ecp self study guide final mar 29 · pre-module self assessment before we begin the self study...

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, though that only a qualified person can conduct a risk assessment According to

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

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)

Work category

(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

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)

Work category

(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.

ECP Self Study Guide

19

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.

Develop and implement screening

tool/questions (especially for screening of

staff and residents for symptoms of ILI.)

Gloves

Use private rooms, where available, for

isolation of patients with ILI respiratory

infections.

Establish and communicate safe zone

distances (at least 2 meters) between

infected residents and staff.

Surgical Masks

Design and/or arrange workspace so that

patients with influenza cannot access

other parts of the facility

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

Gowns/aprons

If there are no private rooms, design or

arrange workspace so there are barriers /

space between infected and uninfected

residents

Ensure potentially contagious patients

wear a surgical mask (if tolerated)

Eye protection

Design or arrange entrance to facility so

access is limited/restricted unless visitors

Check to see if there are private rooms N95 Respirators


20

Examples of Controls For Long Term Care


Staff have been screened for symptoms

of ILI in a reception area.

Provide handwashing sinks. Supervise and coach in safe work

procedures and use of PPE

Provide liquid soap containers and paper

towels

Develop and implement patient isolation

procedures

Provide alcohol gel in wall mounted in all

areas for residents, visitors, staff

Set up procedures for refilling soap/paper

towels alcohol gel at the hand-washing

facilities/alcohol gel stations

Provide personal alcohol gel containers-

pocket sized for staff.

System in place to monitor that the hand-

washing 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


21

Examples of Controls For Long Term Care


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.


22

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.

Use N95 respirators that are fit tested and do a

fit check before use.

Don and doff PPE in the proper sequence.

Establish a TB skin test program to

document TB exposure status for new

employees and to follow-up suspected

workplace tuberculosis exposures.


23




(Along the Path)

3. At the Worker




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 re-

circulated 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.


24




(Along the Path)

3. At the Worker




respiratory infection.)

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.

Establish and communicate safe zone

distances (at least 2 meters) between

infected patients and staff.

N95 respirators when performing an AGMP

Surgical Masks

Gloves, Gowns/aprons

Design and/or arrange workspace so

that patients with respiratory

infections cannot access other parts

of the facility

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

If there are no private rooms, design

or arrange workspace so there are

barriers / space between infected

and uninfected patients




25




(Along the Path)

3. At the Worker




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.

Provide hand washing sinks. Supervise and coach in safe work


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

Develop and implement patient

isolation procedures

Provide alcohol gel in wall mounted

in all areas for patients, visitors, staff

Set up procedures for refilling

soap/paper towels and alcohol gel at

the hand-washing facilities/alcohol

gel stations

Provide personal alcohol gel

containers-pocket sized for staff.

System in place to monitor that the

hand-washing facilities/alcohol gel

stations are replenished.


26




(Along the Path)

3. At the Worker




Provide ‘no-touch’ garbage disposal

and ensure that pick up schedules

and frequency are adjusted

according to waste disposal needs.

Post information on cough/sneeze

etiquette Follow cough/sneeze etiquette.

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

Report fever and cough symptoms to supervisor

and take sick leave until symptoms have

resolved.

Procedures for reporting suspected or

probable reportable respiratory


27




(Along the Path)

3. At the Worker




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


28

Sample Controls Home and Community Care

Examples of Controls For Home & Community Care


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.

Develop and implement screening

tool/questions (especially for screening of

staff and residents for symptoms of ILI.)

Gloves

Provide personal alcohol gel containers-

pocket sized for staff.

Minimize number of workers exposed to

risk i.e. establish protocols for cluster care

or essential services

Surgical Masks

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

Gowns/aprons



Eye protection


29



Supervise and coach in safe work


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


30



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.


31

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



32

Examples of Controls



33

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.


34

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


35

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


36

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

for

Implementation

Input/Information

Required

Completed

By (date/person)

Statement of

Purpose

Risk Identification &

Assessment

Risk Controls:

Engineering

Risk Controls:

Administrative

Risk Controls:

PPE

Education & Training


37

Step Action Needed

for

Implementation

Input/Information

Required

Completed

By (date/person)

Written Work

Procedures

Hygiene Facilities

Decontamination

Procedures

Health Monitoring

Documentation

Annual Review


38

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.


39

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









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



b) Protecting the health and safety of everyone in the workplace

environment



40

4. Installing a glass barrier at reception is an example of what type of control?

a) Administrative

b) Engineering

c) With the worker


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




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


41


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:


b) A person knowledgeable of the work, the hazards and the means to

control the hazards


Great work! To check your answers, flip to the first page of the Appendix.


