Prevention and management of exposure to coronavirus (COVID-19) in the healthcare and social assistance industry

Information about managing the risk of exposure to coronavirus (COVID-19) in clinical and non-clinical settings, including patient transport.

Directions and industry requirements are regularly updated

This guidance is correct as at time of publication, however, Victorian Chief Health Officer (CHO) Directions and industry requirements are regularly updated. Readers of this guidance need to check the latest CHO Directions for applicability.

Restrictions apply across Victoria

Depending on your industry your workplace may:

  • be required to be closed for on-site work
  • remain open for on-site work with a completed COVIDSafe Plan in place
  • be subject to restricted operations or industry specific obligations.

Every Victorian business must have a COVIDSafe Plan.

These restrictions may be updated at any time. You must stay up to date with any changes for your industry.

How are my occupational health and safety (OHS) obligations impacted by the restrictions?

There is no change to your obligations under the Occupational Health and Safety Act 2004 (OHS Act) and Occupational Health and Safety Regulations 2017 (OHS Regulations) as a result of the restrictions.

Preparation of a COVIDSafe Plan forms part of the development of a safe system of work. However having a COVIDSafe Plan and complying with directions issued by the Victorian Chief Health Officer (CHO) does not necessarily mean you have complied with your duties under the OHS Act and OHS Regulations.

You must follow any health directions that apply to how your business must operate, and ensure that you are meeting your obligations under the OHS Act. Employees must also comply with their duties under the OHS Act.

Background

Employees in the healthcare and social assistance industry have a higher risk of being exposed to coronavirus (COVID-19). These employees are likely to come into close contact with patients, clients and residents in facilities (eg hospitals, care facilities, clinics) and in people's homes, and often work in environments with other employees (rather than alone).

Employers have a duty to provide and maintain, so far as is reasonably practicable, a working environment that is safe and without risks to the health of employees. This includes preventing risks to health (including psychological health) and safety associated with potential exposure to coronavirus (COVID-19).

Employees have a duty to take reasonable care of their own and others health and safety in the workplace and cooperate with their employers about any action they take to comply with the OHS Act or Regulations.

More information about employer and employee obligations is set in the Legal duties section below.

Transmission of coronavirus (COVID-19)

Evidence to date suggests that coronavirus (COVID-19) is primarily spread when an infected person is in close contact with another person. Coronavirus (COVID-19) may be transmitted between people through:

  • Droplet transmission, when respiratory droplets from coughing, sneezing or talking are transmitted from an infected person directly onto the mucosal surfaces (eyes, nose, mouth) of another person.
  • Contact transmission through touching surfaces contaminated with infected droplets, and then touching the eyes, nose or mouth.
  • Airborne transmission, which is exposure to very fine droplets that are suspended in the air. The extent to which COVID-19 spreads via this route is still being researched but it is much more likely in certain circumstances such as during aerosol generating procedures in healthcare settings and potentially during singing and shouting in any setting. The risk of aerosol transmission may be higher in poorly ventilated, enclosed environments.

Identifying risks to health in the healthcare and social assistance industry

Employers must identify the level of risk to the health of employees from exposure to coronavirus (COVID-19) at their workplace, including where care is provided in people's homes. This must be done in consultation with health and safety representatives (HSRs) and employees, so far as is reasonably practicable.

Employees are at risk of exposure to coronavirus (COVID-19) infection if they have contact with people (including other employees) with suspected or confirmed coronavirus (COVID-19) infections.

For definitions of suspected and confirmed coronavirus (COVID-19) infections see

Some activities in healthcare and social assistance workplaces that may pose a risk of exposure to coronavirus (COVID-19) include:

