Occupational health and safety

for health workers in the context of COVID-19

WHO / P. Phutpheng

Module 1: Infectious risks to health and safety

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 Learning objectives

By the end of this module, you should be able to:

§ explain how health workers can be exposed to infectious hazards;

§ describe how respiratory infections and bloodborne pathogens are

transmitted to health workers; and

§ describe the steps that health workers can take to protect

themselves from respiratory infections:
• standard precautions
• control measures to prevent different infections.

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 Infectious hazards are present in all health
care facilities
§ Infectious hazards can be bacteria, viruses, fungi, or parasites.

§ Health workers can be exposed to infectious hazards in different ways:

• Through air: Airborne particles (measles, tuberculosis) or respiratory

droplets (acute respiratory infections; COVID-19, influenza,
meningococcal meningitis)

• Blood and body secretions/fluids: HIV/AIDS, Hepatitis B and C,

haemorrhagic fevers (Ebola, Lassa)

• Direct contact with patients and contaminated objects: respiratory

infections, haemorrhagic fevers, cholera, typhoid

• Vectors (such as mosquitos) – malaria, dengue, yellow fever.

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 Biological hazards are present in all health
care facilities
§ All health workers can be at risk, particularly those providing:
• direct health care to patients with infections
• healthcare waste handling
• laboratory tests
• contact tracing in the community.

§ Health workers providing care to patients with COVID-19 may be

exposed to other infections as well.

§ Auxiliary staff, such as cleaners, ambulance divers, security

officers, receptionists can also be exposed to infectious hazards.

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 Health workers can acquire respiratory
infections in three ways:
§ Respiratory droplets (bigger than 5 µm) are generated when an infected
person speaks, coughs or sneezes. Such droplets travel less than a metre
and land quickly on surfaces. Health workers become infected when these
droplets land on their face or are inhaled.

§ Direct contact with contaminated surfaces or objects, including hand

shaking with a patient, and subsequently touching eyes, nose or mouth.
People touch their faces unconsciously on average 16 times an hour.

§ Aerosols are very small particles (<5 µm) that remain suspended in the air
for some time and can travel distances longer than a metre. They are
produced usually during special medical procedures, called aerosol
generating procedures.
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 How health workers can protect themselves
from respiratory infections (1)
§ Health workers should use all measures to protect themselves from
respiratory infections – administrative, environmental and
engineering controls, personal protective equipment and personal
behaviour.

§ Learn and strictly follow infection prevention and control (IPC) rules, use
triage and source control (medical masks) for patients with symptoms of
respiratory infections.

§ Keep physical distancing of at least one metre from anyone all the time,
including patients (unless providing direct care), their relatives and co-
workers.

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 How health workers can protect themselves
from respiratory infections (2)
§ Conduct a risk assessment of potential exposure and follow appropriate
IPC measures of precaution for COVID-19 patients.
§ e.g. Medical masks, face shield or goggles, gowns and gloves when
providing patient care in close contact with the patient (less than 1 metre)

§ Use respirators for aerosol generating procedures. Respirators have to be

fit tested and a seal check should be done upon every use. Keep in mind
facial hair would affect this fit and seal, and should be removed.

§ Perform regular hand hygiene before and after donning and doffing
personal protective equipment, and after contact with potentially
contaminated surfaces and respiratory secretions, before touching the
face, before eating, and after using the toilet.
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 How bloodborne pathogens are transmitted
to health workers
§ All blood or body fluids (urine, saliva, faeces, serum) of patients
can be potentially infectious and should be treated as such.

§ Health workers can be infected in several ways:

• splashes of body fluids landing in the eyes, nose or mouth
• direct contact with blood and body fluids
• needle sticks and sharps injuries with contaminated objects.

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 Sharps injuries lead to bloodborne
infections
Every year, globally there are at least 3 million accidental needle-stick injuries.

Average number of sharps injuries per healthcare worker per year - 2.53.

Annual proportion of HCWs exposed to bloodborne pathogens:

• 5.9% for HBV ~ 66,000 HBV infections

• 2.6% for HCV ~ 16,000 HCV infections
• 0.5% for HIV ~ 1,000 HIV/AIDS infections

Prüss-Üstün et al. WHO, 2003.

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 How can health workers be protected
from occupational infections
§ Health workers can be infected in different ways and it is not always
possible to know whether the patient or the objects in the work
environment are infected or contaminated.

§ Therefore, a basic level of protection from infections, called

standard precautions, should be applied when providing care to
all patients at all times regardless of suspected or confirmed
status of the patient.

§ The standard precautions are meant to reduce the risk of

transmission of bloodborne and other pathogens from both
recognized and unrecognized sources.
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 What are the principles of standard
precautions?

§ The minimum prevention measures that apply at all times to all

patient care.

§ All blood and other body fluids should be treated as potentially

infectious and handled accordingly.

§ Risk assessment is critical for all activities, i.e. assess each

healthcare activity and determine the personal protective equipment
(PPE) that is needed for adequate protection.

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 Key elements of standard precautions (1) –
hand hygiene
§ Perform hand hygiene either by:
• hand rubbing with alcohol-based hand rub or
• hand washing with soap and water if hands are visibly soiled.

§ Perform hand hygiene:

• before touching a patient,
• after touching a patient and patient surroundings,
• before clean/aseptic procedures,
• after body fluid exposure/risk,
• before and after using PPE,
• after using the restroom, and
• before eating.

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 Key elements of standard precautions
to protect health workers (2)

§ Functioning hand hygiene facilities should be present for all health

workers at all points of care, in areas where PPE is put on or taken off,
and where healthcare waste is handled.

