Pandemic Planning: a business angle

Transcription

1 Pandemic Planning: a business angle EPICC Forum 2008 Andrew Wilson, WorkSafeBC WorkSafeBC - who are we? BC s statutory Workers Compensation agency. Our mandate is to serve the workers and employers of BC by acting as both insurance company and OSH agency We work to keep workers and workplaces safe and secure from injury, illness, and disease. Including our own : 2 Andrew Wilson, WorkSafeBC. 1

2 Some 2006 numbers Serve 188,000 employers, 2.2 million workers. 173,014 injuries reported 131,118 claims. 20,000+ phone calls per day. 15,000+ documents per day. 2.7 million days of work lost to injuries. $1.125 billion paid out in claim costs : 3 Are we due an influenza pandemic? Earliest documented influenza pandemic circa 1500s. Some indicators for 412BC. They seem to occur about 3 per century. 18 th Century: 1729, 1732, th Century: 1830, 1833, 1847?, th Century: 1918, 1957, st Century:? : 4 Andrew Wilson, WorkSafeBC. 2

3 Prevalence As of : 5 H5N1 Country Infections (Current Outbreak) Note: data drawn from OIE but is approximate due to delayed/missing outbreak status reports from counties. As of Estimated country count Global population % in infected countries 6.6 billion 100% 90% % % % % 80 40% 60 30% 40 20% 20 10% 0 0% Dec-03. Feb-04. Apr-04. Jun-04. Aug-04. Oct-04. Dec-04. Feb-05. Apr-05. Jun-05. Aug-05. Oct-05. Dec-05. Feb-06. Apr-06. Jun-06. Aug-06. Oct-06. Dec-06. Feb-07. Apr-07. Jun-07. Aug-07. Oct-07. Dec : 6 Source: Andrew Wilson, WorkSafeBC. 3

4 Quarterly cases: present Note: data drawn from WHO but is approximate due to delays in laboratory confirmations. As of Died Recovered Cases Winter '05 Spring '05 Summer '05 Fall '05 Winter '06 Spring '06 Summer '06 Fall '06 Winter '07 Spring '07 Summer '07 Fall '07 Winter ' : 7 Why worry Once a fully contagious virus emerges, its global spread is considered inevitable. a substantial percentage of the world s population will require some form of medical care. Source: WHO, Ten things you need to know about pandemic influenza. Source link : 8 Andrew Wilson, WorkSafeBC. 4

5 Why worry More than a fifth of firms do not have sufficient working capital in place to enable them to survive an outbreak of avian 'flu lasting 12 weeks 22% unable to operate if 30% - 40% staff unavailable. 40% unable to operate if 30% - 50% of staff unavailable : 9 Source: London Chamber of Commerce & Industry, April Source link. Threats to business Can I sell my stuff? Can I get what I need? Do I have staff? - Lean & Mean - SPOFs - Caregivers : 10 Andrew Wilson, WorkSafeBC. 5

6 Staffing levels Unless mortality rate catastrophic, issue is not how many people die. Critical questions are: infection rate duration of recovery/quarantine period worried well dependents factor : 11 The Willing & Able to work Difficult to assess. A couple of recent studies in the health care field. New York health care workers during 2005 by Qureshi et al. Maryland health departments during 2005 by Balicer et al : 12 Andrew Wilson, WorkSafeBC. 6

7 Willing to work? (Qureshi et al, 2005) Smallpox SARS 15% 22% 23% 62% 30% 48% Radiation Willing Not sure Not willing MCI 18% 6% 9% 25% 57% 85% : 13 More general study (Balicer et al, 2006) Study of health department workers. i.e. both clinical and technical and support staff. nearly half of workers likely not to report perception of the importance of one s role single most influential factor [on] willingness to report almost 75% of technical/support workers don t expect to be asked to work : 14 Andrew Wilson, WorkSafeBC. 7

8 General public survey (Harvard, Oct. 2006) 60% of those families with child 0-17 would need one employed adult to remain home if school/day-care closed. Expecting to have a serious money problem if had to miss work for: 7-10 days - 25% 1 month - 57% 3 months - 76% : 15 Source: Harvard School of Public Health, Pandemic Influenza Survey, 2006 Lessons Communicate! Workforce preparedness Crisis counselling Family preparedness Expect healthy absenteeism. Prepare to redeploy staff : 16 Andrew Wilson, WorkSafeBC. 8

