Acknowledgements All materials copyrighted March 2010. Course developed by Stephanie Innes with content contributions from Dr. George Astrakianakis and Phyllis Stoffman. Thanks to the following reviewers who reviewed and commented on early versions of this online course: Mike Sagar - WorkSafe BC Deb Niemi - BCNU Joanne Archer - PicNet Jacqueline Per - VCH Bev Dobbyn - VIHA Joe Divitt - OHSAH Georgina Hackett - OHSAH Catherine Ogden - OHSAH ECP Samples and Template created based on template from: WorkSafe BC publication: Controlling Exposure: Protecting Workers from Infectious Disease Definitions and references to WorkSafe BC Regulations from www.worksafebc.com
Table of Contents Acknowledgements Table of Contents Guide Overview... 1 Objectives...1 Pre-module self assessment... 2 Exposure Control Plans... 5 Essential Elements of An ECP... 7 1: Statement of Purpose...7 2: Key Responsibilities...7 3: Risk Identification, Assessment + Controls...9 Sample Job Risk Table... 15 Activity:... 16 Sample Controls Long Term Care... 19 Sample Controls... 22 Sample Controls... 28 4: Education and Training... 33 5: Safe Work Procedures... 33 6: Hygiene and Decontamination Procedures... 34 7: Health Monitoring... 34 8: Documentation... 35 Activity: ECP Implementation Action Sheet... 36 Summary... 38 Post-module self assessment... 39 Appendices... 42 Correct Answers to Self Assessment... 43 Glossary... 45 Useful Websites... 51 WorkSafeBC Requirements in Relation to an Exposure Control Plan... 52 Education and Training... 52 Records of Training... 55 Excerpts from the WorkSafeBC Regulations... 56
Guide Overview Welcome to OHSAH s Exposure Control Plan creation training for respiratory infections. These training materials were prepared by the Occupational Health and Safety Agency for Healthcare in British Columbia (OHSAH), a bipartite agency that works collaboratively to reduce workplace injuries and illness in healthcare workers and return injured workers back to the job quickly and safely. Objectives This course was designed for JOHS Committee members who work in healthcare settings. This course will give you the information to: Define an Exposure Control Plan (ECP) Identify the goals and outcomes of creating an Exposure Control Plan Demonstrate understanding of the eight elements of an Exposure Control Plan As a JOHS Committee member, you may be involved in developing or reviewing an Exposure Control Plan. It s important that you take the time to review this information and understand all the elements of an ECP so that you can do your part to help create the most effective ECP possible.
Pre-module self assessment Before we begin the self study guide, you are welcome to complete the following self assessment so that you can compare what you knew at the beginning of the course to what you know at the end of the course. If you don t want to do the self assessment just flip past it to the start of the course content. Complete the following 10 questions to the best of your ability, but don t worry if you don t know the answers yet. We ll be covering all of this information in detail in this self paced workbook. 1. When is an Exposure Control Plan required? a) Annually b) In response to an identified risk c) When the JOHS Committee identifies a hazard 2. The elements of an Exposure Control Plan are: a) Statement of Purpose, Routes of Transmission, Engineering Controls, Risk Assessment, Written Work Procedures and Education and Training b) Statement of Purpose, Responsibilities, Risk Identification, Assessment and Controls, Education and Training, Written Work Procedures, Hygiene and Decontamination Procedures, Health Monitoring, and Documentation c) Statement of Purpose, Responsibilities, Exposure limits, Risk Identification and Assessment, Risk Controls, Education and Training, Written Work Procedures, Hygiene and Decontamination Procedures, Health Monitoring, Personal Protective Equipment, Worker Policies, and Documentation 3. The outcome of an effective Exposure Control Plan is: a) Protecting the health and safety of the workers b) Protecting the health and safety of everyone in the workplace environment c) Protecting the health and safety of the patients and visitors
4. Installing a glass barrier at reception is an example of what type of control? a) Administrative b) Engineering c) With the worker 5. Wearing Personal Protective Equipment is an example of what type of control? a) Administrative b) Engineering c) With the worker 6. A policy that states you should delay non-essential tasks until the infectious person is recovered is an example of what type of control? a) Engineering b) Administrative c) With the worker 7. Posters explaining proper hand-washing techniques are an example of: a) Education and training b) Written Safe Work Procedures c) Documentation 8. According to WorkSafe BC, who has the overall responsibility for the Exposure Control Plan? a) JOHS Committee b) Supervisor c) Employer d) Worker 9. An Exposure Control Plan is a: a) Document created for a specific workplace in response to an identified risk which outlines ways to eliminate or minimize the risk b) Guideline determined by WorkSafe BC and implemented in all workplaces
c) Document that contains all infection control policies and written safe work procedures 10. A risk assessment must be conducted by a qualified person. According to WorkSafe BC, a qualified person means: a) The employer or a designate of the employer b) A person knowledgeable of the work, the hazards and the means to control the hazards c) The Joint Occupational Health and Safety Committee Great work! You will have another opportunity at the end of the self study guide to revisit these questions but right now, let s look at Exposure Control Plans in more detail.
