GVMA TOWN HALL ON Pandemic Workplace Safety (10/28/2020)

Pandemic Workplace Safety Town Hall

(edited for clarity and brevity)

Laura Smallwood, DVM, DACVIM (SAIM) (Wellness Committee Chair)

Recommended Measures to Prevent Workplace Transmission of COVID-19:

  • Masks- always/everyone
  • Physical Distancing- every opportunity
  • Hand Hygiene- know when and how; make it easy
  • Surface Sanitation- know when and how; make it easy

Leadership Responsibilities:

  • Provide Clear and Concise Written Safety Directives
  • Make it Easy for People to Comply
  • Model Compliance Yourself
  • Be a Cheerleader for these measures
  • Listen to feedback
  • Pay Attention—identify compliance issues and counter misinformation.

COVID-19 & Workplace SafetyChristine Zurawski, MD, Medical Director for Infection Prevention & Antibiotic Stewardship for Piedmont Hospital

The workplace safeguard we are recommending is for people to wear masks all the time at work. Can speak to this recommendation based on your medical experience?

The way for all your staff to not have to go home because they have all been exposed to COVID-19 is to have people wear masks. The thing that everybody has control of during this pandemic to protect themselves is to wear masks. We have a policy at the hospital that every staff member and patient must wear a mask. Additionally, patients are screened upon entering the building and we call them the day before their appointment to ask if they are feeling okay. If they have a fever, we switch them to a telemedicine visit.

Do you have any first hand experiences of a staff member contracting COVID-19?

Someone who works at our front desk is not working right now because a friend of hers died from COVID-19 and she attended his funeral. She contracted COVID-19 and will be at home until her 10 days of quarantine are completed. None of us at work were considered to have a potential exposure because we are all wearing masks. If all parties are wearing masks the risks on any serious exposures or infection is low. Masks save the workplace from potential exposures and keep everyone at work and doing their jobs.

Breakrooms: We have seen nurse to nurse transmission from people going in the breakroom and taking off their masks to eat and socialize. It’s very frustrating because the breakrooms don’t have enough space for staff to spread out and eat. However, we have come up with ways to take breaks in different spaces, such as conference rooms, and eat in shifts.

What is your perspective on young healthy people and asking them to refrain from large gatherings or meetings in enclosed spaces?

Controlling people’s behavior once they are no longer at work is difficult. Even though you personally may not agree with the risk they are taking, if you are both wearing masks while at work it’s not going to pose a risk to your health. If the person is monitoring their health and not coming into work when they are sick then everybody is still safe.

Any recommendation for when an employee plans to attend a large event like a family wedding?

People are going to go out and live their lives, all you can do is focus on protecting yourself.

On the importance of eye protection:

Eye protection is important because you can still be infected through other mucus membranes. Some people wear face shields, others wear googles, I wear a big pair of glasses unless I am with a patient and then I will put on a face shield. If people are bringing their pets into the clinic you should consider wearing eye protection when you are in an enclosed exam room for an extended amount of time.

Some practices are using temperature checks at the beginning of shifts to screen employees for illness.  Is this helpful?

I personally don’t think temperature checks are helpful. If you have employees who you know will still come to work when they are sick (we all know those people) that might be something you have them do. However, we know that 40% of COVID-19 cases are asymptomatic so they would have no fever. Use your resources for something else that will have a big impact and temperature checks are going to have a small impact.

How should practice leadership respond if a staff member tests positive for COVID-19?

If someone tests positive for COVID-19 they should go home. The person in my office (who tested positive for COVID-19) had a cough but no fever. My partner told the employee that she needed to get tested and please don’t come back to work until she received the results. The recommendation is to stay home for 10 days which begins the first day they experience symptoms.

What should other staff members do if someone at the clinic tests positive?

If you work in a clinic where everyone is not wearing masks then everyone is considered exposed, especially if you have been in close proximity with the individual. If everyone is wearing a mask then the risk of transmission is low.

Don, what about from a legal standpoint?

Don Riddick, BA, JD (GVMA Legal Expert): There is no waiver of the OSHA requirement which states that you must provide a safe work environment. Essentially what the code of federal regulations require is that you provide a safe place. You can do contract tracing and require a negative COVID test before the employee can return to work.  