9 Organisation s bottom line It s the people, stupid! What are your critical processes? Who are your critical resources? What are your dependencies? Activity here is A Good Thing and will pay off in other areas : 17 WorkSafeBC, the employer Infection control Communication Staff policies Environment scanning Business Continuity Plans : 18 Andrew Wilson, WorkSafeBC. 9

10 WorkSafeBC, the regulator Liaison with external agencies e.g. BC CDC, BC Gov., Council of Canadian Academies Creation & enforcement of Regulations Creation of Guidelines : 19 Statutory requirements Workers Compensation Act: General Duties 115(1): Every employer must ensure the health and safety of all workers working for that employer and any other workers present 116(1): Every worker must take reasonable care to protect [the worker and other persons] : 20 Andrew Wilson, WorkSafeBC. 10

11 Regulatory requirements: ECP 6.34 Biohazardous Materials: Exposure Control Plan The employer must develop and implement an Exposure Control Plan meeting the requirements of 5.54, if a worker has or may have occupational exposure to a bloodborne pathogen, or to other biohazardous material as specified by the Board. The virus that causes pandemic influenza would be specified by WorkSafeBC as a biohazardous material and employers will be required to implement Exposure Control Plans. EFFECTIVE : 21 Regulatory requirements: ECP 5.54 Chemical and Biological Substances: Exposure Control Plan Statement of purpose and responsibilities Risk identification, assessment and control Education and training Written work procedures, when required Hygiene facilities and decontamination procedures, when required Health monitoring, when required Documentation, when required Plan must be reviewed at least annually, in consultation with the joint OHS committee or worker OHS representative : 22 Andrew Wilson, WorkSafeBC. 11

12 OHS Guidelines Not regulatory requirements. Practice documents, associated with regulation, providing information, interpretive guidance, and WorkSafeBC decisions Two guidelines of importance: G Exposure Control Plan pandemic influenza G8.33(2)-1 Approved respirators : 23 Guideline G6.34-6: ECP pandemic influenza Note: This was G but was revised and renumbered Addresses Pandemic, Seasonal and Avian influenza The key Exposure Control Plan elements Statement of purpose and responsibilities Risk identification and assessment Risk control Education and training Written work procedures Hygiene facilities and decontamination procedures Health monitoring Documentation Table 2: Personal protective measures REVISED Re-issued: Renumbered: Was G : 24 Andrew Wilson, WorkSafeBC. 12

13 G ECP Pandemic Influenza Note: This was G but was revised and renumbered Hand hygiene Disposable gloves Apron, Gown, or similar body protection Table 2: Personal protective measures for pandemic influenza Low risk: Workers who typically have no contact with pandemic influenzainfected persons 2 Yes (washing with plain or antimicrobial soap and water; or use of hand wipes that contain effective disinfectant) Not required Not required Moderate risk: Workers who may be exposed to infected persons from time to time in relatively large, well ventilated workspaces 3 Yes (washing with plain or antimicrobial soap and water; or use of hand wipes that contain effective disinfectant) Not required (unless handling contaminated objects on a regular basis) Not required High risk: Workers who may have contact with infected patients, or with infected persons in small, poorly ventilated workspaces 4 Yes (washing with plain or antimicrobial soap and water; or use of hand wipes that contain effective disinfectant) Yes in some cases- e.g. when working directly with pandemic influenza patients. Yes in some cases- e.g. when working directly with pandemic influenza patients Eye protection - Goggles or Face shield Airway Protection - respirators : 25 Not required Not required Not required Not required (unless likely to be exposed to coughing and sneezing) Yes in some cases- e.g. when working directly with pandemic influenza patients) Yes (minimum N95 respirator or equivalent) ECP - Risk identification and assessment Routes of transmission Airborne transmission Droplet transmission Contact transmission direct & indirect Work methods Work environment Council of Canadian Academies, Dec/ Inhalable particles (<100μm) - Ballistic particles : 26 Andrew Wilson, WorkSafeBC. 13

14 OSHA Occupational Risk pyramid Very high High e.g. Health Care employees (doctors, nurses) e.g. Health Care support staff (EMTs, doctors, nurses) Staff with high frequency of contact with general public (high volume retail, schools) Medium Staff with minimal contact with public. (many office workers) Lower risk (Caution) : 27 OSHA 2007 Guidance on Preparing Workplaces for an Influenza Pandemic. Hierarchy of Controls PPE Work Practices e.g. no-touch washrooms, communications, cough/sneeze etiquette. Administrative Practices e.g. HR/LR policies encouraging ill people to stay away, enabling telework, reduced face-face work. Engineering Controls e.g. barriers protecting receptionists, security guards : 29 OSHA 2007 Guidance on Preparing Workplaces for an Influenza Pandemic. Andrew Wilson, WorkSafeBC. 14