§ Hand hygiene products (clean water, soap, single use clean towels,
alcohol-based hand rub) should be available and regularly supplied.

§ Cleaning up and disinfection of floors, surfaces and equipment can

prevent transmission of infections through direct contact.

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 Key elements of standard precautions
to protect health workers (3)
PERSONAL PROTECTIVE EQUIPMENT (PPE)

§ ASSESS THE RISK of exposure to body substances or contaminated

surfaces BEFORE any healthcare activity. Make this a routine!

§ Select PPE based on the assessment of risk:

• clean, non-sterile gloves
• clean, non-sterile fluid-resistant gown
• mask and eye protection or a face shield.

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 Key elements of standard precautions
to protect health workers (4)
RESPIRATORY HYGIENE AND COUGH ETIQUETTE

§ Educate health workers, patients and visitors to practice cough etiquette:

• Cover mouth and nose with elbow or disposable tissue when coughing or sneezing
• Perform hand hygiene after contact with respiratory secretions and tissues
• Wear medical masks if having symptoms of respiratory infection
• Health workers should not come to work if unwell. If health workers develop
symptoms while at work, they should put on a medical mask and return home.

§ Spatial separation of persons with acute febrile respiratory symptoms (patient

triage) is very important.

§ Keep at least one metre or more of physical distancing from patients with
respiratory symptoms and use PPE, if distance is not possible.
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 Laundering hospital uniforms/scrubs

§ Health workers should change into and out of uniforms and work clothes
at work and not wear them when commuting to work. This will:
• decrease spread of infection from uniforms worn in hospital/health facility to
the family and community and
• prevent stigma and violence against health workers.

§ Changing rooms/areas should be provided so that staff can change into

uniforms/working clothes on arrival and remove them prior to leaving the
facility. Perform hand hygiene after removing soiled uniforms/work clothes.

§ Do not bring staff uniforms or work clothes to wash at home. This should
be done at the health facility.

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 Administrative controls for prevention
of infections (1)

§ Enforce cough etiquette § Allocate resources for safe

devices and disposal containers
§ Early recognition through
screening of patients § Replace unsafe devices

§ Reduce time patients are in the § Provide regular training on the

facility, if possible safe use of sharp devices

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 Administrative controls for prevention
of infections (2)
§ Establish and use protocols to
control hazards
§ Encourage reporting of all incidents
§ Monitor effectiveness of infection
control and sharps management
§ Set up an infection control/needle
stick injury prevention committee,
if necessary
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§ Provide adequate training to health
workers for:
• IPC measures
• selection and use of PPE.
§ Ensure an adequate patient-to-staff
ratio
§ Monitor compliance with standard
precautions and provide mechanisms
for improvement as needed
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 Administrative controls for prevention
of infections (3)

§ Screen all health workers and visitors for symptoms of COVID-19

§ Ensure that health workers do not come to work if unwell

§ Establish a surveillance process for acute respiratory infections

among health workers

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 Environmental controls

§ Provide and monitor daily natural ventilation

§ Use mechanical ventilation and control the direction of

infectious air flow away from other workers and patients

§ Set up physical barriers to protect workers, for example

sneeze guards, and barriers to ensure physical distancing

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Improving ventilation (1)

§ All working premises have some natural

air ventilation, but in hot climates fresh
air supply might not be sufficient.

§ Mechanical ventilation brings in

additional fresh air.

§ Fans create movements of the air but do

not provide fresh air and should be
avoided when there are respiratory
infections because they can spread
droplets and aerosols.

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 Improving ventilation (2)

Create natural air flow for ventilation by having openings on opposite sides of rooms

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 Prevention of needle-stick injuries and other
blood exposures using a hierarchy of controls (1)
§ Elimination of hazard – remove sharps and needles when possible
§ e.g. By substituting jet injectors for needles and syringes, or using
needleless intravenous systems

§ Engineering controls – isolate or remove a hazard from a workplace

§ e.g. Sharps disposal containers, use of sharps protection devices for all
procedures (devices with needles that retract, sheathe or blunt
immediately after use)

§ Administrative controls – limit exposure to the hazard

§ e.g. A needle-stick injury prevention committee; an exposure control plan;
removal of all unsafe devices; continuous training on the use of safe
devices
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 Prevention of needle-stick injuries and other
blood exposures using a hierarchy of controls (2)
§ Work practice controls – change the behaviour of workers, to reduce
exposure to occupational hazards.
§ e.g. No needle recapping; placing sharps containers at eye level and within
arms’ reach; sealing and discarding sharps containers when they are three
quarters full; establishing means for the safe handling and disposal of
sharps devices before beginning a procedure

§ Personal protective equipment – barriers and filters between the

worker and the hazard. These prevent exposures to blood splashes but
will not prevent needle-stick injuries.
§ e.g. Gloves, eye goggles, masks and gowns

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 Immunizations to protect health workers

Immunizations are important to protect health workers from infections.

Immunizations recommended for all
health workers providing patient care:
• Seasonal influenza
• Measles/Rubella
If high incidence of infection in the
population and risk of transmission to
health workers:
• BCG (for TB)

• Hepatitis B • Meningococcus

• Diphtheria
• Pertussis
• Varicella
• Polio

Standard precautions still need to be followed even if health workers

have received immunizations.

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 Summary: How you can avoid
occupational infections

ü Follow standard precautions

ü Get immunized

ü Get training in IPC

ü Follow IPC procedures

ü Report accidental exposures to blood, body fluids and

respiratory secretions

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