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Workplace health and safety

Clocktower.

The University of Otago is in the process of finalising detailed plans that will provide specific information for staff in various areas of the University, should a pandemic situation occur. This information will be provided as available.

The following general information based on the Ministry of Health guidance documents is provided as a summary and reference point for staff.

Assessing and Managing Workplace Risks

Adapted from Ministry of Health 2006 Guidance for Infection Prevention and Control during an Influenza Pandemic: section 4

Assessing and managing workplace risks

Some sectors of the workforce are likely to be at higher risk than others for getting influenza during a pandemic due to particular activities that are part of their jobs. Information on masks and other protection measures in this section is provided as general guidance, but ultimately the employer needs to make a risk management decision based on the nature of the work undertaken.

As with all hazards, employers should apply a hierarchy of workplace controls according to the risk of harm occurring.

It is particularly important during an influenza pandemic that sick people do not go to work and do stay at home, because their going to work could easily spread pandemic influenza to others. If people become ill at work, they should go home immediately because the onset of influenza symptoms may be rapid and acute. They should also be advised to call Healthline 0800 611 116 or their primary provider for information about their ongoing needs and care.

The Health and Safety in Employment Act 1992 requires that employers take all practicable steps to mitigate risk and protect staff at all times from workplace hazards. Because pandemic influenza could be acquired in the workplace, it is classified as a hazard (see Appendix B). Workplaces need to develop organisational policies and procedures regarding actions during an influenza pandemic before a pandemic, so workers are aware of what to do. Such policies can include details about sending ill people home and enabling staff to work in more isolated settings such as from home.

Personal protective equipment is only one method from a whole range of preventative measures against pandemic influenza. Other workplace controls include:

  • Training of workers in matters such as the basic principles for prevention, likely symptoms of pandemic influenza, modes of transmission, the use and limitations of the various methods to prevent exposure, vaccinations, and health surveillance procedures
  • Plans for changing work practices, such as remote working where possible, or delaying non-essential work procedures until the pandemic is over
  • Engineering controls, such as the installation of perspex isolation screens and portable high-efficiency particulate air filtration units to improve air circulation
  • Cleaning of common working surfaces (eg, keyboards)

When the type of PPE to be used is being considered, the question is sometimes raised about what sort of mask to use: a surgical mask, or an N95 (P2) particulate respirator mask. There is no simple answer to that question. Each of these masks potentially affords the wearer a different (ascending) level of protection.  In terms of the Health and Safety in Employment Act 1992, the employer must assess the level of protection afforded relative to the risk to the worker, and provide appropriate PPE. The recommendations set out in the latter part of this guideline should be considered in that light.

In particular, employers should ensure their staff and other people in the workplace are trained in, and follow, the basic principles for preventing influenza (ie, hand hygiene, cough and sneeze etiquette, social distance and adequate ventilation), and the prevention and control measures in section 3.

Wearing full PPE is not recommended in all situations; nor is it recommended all the time during an influenza pandemic. Personal protective equipment is cumbersome and can be uncomfortable to wear for prolonged periods. Therefore, different levels of PPE are recommended for different workplace situations. For situations where the risk of transmission is high, a higher level of protection is recommended; for situations where the risk of transmission is lower, a lower, more appropriate level of protection is recommended.

Whatever the level of PPE to be used, workers and other workplace participants need to ensure:

  • The protection afforded is commensurate with the level of workplace risk
  • Education and training is provided to ensure the equipment is used and disposed of correctly, so the equipment’s effectiveness is maintained and the PPE is prevented from becoming a means of transmission

Facilities should follow their usual waste disposal policies in ensuring PPE is disposed of correctly. Masks must be disposed of as soon as they become moist or after any cough or sneeze into them. After discarding a used mask, wash and dry hands thoroughly.

Most workplaces

For many workplace situations, most people will be able to keep at least 1 metre away from other people during an influenza pandemic. In addition, all workers must follow the basic principles in section 2 (ie, hand hygiene, cough and sneeze etiquette, social distance and adequate ventilation) and be aware of their workplace's organisational policies about an influenza pandemic.

