Controlling COVID-19 risks in healthcare and social assistance
Information about managing the risk of exposure to COVID-19 in clinical and non-clinical settings, including patient transport.
Background
Employees in the healthcare and social assistance industry have a higher risk of being exposed to COVID-19. This page provides information about managing this risk in clinical and non-clinical settings, including patient transport.
COVID-19
COVID-19 is a respiratory disease caused by a coronavirus (SARS-CoV-2) that can result in mild to very severe illness or death. It can spread through:
- aerosols (very fine particles) breathed in when an infected person does things such as cough, sneeze, talk, shout or sing – the particles can stay in the air for some time, especially in indoor spaces with poor ventilation
- droplets (larger particles) that can directly enter your eyes, nose or mouth when you are in close contact with an infected person who coughs or sneezes
- touching objects or surfaces (such as door handles) contaminated with the COVID-19 virus from settled droplets and aerosols, and then touching your face
For more information about COVID-19 (including symptoms and health effects), go to Coronavirus (COVID-19) Victoria.
Employer 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 (including independent contractors, their employees and labour hire employees)
- provide and maintain plant or systems of work that are safe and without risks to the health of employees
- make arrangements for ensuring the safety and the absence of risks to health in connection with the use, handling, storage or transport of plant or substances
- maintain each workplace under their management and control in a condition that is safe and without risks to health
- provide adequate facilities for the welfare of employees
- monitor the health of their employees
- monitor conditions at any workplace under their management and control
- provide information concerning health and safety to employees, including (where appropriate) in languages other than English
- ensure that people, other than employees, are not exposed to risks to their health or safety from the conduct of the undertaking of the employer
Employers must also provide such information, instruction, training or supervision to employees and independent contractors as is necessary to enable them to perform their work in a way that is safe and without risks to health.
Consult with employees
Employers must consult with employees, independent contractors and any health and safety representatives (HSRs), so far as is reasonably practicable, on matters related to health or safety that directly affect, or are likely to directly affect them. This includes, but not limited to, consultation when:
- identifying or assessing hazards or risks to health or safety at the workplace (including exposure to COVID-19)
- making decisions about the measures to be taken to control risks
- making decisions about the adequacy of facilities for the welfare of employees
- proposing changes to the workplace, plant or substances used at the workplace that may affect the health or safety of employees
Employees must be given a reasonable opportunity to express their views and those views must be considered before a decision is made on health and safety matters.
If there is an agreed procedure for consulting about health and safety matters, the consultation must be done according to those procedures.
Employee duties
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 people 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 or OHS Regulations.
The OHS Act gives HSRs a role in enquiring into anything that poses, or that may pose, a risk to the health or safety and attempt to resolve those OHS issues with the employer. For more information about HSR role and their powers, see:
Identifying risks
Employers must identify the level of risk to the health of employees from exposure to hazards such as COVID-19 at their workplace, including where care is provided in people's homes. This must be done in consultation with HSRs and employees, so far as is reasonably practicable.
Examples of common situations that place employees at an increased risk of exposure to COVID-19 include:
- providing care in close contact to people suspected or confirmed to be infected with COVID-19
- undertaking aerosol generating procedures or being around clients that display aerosol generating behaviours such as yelling, screaming or crying
- working in areas where control measures such as screening or testing may not be practical (for example, emergency services or emergency departments)
- working in areas (or communities) during an outbreak or elevated cases in community
Managing the risk
Employers have a duty to control risks to an employee's health and safety in the workplace. This includes identifying and assessing the risk of exposure to COVID-19.
Where there is a risk to health, employers must, so far as is reasonably practicable, eliminate the risk. If it is not reasonably practicable to eliminate the risk, the risk must be reduced, so far as is reasonably practicable. This must be done in consultation with HSRs and employees, so far as is reasonably practicable. The risk assessment should call on expert advice when needed.
Use the hierarchy of control to identify and implement the highest order of control. In many cases several control measures may need to be implemented to reduce the risk, so far as reasonably practicable.
Employers must ensure that employees receive the necessary information, instruction, training or supervision to enable them to do their jobs safely, this includes for any risk controls that are implemented.
Hierarchy of control
- Eliminate hazards and risks – highest level of protection and most effective control
Eliminating the hazard and the risk it creates is the most effective control measure. - Reduce the risk with one or more of the following controls:
- Substitution – substitute the risks with lesser risks.
- Isolation – isolate people from the risks.
- Engineering – reduce the risks through engineering changes.
- Administrative controls – Low level protection and less reliable control
Use administration actions to minimise exposure to hazards and reduce the level of harm. - Personal protective equipment (PPE) – Lowest level of protection and least reliable control.
