Prevention and management of exposure to COVID-19 in the healthcare and social assistance industry

Background

Employees in the healthcare and social assistance industry have a higher risk of being exposed to COVID-19. These employees are likely to come into close contact with patients, clients and residents in facilities (eg hospitals, care facilities, clinics) and in people's homes, and often work in environments with other employees (rather than alone).

Employers have a duty to provide and maintain, so far as is reasonably practicable, a working environment that is safe and without risks to the health of employees. This includes preventing risks to health (including psychological health) and safety associated with potential exposure to COVID-19.

Employees have a duty to take reasonable care of their own and others health and safety in the workplace and cooperate with their employers about any action they take to comply with the OHS Act or OHS Regulations.

More information about employer and employee obligations is set in the Legal duties section below.

Transmission of COVID-19

Researchers are still learning about COVID-19, its long-term effects and emerging variants.

COVID-19 is a respiratory disease caused by a coronavirus (SARS-CoV-2) that can result in mild to very severe illness and death.

The main way COVID-19 spreads is when a person with COVID-19 exhales droplets and/or aerosol particles containing the virus. This can happen when they breathe out, cough, sneeze, speak, shout or sing.

Exhaled droplets range in size. Large droplets settle out of the air faster than they evaporate. Small droplets remain suspended in the air for longer periods. Very fine droplets may contain the virus, and can stay suspended in the air for anywhere from minutes to hours. Small droplets and particles are often referred to as ‘aerosols’.

Transmission of COVID-19 can occur in a number of ways, and possibly in combination.

1. Airborne transmission

This occurs when a person inhales aerosols that may contain viral particles that are infectious.

While the risk of transmission is highest when close to an infectious person, air currents can disperse small droplets and particles over long distances. These may be inhaled by people who have not had face-to-face contact or been in the same space with the infectious person. Airborne transmission is more likely to occur in indoor or enclosed settings that are poorly ventilated, crowded, or both. In these kinds of settings, the virus may remain suspended in the air for longer and increase the risk of spread as people tend to spend longer periods in indoor settings.

2. Droplet transmission

Transmission occurs where exhaled droplets from a person with COVID-19 come into contact with another person's mucosal surfaces (nose, mouth or eyes). The risk of transmission is highest when close to the source, where the concentration of these droplets is greatest.

3. Contaminated surfaces transmission

People may also become infected by touching surfaces that have been contaminated by the virus, and then touching their eyes, nose or mouth without cleaning their hands.

Identifying risks to health in the healthcare and social assistance industry

Employers must identify the level of risk to the health of employees from exposure to COVID-19 at their workplace, including where care is provided in people's homes. This must be done in consultation with health and safety representatives (HSRs) and employees, so far as is reasonably practicable.

Employees are at risk of exposure to COVID-19 infection if they have contact with people (including other employees) with suspected or confirmed COVID-19 infections.

For definitions of suspected and confirmed COVID-19 infections see

Some activities in healthcare and social assistance workplaces that may pose a risk of exposure to COVID-19 include:

• Providing direct care or support to people with suspected or confirmed COVID-19 infections.
• Interacting with people with suspected or confirmed COVID-19 infections with aerosol generating behaviours (eg screaming, shouting).
• Interacting with people from areas with elevated community transmission (eg patients presenting to emergency departments or clinics).
• Handling of contaminated waste or personal protective equipment (PPE) which has been used by staff caring for people with suspected or confirmed COVID-19 infections.
• Transporting people with suspected or confirmed COVID-19 infections in vehicles.
• Cleaning medical equipment that has been used on people with suspected or confirmed COVID-19 infections.
• Touching or cleaning cutlery, dishes or other objects used by people with suspected or confirmed COVID-19 infections.
• Cleaning rooms and public areas used by people with suspected or confirmed COVID-19 infections.
• Collecting respiratory samples from people with suspected or confirmed COVID-19 infections.
• Reception tasks which involve interactions with people with suspected or confirmed COVID-19 infections.
• Interacting (eg. in communal areas, shared vehicles or in personal time) with other employees who work with patients with COVID-19 infections or who live in an area where community prevalence is elevated.
• Touching objects or surfaces touched by other employees who work with patients with COVID-19 infections or who live in an area where community prevalence is elevated.