42

Appendices


43

Correct Answers to Self Assessment

1. When is an Exposure Control Plan required?

a) Annually









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



b) Protecting the health and safety of everyone in the workplace environment


4. Installing a glass barrier at reception is an example of what type of control?

a) Administrative

b) Engineering

c) With the worker


a) Administrative

b) Engineering

c) With the worker


44

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




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


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:


b) A person knowledgeable of the work, the hazards and the means to control the

hazards



45

Glossary

Airborne Transmission: 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.

Ambulatory Care Settings: 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.

Caregivers: 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.

Case: An individual who is infected with an infectious disease

Cohorting: 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).

Cohort Staffing: 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.


46

Contact: 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).

Contact Precautions: 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.

Client/Patient/Resident: Any person receiving health care within a health care

setting.

Contact Transmission

(Direct And Indirect):

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.

Contamination: The presence of an infectious agent on a body surface, on

clothes, gowns, gloves, bedding, toys, surgical instruments,

dressings or other inanimate objects.

Control: 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.


47

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: 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.

Disease Transmission: 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.

Droplet Nuclei: Particles that are formed by the evaporation of droplets

(see airborne transmission)

Droplet 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).

Exposure: The condition of being subject to an infectious disease by

contact with an infected person or a contaminated

environment.

Fever: An elevation of body temperature above the normal range

(37°C.) A low-grade fever is no higher than 38.3°C.


48

Health Care Facility: A set of physical infrastructure elements supporting the

delivery of health-related services. A health care facility

does not include a patient’s home or physician offices

where health care may be provided.

Health Care Setting: Any location where health care is provided, including

settings where emergency care is provided, hospitals, long-

term care homes, mental health facilities, outpatient clinics,

community health centres and clinics, physician offices,

dental offices, offices of allied health professionals and

home health care.

Health Care Worker

(HCW):

Individual providing or supporting health care services that

will bring them into contact with patients/clients/ residents.

Hospital-Grade

Disinfectant:

A disinfectant that has a drug identification number (DIN)

from Health Canada indicating its approval for use in

Canadian hospitals.

Host In disease transmission host refers to the organism (may be a

human or other animal) in which a parasite (bacteria, virus)

obtains its nutrition and is able to replicate and cause

disease.

Infection: A condition in which the body is invaded by disease-

producing microorganisms that multiply and one or more

organs sustain at least temporary damage. Asymptomatic

or sub clinical infection is an infectious process running a

course similar to that of clinical disease but below the

threshold of clinical symptoms. Symptomatic or clinical

infection is one resulting in clinical signs and symptoms

(disease).

Infectious Disease: A situation in which infection causes signs and symptoms

and is clinically apparent.

Isolation: The physical separation of infected/colonized individuals

from those uninfected for the period of communicability of

a particular disease


49

Patient: An individual who receives care in a hospital or surgical

centre.

Personal Protective

Equipment (PPE):

A variety of barriers used alone or in combination to protect

mucous membranes, skin, and clothing from contact with

infectious agents. PPE includes gloves, masks, respirators,

goggles, face shields, aprons and gowns.

Precautions: Interventions to reduce the risk of transmission of

microorganisms (e.g. patient-to-patient, patient-to-staff,

staff-to-patient, contact with the environment, contact with

contaminated equipment).

Public Health Agency Of

Canada (PHAC):

A national agency focused on efforts to prevent chronic

diseases and injuries and to respond to public health

emergencies and infectious disease outbreaks by working

closely with provinces and territories. Some of the PHAC

activities were originally part of Health Canada and some

publications referred to in this document originated in

Health Canada but are now under the jurisdiction of PHAC.

Resident: An individual who resides in a long-term care facility/or

interim care unit.

Respirator: Personal protective device that fits tightly around the nose

and mouth and reduces the risk of inhaling hazardous

airborne particles and aerosols (including infectious agents).

Reusable Equipment (Non-

Critical):

Patient/resident/client care equipment that can be reused

on another patient/resident/client that either touches only

intact skin, but not mucous membranes or does not directly

touch them. Reprocessing of these items involves cleaning

and/or low level disinfection with facility approved

disinfectant, e.g. commode.


50

Routine Practices: The system of infection prevention and control practices

recommended by the Public Health Agency of Canada to

be used with all clients/patients/residents during all care to

prevent and control transmission of microorganisms in all

health care settings.

Screening: A process to identify clients/patients/residents displaying

symptoms that may be associated with a particular disease,

example: Influenza.

