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Guidance on Preparing Workplaces for an Influenza Pandemic
OSHA 3327-02N 2007
Employers are responsible for providing a safe and healthful workplace for their employees. OSHA's role is to assure the safety and health of America's employees by setting and enforcing standards; providing training, outreach and education; establishing partnerships; and encouraging continual improvement in workplace safety and health.
This handbook provides a general overview of a particular topic related to OSHA standards. It does not alter or determine compliance responsibilities in OSHA standards or the Occupational Safety and Health Act of 1970. Because interpretations and en-forcement policy may change over time, you should consult current OSHA administrative interpretations and decisions by the Occupational Safety and Health Review Commission and the Courts for additional guidance on OSHA compliance requirements.
A pandemic influenza will have little direct impact on the physical infrastructure of America’s Critical Infrastructure/Key Resource sectors, but could have a devastating impact on America’s workforce. Anticipating and planning for a potential 40 percent reduction in the workforce for up to two weeks (and significant absenteeism for up to 12 weeks) will be critical to ensure that essential services are maintained.
Voluntary Isolation/Voluntary Home Quarantine
Voluntary isolation means all persons with confirmed or suspected pandemic influenza remain at home or within a healthcare setting; voluntary home quarantine means members of households with confirmed or suspected influenza stay at home.
Social Distancing of Adults in the Community and Workplace
Social distancing of adults in the community and workplace may include canceling large public gatherings, altering workplace environments, and instituting flexible leave policies.
The Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services (HHS), has developed interim planning guidance for implementing community mitigation strategies in the home, school, workplace and community to reduce pandemic influenza transmission. These strategies are divided into four broad categories: voluntary isolation, voluntary home quarantine, child social distancing (including dismissing children from school and child care), and social distancing of adults in the workplace and community. The strategies challenge employers and their human resources professionals to consider the best planning and response in advance of a pandemic. This document (www.pandemicflu.gov/plan/community/commitigation.html) offers answers to many questions the U.S. business community may have regarding the impact of community mitigation strategies on the workplace.
As an overall matter, employers should be guided in their relationship with their employees not only by federal employment law, but by their own employee handbooks, manuals, and contracts (including bargaining agreements), and by any applicable state or local laws.
How a Severe Pandemic Influenza Could Affect Workplaces
Unlike natural disasters or terrorist events, an influenza pandemic will be widespread, affecting multiple areas of the United States and other countries at the same time. A pandemic will also be an extended event, with multiple waves of outbreaks in the same geographic area; each outbreak could last from 6 to 8 weeks. Waves of outbreaks may occur over a year or more. Your workplace will likely experience:
Absenteeism - A pandemic could affect as many as 40 percent of the workforce during periods of peak influenza illness. Employees could be absent because they are sick, must care for sick family members or for children if schools or day care centers are closed, are afraid to come to work, or the employer might not be notified that the employee has died.
Change in patterns of commerce - During a pandemic, consumer demand for items related to infection control is likely to increase dramatically, while consumer interest in other goods may decline. Consumers may also change the ways in which they shop as a result of the pandemic. Consumers may try to shop at off-peak hours to reduce contact with other people, show increased interest in home delivery services, or prefer other options, such as drive-through service, to reduce person-to-person contact.
Interrupted supply/delivery - Shipments of items from those geographic areas severely affected by the pandemic may be delayed or cancelled.
Who Should Plan for a Pandemic
To reduce the impact of a pandemic on your operations, employees, customers and the general public, it is important for all businesses and organizations to begin continuity planning for a pandemic now. Lack of continuity planning can result in a cascade of failures as employers attempt to address challenges of a pandemic with insufficient resources and employees who might not be adequately trained in the jobs they will be asked to perform. Proper planning will allow employers to better protect their employees and prepare for changing patterns of commerce and potential disruptions in supplies or services. Important tools for pandemic planning for employers are located at www.pandemicflu.gov.
