Swine Flu lessons – presenteeism is real

There is some debate today about whether Swine Flu (in deference to the request from some pig farmers, now renamed “the Mexican Flu outbreak of 2009“) has peaked.  Colleagues in Asia over the weekend told SafetyAtWorkBlog that in most circles, the Mexican Flu outbreak has not generated the same level of interest, or concern, as elsewhere.  Perhaps the media studies academics can contribute to a redefinition of “global pandemic” as any disease outbreak that occurs in a country next to the United States. (Beware the Canadian Beaver Flu)

But flippancy aside, this dry-run at an influenza pandemic has many benefits and one particularly useful benefit will be a change in attitude to presenteeism in workplaces.

As the Southern Hemisphere enters its flu season and the early round of flu vaccinations concludes, Australia and others will be a test case for any attitudinal change in workers towards bringing their flu-ridden bodies to work, or in workers objecting to the contagious hazards that the presenteeists (?) introduce.

It has always been a suitable HR and OHS process to send someone home who appears impaired or unfit-for-work.  In the past “essential” staff would continue to work for the sake of workload or productivity.  Over time the folly of such an attitude has become obvious and workplace safety advocates have had a major role in this change.  The increased absenteeism of, and the decreased productivity from, a team who have been infected by a single member is now an unacceptable health hazard and productivity threat.

This change has also been helped by the increasingly viable option in some industries for people to work from home.

The Mexican flu outbreak is likely to verify the reality of presenteeism, probably from colleagues demanding that control measures be taken on the unthinking infectious workmate.  Masks may be tolerated but in the tradition of the hierarchy of controls, elimination is always preferable to personal protective equipment.

In the 1980s taxation department and many other workplaces, telephone hygienists were employed to disinfect telephone handsets.  Modern handsets cannot be disassembled in the same way however, SafetyAtWorkBlog was reminded of this, at the time, peculiar hygiene practices when watching Mexicans disinfecting subways and public telephones.

In all things there must be balance, but the Mexican flu outbreak of 2009 will undoubtedly revise the way people touch things and others.  In relation to influenza this is a good thing.

Kevin Jones

Australian Prime Minister talks to the great unwashed

The edge of panic is starting to appear in Australian concerns over swine flu.  Some health officials, who should know better, are slipping slightly off message.  The Queensland government’s chief medical officer has recommended that food should be stockpiled.  This was quickly jumped on by the Federal Health Minister, Nicola Roxon, has tried to provide a more palatable context to the stockpiling:

“We want people to be aware of the risk of this disease, we want people to be taking sensible planning steps but we don’t want panic,” she said. “It’s very important that we don’t have a rush on products that people just during the course of their ordinary shopping might think about whether they have some of these extra supplies.”

The Australian Prime Minister, Kevin Rudd, has offered some of the blandest, but relevant, advice:

“For all Australians to engage in the simple practice of washing their hands with soap on a regular basis.”

Kevin Rudd is not the poster boy for personal hygiene unless eating one’s earwax is a suitable hygiene practice.

SafetyAtWorkBlog will continue to watch for evidence of the effectiveness of handwashing in influenza control.

Roxon’s advice is sound however in one very important way – sensible planning steps.  Cut through the hyperbole.  Listen to reputable health advice, and keep your colleagues and employees informed.  If that happens, we’ll get through this threat.

Kevin Jones

Handwashing as a risk control

Everyone knows that we are cleaner for the washing of our hands.  The childhood fibs of our parents that potatoes will grow behind our ears if we don’t wash there regularly have been pretty much dismissed.  There was little evidence for the benefits of washing behind our ears other than the authority and wisdom of parents but for most of one’s life that’s enough (or at least till we turn and mistrust everything our parents say).

In Australia, OHS has been pushing for evidence-based decision making.  Some have twisted this noble aim into short-term empire building on concepts such as a “body of knowledge” (- the more important question should be why do particular people want to control this knowledge in the first place).  But evidence is important and over the last few years some researchers have been seeking the evidence for the safety benefits of hand-washing in infection control, particularly during times of epidemics or pandemics.

The current swine flu scare (it remains a “scare” in many parts of the world) is generating recommendations on personal hygiene, as reported in SafetyAtWorkBlog on yesterday, but is there evidence or is hand-washing a comforting distraction?

Earlier this year Jody Lanard and Peter Sandman wrote:

The “Cover Your Cough” page on the CDC’s seasonal flu website begins this way:

Serious respiratory illnesses like influenza, respiratory syncytial virus (RSV), whooping cough, and severe acute respiratory syndrome (SARS) are spread by: 

  •  
    • Coughing or sneezing
    • Unclean hands….