Exposure Control Plans Before you can be involved in developing or reviewing an effective ECP, you need to know what an ECP is. An Exposure Control Plan (ECP) is a document created by a workplace in response to an identified risk, and it documents the specific and appropriate controls that will minimize or eliminate that risk. Every workplace is responsible for developing an Exposure Control Plan in response to identified risk of exposures including some chemical exposures, blood borne diseases, and contact diseases. And according to WorkSafe BC, the ECP must be reviewed annually. In this self study guide, we will focus on how to create an ECP for respiratory infections such as influenza, pneumonia, tuberculosis, measles, mumps, and chicken pox. But please note that if there is no risk of exposure to a respiratory infection in your organization, then there s no need to create an ECP specific to respiratory infections. Instead, your ECP will focus on your specific workplace hazards. The most important goal of an ECP is to prevent workplace exposure and to help you minimize or eliminate the risk of your workforce having their health affected by a workplace exposure. An effective ECP will: Protect all workers health Prevent and contains infection Protect the health of others including patients and visitors Establish consistent safe work procedures Promote appropriate and proper use of personal protective equipment An effective ECP may also draw from information already developed in other plans, policies and priorities that interact with your ECP. These include: Infection Control Policies Most health care agencies have an Infection Control Manual which consists of policies that are intended to prevent the spread of infections from patient to patient, from staff to patient and from patient to staff within the health-care setting
Patient Safety Patient safety is a healthcare priority that emphasizes the reporting, analysis, and prevention of medical errors that may lead to adverse healthcare events such as giving the wrong medication to a patient Pandemic Planning Pandemic planning is completed by governments, health care agencies, and businesses in order to develop a preparedness plan to help reduce the impacts on the health and safety of healthcare workers, health services, essential services and daily life during an influenza or other infectious disease pandemic (worldwide epidemic) Immunization Policies Employee Health and Wellness or Occupational Health departments will have immunizations polices in place regarding staff immunization requirements. Usually, individuals working in direct patient care areas are required to be immunized for measles, mumps and rubella and Hepatitis B. Influenza vaccine is also offered annually in BC. It should be noted that direct care providers who have not received their influenza vaccine during an outbreak on their unit will be reassigned to another area or they may be placed on unpaid leave There are eight essential elements of an ECP, however, it doesn t matter what order the elements are completed in. Ultimately, each organization must decide what fits the needs of their ECP. 1. Purpose 2. Responsibilities 3. Risk identification and assessment, and risk controls 4. Education and training 5. Safe work procedures 6. Hygiene and decontamination procedures 7. Health monitoring 8. Documentation Now let s look at each of the elements in more detail.
Essential Elements of an ECP 1: Statement of Purpose The purpose describes the requirement or need for the plan. In the end, even at different organizations, ECP statements of purpose will often be very similar. Let s look at an example of a Statement of Purpose: Our organization is committed to providing a safe and healthy work environment for all our staff. A combination of measures will be used to minimize worker exposure to respiratory infections. This Exposure Control Plan is designed to protect the health and well-being of our staff and any contracted staff working in our facilities. All employees must follow the procedures outlined in this plan in order to prevent or reduce exposure to respiratory infections. 2: Key Responsibilities Everyone in the organization has responsibilities around preventing exposure. Your organization s ECP will detail employer, supervisor, and worker responsibilities and the duties of the JOHS Committee specific to your workplace. The overall responsibility for developing, implementing and maintaining the plan rests with the employer. Now, what are some of the key responsibilities that may appear on any organization s ECP? To learn more about who is responsible for which parts of an ECP, review the following responsibilities listed in each category. Employers Ensuring that the safety equipment such as surgical masks, gowns, goggles, N95 respirators, alcohol-based hand rubs, hand washing facilities and other resources required to fully implement and maintain the ECP are readily available where and when they are required. Ensuring supervisors and workers are educated and trained to an acceptable level of competency Ensuring that a copy of the exposure control plan (ECP) is available to all workers
Ensuring that workers are using the proper personal protective equipment including gloves, surgical masks, and N95 respirators Conducting a periodic review with the involvement of the JOHS Committee or Worker Health and Safety Representative to measure the effectiveness of the ECP. This will include a review of the available control technologies to ensure these are selected and used when practical Maintaining records of training, inspections and incident investigations Supervisors Providing adequate instruction to workers around the precautions specified in the ECP. Ensuring that workers receive up-to-date training Directing work in a manner that ensures risk to workers is minimized and adequately controlled Ensuring that workers are using the proper personal protective equipment (as required) Workers Knowing how and when to report exposure incidents. Knowing the hazards of workplace Following established safe work procedures and policies as directed by their employer or supervisor Reporting any unsafe conditions or acts to their supervisor Using the appropriate personal protective equipment in an effective and safe manner JOHS Committee or Worker Health Representative Duties Completing an annual review of the Exposure Control Plan. Ensuring that the Exposure Control Plan is properly implemented Recommending improvements to the Exposure Control Plan
Ensuring that any worker concerns about the Exposure Control Plan or potential exposures are addressed Participating in the development of the ECP 3: Risk Identification, Assessment + Controls Risk identification is extremely important, and includes identifying who may be exposed (risk of exposure) and understanding how they might become infected (modes of transmission). It might sound complicated but it s actually relatively simple. If the risk is respiratory infections, we just need to ask: How are respiratory infections transmitted? What staff might have contact with clients/patients/residents with respiratory infections? Once you understand how respiratory infections are spread from person to person, you will know how to assess and minimize your risk of exposure. So first let s look at the different ways infections spread. Modes of transmission describe how an infection spreads from person to person. Respiratory infections are caused by bacteria and viruses that are able to enter the body through your eyes, nose or mouth and then infect your respiratory system. These infections attack either the upper airway (your nose and throat) causing mild illness or the lower airway (your bronchial tubes and lungs), usually causing a more serious illness. The key modes of transmission for respiratory infections are through contact and through the air, so let s review these modes in more detail.