The Ministry of Health recommends that when possible during an influenza pandemic, workers are encouraged to work from home and to replace personal contact with increased use of computers and telephones. When this is not possible, it is strongly suggested protective barriers are used (eg, clear plastic shields that allow vision and communication).

In the event of an influenza pandemic, many workplaces will not be operating to full capacity. However, some people’s work situation means they may be put at risk by having to be in close contact with people infected or potentially infected with the influenza virus (eg, telephone service providers, electricity supply workers, health care providers, and other service and essential industry workers).

If the basic principles (section 2) are followed and workers use protective barriers or maintain a distance of at least 1 metre from other people, the risk of transmission of pandemic influenza will be minimised. There may be certain situations where the use of distancing or protective barriers is impossible to implement and, in these situations, a mask can be worn when contact with people likely to be infected with pandemic influenza is anticipated. If it is anticipated that masks may have to be used, it is essential that the employer provides training and education in fitting, wearing, removal and disposal. Without such training there is a real risk of the masks themselves becoming a means of virus transmission.

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Hygiene facilities at the University of Otago

Hand sanitisers are available at various locations around campus.

Hand washing facilities are equipped with sinks and two methods of drying your hands.

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Flu vaccine programme

The annual flu vaccination is available to all staff free of charge.

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Health Sciences, health care workers, and clinical risks

Source: Ministry of Health 2006 Guidance for Infection Prevention and Control during an Influenza Pandemic: Section 6

Introduction

The information contained in this section is based on the Ministry of Health guidance information. The information is of most use to staff and students who are working in health care facilities, and for those areas where care may be provided during a pandemic, such as the Halls of Residence. This information is a general guide only and specific information will be provided by the Pandemic Planning Group once the plans are finalised. Please note that for any staff or students working in the district health boards, the Pandemic Planning Group is working towards a signed Memorandum of Understanding for the provision of workplace hazard management processes and personal protective equipment in the event of a pandemic, including infection control training. This information will be posted on the web page when available.

Specific Guidelines and Recommendations

During an influenza pandemic, a range of people who do not have influenza will continue to seek medical care. It is important that health care workers and first responders follow the basic principles in section 2 (i.e., hand hygiene, cough and sneeze etiquette, social distance and adequate ventilation) as well as their usual work practices.

When PPE is to be worn or used, education and training of workers should always have been carried out first, and is the responsibility of employers.

In addition to the specifics listed below, all workers should continue to use or wear the routinely used or worn PPE in their workplace, follow standard precautions, and use standard safety equipment.

Table 1 (see Appendix A) summarises the following information.

Lower/medium risk

Lower/medium risk workers are health care workers and first responders who may have contact with patients with influenza or surfaces that patients with influenza have been in contact with, but who can maintain at least a one-metre distance from a patient (eg, porters, orderlies, dieticians, ward clerks, receptionists, community pharmacists, cleaners, housekeeping staff, police in non-rescue situations and prison staff undertaking general duties).

These workers should follow the basic principles outlined in section 2 (ie, hand hygiene, cough and sneeze etiquette, social distance and adequate ventilation) to minimise the likelihood of their acquiring pandemic influenza. Depending on the risk of exposure, employers should consider implementing additional protection or control measures.

Medium risk

Medium risk workers are health care workers and first responders who can keep at least 1 metre from people with pandemic influenza but, due to the nature of their work, may encounter particular situations where it is difficult to predict whether they can maintain at least 1 metre from people with pandemic influenza. In these situations, they should wear surgical masks and gloves (acknowledging that wearing gloves does not preclude hand hygiene) if direct physical contact is anticipated.

These workers should also follow the basic principles outlined in section 2 (ie, hand hygiene, cough and sneeze etiquette, social distance when possible, and adequate ventilation).

