>> Today on behalf of the National
Institute for Occupational Safety
and Health, again, I'm Dr. Casey Chosewood.
It's my pleasure to have each of you, and
I would like again to thank all of you
for joining us for this installment
of our ongoing webinar series.
This one is dedicated, obviously,
to safeguarding workers
and improving their overall health and wellbeing
as we take important steps to reopen America,
return to the workplace as safely as
possible with total worker health strategies.
I'm joined today by two other speakers who
are really national experts in this topic,
having both long careers dedicated
to occupational safety and health,
but more recently becoming some of the nation's
top public health scientists who are developing
and translating the latest research into
return-to-work guidance in the COVID-19 crisis.
So please join me in welcoming Dr.
Kevin H. Dunn, Mechanical Engineer
and R. Todd Neimeier, a Lead
Industrial Hygienist.
Both are part of the National Institute
for Occupational Safety and Health here
at the Centers for Disease
Control and Prevention.
Here's a quick view of what
we will be covering today.
We will leave some time for your questions,
so please enter questions you have
in the Q&A box just to the right of the slides.
We will answer obviously as many
of these questions as we can.
For those questions that we do not have time to
get to, please know that we will review them,
and we will use them to help inform future
content which is now in development.
Please know that the information covered
in today's webinar is not exhaustive.
There's no one set of guidance that can
guarantee full safety or give you all
of the information you need, but this
is important information that's meant
to convey the critical information that your
business should use when developing plans
for continuing operations
in the setting for COVID-19.
It is applicable to businesses of all
sizes, but we've especially taken steps
to make it applicable to small businesses
who may not have the resources
of larger organizations.
For full guidance and information, please
consult the link that you have here,
and know that you may download these
slides with their embedded links
at any time during the presentation.
The download box is just below the
Q&A box to the right of your screen.
The information that we will be sharing
today is current as of June 17, 2020.
We invite you to check back often for
updates as the information is evolving,
as it does in the midst of any emergency.
For those of you who are not familiar
with the concept of total worker health,
please know that keeping workers safe is the
foundational cornerstone of total worker health,
and indeed, it's mandated by law, but
the best organizations don't stop there.
To a safe workplace, they
add in programs, policies,
and practices that actually grow the health of
their workforce, and increase the opportunities
for healthier, more fulfilling
lives for their workers.
We believe this leads to an increase
in worker wellbeing, but individually
and collectively for the organization.
Ideally, total worker health employers
send workers home each day healthier
than when they arrived.
Total worker health is especially
vital during difficult times.
Total worker health can build in
organizational resilience that's really vital
in situations like the one we're in right now.
So what do workers need most during pandemics,
and how can total worker health approaches
and the framework help organizations to navigate
critical challenges during and after a disaster?
Answering this question is vital.
Why? Because we believe that
COVID-19 has the potential to lead
to other dangerous public
health and societal impacts.
The number of Americans, for instance, suffering
from mental health disorders like anxiety
and depression has almost tripled
between April 2018 and April 2020,
just a few months into the pandemic.
Social isolation, fear of disease, financial
strain, uncertainty about the future,
all raise risks for anxiety and
depression among our workers.
The total worker health approach will be
vital for organizations as they recover
and bring their folks back to work.
In addition to the specifics you will hear
today from Todd and Kevin, key things to address
in your return-to-work plan include
look at workers' needs comprehensively
to include both their physical and
mental safety and health and wellbeing.
Focus on the design, the demands,
and the organization of the work.
Many of those things have
changed in the midst of COVID-19.
Ensure you're taking a good look at your
benefits and policies around return-to-work.
My guess is they will need a relook.
In all likelihood, you will need to add
more flexibility, even if it's temporary.
And lastly, allow workers to participate in,
have a voice in critical
return-to-work decisions.
In summary, I'd like for each of you
to continue to focus on the supports
that workers need most in difficult times.
They obviously want to trust you as they
return back to work, so show compassion,
provide stability, and share hope that
we will all get through this together.
Fair treatment is going to be
essential through these changes.
Pay attention to pay and
benefits, including sick leave.
And above all, keep communicating and
provide those necessary flexibilities
that can make a life or death difference.
Folks, I believe we can all
do this and do it together.
Now it's my pleasure to welcome Todd
Neimeier to provide the latest science
of COVID-19's transmission, symptoms,
complications, and prevention.
Todd, welcome to the Total
Worker Health webinar today.
>> Well, thank you, Dr. Chosewood, and
thanks for that great introduction,
and bringing in the total worker
health concept into this pandemic.
So we're going to begin this part of
the presentation with a quick overview
of Coronavirus disease 2019, or what we call
COVID-19, and I'm sure many of you on the call,
you know, have seen a lot
of this information before,
but we thought it would be
important to reiterate it still.
So a little bit about how the virus spreads.
You know, we know that SARS CoV-2,
the virus that causes COVID-19,
is spread mainly from person to person through
the generation of respiratory droplets produced
when an infected person, you know, coughs or
sneezes or talks, and can spread it with people
that are, that are within close
contact, and we define that as being
within about six feet of one another.
These droplets can land in the respiratory
tract, either the mouth or the nose,
or possibly be inhaled into the lungs
and cause a spread of the infection.
It's also important to note that
some recent studies have suggested
that COVID-19 may be spread by people who are
asymptomatic, who are not showing symptoms,
and certainly that adds to the
challenge of controlling exposures,
both in the workplace and in the community.
CDC recognizes several symptoms
associate with Coronavirus.
These include fever or chills,
cough, or shortness of breath.
These are the main symptoms, but this
list has been updated several times
over the CDC response, and you can see there are
some other, maybe a bit more unusual symptoms
like loss of taste or smell, or
nausea and vomiting, or diarrhea.
And you can see other ones listed here as well.
These symptoms usually occur within two
to 14 days after exposure to the virus.
You know, in terms of complications, there
are a wide range of illness severity.
Some people don't even know that they've
been infected, they have no symptoms.
Other cases are mild, and folks recover very
quickly without any sort of intervention,
but you know, this illness is associated
with severe symptomology as well.
And as everybody probably
knows and has seen on the news
that you know it can result
in death in some cases.
Some of the common complications that,
that are seen with an infection include
that of the respiratory tract:
pneumonia or respiratory failure.
But they also, it causes effects in other
organ systems as well, including in the heart
with cardiomyopathy development
in some cases, or acute injury,
kidney injury or other effects as well.
And you know, we're going to reiterate
this throughout the presentation,
this concept of how do we prevent illness?
How do we prevent infection?
And you're going to see this in the
concept of general businesses and offices
and manufacturing facilities, but I think many
of these concepts, you know,
are, are throughout.
And some of the everyday preventative actions
that we should be thinking about are, you know,
doing things like avoiding
touching your eyes, nose, and mouth.
If you haven't washed your hands, or
just avoiding touching your eyes, nose,
and mouth as much as you can regardless
of if you've washed your hands.
Also avoiding close contact with other
people, and especially people that are sick.
You know, wearing your cloth face
covering when you're out in public,
and making sure that it covers
both your mouth and your nose.
Staying home as much as you can.
Don't go out in public unless you have to.
And then, you know, we'll talk a
lot more about this, but cleaning
and disinfecting frequently
touched objects and surfaces.
This is really important
in the office environment,
and certainly in the manufacturing
environment, too.
And then washing your hands.
You won't hear this enough.
You know, wash your hands with soap
and water for at least 20 seconds.
I usually sing the ABC's to myself twice,
and I think that's about 20 seconds.
I think it's usually under my breath, so that's
good, so that other people aren't hearing it.
You can also use an alcohol-based hand
sanitizer with at least 60% alcohol if soap
and water are not readily available as well.
So with that, I am going to turn the
presentation over to Dr. Kevin Dunn who's going
to give us more information on
guidance for businesses and employers
and within office spaces as well.
So Dr. Dunn?
>> Thanks, Todd.
I, you know, I think there's a couple of
things that I'd like to start off with.
Casey, Casey mentioned earlier that the guidance
we're talking today is certainly not exhaustive.
There are hundreds of guidance
information documents from the CDC,
and so we would encourage you to take a look
at the various offerings on
the CDC Coronavirus website.
But instead we'll talk about, I think, two
or three key guidance documents today for,
for businesses, employers, and employees.
I'm going to be talking about the
CDC Interim Guidance for Business
and Employers regarding COVID-19, so I'll
be walking through this and again talking
about the Resuming Business Toolkit which is
kind of the, the checklist version of this list.
So I'm going to go ahead and get started here.
So it's important to know that businesses
and employers have a role in preventing
and slowing the spread of
COVID-19 in their workplaces.
As an employer, if your business
operations were interrupted, resuming normal
or saved activities presents an opportunity
to update your COVID-19 preparedness
response and control plans.
All employees should, all employers should
implement an updated necessary plan.
A is specific to your workplace.
B identifies all areas and job tasks
with potential exposures to COVID-19,
and C improves control measures to
eliminate or reduce these exposures.
It's important, I think as Casey mentioned
earlier, that we talk to your employees
about plan changes and seek their input,
collaborate with them, collaborate with unions
if the unions are in your workplace,
how to effectively communicate the
important COVID-19 information and changes
to policies and processes in the workplace.
So today I'm going to kind of
walk through three key areas
that are part of the business guidance.
One is how to reduce transmission
in the workplace.
Two is how to maintain a healthy
work environment, and three,
how to maintain healthy business operations.
So it's really important to actively
encourage employees to stay home.
Employees who have symptoms
should notify their supervisor
and stay home or get the care that they need.
There are some CDC recommended steps,
and we can provide some links to that.
The employers, employees should not
return to work until the criteria
to discontinue home isolation are met in
consultation with their healthcare provider.
It's important as well that if they have a
sick family member at home with COVID-19.
Likewise, they should notify their supervisor
and follow the CDC-recommended precautions.
So it's important as we can to keep
the virus out of the workplace.
It's also worth considering conducting
daily in-person or virtual health checks
that might include symptom
questions or temperature screening
of employees before they enter the building.
It's important to think of if
implementing the health checks
in person conduct safely and respectfully.
You want to make sure you utilize social
distancing as Todd mentioned, or barriers
or partitions to keep folks separated.
And you know the screeners may be required
to wear some personal protective equipment.
However, reliance on PPE alone for
effective control is more difficult
to implement given PPE shortages and training
requirements, but it's important to think
about how you will protect the person that will
be doing the screening, and I think a key piece
of that, each workplace has to conduct a
thorough hazard assessment to determine
if hazards are present of if they're likely
to be present, and what types of controls
or approaches are needed
for specific job activities.
Again, you know, separating out sick employees
that appear to have symptoms when they get
to work, or if they become sick during the
work day, these employees should be separated
from other employees to minimize the
likelihood of transmission and sent home.
Workplaces should have a procedure
in place for the safe transport
for an employee who becomes sick at work.
An employee made need to be transported
either home, or if, of if more ill,
they might be needed to go to a
healthcare provider, so that's important.
And we should understand what actions are
necessary to, for, if you have someone
with a suspected or confirmed
COVID-19 infection.
In most places, in most cases, you
don't need to shut down your facility.
If it's been less than six or seven days since
the sick employee has been in the facility,
you might close off any areas that worker
used for prolonged periods of time.
Wait 24 hours or as long as feasible
before cleaning and disinfecting
to minimize the potential for other employees to
become exposed, and during that waiting period,
if you can kind of bring in more outside
air either by opening doors or windows
to increase circulation and dilution in
the area, that's preferred and ideal.
If it's been more than seven days since
the sick employee has been in the facility,
specific additional cleaning and
disinfection is not necessary,
but you should continue doing
routine cleaning as you currently do.
Also implementing and reducing transmission.
It's important to educate and encourage
employees to follow any procedures
and policies related to the illness, cleaning
and disinfection and work meetings and travel.
Again, advising employees to
stay home if they're sick.
Inform their supervisor if they're sick
or have a sick family member at home.
As Todd mentioned earlier, having good general
hygiene and hand hygiene, washing their hands,
or using hand sanitizer with
at least 60% alcohol if soap
and water are not readily available.
And practicing routine cleaning
and disinfection.
Practicing social distancing
by avoiding large gatherings,
and considering how you might implement those
for, for meetings within your workplace,
and as Casey mentioned, too, stress
management is another key piece
of maintaining employee wellness during
this pandemic, and there's several resources
on the CDC Coronavirus resources
related to that key piece.
On maintaining a healthy work environment, as
an engineer, I think a lot about ventilation.
That's the area I work in the most.
It's just a part of the system overall.
It's important if you had a shutdown, if your
air handling units haven't been run in a while,
that you ensure they're operating properly,
and they're providing acceptable indoor air
to different spaces and for
the current occupancy level.
There are a lot of different workplaces are
kind of branching out in the total occupancy,
so it's important to make sure
your systems are operating right
and providing the right indoor air.
There's some things you can do like
considering the [inaudible] the ventilation rate
or increasing the outdoor air
ventilation rate if feasible.
It may not be feasible in all workplaces,
but it's a way of increasing your dilution
of indoor air contaminants,
including any airborne virus.
And also along that same line, improving your
air filtration to the highest compatible level
that doesn't negatively impact
the overall airflow.
So there's a little bit of a balance here.
You know, you can put in
the highest level of filter,
but it also may reduce the overall
airflow, and you don't want,
you don't want to go that direction.
Again, another area that
you need to be considering
after you've had a prolonged shutdown
is your building water system.
And CDC has Guidance for Building
Water Systems which provide eight steps
to take before you reopen
your business or building.
So that's another key piece of making sure you,
your employees come back to
a healthy work environment.
And making sure your employees, your
customers, your visitors have what they need to,
to do good hand hygiene with
cough and sneeze etiquette.
Provide them tissues and
access to no-touch trashcans.
Provide them, make sure they have
access to soap and water, and if soap
and water are not readily
available throughout the worksite,
to make sure that there's some alcohol-based
hand sanitizer with at least 60% alcohol,
and ensure that those adequate
supplies are maintained
or on some sort of routine maintenance.
Make sure that they're checked and maintained.
It's also important to place posters that
reinforce and encourage these practices
at the entrance of the building or in other
areas where they're likely to be seen.
And consider, if you have a workforce
that has non-English speakers,
that you include signs in those languages.
Also as far as travel goes, we
recommend minimizing non-essential travel
and consider resuming nonessential travel in
accordance with what's happening in your state
and local areas, and in conjunction
with those regulations and guidance.
So advise employees to check
themselves for symptoms.
We don't want them to be traveling for work
if they're sick or have symptoms of COVID-19,
and if they are traveling and they come down
with symptoms or illness, to let their employer,
supervisor know, and proper care, you know,
call a healthcare provider if, if that's needed.
And the second piece of this is
cleaning, cleaning, cleaning.
It's important to have a clean
workplace, and to do that,
you're going to make sure you
provide the necessary training,
any materials for your housekeeping
staff and employees.
For the housekeeping staff, they may want to
wear disposable gloves to clean and disinfect.
To disinfect surfaces, it's important to
clean them first using soap and water,
especially if they're visibly
dirty, before using a disinfectant.
Cleaning just reduces the number of germs,
and cleans off the dirt and
impurities on the surface.
The disinfectant kills the germs on the surface,
and many of the disinfectants
don't work very well
if they're just kind of spread
over a dirty surface.
It's important to clean the surface first.
And that you practice routine cleaning
of frequently touched services.
You know, it might be that before COVID-19,
your facility had cleaning done once a day,
and it might be that certain areas and
surfaces need to be cleaned more frequently
than that based on the level of use.
And lastly, EPA published a list of
registered products that are approved for use
against the virus, and it's
available on the EPA website.
And it's important that you follow
the manufacturer's instructions
for using those products.
If you get something that's not ready to
use, you have to make sure that you mix it
to the right concentration, you apply
it appropriately, and most importantly
that you have the appropriate contact time or
the amount of time the surface has to be wet.
For the CDC, excuse me, with the
EPA-registered disinfectants,
I think there are 300 or 400 at this time.
That can range anywhere from 30 seconds to 10
minute, so it's important to know that you,
you leave the surface wet for the appropriate
amount of time to kill the virus on the surface.
So maintaining healthy business
operations, we think it's really key
that you have COVID-19 workplace coordinator,
and that all workers know who that person is
and how to contact them if they're concerned,
and that the coordinator should also be aware of
and follow applicable federal
and state regulations as well
as public health agency guidelines.
It's important to implement flexible
sick leave and supportive policies
and practices, as Casey mentioned earlier.
Maintain flexible policies that allow employees
to stay home to care for a sick family member
or take care of children due to
school or childcare closures.
Other flexibilities that might be worth
considering include, include allowing advancing
on future sick leave or allowing employees
to donate sick leave to each other.
And employers that don't currently offer
sick leave to some or all of their employees,
we suggest considering drafting
non-punitive emergency sick leave policies,
and this is to allow workers that are
potentially sick to stay out of the workplace
so there's not additional
transmission in the workplace.
It's important that we protect workers
at higher risk of severe illness.
That includes older adults and people of any
age with serious underlying medical conditions
which are, who are higher risk for the illness.
So we, some of those would be to support
and encourage options of telework.
Consider offering vulnerable workers
duties that minimize their contact
with customers or other employees.
It might be that, you know, they
could, if they're working as a cashier,
maybe they could work as a restocking, in
a restocking, you know, if it's appropriate
for the worker, and they agree with this.
It's important that you communicate your
supportive workplace policies clearly,
frequently, and through multiple methods.
You need to train workers on how
implementing new policies due
to the spread may affect existing
health and safety practices.
You need to create and test your communication
system so employees know how to self-report
if they're sick, and how you would
notify employees if there's an exposure
in the building, closures of the
building, or certain areas of the building.
It's important to set your critical
functions, your essential functions.
Some of that might require identifying alternate
supply chain for critical goods and services.
Because of this, have gone through, we know
that some services, some goods have become
in high demand and hard, and harder to find.
You need to determine how
to operate if your employee,
if your absenteeism spikes due
to increases in sick employees.
So you need to monitor, figure out a
way to monitor that and respond to it,
and implement plans to continue your, continue
your essential business functions in the,
in the condition of higher-than-usual
absenteeism.
Let's see.
And I think you also need to take action
if a, [inaudible] if there are [inaudible].
Alright, and it's important also to
let, to delegate authority downward.
So that the local businesses, your local
stores can respond based on local conditions.
This is something that, that varies from
state to state and location to location,
so it's important to let the folks locally have
a stake in how, how they respond appropriately.
And also, you should establish social
distancing policies and practices.
This is something that you know, you
see in all CDC guidance at this point.
It's certainly been effective at
reducing, reducing the transmission.
It includes altering, altering your workplace.
So workers and customers can maintain social
distancing and can physically separate employees
from other customers and each other.
It, it includes things like implementing
flexible worksites, like using telework,
implementing flexible work hours, rotating
and staggering shifts to limit the number
of employees in the workplace at the same
time or coming to work at the same time.
Increased physical space between
employees by modifying the workspace.
Using barriers where maybe
physical distancing is harder to do.
We've certainly seen that in restaurants
where they may have an initial barrier
at drive-through services, cash registers,
and certainly things that I've seen
through visual cues: tape on the floor to
help people get a sense of what six feet is,
and where they should stand, especially
when barriers are not there or not possible.
And you may even consider closing
or limiting access to common areas
where employees like to congregate, interact.
In the, the Resuming Business
Toolkit which just came out a couple
of weeks ago is really this
guidance in a checklist form.
It's taking, it takes the Interim Guidance
for Businesses and Employers and puts it
into an easier-to-follow checklist, and it's
helping lowering the impact in the workplace
when you're bringing workers back
into non-healthcare business settings.
And it includes an employer sheet, Restart
Readiness Checklist, a Worker Protection Tool,
and a list of resources where you
can find additional information.
We've had some pretty good feedback already from
the toolkit from industry association member
who said that you know, "When CDC and other
agencies put out guidance and recommendation,
you know, we have to take it and
then turn it into our own checklist,"
so they said turning the guidance into a
checklist for them is a significant amount
of effort, and they appreciated the fact that we
took this important guidance piece and turned it
into a checklist, so it makes
it easier for them to ensure
that they're following the guidance of the CDC.
So I think you'll notice that some of the new
guidance coming out is often being published
as toolkits and checklists, and that includes
some of our meat and poultry guidance,
our agricultural worker guidance,
and several others.
Now we'll have the guidance team come
out, and at the same time a checklist
or a toolkit helps facilities or
employers implement the guidance.
Let's see.
So this is just a picture of
the Restart Readiness Checklist.
It includes more than 80 items of boxes to
check about whether the work has been completed,
whether it's ongoing, whether it's not
yet been started, or is not applicable.
And the checklist falls under
three main categories,
the same ones that I just went through,
like preventing and reducing transmission,
maintain healthy business operations, and
maintaining a healthy work environment.
This is the Worker Protection Tool,
and so it's also in a checklist form,
and it follows the hierarchy of controls
of more effective controls on the right,
on the left the engineering to least effective
controls, personal protective equipment,
and administration, administrative
controls in the middle.
And engineer considerations include like
eight facilities and equipment items
such as ventilation and water
systems, as I talked about before.
And altering the workplace
to maintain social distance.
The middle section, the administrative
controls, contain 26 items that fall
under really three main categories:
management and communications which you see
on the screen now, cleaning
and disinfection, and training.
And the, the final section of the tool is
dedicated to personal protective equipment,
such as determining the needed
PPE for workers' job duties based
on the hazards and existing protection.
So this is kind of a nice complement
to the business guidance in ways
that makes it a little bit easier to
know if you're following the guidance,
and what areas that maybe could improve them.
So now I'm going to talk a little bit about
a second set of guidance that we've put
out for office workplaces, so you'll see
very similar, similar ideas to the ones
for general business, but these
are specific to office workplaces.
So again, you know, if you're resuming
business after a shutdown, you should,
you should make sure your ventilation
system is operating properly.
We, we referenced ASHRAE, or the
American Society for Heating,
Refrigeration, and Air Conditioning Engineers.
Standard 180, which establishes the minimum
HVAC inspection and maintenance requirements
to make sure that you achieve
acceptable thermal temper,
energy efficiency, and indoor air quality.
And so it's kind of a nice, again, checklist
to look at to make sure if you're coming back
to your workplace after being gone,
this will give you some items,
some critical items to assess.
And some of the things that we would
suggest for the ventilation system include,
as I mentioned before, increasing outdoor
air circulation, if that's safe to do.
It will help dilute any air contaminant
including the virus, and you want to again check
for common issues with [inaudible] that haven't
been operational or inhabited for a while,
such as mold growth, rodents or pests, and
potential issues with stagnant water systems.
And then links on this slide for EPA's
guidance on mold in commercial buildings,
and on integrative pest management,
and the last thing having to do
with CDC guidance for building water systems.
And again, isolating workers from the hazards.
So this is really about, you know,
really improving the physical distancing
from, from employee to employee.
You're using some of the same concepts of
considering especially areas where there,
there may be more, more gatherings such as
breakrooms, meeting rooms, parking lots,
so any area where there might be
a group of, of workers together.
So you know that includes
some of the, the visual cues.
And also considering since there's a
potential to transmit the virus from,
from the surfaces of different items,
replacing kind of high-touch communal items
like coffee pots or bulk snacks,
and, and using some alternatives.
And then taking steps to
improve your ventilation.
As I've mentioned before, really bringing
in the highest amount of outdoor air
to get the highest amount of dilution
as you can, improving your filtration,
and another part of this is where the
filter sits in the filter housing,
to make sure there's a good fit so that
there's less air that's bypassing or going
around the filter, so you're
getting your best efficiency,
then making sure that filter is still good, is
not damaged in some way to allow the air to go
around the filter and not
be effectively filtered.
So again, establishing policies
for social distancing.
You know, considering the
use of outdoor seating areas.
Certainly for small group
activities like lunches and breaks,
you get more outside air and dilution.
Again, posting signs at entrances and
other areas on, on the key topics of cough
and sneeze etiquette, symptoms,
and hand hygiene.
The CDC has a lot of resources on
this, posters and infographics,
so those are things you can kind of pick
up off the CDC website and use directly.
And now I'll turn it over to Todd.
Thanks so much for your attention.
>> Alright, well thank you, Kevin,
for presenting that information.
We're going to move on now to just to
[inaudible] a little bit again and talk
about some specific issues and
guidance for manufacturing facilities.
And again, like I indicated in the
beginning of the presentation, you know,
some of the recommendations we're
going to be giving are similar to what,
what Dr. Dunn just talked about, but
manufacturing environments also, you know,
may provide some unique exposures
to workers for COVID-19.
And part of that may be around the
prolonged closeness that these workers have
with one another just by the, the
fact of working on production lines,
and a lot of times they work extended hours.
You know, working maybe 10
to 12 hours per shift.
You know, there's a lot of heavy use of,
you know, locker rooms and breakrooms
in manufacturing facilities that may
not be as common in office settings.
And as we've found, and I'll talk a little
about more, in manufacturing environments,
employees sometimes share transportation to
and from work, and they're friends outside
of the office as well, so there may be
some issues of community exposure as well.