Staff: Anyone conducting activities within a health care setting

that will bring him/her into contact with

clients/patients/residents including

Symptom: Any perceptible, subjective change in the body or its

functions that indicates disease or phases of disease, as

reported by the affected individual. Example: cough, fever


51

Useful Websites Public Health Agency of Canada – Pandemic Plan http://www.phac-aspc.gc.ca/cpip-pclcpi/index-eng.php US Centre for Disease Control www.cdc.gov OHSAH www.ohsah.bc.ca BC Centre for Disease Control www.bccdc.org Provincial Infection Control Network www.picnetbc.ca British Columbia Centres for Disease Control: http://www.bccdc.ca/resourcematerials/newsandalerts/healthalerts/H1N1FluVirusHumanSwineFlu.htm Canadian Centre for Occupational Health and Safety: http://www.ccohs.ca Canadian Standards Association: http://www.csa.ca/Default.asp?language=english National Institute for Occupational Safety and Health: http://www.cdc.gov/niosh NIOSH-Approved Disposable Particulate Respirators (Filtering Facepieces) http://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/default.html

Occupational Health and Safety Agency for Healthcare in BC: http://www.ohsah.bc.ca Provincial Infection Control Network (PICNet): http://picnetbc.ca Public Health Agency of Canada http://www.phac-aspc.gc.ca/alert-alerte/swine_200904-eng.php US Centers for Disease Control and Prevention: http://www.cdc.gov/ - http://www.cdc.gov/h1n1flu World Health Organization: http://www.who.int/csr/disease/swineflu/en/index.html


52

WorkSafeBC Requirements in Relation to an Exposure Control Plan

Education and Training Program to Inform Workers about the Exposure Control Plan (ECP):

Section 6.34(1)(f) of the Regulation requires the employer to inform workers about the

contents of the ECP and to provide them with adequate education and training to work

safely with and in proximity to a biological agent designated as a hazardous substance

in section 5.1.1.

This section applies to any worker (including part-time, full-time, temporary, and casual)

who has or may have occupational exposure. No worker with potential occupational

exposure is exempt from this section. The instruction requirement for lab workers who

handle biohazardous materials is covered under section 30.14 of the Regulation.

Education and training must be provided before a worker begins work with or in

proximity to a biological agent designated as a hazardous substance in section 5.1.1.

Specifically, training needs to be given when a worker is initially assigned to the task and

when changes are made that affect a worker's occupational exposure, such as when a

task is modified or new procedures are being instituted.

Education and training is an element of an ECP, as required by section 5.54(2). To

comply with the requirements of section 5.54(3) of the Regulation, the employer must

review the ECP at least annually and update it as necessary. Consequently, the

employer may need to provide refresher training annually or whenever the ECP is

updated.

Education and training material must be appropriate to the educational level, literacy,

and language of workers. The content will generally include discussion and explanation

of the following items:


53

Applicable sections of the Regulation - applicable sections include section 3.19(1);

sections 5.2, 5.54, and 5.55; sections 6.33 to 6.41; sections 8.2 and 8.3; sections 12.157 and

12.158; Part 30

Applicable sections of the Workers Compensation Act - including section 173 on incidents that must be investigated Definition of a biological agent designated as a hazardous substance in section 5.1.1

1. Occupational exposure

• How it occurs, such as modes of transmission. How to identify tasks

and other activities, such as routine and emergency spills, that

may involve worker exposure to a biological agent designated as

a hazardous substance in section 5.1.1

• Effects of exposure

• What to do in the event of exposure, such as emergency

procedures to be followed, and post-exposure treatment

4. Use and limitations of control measures to prevent or minimize exposure

• Engineering controls

• Work practice, or administrative, controls

• Personal protective equipment (PPE). This element should address

selection, care, use, storage, limitations, maintenance, inspection,

decontamination, and availability of PPE

5. Employers ECP and where to access it

6. Required labels and identification for a biological agent designated as a

hazardous substance in section 5.1.1

When necessary, information on the vaccines required under section 6.40 of the Regulation The training session should also include the opportunity for an interactive question and

answer period.


54

The person providing the education and training must have knowledge about a

biological agent designated as a hazardous substance in section 5.1.1, particularly in the

context of workplace exposure and control. Trainers may be medical or non-medical

professionals. Medical professionals could include infection control practitioners,

registered nurses, and physicians. Non-medical professionals could include occupational

hygienists or other individuals with specialized training in the area of biological agents

designated as a hazardous substance in section 5.1.1. In some workplaces, such as

medical and dental offices, the employer, who is often a physician, may do the training,

provided he or she is familiar with exposure control measures.