Monitor and review risk controls
The risk of exposure to COVID-19 in the workplace can vary due to outbreaks or increased cases circulating in the community. Frequently monitor the local environment and risk to health with a risk assessment and adjust controls as necessary to manage the risk.
Adjusting controls can include, isolation (zoning) of high impacted areas, increased fresh air and air changes to impacted areas and broader use of respiratory protection.
Review risk control measures:
- at regular intervals
- when new information becomes available
- when there are changes in the work environment, work tasks or in the workload
- when an employee or HSR feedback indicates risk control measures are ineffective or not as effective as they should be
- when an HSR or health and safety committee requests a review
- after an incident or near miss, for example, after an outbreak in the workplace
- Elimination
- Offer alternative methods of service delivery including virtual meetings or telehealth, to reduce the need for direct contact and opportunities for exposure.
- For clients who are suspected or confirmed with COVID-19, consider if it is clinically necessary for them to attend the workplace for services, (for example diagnostic appointments or admission) or if they can be offered an alternative time or service.
- Reduce the number of visitors and keep non-essential staff to a minimum, where appropriate.
- Isolation
- Use negative pressure rooms with an anteroom for COVID-19 positive patients, where available.
- Use dedicated wards/areas to isolate people with suspected or confirmed COVID-19 where negative pressure rooms are not available.
- Where practical, allocate infected people to individual rooms with ensuites.
- Provide additional physical spaces to encourage physical distancing and for workers to take breaks, get changed or for donning/doffing PPE.
- Alter the work environment and consider zoning to prevent unnecessary interactions with people who are suspected or confirmed with COVID-19 infection, such as dedicated entry and exit points or paths of travel that minimise contact.
- Provide employees who are more vulnerable to COVID-19 exposure (such as, those who have risk factors for increased severity of illness) with opportunities to work in lower risk settings, where possible.
- Engineering
The physical environment can affect the likelihood of workplace exposure. In high risk workplace settings higher levels of protection may need to be provided. Measures that may reduce the risk include:
Ventilation
Maximising the amount of fresh air (ventilation) supplied to high-risk areas in workplaces (for example, enclosed areas) can help dilute the number of airborne virus particles and lower the risk of exposure.
Improving ventilation alone does not reduce the risk of exposure. It needs to be considered as part of a suite of infection control measures.
Maximising the amount of fresh air can be achieved using natural or mechanical ventilation, or a combination of the two.
- Natural ventilation is fresh air coming in through open windows, doors or air vents.
- Mechanical ventilation is a method of forced or induced ventilation using mechanical air-handling systems that bring in fresh air from outside. It forms part of a building' heating, ventilation and air conditioning (HVAC) system.
Better ventilation can be achieved by:
- increasing the rate that air is supplied
- increasing the supply of fresh outdoor air
- reducing or eliminating recirculated air in HVAC systems
- improving filtration for air recirculated by HVAC systems if the ventilation rate is not compromised
- regularly maintaining the HVAC system, including changing filters
Employers should assess the risk and/or undertake a ventilation assessment to identify what ventilation strategies are appropriate for the space and whether an air cleaner is needed (and consider operational placement and maintenance of these units).
Employers should work with the building's owner or manager to improve ventilation where possible. Engaging a suitably qualified person such as an occupational hygienist or a ventilation engineer to advise and assist should also be considered.
Where the risk assessment has identified the need for further improvements, but the ventilation system cannot be further improved, filtered air cleaners should be considered and implemented where practicable.
Filtered air cleaners
In areas where it is not possible to maintain ventilation and there is a high risk of transmission, portable high-efficiency particulate air (HEPA) filtered air cleaners may help reduce the concentration of airborne virus particles and other aerosol contaminants.
Note: These units are not a substitute for ventilation.
For more information about ventilation, see:
- Coronavirus.vic.gov.au/ventilation
- Department of Health IPC ventilation policy
- Australian Standard 1668.2:2012 - The use of ventilation and air-conditioning in buildings, Part 2: Mechanical ventilation in buildings.
- World Health Organisation (WHO) - Roadmap to improve and ensure good indoor ventilation in the context of COVID-19
Facilities
- Provide additional physical spaces to encourage physical distancing and for workers to take breaks, get changed or for donning/doffing PPE.
- Alter the work environment and consider zoning to prevent unnecessary interactions with people that are suspected or confirmed COVID-19 infection, such as dedicated entry and exit points or paths of travel that minimise contact.
- Provide adequate facilities for hand hygiene, waste management and disposal of contaminated PPE.