One issue that comes up a lot is staff members believing they have a right to not come to work if one of their co-workers has tested positive and that is not true. The regulation is just the opposite, unless they can show that there is a serious hazard to them that hasn’t been mitigated by proper controls then they have to show up. The most important way to show a safe workplace environment is to have consistent records of a written policy that all your employees are following, which include safety policies like the wearing of masks. If you have an employee who doesn’t feel safe about coming to work, FMLA is an option for them to take a leave of absence.

If an employee has contact with someone outside the workplace who has COVID-19, how should that be handled, assuming they weren’t wearing masks?

If your policy is to wear a mask at work, then the person can self-monitor and doesn’t necessarily have to stay home from work. If the exposure was their spouse, then you would want the person to stay home because that is going to be very close contact. Yet, exposure within the household is not at 100%, only 60% percent of people within the same house become infected.

Don: From a liability stance if the person exposed doesn’t want to sit out from work for 10 days you can have them get tested, and come up negative, and have them adhere to the safety standards.

Dr. Zurawski: I would urge caution in the use of testing as a marker of health as it gives a false sense of security. The type of testing and the timing of the testing can impact the results. For example, the rapid antigen test, like they use with professional athletes, can have a 30-40% false negative rate. If you have an exposure and you test the next day you could really just have a false negative that can occur within the first 24 hours. The testing situation is very complicated so most people in healthcare don’t mandate testing to come back to work. We’ve seen patients test positive for up to 90 days after contracting COVID-19, even though they are no longer infectious, so it all depends on timing.

When should you get tested?

Antibody tests are not particularly useful unless you want to be a plasma donor. If you have COVID-19 symptoms, then go get tested to protect those around you. If you have an exposure to someone significant around you, like your spouse, get tested even if you’re asymptomatic. Also, many people get proactively tested if they are going to an event or seeing a loved one who is at risk.

Polymerase Chain Reaction (PCR) tests– Between 72 hours to a week after exposure there is high likelihood that the PCR test will be positive. So the PCR is good to use if you are going to visit your parents who are elderly, but you could contract the virus between the time when you are tested to when you see them.

Antigen tests– Antigen testing, like you see in drive thru testing sites, is useful if you have symptoms but if you are asymptomatic, then it’s not as helpful because you can have a negative test rather easy.

Dealing with Pandemic Fatigue- Dr. Taylor Chastain Griffith, PhD (Mental Health)

  • COVID-19 Pandemic Fatigue is an overarching exhaustion to everything we are facing. The most important thing to remember that everything you are feeling is normal. Pandemic fatigue is a normal response to an abnormal world.
  • We are looking for normal and we don’t know when this will end. In the Spring there was excitement about coming together for a common cause, months later those precautions are taxing. Taking steps like wearing a mask, which can seem taxing, helps us to psychologically feel normal in a world that is abnormal.

 Strategies for coping with stressors:

  • Maintain social interaction -we are seeing a crisis in mental health due to isolation
  • Make/keep a schedule
  • Monitor alcohol consumption
  • Exercise
  • Be careful of screen time
  • Look for opportunities to help others and give back can also help with burnout

Recommendations for how clinics can help:

  • Normalize the fact that this pandemic is a struggle and we are not our best selves right now.
  • Even though we have roles and responsibilities, having a sense of kindness and gentleness towards this shared traumatic experience can be very helpful.
  • Take control of your work culture – for many people work culture is their only culture right now
  • Have clear guidelines – as we feel better when we know what is expected of us

The Role of Clinic Leadership – Dr. Justin Toth, GVMA President, Owner of Dallas Animal Hospital

  • For a team to work effectively, delegation is key.
  • A compliance control officer can be helpful in the situation as they can provide the written controls that we spoke about earlier.
  • A compliance control officer is a worthwhile investment as they can help with infection control after the pandemic.
  • As a practice owner we must strive to offer the highest quality of medicine while ensuring the safety of our team members. We can achieve these simultaneously as our team members are counting on us to protect them.

What better way to improve job satisfaction then to show your staff that they matter, because the consequences could be dire if we fail.