SEVERE ACUTE RESPIRATORY SYNDROME (SARS)
Volume 1 Number 10,
June 9, 2003
This Health Hazard Alert for OPSEU members is provided to supplement information from Public Health, Ministry of Health (MOH), and Health Canada, and explains your rights under the Occupational Health and Safety Act and the Workplace Safety and Insurance Act.
How many cases of SARS are there in Ontario now?
The Ministry of Health reported on June 6, 2003 that there are currently 70 active probable cases and 11 suspect SARS cases in Ontario. To date, transmission has been limited to specific transmission settings such as households, hospitals, and specific community settings. A total of 32 people have died of SARS since it first arrived in
Canada in March.
Get TOUGH on Fit-Testing!
A number of health care workers (our members and members of other unions) have contracted SARS as a result of workplace exposure to the illness. Initially the exposures took place as workers delivered care to patients who were not yet diagnosed with SARS and so the workers were wearing no protective equipment—N95 masks, goggles, face
shields, gowns and gloves. However, since those early days, some health care workers have contracted the illness despite being provided with and wearing all of the available PPE. No one is sure yet how the illness has been transmitted, whether it is droplet borne, or truly an airborne infection. It is speculated that health care workers may have contracted SARS for
one or more of the following reasons:
· Their N95 masks do not fit them correctly and the workers may or may not be aware of the poor fit;
· The workers have not been trained properly to protect themselves as they don and take off their equipment and so unwittingly contaminate themselves;
· The N95 masks even if fitted correctly do not offer adequate protection;
· Because the virus thought to cause SARS can live on a hard surface for some hours, workers may touch contaminated surfaces in patient care areas and then because of inadequate training/knowledge, touch their faces before they wash their hands and so contaminate themselves.
Personal Protective equipment (PPE) is only effective if used correctly; if used improperly PPE will provide a false sense of security, but no real protection. Workers have a right to be trained about how to use PPE properly—such training should cover how PPE is applied, as well as in what order it should be removed to avoid
contamination. The Occupational Health and Safety Act directs employers in Sec 25 (1) (a) that, “the equipment, materials, and protective devices as prescribed are provided”
And in Sec 25 (2) (a) to “provide information, instruction, and supervision to a worker to protect the health and safety of that worker”.
In addition, Health Care Regulation 10 states,
“A worker who is required by his or her employer, or by this Regulation, to wear or use any protective clothing, equipment or device shall be instructed and trained in its care, use, and limitations before wearing or using it for the first time and at regular intervals thereafter and the worker shall participate in such instruction
and training”.
Subsection 2 goes on to direct that the equipment shall be properly used and maintained, that it must be a proper fit, it should be properly inspected for damage and deterioration, and be stored in a convenient, clean and sanitary location when not in use. It is clear in the Act, therefore, that employers bear a responsibility to
ensure that workers are trained to use PPE correctly, and that the equipment be kept in good order.
Workers, however, also have responsibilities under the Act:
· to work in compliance with the Act (Sec 28.1.a)
· to use or wear protective devices or clothing that the employer requires to be used or worn (Sec 28.1.b)
· to report the absence or defect in any equipment or protective device of which the worker is aware (Sec 28.1.c).
· to report violations of the Act (Sec 28.1.d)
This means that workers need to INSIST upon training to ensure they know how to properly use their PPE. Direct contact with a SARS patient, or contact with an environment contaminated by large respiratory droplets, might have led Health Care Workers to contaminate themselves as they removed their PPE. So if the employer is not providing
adequate training, or fit-testing, workers have the responsibility to raise the matter with their employer to protect the safety of themselves, their co-workers, patients, and the broader community. Joint Health and Safety Committees need to ensure that the employer is training workers on PPE, and then continue to monitor and evaluate the PPE training provided to
workers.
Right to Refuse –Breaking News!
