Branch Occupational safety and health in public health emergencies: GENEVA, 2018 A manual for protecting health workers and responders Credit: WHO /Andrew EsieboOccupational safety and health in public health emergencies: A manual for protecting health workers and responders Geneva, 2018Occupational safety and health in public health emergencies: A manual for protecting health workers and responders © World Health Organization and International Labour Organization, 2018 ISBN 978-92-4-151434-7 (print) WHO ISBN 978-92-2-030794-6 (print) ILO ISBN 978-92-2-030795-3 (web pdf) ILO Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareA- like 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; creativecommons/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. 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Printed in Francev Acknowledgements This manual was developed by the World Health Organization (WHO) and the International Labour Office (ILO), with contributions from the WHO collaborating centres for occupational health at the University of British Columbia (Canada), University of Maryland and the Centers for Disease Control and Prevention (CDC)/National Institute for Occupational Safety and Health (NIOSH) (USA). The manual was produced under the direction of Ivan D. Ivanov from the WHO Department of Public Health, Environmental and Social Determinants of Health, and Francisco Santos- OConnor from the ILO Labour Administration, Labour Inspection and Occupational Safety and Health Branch. Shubhendu Mudgal, WHO Consultant on Workers Health, developed the draft versions of the manuscript. Valuable contributions were provided by: Benedetta Allegranzi, Sebastian Bruno, Zhanat Carr, Kenneth Carswell, François Cognat, Rudy J.J.M Connix, Sergey Eremin, Ivan Ivanov, Erin Maura Kenny, Meleckidzedeck Khayesi, Kazunobu Kojima, Mark van Ommeren, Adrienne May Rashford, Joana Helena Tempowski and Ju Yang of WHO; Shengli Niu, Francisco Santos-OConnor, Yuka Ujita and Christiane Wiskow of ILO; Joanna Gaitens, Melissa McDiarmid and G.M. Oliver of the University of Maryland, USA; Karen Lockhart, Stephanie N Parent and Annalee Yassi of the University of British Columbia, Canada; and Claire C. Caruso, Christopher Coffey, Lisa Delaney, Chad Dowell, Selcen Kilinc-Balci, Margaret Kitt, Leslie Nickels and Jill Shugart of CDC/National Institute of Occupational safety and Health of the USA. The publication was prepared with financial support from the WHO Regional Preparedness Programme funded by the Department for International Development of the United Kingdom of Great Britain and Northern Ireland and the WHO cooperative agreement with Centres for Disease Control and Prevention National Institute for Occupational Safety and Health of the United States of America on implementing Resolution WHA 60.26 “Workers Health: Global Plan of Action”. Acknowledgementsvii Contents Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii Purpose of the manual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Chapter 1. Occupational safety and health during emergencies: management aspects . . . . . . . . . . 11.1 Management system approach to occupational safety and health hazards and risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.2 Rights, duties and responsibilities of employers and workers during outbreaks and emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31.3 Overview of health and safety surveillance and monitoring system implemented during the Ebola virus disease response in West Africa . . . . . . . 71.4 Emergency Responders Health Monitoring and Surveillance . . . . . . . . . . . . . 11 Chapter 2. Strategies and tools for protecting occupational safety and health in emergencies and outbreaks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152.1 International Health Regulations, 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . 152.2 Incident Command System for managing outbreaks and emergencies . . . . . . 162.3 The World Health Organization Health Emergencies programme . . . . . . . . . . 212.4 Occupational safety and health controls . . . . . . . . . . . . . . . . . . . . . . . . . . . 232.5 Strategies for infection prevention and control . . . . . . . . . . . . . . . . . . . . . . . 242.5.1 Standard precautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252.5.2 Prevention of occupational respiratory infections in health-care settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Chapter 3. Common risks for safety and health in emergencies . . . . . . . . . . . . . . . . . . . . . . . . . 373.1 Vector-borne diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373.2 Water and foodborne diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383.3 Vaccine-preventable diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393.4 Heat stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403.5 Slips, trips and falls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413.6 Road traffic injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433.7 Ergonomic hazards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Contentsviii OCCUPATIONAL SAFETY AND HEALTH IN PUBLIC HEALTH EMERGENCIES3.8 Violence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 463.9 Fatigue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 473.10 Psychosocial stress during outbreaks and emergencies . . . . . . . . . . . . . . . . 