So you know when we think about
the types of contact for exposure
in these environments, fairly similar, right?
Inhalation of respiratory droplets in the air.
However, we also need to be cognizant of
the fact that workers may come in contact
with contaminated surfaces, and in these
environments, this may be things such as,
you know, shared tools or shared workstations,
within break rooms that we need to be thinking
about how to properly clean
and disinfect those areas.
So the first thing to do to create a
COVID-19 Assessment and Control Program.
And this would include, you know, first
identifying somebody at your facility that,
that has the expertise to do this.
Like this might likely be an
environmental health and safety officer
that can create a plan and maintain it.
Also this person or group of people need to
be able and willing to coordinate with state
and local public health officials and
occupational safety and health professionals
to really get the most updated information
from a public health guidelines standpoint,
and federal regulations that
impact this, this pandemic as well.
Once that person has been identified and,
and has all this information in hand,
it's important then to go through
and do a workplace assessment.
Really think about, you know, initially
where are those areas that you're concerned
about that exposure may be occurring?
You know, whether that be on the
production line or within the breakrooms.
You know, where are those exposures occurring?
And then, and we'll talk about solutions
and controls, but even after that,
you need to go back and continually improve, a
process of continual improvement to make sure
that the controls you're
putting in place are working,
that the workers understand what those controls
are, and that they're being properly utilized.
You also may want to consider the role of
COVID-19 testing and contact tracing as well
for workers that do become
positive with infection.
So worker infection prevention
recommendations are based
on an approach known as the
hierarchy of controls.
This approach grouped actions by their
effectiveness in reducing or removing hazards,
and in most cases, the preferred approach
is to eliminate the hazard or process,
install engineering controls, and
implement appropriate cleaning, sanitation,
and disinfection practices to
reduce exposure or shield workers.
Administrative controls which are work policies
and procedures are also an important part
of an approach to prevention in these
workplaces, and as you can see at the bottom
of this, of the pyramid in this slide,
upside-down pyramid in this slide,
is PPE or personal protective equipment.
You know, we really consider this to
be one of the least effective ways
to prevent pathogen exposure and control.
It's better to rely on engineering
and administration controls over PPE,
so let's talk about these a little bit.
A couple of examples of engineering controls, in
this figure that you see here on the right side
of the slide comes right out
of the Manufacturing Guidance,
and we'll provide a link to that as well.
But you know the thought here is you need to
try to maintain distance between your workers,
at least six feet in every direction, so on a
production line, you know, may be working next
to somebody, and you may be
working across from people as well.
So maintaining that distance and providing,
you know, physical cues or tape marks,
something along the ground is really beneficial.
You also, you may want to use
something like partitions or barriers
to reduce the droplet spread
between these workers.
In addition, and Dr. Dunn talked
a little bit about this, you know,
providing adequate ventilation
in work areas is critical.
And you know for those of you that
are in manufacturing environments,
we know that the ventilation in those
environments can be quite complex,
so I think it's important to really
consult with a qualified HVAC engineer.
CDC also recommends removing personal
cooling fans and taking steps to minimize air
from other vents from blowing across one
worker into another worker's breathing zone.
And you can imagine this could be a way
that respiratory droplets could be spread
from an infectious person to someone else.
So it's important to really consider these fans.
But you also need to take alternate
steps to prevent heat hazards associated
with not using fans in these areas as well.
Things like installing mobile
handwashing stations.
I think this is logical.
You know, provide enough handwashing or
hand sanitizer stations around your facility
so people can, can continually
clean their hands.
We noticed in some of our field visits
that we've done so far in this response
that workers tend to congregate around, and
manufacturing environments tend to congregate
around clock-in and clock-out areas.
You know, at the beginning,
at the end of shifts.
And you know thinking of ways to either
stagger times for workers to start and stop,
or other touch-free methods to clock-in
and clock-out are really important
to maintain distance between these workers.
It's also important to, you know, in break areas
and other areas to increase worker separation
in those areas as well by removing
or rearranging chairs or tables
to maintain distance in those spaces.
When we think about administrative controls
to promote social distancing, you know,
and there's several, and just to give a
few examples, again, just keeping workers
at a distance by at least six feet.
you know, encouraging single movement through,
single-file movement through a plant instead
of all, you know, sort of walking together.
We've talked a little bit about, you know,
the social distancing cues on floor lines.
I think we've all seen this, and I
have seen this in grocery stores.
You know, I'm in a checkout line.
They have marks on the floor to keep everybody
six feet apart as they pay for their groceries.
In terms of carpooling, this is again,
this is something else that we've noticed
in our field studies is that in these types
of environments, sometimes workers come
to work together, they carpool together.
And we would encourage you to,
encourage workplaces to see
if there are alternate ways to, you know, to
really to discourage carpooling if possible.
But if not, it's understood that sometimes
that's not possible, to do things like,
you know, ensuring that workers are practicing
social distancing as much as they can.
You know, good hand hygiene, mask
use, disinfection within the vehicles
as well are really important
controls to think about.
IN addition, you know, there are things you
might be able to do to modify your, your shifts.