Medium/higher risk

Medium/higher risk workers are health care workers and first responders who have a likelihood of potential contact with some respiratory secretions while working within 1 metre of people who have pandemic influenza (eg, paramedics, primary health care physicians, nurses and others who provide in-room patient care, and emergency department staff).

These health care workers and first responders should, after receiving education and training, wear medium-level PPE (eg, surgical masks, gloves and a gown or apron) as well as following the appropriate basic principles outlined in section 2 (ie, hand hygiene, cough and sneeze etiquette, social distance and adequate ventilation).

Higher risk

Higher risk workers are health care workers and first responders who have a high likelihood of direct contact with respiratory secretions, particularly via aerosols, while needing to perform procedures1 on people with pandemic influenza within 1 metre of those people for significant periods.

These workers include first responders needing to resuscitate people, intensive care unit staff, recovery room staff, physiotherapists providing breathing treatments, and first responders with patients producing large amounts of respiratory secretions.

For these higher risk workers, it is recommended high level PPE is worn. This involves wearing disposable particulate respirator masks, eye protection, gloves, a gown or apron as well as adhering to the appropriate basic principles outlined in section 2 (ie, hand hygiene, cough and sneeze etiquette, social distance and adequate ventilation).

1. Aerosol-generating procedures include invasive procedures such as suctioning, intubation, extubation, tracheostomy care, bronchoscopy, collecting nasopharngeal swabs or aspirates, and nebulising patients.

Appendix A: Personal Protection Measures

Table 1: Personal protection measures for workers who need to be in the workplace due to the nature of their role and associated risk level

   

Hand hygiene

Social distance

Cough and sneeze etiquette Adequate ventilation Masks2 Gloves Gown or apron Eye protection

Lower/ medium

People who can maintain more than 1 metre contact distance from people with potential influenza or can implement protective barriers (eg, receptionists, telephone triage personnel, pharmacy staff, orderlies, cleaners, and dieticians).

               
Medium People who, due to the nature of their job, may be unable to maintain more than 1 metre contact distance from people with potential influenza (eg, police, prison staff, ambulance staff and health care workers).         Surgical If direct contact likely    
Medium / Higher People who, due to the nature of their job, cannot maintain at least 1 metre contact distance from people with potential influenza (eg, primary care personnel, emergency department staff).         Surgical      
Higher People who, due to the nature of their job, cannot maintain at least 1 metre contact distance from people with potential influenza AND have a high likelihood of potential contact with aerosolised respiratory secretions from invasive procedures – ventilation, sectioning etc (eg, ICU staff, recovery room staff, people providing hands-on hospital care to people in droplet isolation).         N95/P2      

Note: Basic principles: Hand hygiene, social distancing, safe cough/sneeze etiquette, and good ventilation constitute the basic principles for the prevention of influenza spread. The additional measures (ie, the wearing of masks, gloves, gowns/aprons, and eye protection) should be subject to prudent workplace hazard or risk assessment. Masks: A range of masks are available to provide respiratory protection to workers in medium- to high-risk situations. These vary in the degree of protection offered, but essentially there are two options:

  • surgical masks, designed primarily to contain droplet spread from the wearer, but offering a degree of protection from external infection
  • P2 or N95 particulate masks, which provide a higher degree of filtration of respiratory protection, when appropriately worn and handled.

The appropriate level of protection should be chosen for the degree of risk of infection remaining after all other control measures have been taken. In laboratory conditions, the relative effectiveness of these different measures is easily measured. However, in actual workplace settings, this is harder to measure, because of all the various factors that come into play, such as the degree of exposure to infection, how well the mask fits, hand contact with the mask and the wearer’s face and so on. These factors can greatly limit the effectiveness of even face masks that would otherwise offer a high degree of protection.

2. Information provided on the choice of masks and other protection measures is for guidance to assist employers and staff in specific workplace practices, based on current advice from CDC and WHO. Final decisions with regard to individual workplace risk rests with the employer. This document will be updated to reflect further technical information as it becomes available.

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Working at District Health Boards

Infection control: