxford, J.S., S. Bossuyt, S. Balasingam, A.Mann, et al.: Treatment of epidemic andpandemic influenza with neuraminidase and M2proton channel inhibitors. Clin. Microbiol. Infect.9(1):1–14 (2003).

Kandel, R., and K.L. Hartshorn: Prophylaxis andtreatment of influenza virus infection. Biodrugs15(5):303–323 (2001).

Balicer, R.D., M. Huerta, N. Davidovitch, and I.Grotto: Cost-benefit of stockpiling drugs forinfluenza pandemic. J. Infect. Dis. 192(4):665–672(2005).

Kawai, N., H. Ikematsu, N. Iwaki, I. Satoh, etal.: Factors influencing the effectiveness ofoseltamivir and amantadine for the treatment ofinfluenza: a multicenter study from Japan of the2002-2003 influenza season. Treat. Respir. Med.4(2):107–116 (2005).

Govorkova, E.A., H.B. Fang, M. Tan, and R.G.Webster: Neuraminidase inhibitor-rimantdinecombinations exert additive and synergistic anti-influenza virus effects in MDCK cells. J. Virol.78(22):12665–12667 (2004).

Gubareva, L.V.: Molecular mechanisms ofinfluenza virus resistance to neuraminidaseinhibitors. J. Clin. Virol. 30(2):115–133 (2004).

McKimm-Breschkin, J.L.: Management ofinfluenza virus infections with neuraminidaseinhibitors: detection, incidence, and implicationsof drug resistance. Treat. Respir. Med. 4:107–116(2005).

De Jong, M.D., T.T. Thanh, T.H. Khanh, Y.M.Hien, et al.: Pseltamivir resistance duringtreatment of influenza (H5N1) infection. New Eng.J. Med. 353:2667–2672 (2005).

Moscona, A.: Oseltamivir resistance-Disabling ourinfluenza defenses. New Eng. J. Med. 353:2633–2636 (2005).

Boss, M.: Biological Risk Engineering HandbookInfection Control and Decontamination. BocaRaton, FL: CRC Press, Lewis Publishers. 2003.

Cox, C.: Bioaerosols Handbook. Boca Raton, FL:Lewis Publishers. 1995.

Collins, C.: Occupational Blood-borne Infections Riskand Management. New York, CAB International.1997.

11


Ayliffe, G.: Control of Hospital Infection a PracticalHandbook. New York: Arnold and OxfordUniversity Press. 2000.

Heyman, D.: Control of Communicable DiseasesManual. Washington, D.C.: American PublicHealth Association. 2004.

Liberman, D.: Biohazards Management Handbook.New York: Marcel Dekker, Inc. 1995.

Burge, H.: Bioaerosols. Boca Raton, FL: CRC Press.1995.

12


Complete In Progress Not Started

HAZARDS

❏ ❏ ❏ Assess risk of exposure to biological agents.

RECOMMENDED CONTROLS

Education and Training❏ ❏ ❏ Maintain close involvement in training, recommended safe work

practices, and proper PPE use.❏ ❏ ❏ Establish policy on PPE use.❏ ❏ ❏ Limit use of shared equipment, establish disinfection guidelines.❏ ❏ ❏ Provide on-going worker-training and education.❏ ❏ ❏ Lead by example; encourage continued worker compliance

Workplace Access and Security❏ ❏ ❏ Careful control of access to the workplace using “fit-for-work”

screening tool.❏ ❏ ❏ Prepare policy for tool failure criteria.❏ ❏ ❏ Prepare policy for refusal of access to unfit workers and return-to-

work.❏ ❏ ❏ Implement social distancing practices.

Labor Relations❏ ❏ ❏ Anticipate an increase in worker grievances and union involvement.

Communications❏ ❏ ❏ Participate in development of critical path for emergency

communications.

Engineering❏ ❏ ❏ Apply engineering controls.