The U.S. government has placed a special emphasis on supporting pandemic influenza planning for public and private sector businesses deemed to be critical industries and key resources (CI/KR). Critical infrastructure are the thirteen sectors that provide the production of essential goods and services, interconnectedness and operability, public safety, and security that contribute to a strong national defense and thriving economy. Key resources are facilities, sites, and groups of organized people whose destruction could cause large-scale injury, death, or destruction of property and/or profoundly damage our national prestige and confidence. With 85 percent of the nation's critical infrastructure in the hands of the private sector, the business community plays a vital role in en-suring national pandemic preparedness and response. Additional guidance for CI/KR business is available at: www.pandemicflu.gov/plan/pdf/CIKRpandemicInfluenzaGuide.pdf.
Critical Infrastructure and Key Resources
Key Resources
Government Facilities
Dams
Commercial Facilities
Nuclear Power Plants
Critical Infrastructure
Food and Agriculture
Public Health and Healthcare
Banking and Finance
Chemical and Hazardous Materials
Defense Industrial Base
Water
Energy
Emergency Services
Information Technology
Telecommunications
Postal and Shipping
Transportation
National Monuments and Icons
How Influenza Can Spread Between People
Influenza is thought to be primarily spread through large droplets (droplet transmission) that directly contact the nose, mouth or eyes. These droplets are produced when infected people cough, sneeze or talk, sending the relatively large infectious droplets and very small sprays (aerosols) into the nearby air and into contact with other people. Large droplets can only travel a limited range; therefore, people should limit close contact (within 6 feet) with others when possible. To a lesser degree, human influenza is spread by touching objects contaminated with influenza viruses and then transferring the infected material from the hands to the nose, mouth or eyes. Influenza may also be spread by very small infectious particles (aerosols) traveling in the air. The contribution of each route of exposure to influenza transmission is uncertain at this time and may vary based upon the characteristics of the influenza strain.
Classifying Employee Exposure to Pandemic Influenza at Work
Employee risks of occupational exposure to influenza during a pandemic may vary from very high to high, medium, or lower (caution) risk. The level of risk depends in part on whether or not jobs require close proximity to people potentially infected with the pandemic influenza virus, or whether they are required to have either repeated or extended contact with known or suspected sources of pandemic influenza virus such as coworkers, the general public, outpatients, school children or other such individuals or groups.
Very high exposure risk occupations are those with high potential exposure to high concentrations of known or suspected sources of pandemic influenza during specific medical or laboratory procedures.
High exposure risk occupations are those with high potential for exposure to known or suspected sources of pandemic influenza virus.
Medium exposure risk occupations include jobs that require frequent, close contact (within 6 feet) exposures to known or suspected sources of pandemic influenza virus such as coworkers, the general public, outpatients, school children or other such individuals or groups.
Lower exposure risk (caution) occupations are those that do not require contact with people known to be infected with the pandemic virus, nor frequent close contact (within 6 feet) with the public. Even at lower risk levels, however, employers should be cautious and develop preparedness plans to minimize employee infections.
Employers of critical infrastructure and key resource employees (such as law enforcement, emergency response, or public utility employees) may consider upgrading protective measures for these employees beyond what would be suggested by their exposure risk due to the necessity of such services for the functioning of society as well as the potential difficulties in replacing them during a pandemic (for example, due to extensive training or licensing requirements).
To help employers determine appropriate work practices and precautions, OSHA has divided workplaces and work operations into four risk zones, according to the likelihood of employees' occupational exposure to pandemic influenza. We show these zones in the shape of a pyramid to represent how the risk will likely be distributed (see page 11). The vast majority of American workplaces are likely to be in the medium exposure risk or lower exposure risk (caution) groups.
Occupational Risk Pyramid for Pandemic Influenza
Very High Exposure Risk:
Healthcare employees (for example, doctors, nurses, dentists) performing aerosol-generating procedures on known or suspected pandemic patients (for example, cough induction procedures, bronchoscopies, some dental procedures, or invasive specimen collection).
Healthcare or laboratory personnel collecting or handling specimens from known or suspected pandemic patients (for example, manipulating cultures from known or suspected pandemic influenza patients).
High Exposure Risk:
Healthcare delivery and support staff exposed to known or suspected pandemic patients (for example, doctors, nurses, and other hospital staff that must enter patients' rooms).
Medical transport of known or suspected pandemic patients in enclosed vehicles (for example, emergency medical technicians).
Performing autopsies on known or suspected pandemic patients (for example, morgue and mortuary employees).
