Healthcare workers are at the front line of the COVID-19 outbreak response and are exposed to different occupational hazards including exposure to SARS-CoV-2 and other pathogens, heavy workload and prolonged use of personal protective equipment (PPE). According to government figures based on the intimations received from the states till January 22, the pandemic has claimed the lives of 162 doctors, 107 nurses and 44 ASHA workers in India. However, the Indian Medical Association (IMA) has said that 734 doctors have died due to Covid-19 till February 3, of which 431 are general practitioners.
Workplace risk assessment for COVID-19
The potential for health workers’ occupational exposure to SARS-CoV-2 can be determined by the likelihood of coming into direct, indirect or close contact with a person infected with the virus. This includes direct physical contact or care, contact with contaminated surfaces and objects, through aerosol-generating procedures on patients with COVID-19 without adequate personal protection, or working with infected people in indoor, crowded places with inadequate ventilation. The risk of occupational exposure increases with the level of community transmission of SARS-CoV-2.
Employers, in consultation with health workers and their representatives, and with support from experts in infection prevention and control (IPC) and occupational health, should carry out and regularly update a workplace risk assessment for SARS-CoV-2. The purpose is to determine the level of risk for potential occupational exposure related to different jobs, work tasks and work settings; and to plan and implement adequate measures for risk prevention and mitigation and for assessing the fitness for work, and return to work, of individual health workers.
Levels of workplace risk, even in the same work setting, may vary based on health worker tasks and roles. Therefore, a workplace risk assessment should be carried out for each specific setting, as well as for each role, task or set of tasks.
The following workplace risk levels may be useful for employers and occupational health services when carrying out rapid risk assessments for potential occupational exposure to SARS-CoV-2 for different jobs or tasks:
- Lower risk − jobs or tasks without frequent, close contact with the public or others and that do not require contact with people known or suspected of being infected with SARS-CoV-2.
- Medium risk − jobs or tasks with close frequent contact with patients, visitors, suppliers and co-workers but that do not require contact with people known or suspected of being infected with SARS-CoV-2.
- High risk − jobs or tasks with high potential for close contact with people who are known to be or suspected of being infected with SARS-CoV-2 or contact with objects and surfaces possibly contaminated with the virus.
- Very high risk − jobs and tasks with risk of exposure to aerosols containing SARS-CoV-2, in settings where aerosol-generating procedures are regularly performed on patients with COVID-19 or working with infected people in indoor, crowded places without adequate ventilation.
The WHO recommends strategies to maximize PPE use to protect healthcare workers while minimizing the need for PPE in several ways, including (1) use of telemedicine for initial evaluation, (2) having only essential healthcare workers enter patient rooms, and (3) bundling activities to minimize the number of times a room is entered. Screening clinics not only provide a dedicated area for evaluation of patients with potential COVID-19 but also allow for PPE conservation by staff.
Use engineering controls to shield healthcare workers, patients, and visitors from individuals with suspected or confirmed COVID-19. This includes physical barriers or partitions in triage areas to guide patients, curtains separating patients in semi-private areas, and airborne infection isolation rooms (AIIRs) with proper ventilation. AIIRs are single-patient rooms with negative pressure that provide a minimum of 6 air exchanges (existing structures) or 12 air exchanges (new construction or renovation) per hour.
Restrict the number of personnel entering the room of a patient with suspected or confirmed COVID-19. This may involve training healthcare workers in the appropriate use of PPE so they can perform tasks such as housekeeping and meal service to reduce the need for environmental and food service workers to enter areas where suspected or confirmed COVID-19 patients are isolated.
Safe Work Practices
- Perform as many tasks as possible in areas away from a patient with suspected or confirmed COVID-19
- Work from clean to dirty (i.e., touching clean body sites or surfaces before touching dirty or heavily contaminated areas)
- Use caution when handling needles or other sharps, and dispose of contaminated sharps in puncture-proof, labelled, closable sharps containers
- Workers should avoid touching their faces, including their eyes, noses, and mouths, particularly until after they have thoroughly washed their hands upon completing work and/or removing PPE
- Train and retrain workers on how to follow established protocols