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Pandemic preparation:

When should you do more than wash your hands and cover your sneeze

In June of this year, the World Health Organization (WHO) raised the pandemic threat level to Phase 6 in response to the global spread of the H1N1 “swine flu” virus. Level 6 indicates there is increased and sustained transmission with community level outbreaks in at least one other country in a second WHO region. This is the highest possible WHO phase and indicates that a global pandemic is under way. But what does that really mean?
From the onset of the H1N1 virus outbreak in Mexico, there has been a lot of confusion about what the levels mean. In no small part, this has been due to discrepancies and other significant shortcomings on the part of the primary institutions responsible for communicating pandemic information to the public. In each successive pandemic level, the main recommendations from the CDC remain to wash your hands and cover your mouth when you sneeze. Being at the highest pandemic alert phase, it seems that we would have more guidance and better information, and companies would be better prepared to respond to the pandemic.
Despite numerous publications and guidelines from governments and specialists describing action that organizations should take to plan for a pandemic, many businesses are still not prepared. (W. De Bruin Global Public Health 1(2) 2006). In a paper published in Qualitative Health Research by Rochelle Watkins in July 2008, it was noted there was a perception by business managers and executives that there was nothing that they could do to avoid the consequences of a pandemic, so as a result, many companies are still unprepared to respond. The study also found that business executives did not understand how transmission occurs or what could be done to reduce the consequences of transmission. Before you throw your hands in the air, consider this. Mexico lost $55 million per day between April 24 and May 2 from the H1N1 virus and the World Bank forecasts that a pandemic will lower the world GDP by 4.8 percent.
What is your company’s risk exposure?
Most employees in the oil and petroleum industries would likely be classified at Lower Exposure Risk for pandemic influenza. This pertains to employees who are not required to have frequent contact with the general public, and basic hygiene practices and social distancing can help protect employees at work. (See the sidebar for the general hygiene and social distancing practices recommended for all workplaces.) Also try the following:
Communicate to employees what options may be available to them for working from home.
Communicate the office leave policies, policies for getting paid, transportation issues, and day care concerns.
Make sure your employees know where supplies for hand hygiene are located.
Monitor public health communications about pandemic flu recommendations and ensure that your employees have access to that information.
Work with your employees to designate a person(s), website, bulletin board or other means of communicating important pandemic flu information. Assign roles and responsibilities for planning and response well in advance of a pandemic.
Taking it to the next step
Employees whose responsibilities require them to come in contact with the public on a regular basis are at moderate risk from a pandemic. To protect these employees, policies and procedures that address controls should be put in place for various risk categories. Pandemic planning guidelines that specify various engineering and administrative controls as well as work practices and personal protective equipment are available from a number of sources, including the Occupational Safety and Health Administration. If you already have a pandemic plan for your company, does your plan address the following questions?
How will workers be expected to get to work?
What types of shift and schedule changes may be made? How will employees be informed of the current company status?
What are the key company operations and who will be expected to perform them in a pandemic situation?
Are computer systems up to maintaining the excessive loads that might be expected in a pandemic?
If business is down, how will the company make payroll?
What types of ventilation or filtration systems may be available in the factory or plant?
Will the company provide the means to disinfect or clean sensitive areas?
Will the company provide personal protective equipment (PPE) to employees expected to work together in close quarters? Is there a policy to screen workers as they come to work and send them home if they appear sick, so they won’t infect other employees?
Have allowances been made, and planned for, for parents that may need to stay home with sick children, or children just sent home from school?
How will company leaders communicate with employees during a pandemic?
Communications planning
Communications planning is one of the most important aspects of good pandemic planning. At the beginning of the article, I described how much of the information being made available about the current pandemic isn’t very helpful. More than one reputable source should be used to evaluate conditions and make decisions about the best options for the individual company and the sources of information should be identified prior to the event. Sources of information may include the WHO, CDC, Health and Human Services, state agencies, local board of health departments, universities, NIOSH, labour organizations, and professional organizations such as the American Industrial Hygiene Association. No one agency has all the answers, and they often contradict one another, so a level head is needed to make decisions based on the best information.
Infectious agents change over time. The exposure route, exposure pathway, virulence, infectious dose, lethality, treatment, communicability, incubation, and susceptible host change for each agent. So the methods to control and plan are different for each scenario. And often, this detailed information is not available until months after the outbreak is over.
Take home message
Pandemics often come as waves. It is very reasonable to assume that the H1N1 pandemic will return this fall, and possibly be more widespread. The point for businesses is that with thoughtful planning or a pandemic plan in place, the impacts on their businesses and employees can be minimized.

About the author: Thomas Fuller, ScD, CIH, MSPH, MBA, is the Environmental Health Sciences Program Director for Illinois State University.

For more information on industrial hygiene and to access a list of industrial hygiene consultants who specialize in health and safety issues, visit the American Industrial Hygiene Association Web site at www.aiha.org.

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:
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 six 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 email, phones and text messages to communicate with each other. When meetings are necessary, avoid close contact by keeping a separation of at least six 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 that 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.