  • Providing direct care or support to people with suspected or confirmed coronavirus (COVID-19) infections.
    • Performing aerosol-generating procedures (AGPs) on people with suspected or confirmed coronavirus (COVID-19) infections.
      • Interacting with people with suspected or confirmed coronavirus (COVID-19) infections with aerosol generating behaviours (eg screaming, shouting).
        • Interacting with people from areas with elevated community transmission (eg patients presenting to emergency departments or clinics).
          • Handling of contaminated waste or personal protective equipment (PPE) which has been used by staff caring for people with suspected or confirmed coronavirus (COVID-19) infections.
            • Transporting people with suspected or confirmed coronavirus (COVID-19) infections in vehicles.
              • Cleaning medical equipment that has been used on people with suspected or confirmed coronavirus (COVID-19) infections.
                • Touching or cleaning cutlery, dishes or other objects used by people with suspected or confirmed coronavirus (COVID-19) infections.
                  • Cleaning rooms and public areas used by people with suspected or confirmed coronavirus (COVID-19) infections.
                    • Collecting respiratory samples from people with suspected or confirmed coronavirus (COVID-19) infections.
                      • Reception tasks which involve interactions with people with suspected or confirmed coronavirus (COVID-19) infections.
                        • Interacting (eg. in communal areas, shared vehicles or in personal time) with other employees who work with patients with coronavirus (COVID-19) infections or who live in an area where community prevalence is elevated.
                          • Touching objects or surfaces touched by other employees who work with patients with coronavirus (COVID-19) infections or who live in an area where community prevalence is elevated.

                            Employers must also identify whether there are other increased risks at a workplace as a result of coronavirus (COVID-19), including:

                            • Occupational violence and aggression in the workplace (eg due to poor front-line management, rapidly changing information, increased workload, implementation of government restrictions and public fears).
                              • Fatigue (eg as a result of increased workload, inadequate staffing levels, additional or longer shift lengths and other pressures) which may impact on compliance with procedures and training.
                                • Stress (eg as a result of vicarious trauma, increased workload and ongoing heightened levels of concentration).
                                  • The availability of supplies, such as PPE or cleaning equipment.
                                    • The impact of long term wearing of PPE including respiratory protection (eg pressure injuries and other detrimental effects)
                                      • The appropriateness of particular types of PPE to the environment it is to be used in (eg entering patients' homes, treating patients on the floor of a residence, working outdoors).
                                        • Workforce and skills shortages.
                                          • Home visits where the coronavirus (COVID-19) status of the patient and/or family members may be unknown.

                                            Controlling risks to health

                                            Where a risk to health, including psychological health, is identified at a workplace, employers must, so far as is reasonably practicable, eliminate the risk. Where it isn't possible to eliminate the risk, it must be controlled, so far as is reasonably practicable.

                                            Employers also have a duty to consult with employees and health and safety representatives (HSRs) (if any), on matters related to health or safety that directly affect, or are likely to directly affect them.

                                            This includes consultation on identifying hazards or risks, and decisions about how to control risks associated with coronavirus (COVID-19).

                                            The types of control measures required depends on the level of risk as well as the availability and suitability of controls for each workplace, including individual work areas.

                                            Specific control measures could include:

                                            Facility management systems of work

                                            • Preventing contact with people with suspected or confirmed coronavirus (COVID-19) infection by changing work practices where it does not impact on the quality of care delivery (eg preliminary phone screening to triage to an appropriate facility, telehealth, virtual consultations, working from home where possible).
                                              • Changing the work environment to prevent unnecessary contact with people with suspected or confirmed coronavirus (COVID-19) infection (eg Perspex barriers at reception areas, designated areas, entry and exit points for people with suspected or confirmed coronavirus (COVID-19)).
                                                • Using dedicated wards or areas of facilities to isolate people with suspected or confirmed coronavirus (COVID-19) infections.
                                                  • Screening employees, contractors and visitors for symptoms prior to entering the facility. Note that under the Care Facilities Directions and Hospital Visitor Directions, certain persons must not be permitted to enter these settings (eg those with a fever or other symptoms of COVID-19)
                                                    • Asymptomatic testing of workers, when indicated by the Department of Health and Human Services (DHHS), to aid in early detection of coronavirus (COVID-19) infection.
                                                      • Screening people directly prior to appointments or admission to identify suspected coronavirus (COVID-19) infections.
                                                        • Asymptomatic testing of people, when indicated by DHHS, prior to admission to aid in early detection of coronavirus (COVID-19) infection.
                                                          • Regularly monitoring patients, residents or clients for symptoms of coronavirus (COVID-19), particularly when community prevalence is elevated.
                                                            • Ensuring that systems are in place to prevent fatigue and workload issues due to a surge in demand or staff on leave .
                                                              • Limiting movement of people with suspected or confirmed coronavirus (COVID-19) within a facility to essential purposes only.
                                                                • Regular cleaning and disinfection of workplaces, as per DHHS guidelines.

                                                                  Ventilation

                                                                  Reducing or eliminating recirculation of air and increasing the use of outdoor air of heating ventilation and air conditioning (HVAC) systems can help to reduce the risk of transmission of coronavirus (COVID-19). Air conditioning and ventilation systems that are well-maintained and operated should not increase the risk of virus transmission. All air conditioning and ventilation systems should be regularly inspected, maintained and cleaned.

                                                                  One or more of the following approaches may be selected to improve ventilation depending on the setting:

                                                                  • avoid air recirculation and increase the volume of outside air; the ratio of outdoor air to indoor air should be greater than 40%
                                                                    • increase the number of air changes per hour to more than 6 air changes per hour (ACH)*
                                                                      • in indoor environments where infectious people are likely to be present, a higher air exchange rate of between 6 and 12 ACH of outside or clean air is recommended*
                                                                        • keeping the heating, ventilation and air conditioning (HVAC) system running longer hours
                                                                          • checking filters to ensure they are within service life and appropriately installed
                                                                            • installing enhanced filtration in central HVAC systems
                                                                              • using stand alone “off-the-shelf” high-efficiency particulate air (HEPA) filtered air cleaners that are either ceiling-mounted or portable. These can reduce concentration and residence time of infectious aerosols which can substantially decrease an individual’s likelihood of inhaling an infectious dose*
                                                                                • opening external windows to provide fresh air in homecare environments

                                                                                  *Reference: 

                                                                                  Standard single rooms (where the door can be closed) or negative pressure ventilation rooms are effective in reducing transmission of coronavirus (COVID-19) virus when performing AGPs on patients with suspected or confirmed coronavirus (COVID-19) infection, when used as per DHHS guidelines.

                                                                                  Note that fans may alter the directed airflow pattern and may result in microorganism transmission and possible infection. For further information see DHHS: Coronavirus (COVID-19) transmission from air-circulating, wind-blowing devices and activities

                                                                                  Rostering and cohorting

                                                                                  • Minimising the risk of cross-infection by limiting contact between teams caring for people with suspected or confirmed coronavirus (COVID-19) infections (eg rostering, separate break rooms, change areas, bathrooms).
                                                                                    • Ensuring that employees are only working at a single facility where practical and keeping records and managing the risks of those who do need to work across sites.
                                                                                      • Allocating employees to work in a single ward or area when community prevalence of coronavirus (COVID-19) is elevated.
                                                                                        • Rostering employees to consistently work on the same shifts and avoiding interaction between staff at shift changeover times by staggering shifts when community prevalence is elevated.
                                                                                          • Consistently allocating patients or clients to the same employee for each shift when community prevalence is elevated.
                                                                                            • Revising staff and client activity rosters to stagger numbers of people in work settings to create more room for physical distancing.

                                                                                              Directions from the Chief Health Officer impose additional restrictions on rostering and cohorting for care facilities and high risk settings within hospitals. More information is available on the DHHS website:

                                                                                              Ward/office management systems of work

                                                                                              • Limiting access to wards with suspected or confirmed coronavirus (COVID-19) infection to only those staff working in that area (eg key pass or code).
                                                                                                • Allocating people with suspected or confirmed coronavirus (COVID-19) infections to a single room with ensuite where possible.
                                                                                                  • Doors to rooms of people with suspected or confirmed coronavirus (COVID-19) infections should remain closed, as per DHHS infection control guidelines.
                                                                                                    • Installing signs advising of suspected or confirmed coronavirus (COVID-19) infections on doors/entry points to wards and rooms.
                                                                                                      • Following DHHS guidance regarding showering or toileting people with suspected or confirmed coronavirus (COVID-19) infections.
                                                                                                        • Medical and manual handling equipment (eg slings) used on people with confirmed or suspected coronavirus (COVID-19) infections should be dedicated and remain in rooms, or cleaned and disinfected after each use as per DHHS Infection prevention and control guidelines.
                                                                                                          • Consistently applying physical distancing measures in all workplace settings, including clinical and non-clinical settings, during handovers, outreach, home visits and welfare checks.
                                                                                                            • Splitting teams for critical functions, where remote work is not possible.
                                                                                                              • Minimising shared use of phones, desks, offices, kitchens or other work tools and equipment (or, in cases where this is not practicable, ensure surfaces are cleaned between use). Cleaning needs to be conducted in line with DHHS Infection control guidelines.

