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Severe Acute Respiratory Syndrome (SARS)
OCCUPATIONAL HEALTH & SAFETY MANAGEMENT SYSTEM Severe Acute Respiratory Syndrome POLICY & PROCEDURES MANUAL SARS.01 NEW 05/03 Severe Acute Respiratory Syndrome (SARS) Introduction Recently, the World Health Organization has received reports of severe acute respiratory syndrome (SARS), also known as “atypical pneumonia,” from various parts of the world. The various governments throughout Australia are monitoring the situation closely with the New South Wales Government recently setting up a task force to try and co- ordinate health care resources. What is SARS? “Severe Acute Respiratory Syndrome” refers to a group of mainly respiratory symptoms for which the cause is currently unknown. What are the symptoms of The symptoms of SARS include: SARS and when do they Occur? • high fever (higher than 38 Celsius or 100.4 Fahrenheit) AND • one or more respiratory symptoms including cough, shortness of breath, difficulty breathing AND one or more of the following: • close contact with a person who has been diagnosed with SARS • travel within the last 10 days to areas reporting cases of SARS. SARS may also be associated with other symptoms such as headache, muscle stiffness, sore throat, and fatigue. Some persons may experience increasingly severe breathing symptoms over the course of about a week; they may require oxygen support and sometimes mechanical breathing (intubation). The incubation period for SARS appears to be from 2 to 14 days. How is SARS spread? SARS appears to be spread by close contact with ill persons. Close contact means caring for, living with, or having face-to-face (within one metre) or direct contact with a person who has SARS or with secretions from his or her nose, mouth, or throat or other bodily fluids. This may occur through the air when an infected person coughs or sneezes near another person. Viruses. may be spread through saliva, usually by kissing or by sharing food, drinking glasses, cigarettes, or other items that have contacted the mouth of a person with the infection. The World Health Organization reports that SARS is not highly contagious when protective measures are used and the percentage of cases that have been fatal is low (about 5%). OCCUPATIONAL HEALTH & SAFETY MANAGEMENT SYSTEM Severe Acute Respiratory Syndrome POLICY & PROCEDURES MANUAL SARS.02 NEW 05/03 What is the treatment According to the World Health Organization, at this time no drug can for SARS? Be recommended for prevention or treatment. Antibiotics do not appear to be effective. Patients with SARS are treated for their symptoms. How could persons be Individuals who may be at risk of exposure to SARS are those who exposed to SARS? Have recently travelled to high-risk sites (China – Guangdong Province and Hong Kong; Vietnam – Hanoi; and Singapore). These individuals should monitor their health for 14 days following their departure from these areas. Should they experience a high fever and one or more of the following respiratory symptoms – cough, shortness of breath or difficulty breathing – medical advice should be sought as soon as possible. If as an employer you become aware that an individual at the work site meets these criteria, you must instruct that individual to leave the workplace and to seek medical advice. Note: the ill person should call ahead to his or her personal physician to arrange a consultation, not go to the physician's office before calling. Workers may be exposed to the risk of SARS if they come in close contact with individuals at work who are ill with SARS. To date, the majority of SARS cases are hospital workers who have cared for SARS patients. Infection and Transmission It would appear that SARS is less infectious than influenza. Evidence to date has shown that close personal contact with an infected person is generally needed for the infective agent to spread from one person to another. Contact with exhaled droplets and bodily secretions from an infected person seem to be important. However, there is no evidence of general airborne transmission. Most cases so far have occurred in hospital workers who have cared for SARS patients and the close family members of these patients. Other modes of transmission, possibly an oral-faecal route, may be operating in Hong Kong and this is currently under investigation by experts. The incubation period is short and thought to be in the range of 2 to 10 days, with 3-5 days being more common. The transmission risk is very low during the incubation period when the infected person does not display any symptoms of SARS. Virus particles are viable for only 2~4 hours outside the body, and thus articles arriving from affected areas pose no risk to those who handle them in Australia. OCCUPATIONAL HEALTH & SAFETY MANAGEMENT SYSTEM Severe Acute Respiratory Syndrome POLICY & PROCEDURES MANUAL SARS.03 NEW 05/03 Where can up-to-date Various web locations around the world are the best source of “up to information on SARS be minute” information of the SARS situation: located? World Health Organization: http://www.who.int/csr/sars/en/ Government of Hong Kong (Chinese language): http://www.info.gov.hk/dh/new/index.htm Australian Department of Health & Aging: http://www.health.gov.au/sars NSW Department of Health SARS Updates: http://www.health.nsw.gov.au/public- health/alerts/sars/sars_desn.html National Occupational Health & Safety Commission (NOHSC): http://www.nohsc.gov.au/OHSInformation/SARS/default.asp OH&S Regulations & SARS All Occupational Health & Safety (OH&S) legislation throughout Australia and its territories requires the employer to provide safe and healthy workplaces; and where hazards