OPSEU has been advised that a member of another health care workers’ union has successfully used her ‘Right to Refuse Unsafe Work’ because she had never been fit-tested for the N95 respirator. The worker refused to work with SARS patients because she did not know whether the respirator she was given provided adequate protection. We are
advised that Ministry of Labour orders are pending to force the employer to complete fit-testing of all workers delivering care or services in in-patient areas where they could be exposed to SARS patients. The refusing worker remains out of the workplace until she is properly fit-tested for her respirator. If you have not been fit-tested and you are asked to wear a
N95 mask to deliver care or enter areas where there is the possibility of being exposed to SARS patients, insist that you be fit-tested immediately. If the employer does not comply, immediately contact the Ministry of Labour and formally complain that your employer is asking you to wear equipment that may not be protective enough. Remember — you have the right to
refuse work that you believe is unsafe.
New Directives issued to GTA Hospitals
On June 7, 2003, the Commissioner of Public Health Dr. C D’Cunha issued a letter to all acute care hospitals in Toronto, York and Durham Regions directing them to comply with current directives issued to manage the recent SARS outbreak, and protect against future outbreaks through the “new
normal” hospital procedures. Breaches included:
· delays in reporting suspect and probable SARS cases to public health
· failure to comply with the current provincial directives
· failure to follow the transfer protocols as outlined in the “Updated Provincial Inter-Facility Patient Transfer Directive”, May 12, 2003.
Dr. D’Cunha stresses to hospitals that, “failure to comply with these requirements may put individuals in our community at risk of being infected with the SARS virus and may make you subject to further orders under the Health Protection and Promotion Act (HPPA)”.
Directive to Acute Care Facilities in the Greater Toronto Area (Toronto, York, Peel, Durham Regions and Simcoe County (GTA) (03-08) May 30, 2003
This directive reduces the volume of patient activity in order to respond to emergency department needs. All non-urgent surgeries, booked procedures, and ambulatory activities are cancelled. Note that the Hospital for Sick Children, University Health Network, Sunnybrook, and Women’s College Hospital are exempted from this directive.
Directive to Acute Care Facilities in the Greater Toronto Area (Toronto, York, and Durham Regions) *(Peel, Halton, and Simcoe County are excluded at this time) (03-09) May 31, 2003
This directive enhances directive 03-08 for all GTA facilities except those in Peel, Halton, and Simcoe County, which are excluded so far. The Hospital for Sick Children, University Health Network, Sunnybrook, and Women’s College Hospital are exempted from one provision of this directive—the one that refers to compliance with 03-08. The
rest of the directive applies. This directive mandates all hospital staff to use full SARS precautions (gowns, gloves, N95 mask or equivalent, and protective eyewear) in all patient care areas. Hospitals may enhance this requirement to other areas of the hospital. Hospitals must restrict access, be prepared to implement Code Orange Alerts, and post appropriate signage
updated daily outlining the most recently affected areas and facilities. Hospitals are to move to full surveillance—use the SARS screening tool at all entrances for all persons, and watch patients for any onset of respiratory symptoms or fever.
These directives do not replace the “new normal” directives issued on May 13, 2003—they supplement the following current directives:
· Directives to All Acute Care Facilities – May 13, 2003
· Interim Healthcare Alliance Infectious Disease Control and Management Plan – May 30, 2003 (Detailed below)
· Directives to All Ontario Acute Care Hospitals for High-risk Procedures Involving SARS patients Critical Care Areas – May 13, 2003
· Updated Provincial Inter-Facility Patient Transfer Directive – May 12, 2003
· Directives to All Ontario Acute Care Hospitals Concerning Discharge of Non-SARS Patients – April 11, 2003
· Directives to All Ontario Acute Care Hospitals Concerning Discharge of SARS Patients –April 11, 2003
Interim Health Care Alliance—Infectious Disease Control and Management Plan
The new Healthcare Alliance is a coalition of four GTA Hospitals who have agreed to focus concentrated resources on the assessment and treatment of SARS across the GTA. The hospitals include:
· North York General Hospital
· William Osler Health Centre—Etobicoke Campus
· Scarborough Hospital—General Division
· St Michael’s Hospital—Tertiary Referral Centre
With this area-based approach, three of the four hospitals have been assigned a grouping of hospitals —where a specialized transportation system and transfer protocols have been put in place to transfer SARS and suspected SARS patients to the appropriate designated hospital. Because of its advanced trauma facilities, St Michael’s will
act primarily as a Tertiary Care referral centre for the other 3 Alliance Hospitals, SARS transfers outside of the GTA who require tertiary care, and handle a small number of other transfers—local walk-ins and transfers from Casey House. The approach reflects knowledge gained about effective management and control of SARS, and attempts to minimize the spreading of
SARS to various sites, staff, patients, and the broader community.