Employers must also identify whether there are other increased risks at a workplace as a result of COVID-19, including:

• Work-related violence and aggression in the workplace (eg due to poor front-line management, rapidly changing information, increased workload, implementation of government restrictions and public fears).
• Fatigue (eg as a result of increased workload, inadequate staffing levels, additional or longer shift lengths and other pressures) which may impact on compliance with procedures and training.
• Stress (eg as a result of vicarious trauma, increased workload and ongoing heightened levels of concentration).
• The availability of supplies, such as PPE or cleaning equipment.
• The impact of long term wearing of PPE including respiratory protection (eg pressure injuries and other detrimental effects)
• The appropriateness of particular types of PPE to the environment it is to be used in (eg entering patients' homes, treating patients on the floor of a residence, working outdoors).
• Workforce and skills shortages.
• Home visits where the COVID-19 status of the patient and/or family members may be unknown.

Controlling risks to health

Where a risk to health, including psychological health, is identified at a workplace, employers must, so far as is reasonably practicable, eliminate the risk. Where it isn't possible to eliminate the risk, it must be controlled, so far as is reasonably practicable.

Employers also have a duty to consult with employees and health and safety representatives (HSRs) (if any), on matters related to health or safety that directly affect, or are likely to directly affect them.

This includes consultation on identifying hazards or risks, and decisions about how to control risks associated with COVID-19.

The types of control measures required depends on the level of risk as well as the availability and suitability of controls for each workplace, including individual work areas.

COVID-19 vaccinations in workplaces

COVID-19 vaccination is one control measure that can reduce the risk of COVID-19 in workplaces. This should be part of a suite of controls used to reduce the risk of COVID-19 in workplaces.

Specific control measures could include:

Facility management systems of work

• Preventing contact with people with suspected or confirmed COVID-19 infection by changing work practices where it does not impact on the quality of care delivery (eg preliminary phone screening to triage to an appropriate facility, telehealth, virtual consultations, working from home where possible).
• Changing the work environment to prevent unnecessary contact with people with suspected or confirmed COVID-19 infection (eg Perspex barriers at reception areas, designated areas, entry and exit points for people with suspected or confirmed COVID-19).
• Using dedicated wards or areas of facilities to isolate people with suspected or confirmed COVID-19 infections.
• Screening employees, contractors and visitors for symptoms prior to entering the facility.
  • Note that Pandemic Orders made by the Victorian Minister for Health may impose restrictions on certain persons entering facilities and may require persons seeking to enter facilities to make certain declarations before entry.

• Asymptomatic testing of workers, when indicated by the Department of Health (DH), to aid in early detection of COVID-19 infection.
• Screening people directly prior to appointments or admission to identify suspected COVID-19 infections.
• Asymptomatic testing of people, when indicated by DH, prior to admission to aid in early detection of COVID-19 infection.
• Regularly monitoring patients, residents or clients for symptoms of COVID-19, particularly when community prevalence is elevated.
• Ensuring that systems are in place to prevent fatigue and workload issues due to a surge in demand or staff on leave .
• Limiting movement of people with suspected or confirmed COVID-19 within a facility to essential purposes only.
• Regular cleaning and disinfection of workplaces, as per DH guidelines.

Ventilation

People in indoor environments, particularly in crowded or inadequately ventilated spaces, are at a higher risk of becoming infected with COVID-19. When someone with COVID-19 has been present, the virus may linger in poorly ventilated spaces or areas with stagnant air for a longer period of time.

Providing an adequate supply of fresh air (ventilation) to enclosed areas of a workplace dilutes the number of airborne virus particles and lowers transmission risk. Improving ventilation alone does not reduce the risk of transmission via droplets and contaminated surfaces. It needs to be considered as part of a suite of infection control measures.