                                                                                                                Facilities and communal areas

                                                                                                                • Ensuring employees take regular rest breaks and have access to safe and clean facilities for rest breaks.
                                                                                                                  • Cleaning high touch surfaces in line with DHHS Infection control guidelines.
                                                                                                                    • Providing hand hygiene facilities (eg hand wash stations with soap and hand towels, hand sanitiser with over 60 per cent alcohol).
                                                                                                                      • Providing information, instruction and training on hand hygiene, and monitoring compliance.
                                                                                                                        • Ensuring physical distancing can be maintained in common areas (eg break rooms, offices, meeting rooms, bathrooms, change rooms).
                                                                                                                          • Using video conferencing for teaching and departmental meetings where practical.
                                                                                                                            • Providing employees with time to wash up and change their clothes prior to the end of their shift.

                                                                                                                              For additional information, see DHHS resources on safe staff amenities.

                                                                                                                              PPE and clothing

                                                                                                                              • Having a respiratory protection program in place for anyone required to wear a N95/P2 respirator that includes selection of a N95/P2 respirator that is appropriate for tasks, correct size and fit testing, and training on the use, storage and maintenance of respirators. More information on respiratory protection programs can be found in the Australian/New Zealand Standard on 'Selection, use and maintenance of respiratory protective equipment' (AS/NZS 1715:2009) and DHHS Respiratory Protection Program guidelines.
                                                                                                                                • Providing PPE that is appropriate for the level of risk associated with the task, in accordance with guidance from DHHS.
                                                                                                                                  • Providing information, instruction and training on why PPE is required, how to safely fit and use it, how to safely remove and how to dispose of it in accordance with DHHS guidance.
                                                                                                                                    • Regularly communicating with staff about the availability of PPE (eg stock levels).
                                                                                                                                      • Providing adequate breaks where employees can remove their PPE and rehydrate. A donning and doffing station should be set in up outside or within the break area to support correct use of PPE.
                                                                                                                                        • Eliminating specific brands of respiratory protection that cause pressure injuries from the supply chain where practicable.
                                                                                                                                          • Providing information, instruction and training on preventing pressure injuries and other detrimental effects from wearing respiratory protection (see DHHS guidance relating to extended respirator use)
                                                                                                                                            • Ensuring any provided PPE is practical for the work environment.
                                                                                                                                              • Appropriate waste management systems, including for the safe disposal of contaminated PPE.
                                                                                                                                                • Providing adequate facilities for employees to safely remove and dispose of PPE and contaminated clothing.
                                                                                                                                                  • Providing clothing for employees to wear at work, or asking employees to bring a change of clothes, to reduce risk of cross-contamination of clothing during travel and at home and reduce the risk of occupational violence when commuting.

                                                                                                                                                    Communications and employee welfare

                                                                                                                                                    • Consulting with HSRs and employees to obtain their input to any proposed changes to prevent and manage the risk of exposure to coronavirus (COVID-19).
                                                                                                                                                      • Ensuring that employees understand the risk controls in place to prevent and manage the risk of exposure to coronavirus (COVID-19) in their workplace, and have ready access to the COVIDSafe Plan.
                                                                                                                                                        • Ensuring that employees know what to do, or who to notify if they feel unsafe or uncomfortable in the workplace.
                                                                                                                                                          • Ensuring that employees know what to do, or who to notify if they feel unwell or suspect they have been infected, according to information about coronavirus (COVID-19) provided by DHHS.
                                                                                                                                                            • Communicating any altered expectations and working conditions to patients, clients and visitors to reduce the risk of coronavirus (COVID-19) infection to employees.
                                                                                                                                                              • Providing information in a format and languages that employees can readily understand.
                                                                                                                                                                • Ensuring employees who are considered to be vulnerable (ie have risk factors for increased severity of illness) in relation to coronavirus (COVID-19) exposure are provided with opportunities to work in lower risk settings where possible and in accordance with DHHS’s recommendations for vulnerable workers.
                                                                                                                                                                  • Providing updated information to all employees, including employees on leave, contractors and casual workers.
                                                                                                                                                                    • Ensuring that employees know how to handle, transport and disinfect potentially contaminated clothing and items used at work (eg shoes, phones, identity badges).
                                                                                                                                                                      • Providing education on staff risk reduction behaviours when in the community (eg social distancing, hand hygiene).