One: Contact Transmission through contact means coming into physical contact with someone with a respiratory infection. This contact can be direct or indirect. Direct contact If we touch someone with a respiratory infection and then touch our eyes, mouth, or nose, we might become ill. For example, if someone coughs and then shakes our hand, the infection can be transmitted Indirect contact If we touch an object that has been contaminated by someone with an infection, and then we touch our eyes, mouth or nose, and the virus or bacteria is transmitted
Two: Airborne Airborne transmission means breathing in the virus or bacteria. For example, if someone with a respiratory infection talks, coughs or sneezes on us within close range, we can get a respiratory infection. This contact can be made through either droplet or airborne spread: Droplet spread Large-particle respiratory droplets generally travel only a short distance (<2 meters) through the air, and then settle out of the air quickly. Influenza, pneumonia, TB, mumps, and SARS are usually transmitted in large particle respiratory droplets Airborne spread Small particle airborne droplets are evaporated droplets that are extremely light and therefore can remain suspended in the air for a long time in dust particles, and can travel much further via air currents. Chicken pox and measles viruses are transmitted in small particle airborne droplets Risk Assessment Risk assessment is about assessing a worker s potential exposure to a hazard while completing the assigned tasks of their job. Once the risk has been identified, it s important to assess how that risk will affect specific jobs. It s important to note,
WorkSafe BC, being a qualified person means being knowledgeable of the work, the hazards involved and the means to control the hazards, by reason of education, training, experience or a combination thereof. And the qualified person may not be just one person but could be a team of people including: JOHS Committee members Infection control specialists Public health nurse Occupational hygienists OH&S members
There are several questions the qualified person can ask when completing a risk assessment: What are the observed or expected levels of exposure? The levels of exposure depend on the type of work being done, frequency of contact and how close the contact is. Direct care givers are most likely to be exposed to infected patients, while workers who do not give direct care but may work in the vicinity of either infected patients or contaminated surfaces and or equipment have a lower risk of exposure. What is the likelihood of becoming sick given the task and exposure? Chance of exposure resulting in infection increases the longer you are in the vicinity of the infected person (exposure) and the closer you are to that person (task). You re less likely to become infected from a short exposure to contaminated air because you are breathing in fewer numbers of viruses or bacteria. The other factor which determines your risk of contracting an infection is your immune status and general health. You re more likely to become infected and ill from the exposure if you: Are high risk (have underlying lung, heart or other infection) Have a poorly functioning immune system (immunocompromised) Are not vaccinated against respiratory infections that have vaccinations available What is the impact of becoming sick due to the disease or illness to the worker? Mild symptoms include sneezing, coughing, sore throat or serious respiratory complications causing shortness of breath that may require hospitalization. What is the impact to the organization if workers are affected by the disease or illness? It will impact issues such as staffing, supplies, and will support the need for environmental and administrative controls early on.
Risk Levels Now let s review the risk levels that will be assigned to each worker based on their job and the tasks they are required to do. There are three levels of risk that may be assigned when completing a risk assessment for respiratory infections. Low Risk: Low-risk workers rarely come into contact with potentially infected people or contaminated surfaces or materials Moderate Risk (Indirect Contact): These workers rarely come into contact with infected people but may work in areas where infected people have been. They also may handle potentially contaminated items High Risk (Airborne, Direct and Indirect Contact): High-risk workers care for people who are or may be infected with a respiratory illness Each job within a department will need to be assessed to determine what level of risk applies. Assigning risk levels to jobs will help you understand how the risk of infection will affect your organization. And every organization has different tasks associated with each job, so the risk level table in each ECP will be unique. The following sample Job Risk Table describes the different levels of risk that might apply to different jobs in your organization. People in these jobs may be exposed to ill patients, residents, and clients, so take a moment to review it.