Design
When designing new facilities or modifying them, designers should consider designing out and/or further reducing the risks through engineering controls, such as:
- increasing the number of negative pressure isolation rooms and bays in departments with increased risk of exposure, such as emergency departments and wards
- improving the natural air flow through the facility and/or improving the ventilation systems
- increasing the number of work areas and employee amenities to accommodate required employees
For further information on ventilation see:
Covid-19 infection prevention control guidelines - Ventilation
- Administrative controls
Work Systems
Work systems and procedures are administrative controls and should form part of any risk control strategy. Administrative controls are insufficient on their own to reduce the risk. Where reasonably practicable, they should form part of a suite of controls and should be used with physical work modifications.
Examples of work systems include:
- Implementing policies and information to support employees, visitors or contractors to stay away from the workplace when unwell with symptoms.
- Screening or testing people using Rapid Antigen Testing to identify asymptomatic COVID-19 infections prior to attending workplace (for example, pre-admissions or visitors).
- Regularly monitoring people for symptoms of COVID-19 to aid in early identification and appropriate risk controls.
- Implementing outbreak management plans that include business continuity planning, management of employee absenteeism, surge workforce planning and induction and training requirements for any new or redeployed employees.
- Installing signs advising of suspected or confirmed COVID-19 infections on doors/entry points to wards and rooms.
- Increasing environmental cleaning and waste disposal when transmission risk is elevated (for example, in outbreak situations).
- Ensuring employees take regular rest breaks and have access to safe and clean facilities, including hydration, for rest breaks.
- Rostering and grouping employees to limit interactions between those known to be infectious and other people.
- Using single-use or dedicated medical and manual handling equipment (for example slings) for suspected or confirmed cases and dispose/disinfect after use.
- Providing, supporting and maintaining records for vaccination of respiratory viruses including COVID-19 and influenza.
- Personal Protective Equipment (PPE)
PPE, including Respiratory Protective Equipment (RPE) is the lowest order of control. PPE should always be used in combination with other reasonably practicable control measures to reduce the risk of exposure to COVID-19.
Where PPE is required, including RPE, to further reduce the risk the employers need to:
- provide PPE that is appropriate for the level of risk associated with the task and the work environment
- ensure PPE is fitted, used and stored in accordance with the manufacturer's instructions
- ensure PPE supplies are available for the employees
RPE
Where RPE is required, employers should implement a Respiratory Protection Program (RPP) that includes selection of an appropriate N95/P2 respirator, fit testing and training on the use, storage and maintenance of respirators.
For more information on RPPs see:
- Australian/New Zealand Standard on 'Selection, use and maintenance of respiratory protective equipment (AS/NZS 1715:2009).
- Managing COVID-19 risks: Healthcare and social assistance industry – Respiratory Protective Equipment (RPE).
Surgical masks
Surgical masks do not prevent exposure to aerosols. To reduce the risk of people exposing others to COVID-19 surgical masks can be used to:
- prevent the wearer expelling large droplets
- work as a barrier to protect the wearer from fluid splashes and inhaling larger respiratory droplets
- help reduce exhaled droplets from contaminating sterile environments
Note: Homemade PPE, for example cloth masks, are not recommended for health care employees for the prevention of exposure to COVID-19.
- Vaccinations
COVID-19 vaccination is one control measure that can reduce the risk to health from COVID-19 in workplaces. This should be part of a suite of controls used to reduce the risk of exposure to COVID-19 in workplaces.
Information, instruction, and training
Employers must provide such information, instruction, training or supervision to employees and independent contractors, as is necessary, to enable them to perform their work in a way that is safe and without risks to health. This can include:
- Ensuring employees understand the risk controls in place to prevent and manage the risk of exposure to COVID-19 in their workplace. For example, how to safely handle, transport and disinfect potentially contaminated clothing and items used at work such as shoes, phones, identity badges.
- Ensuring employees understand the risk controls in place to prevent and manage the risk of exposure to COVID-19 in their workplace. For example, how to safely handle, transport and disinfect potentially contaminated clothing and items used at work such as shoes, phones, identity badges.
- Ensuring employees have ready access to information, instruction and any supporting process/procedures. For example, processes and procedures for implementing outbreak management plans.
- Providing updated information to all employees, including employees working at other locations, those on leave, contractors and labour hire or casual employees.
- Providing information in a format and language that employees can readily understand.
- Ensuring that employees know what to do, or who to notify if they feel unwell or suspect they have been exposed or infected, including information on furloughing and exclusion from the workplace.
- Informing employees of any altered expectations and working conditions to reduce the risk of COVID-19 infections.
- Providing education on risk reduction behaviours (for example physical distancing, hand hygiene).
Further information
External
WorkSafe Advisory Service
WorkSafe's advisory service is available between 7:30am and 6:30pm Monday to Friday. If you need more support, you can also contact WorkSafe using the Translating and Interpreting Service (TIS National) or the National Relay Service.