To evaluate compliance with this section, it needs to be verified that education and

training was provided before a worker was placed in a position where occupational

exposure may occur. A WorkSafeBC prevention officer should, by observation and

interviews, determine if workers work safely with and in proximity to a biological agent

designated as a hazardous substance in section 5.1.1. Informed workers can be

identified by their ability to answer the following questions:

1. Do you work with biological agents designated as a hazardous substance? If so,

what are they?

2. What precautions are required for preventing exposure?

3. What do you do in case of an emergency?

4. Where would you go for further information?

Record keeping requirements (details for two on your list, not meant to replace your list.)


55

Records of Training

Should Include:

• Date(s) of training

• Content or a summary of the training sessions

• Type of education and training (for example classroom, video, interactive, or

on-the-job)

• Names and qualifications of those conducting the training -Names, job titles,

and work locations (departments) of workers attending the sessions

• Education and training records should be kept for at least 3 years after the

training session.

Records of Exposure

Under section 6.34(1)(h), employers must keep a record of all workers who have been

exposed to a biological agent designated as a hazardous substance under section

5.1.1. Incidents of occupational exposure may be documented in the following ways:

Incidents of occupational exposure may be documented in the following ways:

• Accident/incident reports (such as an incident report regarding a needle

stick injury)

• First aid treatment records - see section 3.19 of the Regulation

• Medical records (including documentation of post-exposure medical

evaluation, treatment, and counseling, as well as records of hepatitis B and

other vaccinations)

• Inspection reports of documented exposures

• Claim forms

• Worker complaints

• Results of the risk assessment performed in compliance with section 6.35

• Records required as part of the exposure control plan, as per section 6.34,

regarding risk identification, assessment, and control

• (Worker medical records are to be kept confidential and not disclosed or

reported without the worker's written consent to any person within or outside

the workplace except as required by law.)


56

Excerpts from the WorkSafeBC Regulations

5.54 Exposure control plan

(1) An exposure control plan must be implemented when

(a) Exposure monitoring under section 5.53(3) indicates that a worker is or may be

exposed to an air contaminant in excess of 50% of its exposure limit,

(b) Measurement is not possible at 50% of the applicable exposure limit, or

(c) Otherwise required by this Regulation.

(2) The exposure control plan must incorporate the following elements:

(a) A statement of purpose and responsibilities;

(b) Risk identification, assessment and control;

(c) Education and training;

(d) Written work procedures, when required;

(e) Hygiene facilities and decontamination procedures, when required;

(f) Health monitoring, when required;

(g) Documentation, when required.

(3) The plan must be reviewed at least annually and updated as necessary by the

employer, in consultation with the joint committee or the worker health and safety

representative, as applicable.


57

6.34 Exposure control plan

(1) If a worker has or may have occupational exposure, the employer must develop and

implement an exposure control plan, based on the precautionary principle, that meets

the requirements of section 5.54 and that includes the following:

(a) a risk assessment conducted by a qualified person to determine if there is a

potential for occupational exposure by any route of transmission;

(b) a list of all work activities for which there is a potential for occupational

exposure;

(c) engineering controls and administrative controls to eliminate or minimize the

potential for occupational exposure;

(d) standard or routine infection control precautions and transmission-based

precautions for all work activities that have been identified as having a

potential for occupational exposure, including (i) housekeeping practices designed to keep the workplace clean and free

from spills, splashes or other accidental contamination,

(ii) work procedures to ensure that contaminated laundry is isolated, bagged

and handled as little as possible, and

(iii) work procedures to ensure that laboratory or other samples containing a

biological agent designated as a hazardous substance in section 5.1.1

are handled in accordance with the Laboratory Biosafety Manual issued

by the World Health Organization, as amended from time to time, and

the Laboratory Biosafety Guidelines issued by Health Canada, as

amended from time to time;

(e) a description of personal protective equipment designed to eliminate or

minimize occupational exposure;

(f) a program to inform workers about the contents of the exposure control plan

and to provide them with adequate education, training and supervision to

work safely with, and in proximity to, a biological agent designated as a

hazardous substance in section 5.1.1;

(g) a record of all training and education provided to workers in the program

described in paragraph (f);


58

(h) a record of all workers who have been exposed, while performing work

activities, to a biological agent designated as a hazardous substance in

section 5.1.1.

[Enacted by B.C. Reg. 319/2007, effective February 1, 2008.]

ecp self study guide final mar 29 · pre-module self assessment before we begin the self study...

Documents