Sample Job Risk Table Sample Job Risk Table for Long Term Care Low Risk Moderate Risk High Risk Risk Assessment of Exposure Workers who typically have no contact with Novel H1N1 infected persons Work category Workers who may be exposed to Novel H1N1 infected persons through providing indirect or direct care. Workers who are involved in performing Aerosol Generating Medical Procedures (AGMPs) (CPR, Nebulized Therapy) (List names of employees in each category) Maintenance Clerical Administration Reception Supervisory Staff Care Aides Home & Community Care Workers LPN s RN s OT PT Community Health Worker LPN s RN s
Activity: Complete your Job Risk Table Now, take a moment to fill out the Sample Job Risk Table for your organization. This will help you get a sense of what the risk levels are for the different positions in your organization. Job Risk Table Low Risk Moderate Risk High Risk Risk Assessment of Exposure Workers who typically have no contact with Novel H1N1 infected persons Work category Workers who may be exposed to Novel H1N1 infected persons through providing indirect or direct care. Workers who are involved in performing Aerosol Generating Medical Procedures (AGMPs) (CPR, Nebulized Therapy) (List names of positions and employees in each category)
Once your organization has assessed which jobs will be at risk, you need to do everything possible to reduce the risk to the workers in those jobs. Let s look at the ways organizations can minimize or eliminate the risks to their workers. Risk Controls Principles of Control are the accepted occupational best practices to reduce any kind of potential exposure to a risk. Principle of control means different ways to reduce the risk of an exposure in the workplace. Every employer has an obligation to implement appropriate controls, and to implement them according to a hierarchy. The controls are implemented in a hierarchy beginning at the Source, then moving along the Path and finally ending up at the Worker. At the Source controls deal with the hazard itself either by eliminating it or substituting it for something less hazardous. In most situations, this may not be possible. However, an example of an at the source control in a hospital setting would be to place a patient with a respiratory infection in an airborne isolation room. Along the Path controls deal with the hazard before it reaches workers by eliminating or minimizing the risk of exposure. There are two types of controls along the path: Engineering and Administrative. Engineering controls involve doing things which alter the physical space installing glass barriers at reception or installing alcohol based hand rub stations are an example of engineering controls.
Administrative controls involve altering the way that work is done, usually through policies and procedures. An example of this may be a policy to group infectious patients or residents in rooms along one section of a nursing unit. At the Worker controls include the personal protective equipment that must be worn to provide the worker with additional protection from a hazard. To prevent an exposure to an infectious respiratory hazard, the workers usually need gloves, gowns, a face shield and a surgical mask or N-95 respirator. It s important that you understand the principles of control because the JOHS Committee is often involved in reviewing risk level tables, making recommendations about controls and evaluating whether controls have been implemented and are effective. In many cases, more than one level of control may be necessary. For specific examples of the controls used in different settings, look at the following tables. There are samples for home and community care, acute care, and long term care controls.
Sample Controls Long Term Care Examples of Controls For Long Term Care 1. Engineering 2. Administrative Controls 3. PPE Room ventilation (number of air changes, proportion of fresh air to re-circulated air) meets standards for type of facility. Use private rooms, where available, for isolation of patients with ILI respiratory infections. Design and/or arrange workspace so that patients with influenza cannot access other parts of the facility If there are no private rooms, design or arrange workspace so there are barriers / space between infected and uninfected residents Design or arrange entrance to facility so access is limited/restricted unless visitors Develop and implement screening tool/questions (especially for screening of staff and residents for symptoms of ILI.) Establish and communicate safe zone distances (at least 2 meters) between infected residents and staff. Minimize number of workers exposed to risk i.e. group care tasks so multiple activities are performed at one time with minimum staff rather than multiple people or room visits Ensure potentially contagious patients wear a surgical mask (if tolerated) Check to see if there are private rooms Gloves Surgical Masks Gowns/aprons Eye protection N95 Respirators ECP Self Study Guide 19
Examples of Controls For Long Term Care 1. Engineering 2. Administrative Controls 3. PPE Staff have been screened for symptoms of ILI in a reception area. Provide handwashing sinks. Provide liquid soap containers and paper towels Provide alcohol gel in wall mounted in all areas for residents, visitors, staff Provide personal alcohol gel containerspocket sized for staff. Supervise and coach in safe work procedures and use of PPE Develop and implement patient isolation procedures Set up procedures for refilling soap/paper towels alcohol gel at the hand-washing facilities/alcohol gel stations System in place to monitor that the handwashing facilities/alcohol gel stations are replenished. Post information on cough/sneeze etiquette Create a system for admission screening, and procedures to reduce risks of transmission from new admissions ECP Self Study Guide 20
Examples of Controls For Long Term Care 1. Engineering 2. Administrative Controls 3. PPE Implement a system to take meals to residents with influenza Establish appropriate housekeeping procedures (frequency and level) and monitor cleaning outcomes Implement policies and procedures for staff with ILI to take sick leave Implement policies and procedures to cancel day trips and restrict visitors during an influenza outbreak in the community or in the facility Educate and train staff in hazards, safe work procedures, and correct use of PPE Procedures for reporting suspected or probable influenza cases to public health; investigating occupational exposures. ECP Self Study Guide 21
Sample Controls Acute Care Examples of Controls For Acute Care 1. Engineering (Along the Path) 2. Administrative Controls (Along the Path) 3. At the Worker At the Worker includes PPE and other things workers can do to prevent transmission Always follow Routine Practices (see above) Airborne Transmission Route: Place patients with probable or confirmed infections with respiratory infections spread through the airborne route in isolation rooms with negative air pressure: Tuberculosis, SARS Establish a respiratory protection program that includes fit testing N95 respirators. Establish a TB skin test program to document TB exposure status for new employees and to follow-up suspected workplace tuberculosis exposures. Use N95 respirators that are fit tested and do a fit check before use. Don and doff PPE in the proper sequence. ECP Self Study Guide 22
Examples of Controls For Acute Care 1. Engineering (Along the Path) 2. Administrative Controls (Along the Path) 3. At the Worker At the Worker includes PPE and other things workers can do to prevent transmission Always follow Routine Practices (see above) Vaccine Preventable Respiratory Infectious Diseases Place patient with suspected or confirmed vaccine preventable airborne or droplet spread respiratory infection in negative pressure isolation rooms. (measles, chicken pox, mumps, rubella) Establish an occupational health program that checks all new and current employees for immunity to measles, mumps, rubella and chicken pox. Offer vaccine to all employees who are not immune. Employees who are not immune will not be assigned to any patients with suspected or confirmed measles, Mumps, rubella or chicken pox infection. Airborne and Contact Transmission Route Room ventilation (number of air changes, proportion of fresh air to recirculated air) meets standards for type of facility. Develop and implement a screening tool/questions (especially for screening of staff and patients for fever and cough: symptoms of Report any respiratory symptoms according to facility policy. ECP Self Study Guide 23
Examples of Controls For Acute Care 1. Engineering (Along the Path) 2. Administrative Controls (Along the Path) respiratory infection.) 3. At the Worker At the Worker includes PPE and other things workers can do to prevent transmission Always follow Routine Practices (see above) Use private rooms, preferably with negative pressure ventilation, where available, for isolation of patients with fever and cough: suspected or confirmed Influenza and viral pneumonia. Design and/or arrange workspace so that patients with respiratory infections cannot access other parts of the facility If there are no private rooms, design or arrange workspace so there are barriers / space between infected and uninfected patients Establish and communicate safe zone distances (at least 2 meters) between infected patients and staff. Minimize number of workers exposed to risk i.e. group care tasks so multiple activities are performed at one time with minimum staff rather than multiple people or room visits Ensure potentially contagious patients wear a surgical mask (if tolerated) N95 respirators when performing an AGMP Surgical Masks Gloves, Gowns/aprons ECP Self Study Guide 24
Examples of Controls For Acute Care 1. Engineering (Along the Path) 2. Administrative Controls (Along the Path) Design or arrange entrance to facility so access is limited/restricted unless visitors /staff have been screened for fever and cough symptoms in a reception area. Supervise and coach in safe work Provide hand washing sinks. procedures and use of PPE 3. At the Worker At the Worker includes PPE and other things workers can do to prevent transmission Always follow Routine Practices (see above) Use PPE as per policies and wash hands before and after all patient contact and contact with contaminated surfaces and materials. Provide liquid soap containers and paper towels Provide alcohol gel in wall mounted in all areas for patients, visitors, staff Provide personal alcohol gel containers-pocket sized for staff. Develop and implement patient isolation procedures Set up procedures for refilling soap/paper towels and alcohol gel at the hand-washing facilities/alcohol gel stations System in place to monitor that the hand-washing facilities/alcohol gel stations are replenished. ECP Self Study Guide 25
Examples of Controls For Acute Care 1. Engineering (Along the Path) 2. Administrative Controls (Along the Path) Provide no-touch garbage disposal and ensure that pick up schedules Post information on cough/sneeze and frequency are adjusted etiquette according to waste disposal needs. Create a system for admission screening, and procedures to reduce risks of transmission from newly admitted patients with fever and cough symptoms by using private and/or isolation rooms. Establish appropriate housekeeping procedures (frequency and level) and monitor cleaning outcomes Implement policies and procedures for staff with fever and cough to take sick leave 3. At the Worker At the Worker includes PPE and other things workers can do to prevent transmission Always follow Routine Practices (see above) Follow cough/sneeze etiquette. Report fever and cough symptoms to supervisor and take sick leave until symptoms have resolved. Procedures for reporting suspected or probable reportable respiratory ECP Self Study Guide 26
Examples of Controls For Acute Care 1. Engineering (Along the Path) 2. Administrative Controls (Along the Path) infection cases (Influenza, TB, measles, mumps, chicken pox,) to public health; investigating occupational exposures. Educate and train staff in hazards, safe work procedures, and correct use of PPE 3. At the Worker At the Worker includes PPE and other things workers can do to prevent transmission Always follow Routine Practices (see above) ECP Self Study Guide 27