are known to protect employees from those hazards. These responsibilities are absolute; that should always be remembered. SARS & Risk Assessment The following guidelines are based upon information available as at 30/4/03. As further evidence and guidance becomes available this procedure shall be amended in accordance with the state of knowledge at the time. At the present time the primary sources of information as regards SARS management is the United States Center for Disease Control (CDC), the World Health Organisation (WHO) and various national health management bodies. Whilst it is clear that SARS is an “unknown organism” with no remedial treatment path identified it would not appear to be an “easy” illness to personally attract. That is not to say it may not undergo further metamorphosis in the future. What is “occupational The definition of "occupational exposure" applies to all workers exposure” to SARS? who could reasonably be anticipated to be at risk of harmful contact with bloodborne pathogens, or other potentially biohazardous materials, as a result of performing their regular or assigned job duties. At the present time the CDC identifies a number of specific occupational groupings that are at greater risk of attracting the SARS virus. These are:- Employees within Health Care facilities that have had SARS infected patients present. OCCUPATIONAL HEALTH & SAFETY MANAGEMENT SYSTEM Severe Acute Respiratory Syndrome POLICY & PROCEDURES MANUAL SARS.04 NEW 05/03 Employees working within laboratory facilities involved in the diagnosis of SARS infected patients. Employees working within airports and air transit services, eg flight crew, taxi services etc Airport cleaning staff involved in the cleaning of cabins that have housed SARS infected patients. Employees of organisations providing medical transport of SARS infected patients. Employees handling SARS infected patents who have died. SARS and the general work At the present time there are no work restrictions within Australia environment unless you operate within the occupational groupings described above. Whilst there have been some suggestions regarding the use of specific respiratory protection in areas of increased risk; eg airport lounges etc such has not been, as yet, seen to be necessary or appropriate within the general workplace. It is better to remain vigilant as regards persons with flu like symptoms and to practice appropriate infection control procedures as such occurs. It would be appropriate to remove such person from the workplace until, such time as they have been appropriately assessed medically. If the person has visited any known SARS infected communities then a period of “isolation” for approximately ten (10) days has been recommended. CDC recommendations to The CDC has developed interim infection control recommendations prevent transmission of SARS for patients with suspected SARS in the household. The basic in households? precautions include the following: • Infection control precautions should be continued for SARS patients for 10 days after respiratory symptoms and fever are gone. SARS patients should limit interactions outside the home and should not go to work, school, out-of-home day care, or other public areas during the 10-day period. • During this 10-day period, all members of the household with a SARS patient should carefully follow recommendations for hand hygiene, such as frequent hand washing or the use of alcohol-based hand rubs. • Each patient with SARS should cover his or her mouth and nose with a tissue before sneezing or coughing. If possible, a person recovering from SARS should wear a surgical mask during close contact with uninfected persons. If the patient is unable to wear a surgical mask, other people in the home should wear one when in close contact with the patient. • Disposable gloves should be considered for any contact with body fluids from a SARS patient. However, immediately after activities involving contact with body fluids, gloves should be removed and discarded, and hands should be washed. Gloves should not be washed or reused, and are not intended to replace proper hand hygiene. • SARS patients should avoid sharing eating utensils, towels, and bedding with other members of the household, although these items can be used by others after routine cleaning, such OCCUPATIONAL HEALTH & SAFETY MANAGEMENT SYSTEM Severe Acute Respiratory Syndrome POLICY & PROCEDURES MANUAL SARS.05 NEW 05/03 as washing or laundering with soap and hot water. Corona viruses (the family to which SARS belongs) can survive in the environment for as long as three hours. • Common household cleaners are sufficient for disinfecting toilets, sinks, and other surfaces touched by patients with SARS, but the cleaners must be used frequently. Other members of the household need not restrict their outside activities unless they develop symptoms of SARS, such as a fever or respiratory illness. It needs to be remembered there have been no confirmed cases of SARS in Australia although the above infection control procedures make good sense. SARS & Travel In Australia the Department of Foreign Affairs and Trade has issued a number of Travel Advisories as regards how one should approach the issue of travel to SARS infected locations. The best source of current information is to be found at www.dfat.gov.au. Risks from people arriving People arriving in Australia with symptoms suggestive of SARS are in Australia being referred by airline and border authorities for evaluation by health authorities. If the diagnosis of SARS cannot be excluded at the port of entry, any symptomatic person will be referred for specialist diagnosis and treatment, and precautions taken to