COMMUNICATIONS COORDINATION

Communications Planning❏ ❏ ❏ Develop dissemination/communication plan with staff. ❏ ❏ ❏ Develop and test platforms.❏ ❏ ❏ Disseminate information on your pandemic preparedness and

response plan.❏ ❏ ❏ Disseminate information from public health sources.❏ ❏ ❏ Anticipate and plan communications to address potential fear and

anxiety.

Plan for Pandemic Impact on Your Organization❏ ❏ ❏ Identify key staff with authority to help.❏ ❏ ❏ Determine impact of a pandemic on your organization and its mission.❏ ❏ ❏ Determine impact on pandemic on outside vendors.❏ ❏ ❏ Outline organization structure in the event of an emergency.❏ ❏ ❏ Train essential staff needed to continue business during a pandemic.❏ ❏ ❏ Find up-to-date pandemic information from state and local health

departments.❏ ❏ ❏ Test your response and preparedness plan using an exercise drill.

13

APPENDIX 1Industrial Hygiene Planning Checklist


Complete In Progress Not Started

Plan for Impact of a Pandemic on your Staff❏ ❏ ❏ Plan for absences.❏ ❏ ❏ Encourage yearly influenza vaccinations.❏ ❏ ❏ Evaluate access to mental health and social services during a pandemic.❏ ❏ ❏ Identify people with special needs. Be sure to include them your

preparedness plan.

Pandemic Policies❏ ❏ ❏ Set-up policies for non-penalized leave.❏ ❏ ❏ Set-up mandatory sick leave policies for staff suspected to be ill.❏ ❏ ❏ Set-up policies for flexible work hours and work from home.❏ ❏ ❏ Set-up policies to prevent spread of pandemic influenza during your

organization’s usual activities.❏ ❏ ❏ Make CDC travel recommendations public.❏ ❏ ❏ Set-up procedures to activate your organization’s response plan.

Allocate Resources to Protect Staff❏ ❏ ❏ Determine supplies needed to promote respiratory hygiene and

cough etiquette.❏ ❏ ❏ Focus organization’s efforts to providing services that are most needed.

Communication❏ ❏ ❏ Distribute information about pandemic influenza. When appropriate

include in public meetings.❏ ❏ ❏ Develop tools to communicate with staff about pandemic status.❏ ❏ ❏ Consider your organization’s unique contribution to addressing

rumors, misinformation, fear, and anxiety.❏ ❏ ❏ Share information about your pandemic preparedness and response

plan with staff.❏ ❏ ❏ Advise staff to follow information provided by public health authorities.❏ ❏ ❏ Ensure what you communicate is appropriate for cultures, lan

guages, and reading levels.

Coordinate with External Organizations❏ ❏ ❏ Understand roles of federal, state, and local health agencies.❏ ❏ ❏ Appoint a point of contact to maximize communication between

your organization and your state and local health systems.❏ ❏ ❏ Ensure availability of medical advice and timely/urgent healthcare

services.❏ ❏ ❏ Share what you’ve learned with other companies.❏ ❏ ❏ Work together with Community Organizations to help communities

prepare for pandemic influenza.

Coordinate with Infection and Prevention Control Specialists❏ ❏ ❏ Make your expertise and services available to the infection and

prevention control team.

Emergency Responders/Emergency Preparedness Personnel❏ ❏ ❏ Advise emergency response community on means to effectively identify,

manage, and control health, safety and environmental risks.

Communication/Coordination with Workforce❏ ❏ ❏ Plan for 50% staff absences for at least two weeks, and lower levels

of staff absences for a few weeks on either side.❏ ❏ ❏ Begin communications plan right away.

COMMUNICATION/COORDINATION WITH PUBLIC

❏ ❏ ❏ Assist public information officers and their staff in the transmission of vital information.

❏ ❏ ❏ Assist in the control and spread of rumors.

