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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

“Getting back on the (trauma) horse”

Mental health in the workplace is one of those recent manifestations of psychosocial hazards. It continues to evolve and during this process one is never quite sure where the best and most relevant information can be obtained.

Cnfusion for the safety professional can come from new, slightly off-topic, issues that can skew the public perception and understanding of exactly what it is one is trying to manage.

Is it reasonable to take inspiration (if that is the right term) from studies of Iraq War sufferers of post traumatic stress syndrome in providing clues to handling mental health issues at work?

During tertiary risk management courses the debt owed to the armed forces and their planning processes is acknowledged but soldiers operate in a unique culture of accountability, clearly defined duties and a rigid hierarchical structure. In most circumstances only the broadest of concepts could be translated to the real (non-militarised) workplace. In a similar way studies of Scandinavian workforce management are interesting but are highly unlikley to be transferable outside the cultural geography.

A very recent example of this problem of getting excited about innovation and then wondering about its genuine applicability, can be seen in the TV show, Catalyst, (video available online for a short time) broadcast by the Australian Broadcasting Corporation on 16 April 2009.

The program provides a profile on a computer simulation program that purports to aid the rehabilitation of war veterans by returning them to traumatic events of the war zone. It seems that the theory is the same as “getting back on the horse that threw you”.

In OHS terms, the applicability for firefighters, emergency response personnel etc is obvious but SafetyAtWorkBlog has reservations. The use of video simulations and games by the armed services before, during and after combat is discomforting.

Managers and health care professionals may need to carry some of the responsibility for the cloudiness of mental health and trauma by applying the hyperbole of trauma to relatively benign workplace issues. Many elements of work are being described as traumatic when they are not. They maybe disturbing, disconcerting or even harmful but there is a big difference between being punched in the face by a psych patient and driving over a car of civilians in an armoured vehicle.

In other industry sectors, such hyperbole would be described as spin. It is the responsibility of OHS professionals to cut through the spin and not be distracted by “exciting”, but indirect, innovative solutions. Let’s look for the evidence and operate from what we know works. At least until new evidence appears.

Kevin Jones

Trade unionist talks about nanotechnology risks

In October 2008, SafetyAtWorkBlog spoke with Renata Musolino of the Victorian Trades Hall Council. At that time the trade union movement was finalising its policies and positions on nanotechnology into the campaign that is being rolled out at the moment.

In the SafetyAtWork podcast released in April 2009, Renata talks about how nanotechnologies links with mesothelioma but also some parallels with genetically modified organisms. She discusses the need for more information about the nanomaterials and how one should apply the precautionary principle in this case.

More information about Renata is available at the Victorian Trades Hall Council website

Lawyer speaks on nanotechnology risks

A leading Australian OHS lawyer, Michael Tooma, spoke to ABC Radio on 16 April 2009.

Tooma spoke about the potential risks employers face by dealing with a substance whose hazard rating is unclear. HE says

“Employers at the moment may be unaware of the extent of the potential liability sometime down the track. …We could be facing another epidemic in our industrial history of people, large groups of people, displaying latent symptoms from current exposures that are taking place at the moment. “

The unions have repeatedly made the comparison with asbestos hazards but as Dr Craig Cormick of the Australian Office of Nanotechnology says, in the same interview, that in the early usage of asbestos evidence of potential harm was available but not shared.

An April 2007 legal update from Tooma on the issue is available

Roadwork zone speed limit enforcement

At the Safety In Action Conference recently, Geoff Knox, CEO of Downer EDI spoke about the need to respect speed limits on roadwork sites. He mentioned this because his company conducts a lot of this type of work, but anyone who has driven through such a zone at the reduced speed limit sees many cars and truck travelling much faster, and only metres away from workers.

Crikey.com included a rumour in its 9 April 2009 bulletin that says on a stretch of the Monash Freeway that is being widened, that

“..within the Vic State Government that there is a tacit understanding not to police this stretch of road outside of peak hours and that between 50% & 60% of drivers are speeding. “

There are many instances where “tacit understandings” evolve into, or are considered, corruption and it is very disappointing that speed cameras, or other speed enforcement tactics, are not being applied in a circumstance where the need has never been more obvious.

Police threatened a blitz on the Monash in November 2008 if speed was not reduced.

In typical Crikey styles, there is a suggestion that there is a political advantage in this for nearby shaky electorates but the rumourmonger’s final comment brought the rumour into our context.

“Vicroads are known to be particularly concerned about worker safety, particularly at night when work is being undertaken. There is a tragedy waiting to happen, and the finger pointing after the fact will be most interesting.”

Kevin Jones

Category: risk

Swine Flu lessons – presenteeism is real

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Australian Prime Minister talks to the great unwashed

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Handwashing as a risk control

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“Getting back on the (trauma) horse”

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Trade unionist talks about nanotechnology risks

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Lawyer speaks on nanotechnology risks

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Roadwork zone speed limit enforcement

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