You know, stagger your shifts so your schedules
spread workers out as much as possible.
And then potentially reserving a shift
for cleaning if that's possible as well.
In addition, one of the recommendations the
CDC gives us is considering cohorting groups
of workers together, and this may help with,
you know, the effectiveness of shift scheduling,
but also what it really does is helps to
minimize the number of different individuals
that a symptomatic worker
may be in contact with.
So if, if workers are exposed, you're
exposing, you know, a lower number of workers
that are cohorted with that infectious
person instead of perhaps a larger group
within your manufacturing environment.
You know, things like establishing a
reporting system for sharing health information
in COVID-19 context status with a
supervisor or someone at the facility.
But you know maintaining
confidentiality if you do that is required
by the American with Disabilities Act as well.
And really just overall, and I know we're
coming to the end, so I'm going to speed
up just a little bit here, but just
to, you know, promote personal hygiene
within your facility in any
of the ways that you can.
From a personal protective equipment standpoint,
you know, and I said we want to avoid PPE
if we can, but sometimes we need to
use personal protective equipment,
but it's important to do it in the right way.
And the first thing you're going to need
to do if you're going to need to use PPE is
to conduct a hazard assessment to determine
whether or not you really need it or can you,
can you find a different
control that works better?
If you do decide to use PPE, you
should follow the Occupational Safety
and Health Administration
standard for PPE usage.
And training is so important here.
You need to demonstrate for workers how
to properly put on and take off PPE,
either by video or by in-person demonstration.
Then it's important that if you do
in-person demonstrations, that folks are,
are appropriately distanced
during these demonstrations.
And you know empathizing that when you take on
and put on and take off PPE that you're not,
that workers are not contaminating themselves,
especially with PPE around their face.
It is really important.
Disposable PPE is preferred.
That's not always available though,
and if you have to use reusable PPE,
just make sure it's properly
disinfected and stored in a,
in a location that's clean when it's not in use.
And make sure that you know workers
are not taking it home or sharing it
with other workers at the facility as well.
It's also important to stress here
hygiene before and after handling PPE.
And you know really consider when
PPE is necessary to protect workers,
but just like when engineering or administrative
controls are difficult to maintain.
You can also consider the voluntary use of
filtering facepiece respirators like N-95's,
and you can refer to the OSHA Respiratory
Protection standards for more information
about using N-95's under voluntary use.
It is important to note that PPE such as
gloves, face and eye protection may be needed
when using cleaning and disinfection chemicals.
However, in all cases of using PPE,
be sure to consider the potential
for additional hazards created by poorly-fitting
PPE, and examples of this are, you know,
PPE that gets caught in machinery
or causes impairing of vision
when people are trying to do their work.
You know, education is key, and I can say that
within the Manufacturing Guidance, you know,
we provide some posters and other
things in several languages.
You know, the materials that you provide
either training or posters or, you know,
handwashing information needs
to be easily understood.
It needs to be in the right language, in the
right literacy level, and more importantly,
it needs to be accurate and timely.
And as Dr. Chosewood said in the
beginning of the presentation, you know,
we are-- this response is changing.
It's constantly changing.
We're constantly updating information, so
making sure that you're checking, you know,
your sources of information to
make sure they haven't changed
since you last obtained information
is really important.
And then this is my last slide.
It's on cleaning and disinfection.
You know, this is an important component of
your control plan as well, and it's important
to clean and disinfect tools when workers
change workstations or they use new tools.
The US Environmental Protection Agency, EPA,
has published a list of disinfectants that are,
are effective against SARS CoV-2,
the virus that causes COVID-19.
Since you may be cleaning more frequently
than normal, it's also recommended
that you establish protocols, and provide
adequate supplies for sanitizing work
and common spaces, and disinfecting
tools, equipment,
and frequently touched surfaces
in your facility.
And you should try to do this, you know,
if you can at least once per shift.
As I mentioned before, workers
who perform cleaning
and disinfecting tasks may require
additional PPE and other controls to protect
against chemical hazards, and it's important
with this that you review the product labels
and safety data sheets for these chemicals
to understand these hazards and to make sure
that you're following a hazard
communication program.
With that, we've provided some additional
resources based on the information
that we provided today, and these are all
hyperlinks, and the presentation is available,
so you can certainly go right to the
pages that we cite for this information.
And I think that we've come to the
end of the formal presentation.
>> Great! Thanks very much, Todd, and
also to Kevin for your excellent remarks.
Really, really valuable information.
I'm going to leave these resources
up so folks have just a sense
of where they can get more detailed
information but we do have some great questions,
and we have time for quite a few,
I do believe, so I'm really happy
to take some great questions
coming in from the audience.
And Todd, rather Kevin, I'm going in just
a minute to ask you about business travel
because I know that is, has been on the minds
of some of our audience members, but first Todd,
I'm going to start with a couple
questions for you about transmission
because we did get a couple of
questions about that including what
about aerosol transmission besides just some
of the large droplets that
we've been hearing about?
And also what information do we have to suggest
that the six-foot rule is
the right kind of guidance?
>> Sure, Dr. Chosewood.
I'd be happy to answer that.
