# Guidance on Preparing Workplaces for an Influenza Pandemic/Workplaces Classified at Very High or High Exposure Risk for Pandemic Influenza: What to Do to Protect Employees

​ Workplaces Classified at Very High or High Risk (Caution) for Pandemic Influenza: What to Do to Protect Employees
If your workplace requires your employees to have contact with people that are known or suspected to be infected with the pandemic virus, there are many practices that can be used to reduce the risk of infection and to protect your employees. Additional guidance for very high and high exposure risk workplaces, such as health care facilities, can be found at: www.pandemicflu.gov and www.osha.gov.
Very high and high exposure risk occupations require employers to address enhanced safety and health precautions in addition to the basic work practices that every workplace should adopt (see page 26). Employers should also be aware that working in a high ​risk occupation can be stressful to both employees and their families. Employees in high risk occupations may have heightened concern about their own safety and possible implications for their family. Such workplaces may experience greater employee absenteeism than other lower risk workplaces. Talk to your employees about resources that can help them in the event of a pandemic crisis. Keeping the workplace safe is everyone’s priority. More information about protecting employees and their families can be found at: www.pandemicflu.gov.
Work Practice and Engineering Controls Employers should ensure that employees have adequate training and supplies to practice proper hygiene. Emergency responders and other essential personnel who may be exposed while working away from fixed facilities should be provided with hand sanitizers that do not require water so that they can decontaminate themselves in the field. Employers should work with employees to identify ways to modify work practices to promote social distancing and prevent close contact (within 6 feet), where possible. Employers should also consider offering enhanced medical monitoring of employees in very high and high risk work environments.
In certain limited circumstances ventilation is recommended for high and very high risk work environments. While proper ventilation can reduce the risk of transmission for healthcare workers in the same room as infectious patients, it cannot be relied upon as the sole protective measure. Thus, a combination of engineering controls and personal protective equipment will be needed.
* When possible, health care facilities equipped with isolation rooms should use them when performing aerosol generating procedures for patients with known or suspected pandemic influenza.
* Laboratory facilities that handle specimens for known or suspected pandemic patients will also require special precautions associated with a Bio-Safety Level 3 facility. Some recommendations can be found at: www.cdc.gov/flu/h2n2bs13.htm.
* Employers should also consider installing physical barriers, such as clear plastic sneeze guards, to protect employees where possible (for example, reception or intake areas). The use of barrier protections, ​such as sneeze guards, is common practice for both infection control and industrial hygiene.
Administrative Controls (Isolation Precautions) If working in a health care facility, follow existing guidelines and facility standards of practice for identifying and isolating infected individuals and for protecting employees. See the U.S. Department of Health and Human Services’ pandemic influenza plan for health care facilities at: www.hhs.gov/pandemicflu/plan/sup4.html.
Personal Protective Equipment (PPE) Those who work closely with (either in contact with or within 6 feet) people known or suspected to be infected with pandemic influenza should wear:
* Respiratory protection for protection against small droplets from talking, coughing or sneezing and also from small airborne particles of infectious material.
** N95 or higher rated filter for most situations.
** Supplied air respirator (SAR) or powered air purifying respirator (PAPR) for certain high risk medical or dental procedures likely to generate bioaerosols.
** Use a surgical respirator when both respiratory protection and resistance to blood and body fluids is necessary.
* Face shields may also be worn on top of a respirator to prevent bulk contamination of the respirator. Certain respirator designs with forward protrusions (duckbill style) may be difficult to properly wear under a face shield. Ensure that the face shield does not prevent airflow through the respirator.
* Medical/surgical gowns or other disposable/decontaminable protective clothing.
* Gloves to reduce transfer of infectious material from one patient to another.
* Eye protection if splashes are anticipated.
The appropriate form of respirator will depend on the type of exposure and on the transmission pattern of the particular strain of ​influenza. See the National Institute for Occupational Safety and Health (NIOSH) Respirator Selection Logic at: www.cdc.gov/niosh/docs/2005-100.
Educate and train employees about the protective clothing and equipment appropriate to their current duties and the duties which they may be asked to assume when others are absent. Education and training material should be easy to understand and available in the appropriate language and literacy level for all employees. Employees need to be fit tested and trained in the proper use and care of a respirator. It is also important to train employees to put on (don) and take off (doff) PPE in the proper order to avoid inadvertent self-contamination (www.osha.gov/SLTC/respiratoryprotection/ index.html). Employees who dispose of PPE and other infectious waste must also be trained and provided with appropriate PPE.
During a pandemic, recommendations for PPE use in particular occupations may change depending on geographic location, updated risk assessments for particular employees, and information on PPE effectiveness in preventing the spread of influenza. Additional respirator and surgical mask guidance for healthcare workers has been developed and is available at www.pandemicflu. gov/plan/healthcare/maskguidancehc.html. This document, Interim Guidance on Planning for the Use of Surgical Masks and Respirators in Health Care Settings during an Influenza Pandemic, provides details on the differences between a surgical mask and a respirator, the state of science regarding influenza transmission, and the rationale for determining the appropriate protective device.