                                                                                                                                                                        Working from locations other than the usual place of work

                                                                                                                                                                        In some circumstances, employers may require employees or contractors to work from a location other than their usual place of work to reduce the risk of transmission or address changes in service demands relating to coronavirus (COVID-19). This includes working from home, working in a different area, newly established clinics, improvised hospitals, contingency units, changes in home-based care or providing support to other employers.

                                                                                                                                                                        When making decisions about whether employees should work from a different location, employers must consult with employees and HSRs (if any) and must ensure that so far as reasonably practicable the working environment is safe and without risks to the health of employees. Employers should also:

                                                                                                                                                                        • Ensure that an adequate induction and context-specific training is provided in the new work environment, including infection prevention training.
                                                                                                                                                                          • Ensure that support systems are in place for PPE, IT, equipment and personal needs.
                                                                                                                                                                            • Consider whether an employee is vulnerable (ie have risk factors for increased severity of illness), in relation to contracting coronavirus (COVID-19), or high risk of experiencing associated complications, before deploying them to an area of high exposure risk. Employees should also consult their treating medical practitioner in this instance.
                                                                                                                                                                              • Consider whether working from a different location will introduce additional risks, such as risks associated with hazardous manual handling or psychological risks associated with isolation.
                                                                                                                                                                                • Establish communication systems for providing information to employees about working arrangements.
                                                                                                                                                                                  • Ensure that working hours are monitored and flexible, where possible.
                                                                                                                                                                                    • Ensure that accommodation provided for employees is safe, and minimises the risk of cross-infection among staff.
                                                                                                                                                                                      • Ensure that transport arrangements minimise the risk of cross-infection among staff.

                                                                                                                                                                                        Notifiable incidents and coronavirus (COVID-19)

                                                                                                                                                                                        From 28 July 2020 new temporary regulations under the Occupational Health and Safety Act 2004 specify when employers and self-employed persons must notify WorkSafe of a confirmed diagnosis of coronavirus (COVID-19) in the workplace. For more information see the guidance Notifiable incidents involving coronavirus (COVID-19).

                                                                                                                                                                                        Legal duties

                                                                                                                                                                                        Employers have duties under the Occupational Health and Safety Act 2004 (OHS Act), which include that they must, so far as is reasonably practicable:

                                                                                                                                                                                        • Provide and maintain a working environment that is safe and without risks to the health of employees and independent contractors.
                                                                                                                                                                                          • Provide adequate facilities for the welfare of employees and independent contractors.
                                                                                                                                                                                            • Provide such information, instruction, training or supervision to employees and independent contractors as is necessary to enable those persons to perform their work in a way that is safe and without risks to health.
                                                                                                                                                                                              • Monitor the health of employees of the employer.
                                                                                                                                                                                                • Monitor conditions at any workplace under the employer's management and control.
                                                                                                                                                                                                  • Provide information concerning health and safety to employees, including (where appropriate) in languages other than English.
                                                                                                                                                                                                    • Ensure that persons other than employees of the employer are not exposed to risks to their health or safety arising from the conduct of the undertaking of the employer. Consult with employees and HSRs (if any), on matters related to health or safety that directly affect, or are likely to directly affect them.

                                                                                                                                                                                                      A person with management or control of a workplace must ensure, so far as is reasonably practicable, that the workplace and the means of entering and leaving it are safe and without risks to health.

                                                                                                                                                                                                      Employees also have duties under the OHS Act, which includes that they must:

                                                                                                                                                                                                      • Take reasonable care for their own health and safety and that of persons who may be affected by the employee's acts or omissions at a workplace.
                                                                                                                                                                                                        • Co-operate with their employer with respect to any action taken by the employer to comply with a requirement imposed by or under the OHS Act.

                                                                                                                                                                                                          The OHS Act gives HSRs a role in raising and resolving any OHS issues with their employer, and powers to take issues further if necessary.