If you don’t have a tissue, cough or sneeze into your upper sleeve, not your hands.

We have been unable to find a single study that supports this recommendation with regard to influenza. The World Health Organization Writing Group report on “Nonpharmaceutical Interventions for Pandemic Influenza” makes the same recommendation for flu specifically, but concedes that it has been made “more on the basis of plausible effectiveness than controlled studies.”

As for hand-washing, a Mayo Clinic publication on hand-washing includes flu on a list of infectious diseases “that are commonly spread through hand-to-hand contact.” The Government of Alberta’s “Influenza Self-Care” publication advises: “Wash Your Hands to Prevent Influenza…. Next to immunization, the single most important way to prevent influenza is to wash your hands often.”

But here’s what the World Health Organization Writing Group report says: “Most, but not all, controlled studies show a protective effect of handwashing in reducing upper respiratory infections…. Most of the infections studied were likely viral, but only a small percentage were due to influenza…. No studies appear to address influenza specifically.” 

The Lanard/Sandman article discusses at length the way that hand-washing may be affecting our approaches to other control measures such as vaccination.  It tries to cut through the hyperbole on influenza and if you are a health care worker, the full article is strongly recommended.

At the moment there is no clear evidence of the benefits of hand-washing and if this swine flu scare remains a scare for most people, one of the areas for further research should be the effectiveness, and role, of hand-washing in the control of pandemic infections.  It just may be that “universal precautions” should not be so unquestioningly universal.

Kevin Jones

Swine Flu – workplace preparations

There is swine flu information coming at us from all directions.  Thankfully in Australia the flu itself has not appeared from any direction but…

For those businesses that are not prepared for potential pandemics, don’t panic, but remember that you have known about this potential since before SARS and if you have not put any plans in place, it’s your own fault.

Now that the criticism is out of the way, if you are concerned, what you should do is hit the Australian internet sites that are relevant to pandemic preparation.  One particularly good and local (ie Australian) site is the Australian Government site on pandemic influenza.

There is a very useful Australian podcast on the issue available through ABC Radio.

It is also useful for companies in general to remind its employees about basic hygiene practices.  A particularly good source of work-related information on hygiene is at the government site for infection control for health care providers.

Dr Danilla Grando is a hygiene expert and Lecturer in Clinical Microbiology in the School of Applied Sciences at RMIT University in Melbourne and provides her take on this simple and effective hazard control measure 

wash_dry_hands“Research has shown that one of the most powerful weapons against the spread of respiratory illness, including any strain of influenza, is simply improving your hand hygiene.

We know that contact transmission is one of the key ways that people become infected by influenza. While flu is an airborne virus, people often fall sick from touching something that carries the influenza germs and then putting their hands in their mouths, often while eating.

Always washing your hands before meals is vital but using an alcohol-based hand sanitiser throughout the day is also extremely effective, and an essential tool in helping to prevent the spread of influenza.

Several years ago SafetyAtWorkBlog interviewed Peter Sandman, a world-renowned risk communicator.  He had been undertaking some work in Asia with the World Health Organisation around the bird-flu outbreaks.  He and Jody Lanard wrote a series of articles on communicating an imminent pandemic.  It should be obligatory reading for those at the forefront of public health initiatives at the moment but safety and risk managers may find some assistance in how to communicate with one’s own staff.

The initial response to the current swine flu is generating optimism and it is heartening to see so many government departments reacting in a planned way.  However we should remember the lessons of SARS and the lasting impact SARS had on travel and trade.

Click on the image below for a 2003 edition of Safety At Work magazine which includes several articles about SARS and pandemic risks generally.

Kevin Jones

419-cover

 

“Pilgrim’s Plague” and workplace absenteeism

 Last year, Sydney Australia hosted World Youth Day (WYD).  In some ways Australia had not seen such a large influx of people from so many countries for a single event before.  The Sydney Olympics had a high proportion of locals attending and the 1956 Melbourne Olympics never had the infrastructure to provide so many overseas visitors.

For several months after the 2008 World Youth Day, it was rumoured that the level of absenteeism in workplaces was very high.  At the time of WYD there were several reports of quarantined pilgrims and the risk to public health of the Sydney population was assessed. (Peter Curson, professor of population and security in the Centre for International Security Studies at the University of Sydney wrote a discussion piece on this)

There were reports of influenza and viral gastroenteritis amongst pilgrims who were required to be quarantined.

The Medical Journal of Australia has released a report into the impact of World Youth Day on the emergency departments of hospitals (MJA 2008; 189 (11/12): 630-632).  This study found minimal impact in this sector of the hospital care.