We know that the virus is spread via respiratory
droplets, and it's important to understand,
you know, respiratory droplets
are usually larger,
and they usually fall out
of the air quite readily.
So that's kind of what that
six-foot rule is they don't,
they don't tend to stay in
the air and float around.
You know, aerosols which are much smaller
particles, can you know spread around
and float around in the air for a while.
You know, there, there continues
to be ongoing research on whether
or not you know aerosol spread
is a part of this illness or not.
In most of the controls that we know
are based on respiratory droplets.
In one particular case, I know there's
concern within healthcare environments
where aerosol-generation procedures
such as intubation are used,
that those can generate aerosols, and in a lot
of times we would recommend using, you know,
higher levels of PPE such as
filtering facepiece respirators,
N-95's for those types of procedures.
So I, I hope I answered your question there.
>> Yeah, I think that was great.
I think we did receive a comment that it's
really important to reinforce the difference
between a cloth-based covering surgical mask
and an actual respirator that needs fit testing
and training to assure that it's
effective, so thank you for that.
Kevin, let's shift to that
question about business travel.
You know, I've seen the TSA stats that show
people are returning to travel quite quickly,
and a lot of businesses obviously
depend on travel,
whether it's local, regional, or international.
How can people determine the level of
risk, depending on where they're going?
And how can folks really fly
safely if they really do need
to conduct essential business travel?
>> Yeah, I think this is
still a key business question.
And, and we're still recommending that,
that businesses limit or
minimize nonessential travel.
It's good for travelers to look to CDC health
notices, especially if they're going overseas,
and, and it's important that folks kind of
take stock of their health before they leave.
If they think they might be coming
down with something, COVID-19,
you should talk to your employer,
your supervisor,
and decide whether it makes
sense to travel or not.
You know, in general traveling
kind of from your home base
or your local community may increase your chance
of other employees or unknowingly spreading it
to others, particularly if you travel to an
area of high or low COVID-19 transmission.
So it's important to get an understanding of you
know where you're at, and what the situation is
where you're at, and also where you're going to.
And, and you want to kind of ask some questions
like is, you know, is it spreading in your home
or in your destination community?
Do you think you'll be within this social
distance of six feet before or after your trip?
Are the, you know, the folks
that you're traveling more likely
or could they be vulnerable
populations that might get very ill
from COVID-19 if they were to get it?
So I think, and then also is there a
possibility you might, you bring it home,
or if you live with somebody
who's in a vulnerable population,
that might be something you want
to consider before you travel.
And then also, you know, the, you know lots of
different states are putting out kind of rules
and policies relating to folks
coming in from out of state.
I noticed I think the state of,
I think New York, New Hampshire,
and New Jersey yesterday said
that if you come into the state
from nine high-transmission states, they're
requiring a 14-day quarantine in-state.
And so I think it's important
to know what the policies are
of the state that you're going into.
So there's lots of the different
pieces that are important to consider.
>> Right. Thank you for that, Kevin.
I'd like to stick with you, as our engineer
on the call, can you talk a little bit
about the value of diluting the
air by increasing the flow in a,
in a central air handling
system versus filtering.
And I'll just remind you that we
don't have a lot of time left.
>> Yeah, I think they, they're
both, they're two sides of the coin.
The way, you know, you, you improve the
air is you can filter out what's in the air
with improved filtration, or you can add
more air, outside air which would bring
in less contaminated air as long as
you're not in an urban environment.
So I think they're both, both
ways that you can improve,
so I don't think you'd say
one is better than the other.
They're both good approaches
for improving indoor air.
>> Great, thanks for that.
Todd, I want our last question really
to focus on a question about, you know,
we've seen a lot of screenings, we've
seen the temperature checks that a lot
of organizations are doing, but what should
an employer do if an actual employee comes
to work with symptoms of COVID-19?
Whether that's cough or fever
or shortness of breath?
What steps really should an employer
take if that, if that were to occur?
>> Yeah, no that's a great question,
Casey, and I think that the first thing
that an employer should do at that point is to
really isolate that person from the rest of the,
the workplace to try to ensure that they're
not infecting others that may be in the area.
And I think it's important to have
a plan in place to be prepared
for if that situation would happen.
And then after that, it's really, you know,
important to have that employee, you know,
once they're able to leave the workplace, you
know, follow up with their physician to get,
you know, the medical advice that they need
for evaluation or, or treatment from there.
But I think you know within the workplace
environment, the key is really just trying
to have that person be isolated as much as
possible while they're at, you know, on,
on the, at the workplace facility.
>> Right. Thank you very much for that.
Folks, we are at the end of our time today,
and it's been my pleasure
to have each of you join us.
We will be following up with all of you who
have registered today to provide the direct,
the direct links that we
mentioned during our remarks
so you have even more resources
available to you.
Obviously, please download the slide set
using the download box at the lower right,
and if you still have questions, you
can always email us at TWH@cdc.gov.
That's TWH for total worker health @cdc.gov,
and we will find the information that you need.
Folks, you are the key to the total
worker health of America's workers
as we weather this challenging time together.
Your workers are counting on you, and we
pledge to be there to help you along the way.
We wish you all well.
Thanks for joining us.
Have a great day!