Sample Controls Home and Community Care Examples of Controls For Home & Community Care 1. Engineering 2. Administrative Controls 3. PPE Design or arrange entrance to organization office so access is limited/restricted unless visitors /staff have been screened for symptoms of ILI in a reception area. Provide personal alcohol gel containerspocket sized for staff. Develop and implement screening tool/questions (especially for screening of staff and residents for symptoms of ILI.) Minimize number of workers exposed to risk i.e. establish protocols for cluster care or essential services Develop and implement patient isolation procedures: i.e. establish service provision expectations such as family members with ILI respiratory infections remaining in a separate room while HCC worker present Ensure potentially contagious patients wear a surgical mask (if tolerated) Gloves Surgical Masks Gowns/aprons Eye protection ECP Self Study Guide 28
Examples of Controls For Home & Community Care 1. Engineering 2. Administrative Controls 3. PPE Supervise and coach in safe work procedures and use of PPE N95 Respirators Establish expectations for service with client ie: client wearing masks if required, client providing access to sinks, soap, paper towels, and/or alcohol gel Provide clients / family members with information on cough/sneeze etiquette Create and implement effective communication plan for HCC worker. For example, provide information on cough/sneeze etiquette with posters, brochures, mailouts, in-serivces, and phone messages. Communicate similar information to schedulers and supervisors. Establish expectations for cleaning with client, and procedures with HCC worker s as required ECP Self Study Guide 29
Examples of Controls For Home & Community Care 1. Engineering 2. Administrative Controls 3. PPE Implement policies and procedures for staff with ILI to take sick leave Create a system for intake screening / risk assessment: i.e. identify clients who are essential service, identify client ability to comply with respiratory hygiene practices Educate and train staff in hazards, safe work procedures, and correct use of PPE Implement procedures for reporting suspected or probable influenza cases to public health; investigating occupational exposures. ECP Self Study Guide 30
Activity: Fill in examples of controls for your organization Now that you have viewed some examples of controls, write down some of the controls that you could use in your organization in each category. Examples of Controls 1. Engineering 2. Administrative Controls 3. PPE ECP Self Study Guide 31
Examples of Controls 1. Engineering 2. Administrative Controls 3. PPE ECP Self Study Guide 32
4: Education and Training Once the ECP has been developed, employers must ensure that the plan is put into practice by informing workers about the contents of the ECP and educating and training them to work safely. For this reason, ECP s should describe the worker education and training required and how that training will be carried out. Education and training is particularly important for new workers. Your organization s training plan will need to: Educate staff on the specific hazard or risk Educate staff on the ECP Educate staff on the appropriate safe work procedures and how best to use them Include training for new hires and annual training where appropriate. 5: Safe Work Procedures Documenting and making Safe Work Procedures available to staff is an important component of your ECP. And while the ECP only has to list what already exists in the work environment in terms of Safe Work Procedures, it is important to ensure that all of the relevant Safe Work Practices are included. Some examples of written Safe Work Procedures might be: Staff self-assessments Surface and equipment disinfection Proper hand washing Correct donning and doffing of PPE Providing education and training sessions is one good way of communicating Safe Work Procedures, but posters and adequate supervision can also remind staff to follow safe work procedures. In some sectors, creating pocket size hand washing cards and other reminders may be more appropriate. You can download these and other OHSAH posters at: www.ohsah.bc.ca/en/posters. ECP Self Study Guide 33
6: Hygiene and Decontamination Procedures An ECP will need to incorporate procedures for hygiene and disinfection, which are a very important precautionary measure. For example, the organization should provide an adequate supply of hand hygiene stations either sinks with running water, soap and paper towels, or alcohol-based hand rub containers. There should also be procedures in place to ensure regular and thorough cleaning of frequently touched surface areas with hospital approved disinfectant. 7: Health Monitoring The health monitoring section of the ECP should detail how and to whom workers are to report symptoms. For example, as soon as symptoms arise, someone must notify the First Aid attendant, Supervisor, or Occupational Health Nurse. The organization will also need to designate and train a staff member to: Monitor staff infection (keep a record of workers with cough and fever (respiratory symptoms), days off sick, etc.) Report illness and daily absenteeism rates to Occupational Health Communicate with public health about how you will record and report exposures and respiratory infections in your staff Teach staff self-screening for symptoms: new or worsening cough, productive cough, fever, sore throat, or rashes are all signs of a possible contagious respiratory infection Conduct ongoing monitoring Confirm immunization history of all new hires ECP Self Study Guide 34
8: Documentation Your organization also needs to maintain and create a variety of documents as part of their ECP, and in order to support its use. These may include: Written Safe Work Procedures Workplace inspections Joint Occupational Health and Safety Meetings Investigations that take place after exposure incidents Records of exposed workers and any health monitoring required Immunization records Staff attendance at training ECP Self Study Guide 35
Activity: ECP Implementation Action Sheet We have included an action sheet to help you plan what you will need to do in order to complete and implement your Exposure Control Plan. You can use this sheet to determine what action you will need to take to complete each step of the ECP as well as what information you require and who will be responsible. Step Action Needed Input/Information Completed for Required By Implementation (date/person) Statement of Purpose Risk Identification & Assessment Risk Controls: Engineering Risk Controls: Administrative Risk Controls: PPE Education & Training ECP Self Study Guide 36