However, SafetyAtWorkBlog is not aware of any research having been done on the impact of  World Youth Day on workplace absenteeism.  The EMJA study correlates World Youth Day with hospital admissions but it would be useful to see a comparative study of workplace absenteeism in the weeks after WYD, during the incubation period of influenza in particular.

World Youth Day did seem to overlap with the existing flu season in Australia’s winter but those statistical peaks are well-established and it would be interesting to see if those peaks had increased just after World Youth Day.

If there were a correlation, cost estimates for hosting the event may need adjusting to include the reduced productivity due to the “pilgrim’s plague”.


Another safety culture disaster in Australia

In August 2007 the Australian equestrian industry was struck by its first-ever outbreak of Equine Influenza (EI).  The Federal Government’s report on the incident has been released and has significant lessons for several reasons.

Australia has been proud of its biosecurity and customs service for decades.  As an island nation at the end of the world, there is a level of purity in its ecology that needs to be preserved (even though there were many earlier mistakes – foxes, rabbits, cane toads – to name a few).  The country’s pride was obviously out of touch with reality as Justice Callinan was highly critical of the Australian Quarantine Inspection Service.  Few government reports have included the clarity (or bluntness) of phrase as this report includes.

“The objective of biosecurity measures at a post-arrival quarantine station for animals, such as Eastern Creek, is to prevent the escape of disease that might be present in the station. It is therefore essential that people and equipment having contact with the animals are adequately decontaminated before leaving the station. That was not happening at Eastern Creek in August 2007. Had such biosecurity measures been in place, it is most unlikely that there could have been any escape of equine influenza from the Quarantine Station.
That such measures were not being implemented was a consequence of a number of acts and omissions on the part of various employees and officers of AQIS at different levels of that organisation and over a number of years.”

As the media reports appeared and the Agriculture Minister, Tony Burke, spoke passionately about the need to review the entire biosecurity process, farmers and other were thanking their luck that the outbreak was EI and not Foot & Mouth or other equally nasty infection.

Indonesia, a consistent sufferer of Avian Influenza, is only a few hundred kilometres away.  If Australia had a poultry industry on its northern shores, would the Government’s approach to quarantine inspecton be different?

Callinan goes on to depict an organisation of mismanagement and is not afraid to point the finger of blame and responsibility.  He summarises:

“What I describe bespeaks an organisation that lacked clear lines of communication between those responsible for formulating procedures and work instructions and those responsible for implementing them; one in which there was insufficient training and education in relation to the procedures and instructions to be followed; one in which there was no checking to ensure that those procedures and instructions were being implemented; and one in which any business plan or other reporting system did not alert senior management to these failures.”

For OHS professionals and risk managers, these systemic failures would fit with too many other risk management failures.  It is too easy a criticism to say that the organisation was devoid of a safety culture.  In the case of quarantining possible infectious animals, the organisation and process was inept.

A few years ago, Chris Maxwell undertook a review of Victoria’s OHS regime and stated that he thought citizens should be able to expect government departments to be exemplars of workplace safety.  It is an expectation that may be unfair in many areas but when an organisation has been urging the public to be super-diligent over the importation of items that could potentially decimate agricultural industries, and then fails disastrously itself, maybe the public campaign funds could have been better spent inside the organisation.

ABC Radio report – http://mpegmedia.abc.net.au/news/audio/pm/200806/20080612-pm01-horseflu.mp3
Government response http://www.daff.gov.au/__data/assets/pdf_file/0008/690704/ei-response.pdf

Aircraft Cabins and Infections

According to a report released on 10 June 2008 by the Australian Transport Safety Bureau, 

“passengers’ health is not greatly at risk through air travel and widespread infections are unlikely.”

On the cases that have been reported of infection, the ATSB says

“such transmission was primarily due to the crowding together of a large variety of people in a confined space, not specifically due to aircraft cabin conditions.”

It goes on to say

“Perhaps of greater concern is the opportunity for infection to spread in airport terminals, where passengers who are travelling to or from many destinations are gathered together.”

At the moment Qantas Airways has a reputation of being a safe airline, principally because its planes do not fall out of the sky.  But there is a further definition of a safe airline and that is one whose management actively minimises the risk of infections and pandemics both in the aircraft and the terminal.

Important lessons were learnt from the “dry-run” on modern pandemic from SARS but this focussed on the air traveller and the aircraft and did not include the airport terminal.  Perhaps as well as the safety airline, Australia needs to establish the safety airport.

Boy, web-conferencing is becoming more attractive.

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