15 Respiratory protection : 32 Three questions: Is airborne particulate spread by coughs, sneezes and medical procedures? Yes. Do approved respirators provide better protection against airborne particles than surgical masks? Yes. Can infection occur by airborne transmission in enclosed spaces? Yes. CCA concluded that evidence sufficient to support airborne infection as primary route of influenza infection. What next? : 33 Andrew Wilson, WorkSafeBC. 15

16 Some final thoughts During the last two decades of the 20 th century, there was roughly one new (or newly identified) human pathogen per year. A similar situation applies to animal pathogens *. e.g. HIV, Lyme Disease, E.Coli 0:157, BSE SARS and H5N1 suggest that things haven t changed much. As of 2000, there were an estimated 1,415 pathogens. 175 are considered emerging ** : 34 Sources: *Woolhouse MEJ, Dye C, 2000, ** Taylor LH, Latham SM, Woolhouse MEJ, Public Health events Events of potential international concern by WHO region Events n = : 35 Africa Western Pacific Eastern Mediterranean South-East Asia Europe Americas Source: WHO World Health Report 2007 Andrew Wilson, WorkSafeBC. 16

17 Corporate bottom line Any analysis, planning and communications will benefit you in terms of your Business Continuity. Any infection control enhancements will benefit you in terms of overall staff illness levels. The benefits extend far beyond pandemic planning. Keep monitoring your environment : 36 Individual s bottom line Personal Preparedness Wash your hands Wash your hands Wash your hands Learn Stay current Beware the hype : 37 Andrew Wilson, WorkSafeBC. 17

18 Our backup plan Thank you! : 38 Andrew Wilson, WorkSafeBC. 18

19 Additional information References (continued) Blendon R.J., Benson J.M., Weldon K.J. & Herrman M.J. (2006). Pandemic Influenza and the public: survey findings. Retrieved February 2, 2008, from Campbell A. (2006). The SARS Commission Executive Summary, ISBN , p.24. Retrieved February 2, 2008, from Balicer RD, Omer SB, Barnett DJ & Everly GS. (2006). Local public health workers perceptions toward responding to an influenza pandemic. BMC Public Health, 6(99). Retrieved Febrary 2, 2008, from Kilpatrick AM, Chmura AA, Gibbons AW, Fleischer RC, Marra PP & Daszak P. (2006). Predicting the global spread of H5N1 avian influenza. PNAS, 103, Retrieved February 2, 2008, from Lee VJ, Chen MI. (2007). Effectiveness of neuraminidase inhibitors for preventing staff absenteeism during pandemic influenza. Emerging Infectious Diseases, 13(3). Retrieved February 2, 2008, from OIE. (2008). Facts & Figures: H5N1 Timeline. Retrieved February 2, 2008, from Qureshi K, Gershon RRM, Sherman MF, Straub T, Gebbie E, McCollum M, Erwin MJ & Morse SS. (2005). Health Care Workers Ability and Willingness to report to duty during catastrophic disasters. Journal of Urban Health, 82(3), : 41 Andrew Wilson, WorkSafeBC. 19

20 References Taylor LH, Latham SM, Woolhouse MEJ. (2000). Risk factors for human disease emergence. Philosophical Transactions of the Royal Society B: Biological Sciences, 356(1411), Retrieved February 4, 2008, from Webster RG, Govorkova EA. (2006). H5N1 influenza continuing evolution and spread. New England Journal of Medicine, 355(21), Retrieved February 2, 2008, from WHO. (2004). Laboratory Biosafety Manual (3 rd Edition). Web link. Woolhouse MEJ & Dye C. (2000). Preface. Philosophical Transactions of the Royal Society B: Biological Sciences, 356(1411), Retrieved February 4, 2008, from WorkSafeBC: Exposure Control Plan Pandemic Influenza. Web link : 42 Pandemic Planning: a business angle EPICC Forum 2008 Richmond, British Columbia Andrew Wilson, WorkSafeBC , Andrew.Wilson@WorkSafeBC.com Andrew Wilson, WorkSafeBC. 20