Step Action Needed Input/Information Completed for Required By Implementation (date/person) Written Work Procedures Hygiene Facilities Decontamination Procedures Health Monitoring Documentation Annual Review ECP Self Study Guide 37
Summary Now that you have completed the self study guide, we hope that you have all of the information necessary to participate in developing or reviewing an ECP. When we started the module, we outlined three objectives. We hope the guide has helped you to: Define an Exposure Control Plan (ECP) Identify the goals and outcomes of creating an Exposure Control Plan Demonstrate understanding of the eight elements of an Exposure Control Plan We have created sample ECPs for each sector so that you will have a sample to refer to if you need one. Remember, these are samples and they do not cover every situation. Every organization must create a unique ECP that addresses the specific risks and jobs in their own organization. However, taking a look at some sample ECPs can give you some ideas about what should be in an ECP. If you would like to print a sample of what a completed ECP looks like in your sector, please go to the OHSAH website and you will find: ECP Sample - Acute Care ECP Sample - Home Care ECP Sample - Long Term Care OHSAH also has a variety of health and safety resources to help you participate in creating or reviewing an ECP. There is a template that you can download from our website: www.ohsah.bc.ca And you can always access products and online databases using the Resources link on the OHSAH website. Thank you for taking the time to complete OHSAH s Exposure Control Plan course for respiratory infections! This information will play a vital role in your capacity as a JOHS Committee member, so we hope this training has helped you to understand all the elements of an ECP. You can review this self study guide at any time for reference or review. ECP Self Study Guide 38
Post-module self assessment If you want to compare how much you know now to how much you knew before you started this self study guide, you are welcome to complete the following self assessment. If you don t want to do the self assessment just flip past it to the appendix. Complete the following 10 questions to the best of your ability. 1. When is an Exposure Control Plan required? a) Annually b) In response to an identified risk c) When the JOHS Committee identifies a hazard 2. The elements of an Exposure Control Plan are: a) Statement of Purpose, Routes of Transmission, Engineering Controls, Risk Assessment, Written Work Procedures and Education and Training b) Statement of Purpose, Responsibilities, Risk Identification, Assessment and Controls, Education and Training, Written Work Procedures, Hygiene and Decontamination Procedures, Health Monitoring, and Documentation c) Statement of Purpose, Responsibilities, Exposure limits, Risk Identification and Assessment, Risk Controls, Education and Training, Written Work Procedures, Hygiene and Decontamination Procedures, Health Monitoring, Personal Protective Equipment, Worker Policies, and Documentation 3. The outcome of an effective Exposure Control Plan is: a) Protecting the health and safety of the workers b) Protecting the health and safety of everyone in the workplace environment c) Protecting the health and safety of the patients and visitors ECP Self Study Guide 39
4. Installing a glass barrier at reception is an example of what type of control? a) Administrative b) Engineering c) With the worker 5. Wearing Personal Protective Equipment is an example of what type of control? a) Administrative b) Engineering c) With the worker 6. A policy that states you should delay non-essential tasks until the infectious person is recovered is an example of what type of control? a) Engineering b) Administrative c) With the worker 7. Posters explaining proper hand-washing techniques are an example of: a) Education and training b) Written Safe Work Procedures c) Documentation 8. According to WorkSafe BC, who has the overall responsibility for the Exposure Control Plan? a) JOHS Committee b) Supervisor c) Employer d) Worker ECP Self Study Guide 40
9. An Exposure Control Plan is a: a) Document created for a specific workplace in response to an identified risk which outlines ways to eliminate or minimize the risk b) Guideline determined by WorkSafe BC and implemented in all workplaces c) Document that contains all infection control policies and written safe work procedures 10. A risk assessment must be conducted by a qualified person. According to WorkSafe BC, a qualified person means: a) The employer or a designate of the employer b) A person knowledgeable of the work, the hazards and the means to control the hazards c) The Joint Occupational Health and Safety Committee Great work! To check your answers, flip to the first page of the Appendix. ECP Self Study Guide 41
Appendices ECP Self Study Guide 42
Correct Answers to Self Assessment 1. When is an Exposure Control Plan required? a) Annually b) In response to an identified risk c) When the JOHS Committee identifies a hazard 2. The elements of an Exposure Control Plan are: a) Statement of Purpose, Routes of Transmission, Engineering Controls, Risk Assessment, Written Work Procedures and Education and Training b) Statement of Purpose, Responsibilities, Risk Identification, Assessment and Controls, Education and Training, Written Work Procedures, Hygiene and Decontamination Procedures, Health Monitoring, and Documentation c) Statement of Purpose, Responsibilities, Exposure limits, Risk Identification and Assessment, Risk Controls, Education and Training, Written Work Procedures, Hygiene and Decontamination Procedures, Health Monitoring, Personal Protective Equipment, Worker Policies, and Documentation 3. The outcome of an effective Exposure Control Plan is: a) Protecting the health and safety of the workers b) Protecting the health and safety of everyone in the workplace environment c) Protecting the health and safety of the patients and visitors 4. Installing a glass barrier at reception is an example of what type of control? a) Administrative b) Engineering c) With the worker 5. Wearing Personal Protective Equipment is an example of what type of control? a) Administrative b) Engineering c) With the worker ECP Self Study Guide 43