Medium Exposure Risk:
Employees with high-frequency contact with the general population (such as schools, high population density work environments, and some high volume retail).
Lower Exposure Risk (Caution):
Employees who have minimal occupational contact with the general public and other coworkers (for example, office employees).
How to Maintain Operations During a Pandemic
As an employer, you have an important role in protecting employee health and safety, and limiting the impact of an influenza pandemic. It is important to work with community planners to integrate your pandemic plan into local and state planning, particularly if your operations are part of the nation's critical infrastructure or key resources. Integration with local community planners will allow you to access resources and information promptly to maintain operations and keep your employees safe.
Develop a Disaster Plan
Develop a disaster plan that includes pandemic preparedness (See www.pandemicflu.gov/plan/businesschecklist.html) and review it and conduct drills regularly.
Be aware of and review federal, state and local health department pandemic influenza plans. Incorporate appropriate actions from these plans into workplace disaster plans.
Prepare and plan for operations with a reduced workforce.
Work with your suppliers to ensure that you can continue to operate and provide services.
Develop a sick leave policy that does not penalize sick employees, thereby encouraging employees who have influenza-related symptoms (e.g., fever, headache, cough, sore throat, runny or stuffy nose, muscle aches, or upset stomach) to stay home so that they do not infect other employees. Recognize that employees with ill family members may need to stay home to care for them.
Identify possible exposure and health risks to your employees. Are employees potentially in contact with people with influenza such as in a hospital or clinic? Are your employees expected to have a lot of contact with the general public?
Minimize exposure to fellow employees or the public. For example, will more of your employees work from home? This may require enhancement of technology and communications equipment.
Identify business-essential positions and people required to sustain business-necessary functions and operations. Prepare to cross-train or develop ways to function in the absence of these positions. It is recommended that employers train three or more employees to be able to sustain business-necessary functions and operations, and communicate the expectation for available employees to perform these functions if needed during a pandemic.
Plan for downsizing services but also anticipate any scenario which may require a surge in your services.
Recognize that, in the course of normal daily life, all employees will have non-occupational risk factors at home and in community settings that should be reduced to the extent possible. Some employees will also have individual risk factors that should be considered by employers as they plan how the organization will respond to a potential pandemic (e.g., immuno-compromised individuals and pregnant women).
Stockpile items such as soap, tissue, hand sanitizer, cleaning supplies and recommended personal protective equipment. When stockpiling items, be aware of each product's shelf life and storage conditions (e.g., avoid areas that are damp or have temperature extremes) and incorporate product rotation (e.g., consume oldest supplies first) into your stockpile management program.
Make sure that your disaster plan protects and supports your employees, customers and the general public. Be aware of your employees' concerns about pay, leave, safety and health. Informed employees who feel safe at work are less likely to be absent.
Develop policies and practices that distance employees from each other, customers and the general public. Consider practices to minimize face-to-face contact between employees such as e-mail, websites and teleconferences. Policies and practices that allow employees to work from home or to stagger their work shifts may be important as absenteeism rises.
Organize and identify a central team of people or focal point to serve as a communication source so that your employees and customers can have accurate information during the crisis.
Work with your employees and their union(s) to address leave, pay, transportation, travel, childcare, absence and other human resource issues.
Provide your employees and customers in your workplace with easy access to infection control supplies, such as soap, hand sanitizers, personal protective equipment (such as gloves or surgical masks), tissues, and office cleaning supplies.
Provide training, education and informational material about business-essential job functions and employee health and safety, including proper hygiene practices and the use of any personal protective equipment to be used in the workplace. Be sure that informational material is available in a usable format for individuals with sensory disabilities and/or limited English proficiency. Encourage employees to take care of their health by eating right, getting plenty of rest and getting a seasonal flu vaccination.
Work with your insurance companies, and state and local health agencies to provide information to employees and customers about medical care in the event of a pandemic.
Assist employees in managing additional stressors related to the pandemic. These are likely to include distress related to personal or family illness, life disruption, grief related to loss of family, friends or coworkers, loss of routine support systems, and similar challenges. Assuring timely and accurate communication will also be important throughout the duration of the pandemic in decreasing fear or worry. Employers should provide opportunities for support, counseling, and mental health assessment and referral should these be necessary. If present, Employee Assistance Programs can offer training and provide resources and other guidance on mental health and resiliency before and during a pandemic.
