Guidelines for preparations in the workplace for COVID-19 prevention
Awebinar was recently organized by the Sri Lanka Medical Association (SLMA) for members of the Ceylon Chamber of Commerce and the National Chamber of Commerce of Sri Lanka aimed at helping workplaces ( offices) and factories understand the need to have precautions in place when work resumes.
The panelists were Dr. Ananda Wijewickrama, President, Ceylon College of Physicians; Prof. Saroj Jayasinghe, Professor of Medicine, Faculty of Medicine, University of Colombo; Prof. Manuj Weerasingha, Prof of Community Medicine, Faculty of Medicine, University of Colombo; Dr. L.T. Gamlath, Deputy Director General, Environment and Occupational Health and Food Safety Unit, Ministry of Health, Nutrition and indigenous Medicine; Dr. N. Shirani Chandrasiri, President, Sri Lanka College of Microbiologists, Dr. Padma Gunaratne, President- Elect SLMA and Prof. Lal Chandrasena, Health Sector Advisor of the National Chamber of Commerce. The moderator was Pro f. Indika Karunathilaka, President, SLMA.
Asked whether there were any antiviral drugs effective against COVID- 19 infection, the response was that ‘not at the moment’ but many drugs are being tested. The Ministry of Health (MOH) has issued detailed guidelines for patient management in Sri Lanka.
It was stated that the main COVID-19 test is real-time PCR test done one week after the exposure to detect the presence of viral RNA. Antibody tests are not useful for diagnosis of the disease. There is no place for screening of all workers with RT- PCR tests. Even if a PCR test becomes negative, it should be repeated if there is a high degree of suspicion of possible infection. There is no guarantee that a person tested negative will not catch the COVID- 19 infection in future.
Living with COVID-19
Asked whether people have to live with COVID 19, the answer was that the disease is highly infectious and at present no vaccination is available against the infection in the foreseeable future. As such, adherence to laid down measures of avoiding exposure to the infection for at least another 1 -2 years is essential for prevention.
On whether there is a community spread of the disease in Sri Lanka, it was stated that the epidemic is still confined to clusters and there is no evidence of community spread up to now. Tests are carried out among the high-risk community that include the associates of COVID patients and the rate of positivity is much lower even among them, when compared to other countries. However, as the country returns to ‘normal’, there is a potential risk of transmission of infection, unless prevention practices are strictly adhered to. Leaving room for errors would lead to development of new clusters and stoppage of work at the company, it was noted.
Asked whether a resurgence of the epidemic is possible and if so, when, the reply was that “yes, it’s possible, especially within vulnerable populations such as crowded confined spaces. There can be a surge of cases due to the spread from current clusters around mid-May”.
On measures to prevent a resurgence, it was stated that there is a four-pronged, highly coordinated mechanism that needs to be implemented at national level; institutional measures; law- enforcement - prevent overcrowding, spitting in places; and at an individual level.
The national level measures to control the epidemic are daily monitoring; risk assessment based on real time data; surveillance; policy on gradual reopening based on risk assessment and economic impact; low risk – high impact industryeg. farming, fishing; high risk – high impact industry e. g. highly populated industrial factories, hospitality; low risk - low impact industry-where work from home is possible; and high risk – low impact industry e.g. schools, universities.
The institutional measures needed are: Management should identify a team/ unit for the risk assessment and to develop, implement and monitor an institutional COVID plan.
The team should develop a plan based on guidelines issued by the Ministry of Health
They should conduct awareness programmes using videos, posters and preparedness drills for workers on hygienic practices in relation to COVID prevention.
The company should screen workers at the entrance for temperature and use a questionnaire to reveal exposure and symptoms of the COVID infection.
Measures should be taken to reduce overcrowding and movement between different sections, dining areas, exit and entry.
Management should plan for maximum efficiency using minimum number of workers.
Facilities for hand washing/sanitization at entrance, work areas, dining areas and washrooms should be made available.
There should be a mechanism for waste disposal.