6. A policy that states you should delay non-essential tasks until the infectious person is recovered is an example of what type of control? a) Engineering b) Administrative c) With the worker 7. Posters explaining proper hand-washing techniques are an example of: a) Education and training b) Written Safe Work Procedures c) Documentation 8. According to WorkSafe BC, who has the overall responsibility for the Exposure Control Plan? a) JOHS Committee b) Supervisor c) Employer d) Worker 9. An Exposure Control Plan is a: a) Document created for a specific workplace in response to an identified risk which outlines ways to eliminate or minimize the risk b) Guideline determined by WorkSafe BC and implemented in all workplaces c) Document that contains all infection control policies and written safe work procedures 10. A risk assessment must be conducted by a qualified person. According to WorkSafe BC, a qualified person means: a) The employer or a designate of the employer b) A person knowledgeable of the work, the hazards and the means to control the hazards c) The Joint Occupational Health and Safety Committee ECP Self Study Guide 44
Glossary Airborne Transmission: Ambulatory Care Settings: Caregivers: Case: Cohorting: Cohort Staffing: Transmission of microorganisms by inhaling infectious aerosols (solid or liquid particles in the air). This can occur as a result of an infected person coughing, sneezing or talking, or during some medical procedures. Facilities that provide health care to patients who do not remain overnight (e.g., hospital-based outpatient clinics, non-hospital-based clinics and physician offices, urgent care centers, surgi-centers, free-standing dialysis centers, public health clinics, imaging centers, ambulatory behavioral health and substance abuse clinics, physical therapy and rehabilitation centers, and dental practices. All persons who are not employees of an organization, are not paid, and provide or assist in providing healthcare to a patient (e.g., family member, friend) and acquire technical training as needed based on the tasks that must be performed. An individual who is infected with an infectious disease This term applies to the practice of grouping patients infected or colonized with the same infectious agent together to confine their care to one area and prevent contact with susceptible patients (cohorting patients). During outbreaks, healthcare personnel may be assigned to a cohort of patients to further limit opportunities for transmission (cohorting staff). The practice of assigning specified personnel to care only for clients/patients/residents known to be colonized or infected with the same microorganism. Such personnel would not participate in the care of clients/patients/residents who are not colonized or infected with that microorganism. ECP Self Study Guide 45
Contact: Contact Precautions: Client/Patient/Resident: Contact Transmission (Direct And Indirect): Contamination: Control: An individual who is exposed to a person colonized or infected with a contagious infectious disease in a manner that allows transmission to occur (e.g. roommate). A type of Additional Precautions to reduce the risk of transmitting infectious agents via contact with an infectious person. Contact Precautions are used in addition to Routine Practices. They are a set of practices used to prevent transmission of infectious agents that are spread by direct or indirect contact with the patient or the patient s environment. Healthcare personnel caring for patients on Contact Precautions wear a gown and gloves for all interactions that may involve contact with the patient or potentially contaminated areas in the patient s environment. Donning of gown and gloves upon room entry, removal before exiting the patient room and performance of hand hygiene immediately upon exiting. Any person receiving health care within a health care setting. Direct contact occurs when microorganisms are transferred directly from an infected person (body surface to body surface). Some bacteria and viruses can survive on surfaces for several hours or days. Indirect contact involves the transfer of microorganisms from a contaminated intermediate source (e.g., door handle, table surface, and tray), contaminated instruments or hands. The presence of an infectious agent on a body surface, on clothes, gowns, gloves, bedding, toys, surgical instruments, dressings or other inanimate objects. Short for control measure. A method that controls the risk to workers. Risk controls must eliminate the risk to workers or, if elimination is not possible, minimize the risk. ECP Self Study Guide 46
Controls should be implemented in the following order: Engineering controls reduce risk by mechanical means (e.g., installing barriers, increasing room ventilation, utilizing a negative pressure isolation room). Administrative controls involve changes to scheduling or job rotation, or work procedures to reduce exposure (e.g., hand washing, respiratory cough/sneeze etiquette). Personal protective equipment (e.g., gloves, gowns, eye goggles, surgical masks, respirators). Direct Care: Disease Transmission: Droplet Nuclei: Droplet Transmission: Exposure: Fever: Providing hands-on care, such as bathing, washing, turning client/patient/resident, changing clothes/diapers, dressing changes, care of open wounds/lesions or toileting. Feeding and pushing a wheelchair are not classified as direct care. Refers to the way a pathogen is transmitted (passed) from person to person or animal to person. Infectious diseases can be transmitted through blood, through the air, and through direct contact with contaminated surfaces. Particles that are formed by the evaporation of droplets (see airborne transmission) Transmission occurs when droplets containing a microorganism are propelled a short distance through the air and deposited on the mucous membranes (e.g., of the eyes, nose or mouth). The condition of being subject to an infectious disease by contact with an infected person or a contaminated environment. An elevation of body temperature above the normal range (37 C.) A low-grade fever is no higher than 38.3 C. ECP Self Study Guide 47