Protect Employees and Customers
Educate and train employees in proper hand hygiene, cough etiquette and social distancing techniques. Understand and develop work practice and engineering controls that could provide additional protection to your employees and customers, such as: drive-through service windows, clear plastic sneeze barriers, ventilation, and the proper selection, use and disposal of personal protective equipment.
These are not comprehensive recommendations. The most important part of pandemic planning is to work with your employees, local and state agencies and other employers to develop cooperative pandemic plans to maintain your operations and keep your employees and the public safe. Share what you know, be open to ideas from your employees, then identify and share effective health practices with other employers in your community and with your local chamber of commerce.
Personal Protective Equipment (PPE) - While administrative and engineering controls and proper work practices are considered to be more effective in minimizing exposure to the influenza virus, the use of PPE may also be indicated during certain exposures. If used correctly, PPE can help prevent some exposures; however, they should not take the place of other prevention interventions, such as engineering controls, cough etiquette, and hand hygiene (see www.cdc.gov/flu/protect/stopgerms.htm). Examples of personal protective equipment are gloves, goggles, face shields, surgical masks, and respirators (for example, N-95). It is important that personal protective equipment be:
Selected based upon the hazard to the employee;
Properly fitted and some must be periodically refitted (e.g., respirators);
Conscientiously and properly worn;
Regularly maintained and replaced, as necessary;
Properly removed and disposed of to avoid contamination of self, others or the environment.
Employers are obligated to provide their employees with protective gear needed to keep them safe while performing their jobs. The types of PPE recommended for pandemic influenza will be based on the risk of contracting influenza while working and the availability of PPE.
Steps Every Employer Can Take to Reduce the Risk of Exposure to Pandemic Influenza in Their Workplace
The best strategy to reduce the risk of becoming infected with influenza during a pandemic is to avoid crowded settings and other situations that increase the risk of exposure to someone who may be infected. If it is absolutely necessary to be in a crowded setting, the time spent in a crowd should be as short as possible. Some basic hygiene (see www.cdc.gov/flu/protect/stopgerms.htm) and social distancing precautions that can be implemented in every workplace include the following:
Meds help treat Cough & Cold Symptoms
Encourage sick employees to stay at home.
Encourage your employees to wash their hands frequently with soap and water or with hand sanitizer if there is no soap or water available. Also, encourage your employees to avoid touching their noses, mouths, and eyes.
Encourage your employees to cover their coughs and sneezes with a tissue, or to cough and sneeze into their upper sleeves if tissues are not available. All employees should wash their hands or use a hand sanitizer after they cough, sneeze or blow their noses.
Employees should avoid close contact with their coworkers and customers (maintain a separation of at least 6 feet). They should avoid shaking hands and always wash their hands after contact with others. Even if employees wear gloves, they should wash their hands upon removal of the gloves in case their hand(s) became contaminated during the removal process.
Provide customers and the public with tissues and trash receptacles, and with a place to wash or disinfect their hands.
Keep work surfaces, telephones, computer equipment and other frequently touched surfaces and office equipment clean. Be sure that any cleaner used is safe and will not harm your employees or your office equipment. Use only disinfectants registered by the U.S. Environmental Protection Agency (EPA), and follow all directions and safety precautions indicated on the label.
Discourage your employees from using other employees' phones, desks, offices or other work tools and equipment.
Minimize situations where groups of people are crowded together, such as in a meeting. Use e-mail, phones and text messages to communicate with each other. When meetings are necessary, avoid close contact by keeping a separation of at least 6 feet, where possible, and assure that there is proper ventilation in the meeting room.
Reducing or eliminating unnecessary social interactions can be very effective in controlling the spread of infectious diseases. Reconsider all situations that permit or require employees, customers, and visitors (including family members) to enter the workplace. Workplaces which permit family visitors on site should consider restricting/eliminating that option during an influenza pandemic. Work sites with on-site day care should consider in advance whether these facilities will remain open or will be closed, and the impact of such decisions on employees and the business.
Promote healthy lifestyles, including good nutrition, exercise, and smoking cessation. A person's overall health impacts their body's immune system and can affect their ability to fight off, or recover from, an infectious disease.
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