Adequate ventilation can be achieved using natural or mechanical ventilation, or a combination of the two.

• Natural ventilation is fresh air coming in through open windows, doors or air vents.
• Mechanical ventilation means a method of forced or induced ventilation using mechanical air-handling systems that bring in fresh air from outside. It forms part of a building’s heating, ventilation and air conditioning (HVAC) system.

Better ventilation can be achieved by:

• increasing the rate that air is supplied
• increasing the supply of fresh outdoor air
• reducing or eliminating recirculated air in HVAC systems
• improving filtration for air recirculated by HVAC systems if the ventilation rate is not compromised
• regular maintenance of the HVAC system, including changing filters

Guidance on HVAC systems is available in AS1668.2:2012 The use of ventilation and air-conditioning in buildings, Part 2: Mechanical ventilation in buildings. Further information on HVAC systems and COVID-19 is available in World Health Organization (WHO) guidance.

In areas where it is not possible to maintain adequate ventilation and there is a high risk of transmission, portable high-efficiency particulate air (HEPA) filtered air cleaners may be appropriate to be used to reduce the concentration of airborne virus particles and other aerosol contaminants. These units are not a substitute for ventilation. should assess the risk and/or undertake a ventilation assessment to identify what ventilation strategies are appropriate for the space and whether an air cleaner is needed (and consider operational placement and maintenance of these units.

Employers should work with the building’s owner or manager to improve ventilation where possible. Engaging a suitably qualified person such as an occupational hygienist or a ventilation engineer to advise and assist should also be considered.

For more information about ventilation, see the following documents on the DH Infection prevention control resources page:

• Department of Health IPC Ventilation Policy
• Coronavirus (COVID-19) transmission from air-circulating, wind-blowing devices and activities
• Ventilation strategies to reduce COVID-19 infection, when used as per DH guidelines

Rostering and cohorting

• Minimising the risk of cross-infection by limiting contact between teams caring for people with suspected or confirmed COVID-19 infections (eg rostering, separate break rooms, change areas, bathrooms).
• Ensuring that employees are only working at a single facility where practical or as directed by the Victorian Minister for Health and keeping records and managing the risks of those who do need to work across sites.
• Allocating employees to work in a single ward or area when community prevalence of COVID-19 is elevated.
• Rostering employees to consistently work on the same shifts and avoiding interaction between staff at shift changeover times by staggering shifts when community prevalence is elevated.
• Consistently allocating patients or clients to the same employee for each shift when community prevalence is elevated.
• Revising staff and client activity rosters to stagger numbers of people in work settings to create more room for physical distancing.

Pandemic Orders made by the Victorian Minister for Health impose additional restrictions on rostering and cohorting for care facilities and high risk settings within hospitals.

Ward/office management systems of work

• Limiting access to wards/areas with suspected or confirmed COVID-19 infection to only those staff working in that area (eg key pass or code).
• Allocating people with suspected or confirmed COVID-19 infections to a single room with ensuite where possible.
• Bathrooms should have exhaust fans operating at all times.
• Doors to rooms of people with suspected or confirmed COVID-19 infections should remain closed, as per DH infection control guidelines.
• Installing signs advising of suspected or confirmed COVID-19 infections on doors/entry points to wards and rooms.
• Following DH guidance regarding showering or toileting people with suspected or confirmed COVID-19 infections, including alternative hygiene care methods (e.g. bed baths) for people requiring direct supervision or physical support.
• Medical and manual handling equipment (eg slings) used on people with confirmed or suspected COVID-19 infections should be dedicated and remain in rooms, or cleaned and disinfected after each use as per DH Infection prevention and control guidelines.
• Consistently applying physical distancing measures in all workplace settings, including clinical and non-clinical settings, during handovers, outreach, home visits and welfare checks.
• Splitting teams for critical functions, where remote work is not possible.
• Minimising shared use of phones, desks, offices, kitchens or other work tools and equipment (or, in cases where this is not practicable, ensure surfaces are cleaned between use). Cleaning needs to be conducted in line with DH Infection control guidelines.