50 Chapter 4. Occupational safety and health in outbreaks of communicable diseases: clinical and community settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 574.1 Occupational safety and health in Ebola treatment and care units . . . . . . . . . 584.2 Occupational safety and health in the cholera treatment unit . . . . . . . . . . . . 594.3 Managing occupational safety and health in laboratories handling infectious agents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 604.4 Management of exposure to blood, body fluids and other contaminants in health-care settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 614.5 Occupational safety and health protection of health workers from acute respiratory diseases during respiratory disease outbreaks . . . . . . . 644.6 Occupational safety and health in outbreak response in community settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 664.6.1 Community work (e.g. social mobilization, contact-tracing, case-finding) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 664.6.2 Ambulances and vehicles for patients or dead bodies . . . . . . . . . . . . . 674.6.3 Post-mortem examinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 684.6.4 Safe and dignified burials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 694.6.5 Points of entry and exit, land crossings, airports and sea ports . . . . . . 714.6.6 Aircraft . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 714.6.7 Ships . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 734.6.8 Taxis and public transport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 754.6.9 Waste-water workers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 764.6.10 Insecticidal spraying for vector control activities . . . . . . . . . . . . . . . . 76 Chapter 5. Occupational safety and health in chemical incidents . . . . . . . . . . . . . . . . . . . . . . . . 815.1 Emergencies caused by chemical incidents . . . . . . . . . . . . . . . . . . . . . . . . . 815.2 Occupational safety and health hazards and risks of chemicals . . . . . . . . . . . 815.3 Occupational safety and health management of emergency responders during chemical incidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 835.3.1 Incident Command System for managing chemical emergencies . . . . 835.3.2 Personal protective equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . 875.3.3 Decontamination of emergency response personnel . . . . . . . . . . . . . . 885.3.4 Medical surveillance of emergency responders . . . . . . . . . . . . . . . . . 91ix Contents Chapter 6. Occupational safety and health in radiation incidents . . . . . . . . . . . . . . . . . . . . . . . . 936.1 Sources and scenarios of radiation incidents . . . . . . . . . . . . . . . . . . . . . . . . 936.2 Occupational safety and health management of emergency responders during radiation emergencies . . . . . . . . . . . . . . . . . . . . . . . . . 946.2.1 Guidance for protection of emergency responders during radiation emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 976.2.2 Incident Command System for managing radiation emergencies . . . . 986.2.3 Personal protective equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 06.2.4 Decontamination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 06.2.5 Occupational health surveillance of persons occupationally exposed to radiation in emergencies . . . . . . . . . . . . . . . . . . . . . . . . 101 Chapter 7. Occupational safety and health hazards in natural disasters . . . . . . . . . . . . . . . . . . 10 57.1 Occupational safety and health hazards and risks due to floods . . . . . . . . . 10 67.2 Tropical storms, hurricanes, cyclones and typhoons . . . . . . . . . . . . . . . . . . 1077.3 Earthquakes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 87.4 Common occupational safety and health hazards encountered during response activities following natural disasters . . . . . . . . . . . . . . . . . 10 97.4.1 Search and rescue team operations . . . . . . . . . . . . . . . . . . . . . . . . 10 97.4.2 Hazards and risks associated with the use of chainsaws and their control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1127.4.3 Hazards due to animal/insect bites and contact with poisonous plants during outdoor work . . . . . . . . . . . . . . . . . . . . . . . 113 Chapter 8. Managing the health and safety of health workers during humanitarian response in conflict situations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1158.1 Management of occupational safety and health in health facilities during conflicts and emergencies . . . . . . . . . . . . . . . . . . . . . . . . 1158.1.1 Measures for the safety of health facilities . . . . . . . . . . . . . . . . . . . 1168.1.2 Measures for protection of people working in health facilities . . . . . . 1178.1.3 Management of stress during conflicts . . . . . . . . . . . . . . . . . . . . . . 118 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Appendix Toolkit . . . . . . . . .