14


15

Appendix 2: Standard Precautions

According the Centers for Disease Control standard precautions apply to 1) blood; 2) all body fluids, secre-tions, and excretions except sweat, regardless of whether or not they contain visible blood; 3) non-intact skin;and 4) mucous membranes.

Standard Precautions are designed to reduce the risk of transmission of microorganisms from both recog-nized and unrecognized sources of infection in hospitals.

HANDWASHING

• Wash hands after touching blood, body fluids, secretions, excretions, and contaminated items,whether or not gloves are worn.

• Wash hands immediately after gloves are removed, between patient contacts, and when otherwiseindicated to avoid transfer of microorganisms to other patients or environments.

• It may be necessary to wash hands between tasks and procedures on the same patient to preventcross-contamination of different body sites.

• Use a plain (nonantimicrobial) soap for routine handwashing.• Use an antimicrobial agent or a waterless antiseptic agent for specific circumstances (e.g., control of

outbreaks or hyperendemic infections), as defined by the infection control program.

GLOVES

• Wear gloves (clean, nonsterile gloves are adequate) when touching blood, body fluids, secretions,excretions, and contaminated items.

• Put on clean gloves just before touching mucous membranes and nonintact skin.• Change gloves between tasks and procedures on the same patient after contact with material that

may contain a high concentration of microorganisms.• Remove gloves promptly after use, before touching noncontaminated items and environmental

surfaces, and before going to another patient, and wash hands immediately to avoid transfer ofmicroorganisms to other patients or environments.

MASK, EYE PROTECTION, FACE SHIELD

• Wear a mask and eye protection or a face shield to protect mucous membranes of the eyes, nose,and mouth during procedures and patient-care activities that are likely to generate splashes or spraysof blood, body fluids, secretions, and excretions.

GOWN

• Wear a gown (a clean, nonsterile gown is adequate) to protect skin and to prevent soiling of clothingduring procedures and patient-care activities that are likely to generate splashes or sprays of blood,body fluids, secretions, or excretions.

• Select a gown that is appropriate for the activity and amount of fluid likely to be encountered.• Remove a soiled gown as promptly as possible, and wash hands to avoid transfer of microorganisms

to other patients or environments.

http://www.cdc.gov/ncidod/dhqp/gl_isolation_standard.html


Appendix 3Pandemic Planning Template

Pandemic Planning

Purpose

Roles and Responsibilities

Hazards

Recommended Controls

Administrative/Work Practices

Education & Training

Workplace Access & Security

Cleaning, Disinfection and Sterilization

Labor Relations

Communications

Engineering

Personal Protective Equipment

Communication/Coordination

Coordinate with Infection & Prevention Control Specialists

Emergency Responders/Emergency Preparedness Personnel

Communications Planning

Plan for the Impact to your Organization

Plan for the Impact to your staff

Set Up Policies

Allocate Resources to protect Staff

Communication with and Educate

Coordinate with External Organizations

Coordinate with Infection & Prevention Control Specialists

Communication/Coordination with Workforce

Communication/Coordination with Public

Resources

Additional Information

17


19

NOTES


20

NOTES


The Role of the Industrial Hygienist in a PandemicBy the AIHA Biosafety and Environmental Microbiology Committee

Industrial hygienists are provided resources, information,

and tools to advise and assist general workers, health care

workers, and management to protect workers in the case

of a flu pandemic. This guide identifies hazards, risk groups

and recommended controls; offers a communication plan;

describes the impact of a flu pandemic on organizations,

and lists key resources to contact for further information.

STOCK NUMBER: SEPG06-711

A Publication by American Industrial Hygiene Association

HOT TOPICS & EMERGING ISSUES

HAZMAT

The Role of the Pandemic · The Role of the Industrial Hygienist in a. AIHA Guideline 7 – 2006...

Documents

Transcript of The Role of the Pandemic · The Role of the Industrial Hygienist in a. AIHA Guideline 7 – 2006...