Facilities and communal areas

• Ensuring employees take regular rest breaks and have access to safe and clean facilities, including hydration, for rest breaks.
• Cleaning high touch surfaces in line with DH Infection control guidelines.
• Providing hand hygiene facilities (eg hand wash stations with soap and hand towels, hand sanitiser with over 60 per cent alcohol).
• Providing information, instruction and training on hand hygiene, and monitoring compliance.
• Ensuring physical distancing can be maintained in common areas (eg break rooms, offices, meeting rooms, bathrooms, change rooms).
• Using video conferencing for teaching and departmental meetings where practical.
• Providing employees with time to wash up and change their clothes prior to the end of their shift.

For additional information, see DH resources on safe staff amenities.

PPE and clothing

Face masks

Surgical masks

Surgical masks are designed as a loose fitting barrier to prevent the wearer expelling large droplets and as a barrier to protect the wearer from fluid splashes and inhaling larger respiratory droplets. They:

• are loose fitting, covering the nose, mouth, and chin
• may be worn by infected people to help reduce the spread of viruses via exhaled droplets that occur through coughing or sneezing
• when worn with safety glasses or goggles or face shields, are used to help protect healthcare workers’ mucous membranes (eyes, nose, and mouth) from droplet transmission
• are worn by healthcare professionals in sterile environments to reduce exhaled droplets from contaminating the sterile field
• are worn when high velocity fluid risks are present

Surgical masks do not prevent exposure to aerosols.

Homemade PPE including cloth masks

Homemade PPE, for example cloth masks, are not recommended for health care workers for the prevention of exposure to COVID-19.

With worldwide increase in demand for surgical masks and N95/P2 respirators, and subsequent diminished supplies, there has been a rise in use of homemade masks. Although any material may provide a physical barrier between the wearer and airborne droplets, cloth masks (unlike surgical masks) are not designed and tested to a standardised method. Homemade PPE may also result in an increased risk of infection due to moisture retention and poor filtration.

The difference between surgical masks and RPE

It is important to understand the difference between surgical masks and RPE:

• single-use surgical masks are designed for use in procedures that do not require respiratory protection for the wearer from the airborne transmission pathway
• RPE is designed to protect the wearer and prevent the inhalation of contaminated air (eg P2 respirator).

There are many types of RPE across a range of brands, designs and models.

Respiratory Protective Equipment (Respirators)

• Having a respiratory protection program in place for anyone required to wear a N95/P2 respirator that includes selection of a N95/P2 respirator that is appropriate for tasks, correct size and fit testing, and training on the use, storage and maintenance of respirators. More information on respiratory protection programs can be found in the Australian/New Zealand Standard on 'Selection, use and maintenance of respiratory protective equipment' (AS/NZS 1715:2009) and DH Respiratory Protection Program guidelines.

• Providing PPE that is appropriate for the level of risk associated with the task, in accordance with guidance from DH.

• Providing PPE that is appropriate for the level of risk associated with the task and used appropriately, in accordance with guidance from DH, risk assessment and the manufacturer's instructions.
• Regularly communicating with staff about the availability of PPE (eg stock levels).
• Providing adequate breaks where employees can remove their PPE and rehydrate. A donning and doffing station should be set up outside the break area to support correct use of PPE.
• Eliminating specific brands of respiratory protection that cause pressure injuries from the supply chain where practicable.
• Providing information, instruction and training on preventing pressure injuries and other detrimental effects from wearing respiratory protection.
• Ensuring any PPE provided is suitable for the work environment.
• Appropriate waste management systems, including for the safe disposal of contaminated PPE.
• Providing adequate facilities for employees to safely remove and dispose of PPE and contaminated clothing.
• Providing clothing for employees to wear at work, or asking employees to bring a change of clothes, to reduce risk of cross-contamination of clothing during travel and at home and reduce the risk of occupational violence when commuting, and providing appropriate facilities for staff to safely change.
• In high-risk areas, such as COVID wards or emergency departments, where staff are working with confirmed or high risk suspected COVID-19 positive patients, providing laundry services for employees to reduce the need to transport and handle potentially contaminated clothing.