New Q & A on Self Monitoring – June 2, 2003
Self monitoring is necessary when a person exhibiting mild symptoms has been sent home for observation by a doctor. The person should measure their own temperature twice a day, and monitor themselves for other symptoms, such as shortness of breath, or difficulty breathing. If any of these symptoms develop, the person should call their
doctor immediately. The Q&A also provides information on precaution that prevents transmission to family members.
Are there any other measures that can be taken to protect workers’ health and safety in the healthcare sector?
INSIST that your JHSC meet to discuss all infection control measures being taken and how the provincial directives are being implemented in your facility. INSIST that the employer ensure that fit-testing of respirators is being done for all workers who are required to wear N95 masks.
If the employer will not attend a JHSC meeting and if you are not confident that all reasonable precautions are being taken to protect the health and safety of all members, contact the Ministry of Labour and formally complain to them. Insist that the Ministry of Labour send an inspector to investigate the measures, including fit-testing
and training that your employer is taking to protect your health and safety.
OPSEU continues to advise that Joint Health and Safety Committees (JHSCs) within the health care sector meet to discuss directives and all infection control measures in their facilities. If OPSEU members of the JHSCs believe that worker training is inadequate, insist that the employer take steps to improve and correct training to prevent
further transmission of SARS.
For more information, contact OPSEU’s Health and Safety Unit: 1-800-268-7376, 416-443-8888, ext. 772. Check the OPSEU website at www.opseu.org for future updates.
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Directives from SARS Provincial Operations Centre
NEW ! Directive to Acute Care Facilities in the Greater Toronto Area (Toronto, York, Peel, Durham Regions and Simcoe County (GTA) (03-08) – May 30,
2003
NEW ! Directive to Acute Care Facilities in the Greater Toronto Area (Toronto, York, and Durham Regions) *(Peel, Halton, and Simcoe County
are excluded at this time) (03-09) — May 31, 2003
NEW ! Interim Healthcare Alliance – Infectious Disease Control and Management Plan – May 30, 2003
Directives to All Ontario Acute Care Facilities – May 13, 2003
Directives to All Ontario Acute Care Hospitals for High-risk Procedures involving SARS patients Critical Care Areas May 13, 2003.
Directives to All Ontario Acute Care Hospitals Regarding Infection Control Measures - April 24, 2003
Directives to All Ontario Acute Care Hospitals Concerning Discharge of Non-SARS Patients – April 11, 2003
Directives to All Ontario Acute Care Hospitals Concerning Discharge of SARS Patients –April 11, 2003
Directive to All Ontario Non-Acute Care Facilities – May 13, 2003.
Directive to Ontario Health Care Providers in Community Settings and Community Health Care Agencies (excluding Community Care Access Centres) – May 13, 2003
Directive to All Community Care Access Centres – May 13, 2003
Directives to All Ontario Prehospital Care Providers and Ambulance Communications Services – May 13, 2003
Updated Provincial Inter-Facility Patient Transfer Directive – May 12, 2003
Inter-Facility Patient Transfer Form – May 12, 2003
NEW ! SARS Bulletin for Healthcare Providers – June 4, 2003
NEW ! Q & A on Self Monitoring– June 2, 2003
Healthcare Facility SARS Categories - April 14, 2003
Emergency Department Barrier Precautions
SARS POC Questions and Answers – May 6, 2003
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Useful Links:
Health Canada for updates and Guidelines: www.hc-sc.gc.ca/pphb-dgspsp/sars-sras
Toronto Public Health updates: www.toronto.ca/health
Centres for Disease Control: www.cdc.gov/ncidod/sars/
World Health Organization for daily updates and guidelines: www.who.int/csr/sars/
Ministry of Health: www.health.gov.on.ca
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