To manage the risk of COVID-19 in the healthcare workplace,
we need to look at how the infection spreads and how to reduce exposure.
We know that COVID-19 is mostly spread by droplets and aerosols,
which are breathed, coughed, or sneezed out and can directly enter another person’s ‘mucous membranes’,
such as the eyes, nose or mouth, allowing it to enter the body.
This is known as direct spread, and it’s most likely to happen when people are close together.
It can also spread indirectly when infected droplets find their way onto surfaces
– for example, if an infected person blows their nose, then touches something such as a door handle –
someone else could become infected it they touch it, then touch their eyes, nose or mouth.
The chances of spreading COVID-19 increases if people are closer to each other,
and if they spend more time with an infected person and their environment.
To reduce the risk of spreading COVID-19, we need to apply a set of control measures.
These are known as the hierarchy of controls.
Elimination, substitution, engineering controls, administrative controls and PPE.
This is an important framework for all of us as employers, managers and staff to use together
when assessing and managing risks associated with any hazard in the workplace.
The controls in the hierarchy should be considered in this order,
as they have more effect on reducing the risk from the hazard.
The most effective controls involve getting rid of, or ‘eliminating’ the hazard where possible.
It is extremely important that staff are vaccinated,
but we must also continue to take further preventative actions to eliminate or reduce the risk of exposure.
We can use video or phone calls for meetings with patients or colleagues instead of meeting face-to-face.
We can use COVID testing and symptom screening to identify patients and staff who are infected with the virus.
Then, depending on what the result of the test is,
we can segregate patients according to whether they currently have the infection or not.
It’s really important that the rules for taking COVID tests and acting on the results
are followed to prevent infection being spread in the healthcare setting.
Where possible based on local clinical judgment
we can temporarily postpone treatment of a patient until they are no longer infectious
so that others are not unnecessarily exposed to the virus.
Substitution means switching a process or practice so that you can try to avoid a hazard,
such as cycling to work, instead of car sharing with a colleague you don’t live with
Engineering controls work by removing or containing the hazard.
We can make changes to the care environment to reduce the spread of COVID.
An important example is increasing airflow in areas where patients with COVID are – such as:
- increasing the turnover of air delivered by the ventilation system
- or opening doors and windows to increase air circulation
Another example is using barriers or screens to prevent spread between people who are close to each other.
Administrative controls involve changing the way people work.
The virus is most likely to spread when people are close to each other,
so changing the way that staff work together can help to avoid extended periods of close contact.
For example: - Don't mix at the central station or in offices
- Provide areas where socially distanced breaks can be taken
- or hold remote meetings and access data digitally
However, when delivering care, it is not always possible to keep 2m apart – in which case, PPE is required.
PPE is the last level of control in the hierarchy.
When care involves close contact with a patient who has COVID,
PPE provides an additional barrier for example by protecting the eyes, nose and mouth.
For PPE to be effective, we must wear it correctly,
for example mask, eye and face protection must be fitted properly over the eyes, nose or mouth.
We must also avoid spreading infection to others.
You can easily spread bacteria and viruses on your gloves,
so it’s important to take them off after each task and to clean your hands.
Although PPE can be uncomfortable,
you need to ensure that you are wearing it properly, that you get rid of it safely,
and you must always wash your hands after doing so.
Even if you have had COVID or have been vaccinated, you are not 100% protected against getting it again,
and you could still spread the virus to others,
so it’s still important to wear the correct PPE and follow the other control measures.
Encourage patients to wear a face covering or face mask, if they are able to do so,
as this will help reduce spread to other patients and staff.
By working together to apply the hierarchy of controls and follow policies and procedures,
we can make the care and work environment safer,
and reduce the risk of COVID infection for patients and those caring for them.
Every action counts:
By following these control measures at all times,
we will help to reduce the spread of COVID,
helping to keep our patients and colleagues safe.