prevent the possible spread of infection to others. People departing some areas where SARS is being transmitted locally are also subject to screening prior to departure. There have been a very small number (<6) probable cases of SARS detected in Australia so far. Three were all from the same family who arrived in Victoria from Canada and they have since recovered without transmitting the disease to anyone else. One person is currently under investigation for SARS (None of these cases has been confirmed as being SARS as yet). The risk of someone with SARS arriving in Australia without detection is low. The risk of transmission of SARS from such a person to another person is also low, particularly for normal social contact, as there is no evidence of general airborne transmission. No special precautions are required in ordinary social settings in Australia, including most workplaces; the exceptions being health care establishments treating possible SARS cases, as has been indicated via the CDC information. The Commonwealth Department of Health and Ageing has advised that all travellers arriving from affected areas should monitor their health for at least 10 days. Any traveller from such an area who becomes ill with fever, cough or difficulty in breathing should leave work, university or public places and promptly seek medical attention. OCCUPATIONAL HEALTH & SAFETY MANAGEMENT SYSTEM Severe Acute Respiratory Syndrome POLICY & PROCEDURES MANUAL SARS.06 NEW 05/03 The following precautions also apply to travellers from SARS affected areas: Exposure Health Status Action Known contact with probable Active surveillance for 10 days & voluntary Well SARS case in affected area home isolation. Known contact with suspected Passive surveillance for 10 days. Work Well SARS case in affected area restrictions for Health Care Workers. Active surveillance and home isolation for Known contact with probable mild illness; do not work until symptoms or suspected SARS case in Cough or fever have resolved and for at least 10 days after affected area onset of fever. No special precautions unless Health Care Travel or work in affected area Well Worker. Investigate illness; do not until symptoms Fever > 38 C & Travel or work in affected area have resolved and for at least 10 days after cough onset of fever. For more details of the recommended precautions see the Communicable Diseases Network Australia endorsed information. Risks for people currently The risk of contracting SARS for people currently resident in overseas in affected areas affected areas is also low unless the person has been in close contact with someone already ill with SARS. People resident in such areas should take heed of local authority warnings and requirements. Those on non-essential business are advised to consider returning to Australia, where they can expect to be screened by the Australian Authorities on arrival. In the case of those persons who works as “expats” in SARS infected countries who remove themselves from a SARS infected region special consideration needs to be given to the need for their return (i.e. are their duties “business critical”). If not consideration should be given to their continued absence until the situation has stabilised. Travel to affected areas Non-essential travel to affected areas should be postponed for the time being. However, if travel to an affected area is business critical, people should reduce the risk of exposure by avoiding close contact with ill persons. Training/Education should be provided to all persons travelling to SRAS infected areas prior to departure. An excellent source of education in the area of international health is Health Services Australia. Generally, if in a SARS infected area avoidance of crowded situations such as public transport, street markets etc is probably a good precaution to take. Special attention should be given to where one takes their meals; definitely no street vendors. Recognised International Hotel Restaurants are probably more reliable. OCCUPATIONAL HEALTH & SAFETY MANAGEMENT SYSTEM Severe Acute Respiratory Syndrome POLICY & PROCEDURES MANUAL SARS.07 NEW 05/03 Refusal of unsafe work Under Australian Occupational Health and Safety legislation a worker has the right to refuse any work which that person has “reasonable cause to believe …would create an undue hazard to the health and safety of any person.” Should that situation arise, the worker must follow the protocol set out within their particular State guidelines. If an employer requires a worker to work with a known or suspected case of SARS, without providing the appropriate personal protective equipment (PPE) and safe work procedures, then this would clearly constitute a case where there is undue risk to that worker’s health. In many cases employers need to give some consideration to the psychological impact of asking persons to function in an area known to be a source of SARS infection. Legislation encompasses psycho- behavioural hazards as well as those that are physical. It is suggested that if an employee requests a duty transfer die to SARS related concerns arrangement be made for them to receive education from an health adviser. Should they maintain their concern then arrangements should be made for the duty transfer; if such does not case a secondary problem greater than that being presented with. Based on currently available information, there is not an undue hazard to a worker’s health in circumstances where he or she works with other workers or members of the public who are not ill and show no symptoms of SARS, even if those individuals have recently traveled from affected areas in the Far East.
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