All surfaces that are frequently touched should be cleaned with disinfectants with 70 per cent alcohol. Ensure adequate ventilation keeping doors and windows opened as much as possible.
Workers should avoid sharing instruments and equipment.
In case a worker develops suspicious symptoms of COVID, there should be a mechanism to isolate the patient ensuring confidentiality and to get medical advice avoiding stigmatization.
The company should follow the guidelines prepared by the Ministry of Health for workers with risk exposure following a risk assessment.
Use of ACs
On using ACs in a factory/office setting, the response was that there is a higher risk of transmission if the air is recycled in a closed compartment. If ventilation is with fresh air coming in, the risk is minimum. The number of people in an A/C room at a given time should be a minimum and use of standard precautions should be encouraged. It is advisable to have good natural ventilation at workplaces.
On the use of decontamination chambers to prevent the spread of COVID 19, it was stated that there is a minimum concentration and a contact time for any disinfectant ( alcohol, ozone, TCA) to be effective. These requirements are not met in decontamination chambers.
Concentration of certain disinfectants such as ozone that is needed to kill viruses is harmful for humans. All disinfectant chemicals have their own harmful effects. It may either cause asthma or other respiratory symptoms or dermatological symptoms such as allergies. Ozone may cause chest pain, vomiting and abdominal pain. Therefore, decontamination chambers are not recommended. It was stated that the WHO does not recommend the use of decontamination chambers.
Spraying disinfectants on vehicles There is no scientific basis for spraying disinfectants on all types of vehicles. There are guidelines developed by the Ministry of Health for decontamination of vehicles that have been used to transport COVID patients. Frequent cleaning using disinfectants with 70 per cent alcohol on surface areas of vehicles frequently touched eg; handrails, doorknobs etc. is recommended.
Stigma associated with COVID 19
The stigma will discourage patients to reveal the truth particularly with regard to important points in the history, leading to delayed diagnosis. Therefore, there shouldn’t be stigmatization. The employer could display a simple message such as “COVID is a preventable disease” and promote the employees to follow the measures of prevention and to inform the management, in case they develop symptoms. The media should take all measures to maintain confidentiality of patients and to avoid the stigma associated with the disease at present.
Personal protective equipment (PPE)
Surgical masks or simple 3 layer cloth masks are adequate for day-to-day use. The surgical mask gives better protection than the cloth mask. The mask should adequately cover the nose, mouth and chin. After wearing the mask, touching the face and adjusting the mask frequently should be avoided. The cloth mask could be washed with soap and water. N95 masks are recommended for aerosol-generating procedures. Gloves could be worn in environments where there are many customers to deal with.
Individual level measures at the workplace:
Maintain one meter distance from each other. Wash/sanitize hands regularly. Disinfectant the contaminated surfaces.
Properly wear masks.
If you have fever, sore throat, dry cough/suspicion of contact, inform the office and get immediate medical advice.
On the question of what needs to be done if a worker develops symptoms of fever or respiratory tract infection, the response was that all workers should be made aware of possible symptoms of the illness. The management should encourage workers to remain at home if they develop symptoms of fever or respiratory tract illness. If symptoms develop at the workplace, they should isolate the patient immediately and request medical help.
Using public transport safely
It is useful to carry a pocket, alcohol-based hand rub and to disinfect the hands before getting in and as soon as getting out of the public transport. It is necessary to adhere to the guidelines issued by the government for seating. Before commencing and after completing the journey, the vehicle needs to be disinfected.
Precautions to be taken after returning home from work
Children should not be cuddled soon after returning home. If using a disposable mask, dispose it properly. There should be a dedicated place to keep the belongings. The number of items that you will bring home must be minimised. After returning home, have a proper body wash straightaway in the washroom. Worn clothes should be washed thoroughly with soap and water, dried and ironed before reuse. If clothes are left for washing later, they should be kept in a sealed bag. Car keys and mobile phones should be disinfected using a sanitizer with 70 per cent alcohol prior to keeping them on the dedicated place.