Communications and employee welfare

• Consulting with HSRs and employees to obtain their input to any proposed changes to prevent and manage the risk of exposure to COVID-19.
• Ensuring that employees understand the risk controls in place to prevent and manage the risk of exposure to COVID-19 in their workplace, and have ready access to the COVIDSafe Plan.
• Ensuring that employees know what to do, or who to notify if they feel unsafe or uncomfortable in the workplace.
• Ensuring that employees know what to do, or who to notify if they feel unwell or suspect they have been exposed or infected, including information on furloughing and exclusion from work.
• Communicating any altered expectations and working conditions to patients, clients and visitors to reduce the risk of COVID-19 infection to employees.
• Providing information in a format and languages that employees can readily understand.
• Ensuring employees who are considered to be vulnerable (ie have risk factors for increased severity of illness) in relation to COVID-19 exposure are provided with opportunities to work in lower risk settings where possible and in accordance with DH’s recommendations for vulnerable workers.
• Providing updated information to all employees, including employees on leave, contractors and casual workers.
• Ensuring that employees know how to handle, transport and disinfect potentially contaminated clothing and items used at work (eg shoes, phones, identity badges).
• Providing education on staff risk reduction behaviours when in the community (eg physical distancing, hand hygiene).

Working from locations other than the usual place of work

In some circumstances, employers may require employees or contractors to work from a location other than their usual place of work to reduce the risk of transmission or address changes in service demands relating to COVID-19. This includes working from home, working in a different area, newly established clinics, improvised hospitals, contingency units, changes in home-based care or providing support to other employers.

When making decisions about whether employees should work from a different location, employers must consult with employees and HSRs (if any) and must ensure that so far as reasonably practicable the working environment is safe and without risks to the health of employees. Employers should also:

• Ensure that an adequate induction and context-specific training is provided in the new work environment, including infection prevention training.
• Ensure that support systems are in place for PPE, IT, equipment and personal needs.
• Consider whether an employee is vulnerable (ie have risk factors for increased severity of illness), in relation to contracting COVID-19, or high risk of experiencing associated complications, before deploying them to an area of high exposure risk. Employees should also consult their treating medical practitioner in this instance.
• Consider whether working from a different location will introduce additional risks, such as risks associated with hazardous manual handling or psychological risks associated with isolation.
• Establish communication systems for providing information to employees about working arrangements.
• Ensure that working hours are monitored and flexible, where possible.
• Ensure that accommodation provided for employees is safe, and minimises the risk of cross-infection among staff.
• Ensure that transport arrangements minimise the risk of cross-infection among staff.

Legal duties

Employers have duties under the OHS Act, which include that they must, so far as is reasonably practicable:

• Provide and maintain a working environment that is safe and without risks to the health of employees and independent contractors.
• Provide adequate facilities for the welfare of employees and independent contractors.
• Provide such information, instruction, training or supervision to employees and independent contractors as is necessary to enable those persons to perform their work in a way that is safe and without risks to health.
• Monitor the health of employees of the employer.
• Monitor conditions at any workplace under the employer's management and control.
• Provide information concerning health and safety to employees, including (where appropriate) in languages other than English.
• Ensure that persons other than employees of the employer are not exposed to risks to their health or safety arising from the conduct of the undertaking of the employer. Consult with employees and HSRs (if any), on matters related to health or safety that directly affect, or are likely to directly affect them.

A person with management or control of a workplace must ensure, so far as is reasonably practicable, that the workplace and the means of entering and leaving it are safe and without risks to health.

Employees also have duties under the OHS Act, which includes that they must:

• Take reasonable care for their own health and safety and that of persons who may be affected by the employee's acts or omissions at a workplace.
• Co-operate with their employer with respect to any action taken by the employer to comply with a requirement imposed by or under the OHS Act or OHS Regulations.

The OHS Act gives HSRs a role in raising and resolving any OHS issues with their employer, and powers to take issues further if necessary.