Airborne pathogens are highly contagious.

Keeping Pathogens Out of the Workplace

Airborne pathogens are not only highly contagious, but also they can put a workforce completely out for weeks at a time.

During the 2013-2014 flu season, more than 300 people have died in the state of California alone. In 2012, more than 48,000 cases of pertussis (otherwise known as whooping cough) were reported, with thousands of cases likely going unreported. And while the disease is less common in the United States, nearly one-third of the world's population is infected with latent tuberculosis. Nearly 10,000 cases of it were reported in the United States during 2012.

Airborne infections such as influenza, pertussis, and tuberculosis spread so quickly and pervasively that many times, employers find themselves with an outbreak and struggling to figure out where or when it began. Creating an infection control program, ensuring your employees are adequately reporting their illnesses, and equipping your employees with respirators are all steps to take to ensure an outbreak does not affect your company. Here are some tips and tools for knowing what to look out for, how to create a plan, and what to do if an outbreak does occur.

What to Protect Against
In order to create a solid infection control plan, employers need to first know what possible airborne infections could spread in their workplace. Employers should protect not only against seasonal airborne illnesses, such as influenza and streptococcal infections, but also those without seasonality, such as pertussis, tuberculosis, and norovirus. Langdon Dement, a safety and health specialist with Underwriters Laboratories and an infectious diseases expert, said vaccinations have helped--but not nearly enough.

"There are a lot of benefits to vaccines, but they cannot protect against everything," he said. "One thing that is relatively recent is norovirus--it's rampant." Dement pointed out that norovirus is spread both through the air and through direct contact and is very difficult to kill once it appears in the workplace. While most healthy adults will not die from norovirus, it is highly contagious. In a workplace of thousands, hundreds could become infected. More than 600 passengers on a recent cruise became infected with norovirus in a matter of days, representing 20 percent of the passengers on board.

In addition to norovirus, employers have seen a resurgence in cases of pertussis and even tuberculosis recently. Nicole McCullough, Global Technical Services manager at 3M's Personal Safety Division, said employers need to be aware of these conditions. "We do see adults come down with pertussis occasionally, but many adults may not realize they have it just because they have a cough, and they can infect others in the workplace," she said. While whooping cough more commonly affects children, it can spread from adult to adult, as well.

Though outbreaks of pertussis, tuberculosis, and norovirus may not be common, flu outbreaks are. McCullough suggested that employers have a strong plan in place for reporting and dealing with the flu. "Influenza is typically a more mild disease that you can recover from, and it doesn't have long-term effects. But it certainly can affect the productivity of your workplace," she said. "If you have a sick worker come in and infect a lot of people all at once, you could end up with a significant portion of your workforce out at the same time."

Creating a Plan
The most efficient way to ensure your company does not see an outbreak of an airborne illness is by encouraging your employees to report when they have an infectious disease. In certain states, the department of health requires reporting of diseases such as tuberculosis. McCullough warned that, although not every state has mandatory reporting and not every disease falls under mandatory reporting, it is important for employers to educate their employees and ensure they are being notified in the event that an employee has an infectious disease. "I think it is very important that the employers and their health and safety officer, in conjunction with the medical department, understand what diseases do have mandatory reporting in their state, and if they have concerns about populations of workers that may be at risk, then they should know which diseases will be reported to them," McCullough said. "If there are any that wouldn’t be reported, they need to make sure they're communicating that to their employees."

Dement echoed this sentiment and emphasized that having an infection control program in place is key to a company's success and the prevention of an outbreak. "I think it is important to have an exposure control program or infection control program in place so you can be kept aware, determine what that exposure is, and try to figure out what the methods are to reduce it," he said.

Some employers already may have an infection control plan in place if they comply with OSHA's bloodborne pathogens standard (29 CFR 1910.1030), which applies to employers who anticipate contact with blood or infectious materials in their workplace that can spread infectious diseases, such as HIV or hepatitis. The regulation requires employers to create a written exposure control plan explaining how the employer will protect its employees from exposure.

For companies that have no infection control program in place or do not need to comply with the bloodborne pathogens standard, Dement suggested consulting resources provided by the CDC and the World Health Organization, as well as OSHA's Occupational Exposure Control Plan, which is part of the bloodborne pathogens standard.

In addition to having an infection control program in place, both Dement and McCullough emphasized the need for employers to educate workers when they travel overseas. "In general, it's not as important to be aware of diseases going on throughout the world. But for many organizations, travel is very important," Dement said. "And for those individuals and companies as a whole, it's pivotal to be knowledgeable of what diseases could affect them. If you’re traveling to those areas, the potential for contact could be greater."

Selecting the Correct Respirator
Not every airborne illness can be reported early enough to prevent its spread in a workplace. That is where respirators come into play. Respirators can keep a workforce healthy and safe by preventing the spread of the infection from worker to worker while also helping prevent the spread of infection from a worker to his or her family.

The first step is to ensure you are selecting a NIOSH-approved respirator, which will be apparent on the respirator's label, McCullough said. "The pathogens, bacteria, and virus will be filtered out by the filter media in NIOSH-approved respirators and it's very important, obviously, that the worker ensures the respirator seals to their face," she said, adding that some respirators are FDA-approved, though those are mainly used in surgical situations and are not necessary to prevent against airborne infections.

There are a variety of different respirators on the market, with the most basic one being a filtering facepiece respirator. There are also half-piece elastomeric or rubber respirators, which have the same protection level as a filtering facepiece respirator but are reusable. "For most applications with infection prevention, people are using the filtering facepieces because then they don't have to worry about cleaning them," said McCullough. "If this is something they frequently see happening and they want to clean the respirators, then they could use an elastomeric."

Fit is key. In order to ensure the respirator seals properly, McCullough suggested that employers do fit testing with Bitrex. Employees put on a respirator and hood, and a foul-smelling and -tasting solution is sprayed in. If their respirator is fitted correctly, they won't smell or taste the solution.

Some employers may have trouble getting employees to wear the respirators--they will say they feel restricted or uncomfortable. "Obviously, employers need to be firm. They really need to provide the education and clearly explain to the employees why they're being asked to do this," McCullough said--even taking the respirator off for 30 minutes during an eight-hour period can overexpose a worker. She said one way to get employees to comply is to involve them in the decision-making process by selecting four or five respirators and letting employees test them out for a few days to decide which one they like best.

Overall, the most important thing is for employers to be on their feet. Many infectious diseases are not seasonal, and new strains of viruses can pop up suddenly. Infection control plans needed to be living documents, Dement said. "The plan is something that will be ever-evolving," he said. "It is meant to be used continually and should be able to be changed at any given time. Diseases can evolve over time and will not necessarily stay the same."

Though there are several reasons to implement an infection control plan in your workplace, one reason ranks above the rest. "Obviously, the primary reason is to protect your employees' health because you certainly want to minimize the transmission of infectious diseases at work," McCullough said.

This article originally appeared in the April 2014 issue of Occupational Health & Safety.

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