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Severe Acute Respiratory Syndrome (SARS)

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Severe Acute Respiratory Syndrome (SARS)

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									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
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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
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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
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                                       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
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                                     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
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                                 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
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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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