Infection Control and Prevention

Infection Control Principles and Practices for Local Public Health Agencies

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Pandemic Influenza

The Occupational Safety and Health Administration (OSHA) has developed a guidance document (exit DHS) on how to help reduce transmission of pandemic influenza in the workplace, based on traditional infection control and industrial hygiene practices. It is recommended that local public health agencies use the document to determine the worksite exposure risk and accordingly to develop a control plan that includes hand hygiene, cough etiquette, social distancing, use of personal protective equipment (PPE), and policies that ensure sick employees remain at home during their period of communicability.

The first step in developing a work place pandemic influenza plan is to determine the level of exposure risk for a particular work site. Work places have been classified into very high, high, medium, and low exposure risk sites for transmitting pandemic influenza. Most local public health agencies will fall into the low or medium exposure risk categories, but some employees may be assigned higher exposure risk activities and will need higher levels of protection.
Employee Protection Measures

Once a work place level of exposure risk has been identified, steps to protect employees from acquiring pandemic influenza in the work place can be formulated into a plan, which will include a combination of work practice and engineering controls, administrative controls, and use of PPE. The ways in which these controls will be implemented depends on the level of exposure risk in the workplace and the tasks assigned to employees.
  
Work practices are ways in which workers go about their job tasks that minimize the chances of exposure to a hazard. Examples of work practices are practicing cough etiquette and implementing social distancing during a pandemic.

Engineering controls are changes in the environment that allow employees to observe safe practices. The installation of “sneeze guards” in front of reception areas is an example of an engineering control. Administrative controls include development of policies such as annual employee influenza vaccination policies, sick leave policies, and telecommuting during an influenza pandemic.

• PPE is used when the above measures cannot completely eliminate exposure to a hazard.
• PPE is used in addition to, not instead of other control measures.
  Surgical masks and respirators.
• The primary PPE items that will be used during an influenza pandemic are surgical masks and respirators.

A surgical mask acts as a physical barrier that protects the nose and mouth from splashes and sprays of large droplets of blood and other body fluids. It can also help prevent small particles such as influenza viruses from entering the respiratory tract. When worn by a sick individual, they may prevent infectious droplets from being expelled by sneezing, coughing, or talking. When worn by well persons in contact with sick patients, they may help prevent infectious droplets from entering the respiratory tract of the uninfected person. Surgical masks are worn loosely around the face, and do not require fit-testing for use.

Respirators such as a National Institute of Occupational Safety and Health (NIOSH)-certified N-95 respirator are designed to filter tiny airborne infectious particles before they enter the wearer’s respiratory tract. They are used to protect against tuberculosis, SARS, and other infectious diseases that can be transmitted by air currents as much as 25 feet from the infectious source. Persons must receive medical evaluation and training before using respirators, and tight fitting ones such as the N-95 require fit-testing before initial use. 

OSHA recommends the use of N-95 respirators during medical activities that have a high likelihood of producing infectious respiratory aerosols (cough inducing procedures, bronchoscopy, suctioning), during direct patient care (feeding, bathing, examining) of persons suspected or known to have pandemic influenza, and for persons who may have direct contact with persons infected with pandemic influenza. 

Local public health agencies employing staff needing respiratory protection must have a written respiratory protection plan according to OSHA standard 29 CFR 1910.134 (exit DHS)

Classifying Employee Exposure to pandemic influenza at work

Very high exposure risk occupations are those in which employees are highly likely to be exposed to very high concentrations of known or suspected sources of pandemic influenza during specific medical procedures. This includes doctors, nurses, dentists, and others who perform aerosol generating procedures such as cough induction, bronchoscopies, and some dental procedures. Laboratory personnel who manipulate cultures from pandemic influenza patients also fall into this category.

This risk category requires enhanced measures such as the use of respirators in addition to basic work practices and engineering controls. Local public health agencies will not likely have personnel with this level of risk exposure. 

High exposure risk occupations include healthcare delivery and support staff exposed to known or suspected pandemic influenza patients (e.g. doctors, nurses, and other hospital staff that must enter a hospital patient’s room or local public health workers doing direct care in a client’s home). Emergency medical technicians transporting pandemic influenza patients and those performing autopsies on known or suspected pandemic influenza patients are also examples of those with high exposure risk. 

Protective measures are similar to those in the very high exposure risk category and include respiratory protection in addition to basic controls. Some local public health agency staff may fall into this category.

Medium exposure risk occupations are those that have high frequency contact with members of the general public. Employees working in crowded work places or those with many clients entering the facility daily may be classified as having medium risk. Use of surgical masks rather than respirators is recommended for this level of exposure risk, in addition to other work practice and engineering controls. 

Lower exposure risk occupations have minimal close (within 6 feet) exposure to the general public and co-workers in the work place (e.g. office workers). Although respirators and surgical masks may not be needed, other protective measures such as cough etiquette and social distancing should be employed.

Most local public health agency employees will probably fall into either the medium or lower exposure risk categories. 

More Resources

OSHA Guidance on Preparing Workplaces for an Influenza Pandemic (exit DHS)

OSHA Respiratory Protection Standard (exit DHS)

OSHA Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers & Employers (exit DHS)

CDC Pandemic Influenza (exit DHS)  

Wisconsin Division of Public Health Pandemic Influenza (exit DHS)

CDC Guidance on Facemask & Respirator Use (exit DHS) for influenza A (H1N1)

For Infection Control Information 
Gwen Borlaug  Infection Control Epidemiologist
WI Division of Public Health
Bureau of Communicable Diseases
   608-267-7711  Phone
   608-261-4976  Fax

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Last Revised: June 29, 2011