key: cord-0743446-7ujkqttx authors: Breeher, Laura E.; Sampathkumar, Priya; Beam, Elena; Hainy, Caitlin M.; Austin, Matthew D.; Swift, Melanie D. title: Mayo Clinic Strategies for COVID-19 Revisiting the Safety of Health Care Workers date: 2020-07-07 journal: Mayo Clin Proc DOI: 10.1016/j.mayocp.2020.06.019 sha: 9f137b3b470fb09c48c2793dd2bcc6ad9f7537af doc_id: 743446 cord_uid: 7ujkqttx nan Even before the COVID-19 pandemic, HCWs had the highest rate of occupational injuries of workers in any industry, 2 higher than that of manufacturing, construction, or mining. 3 Additionally, HCWs were in 6 of the 8 occupations most impacted by occupational injuries and illnesses. 4 Health care professionals routinely put the needs of their patients ahead of their own needs and consequently face risks ranging from musculoskeletal injury to violence. Infectious diseases are ubiquitous in health care, but with the emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and COVID-19, HCWs must now treat every patient and coworker as potentially infectious because of widespread ongoing transmission. 4 This became particularly important as we learned more about the role of disease transmission by presymptomatic and asymptomatic individuals with COVID-19. Health care settings are the epicenters in the fight against COVID-19, and the pandemic has brought the importance of HCW safety into sharp focus. 5 Of immediate importance is the effect of a potentially fatal disease on an infected HCW. If large numbers of HCWs are out ill, the negative effects extend to patient care. Thus, the pandemic has made the link between HCW safety and patient safety glaringly obvious. Occupational health and safety professionals use the concept hierarchy of controls to design safety programs. 6 For infectious hazards like COVID-19, HCW safety is optimized through use of engineering controls, such as technology to deliver remote care; administrative controls, including restrictions on hospital visitation or quarantine of 8 which allowed staff to complete medical clearance at any time of the day or night. This process improvement will be a permanent addition to the occupational health program. Fit-testing stations were also opened for walk-ins with care taken for physical distancing, and fit-testing was available on all shifts, including weekends. This approach allowed for medical clearance and fit-testing of thousands of HCWs within weeks. Appropriate PPE use and precautions such as physical distancing and hand hygiene are fundamental to prevent exposure to COVID-19. However, situations do arise where HCWs are exposed to the virus, whether at work, in the community, at home, or through travel. Occupational health programs for HCWs routinely manage employee exposure to infectious hazards, including bloodborne and respiratory pathogens. These exposure events may involve only 1 worker being exposed to a patient who is infectious, as in a bloodborne pathogen exposure through a needlestick. However, other exposure investigations can involve identifying dozens, even hundreds, of exposed individuals through contact tracing for pathogens such as tuberculosis, pertussis, and varicella. Once the exposed individuals are identified, they need to have a risk assessment and be given appropriate preventive actions, which may include postexposure prophylaxis, laboratory evaluation or symptom monitoring, or work restrictions. At present, quarantine of individuals who have sustained a medium-or high-risk exposure to a person with COVID-19 is our best available intervention to prevent ongoing transmission should the exposed health care worker acquire COVID-19. This approach, however, can pose a major challenge to health care systems experiencing a large number of exposures, depleting the available workforce. Safety controls are key to limiting such exposures. At Mayo Clinic, new technology and resources, including digital tools, have been allocated to support a systematic approach to contact tracing, 9 quarantine, and returnto-work assessments for HCWs exposed to persons with positive COVID-19 test results. This system will be useful in the future for contact tracing and exposure investigation for other pathogens such as tuberculosis. Systems to support the occupational health and safety of HCWs through PPE management, exposure investigation, and contact tracing of exposed workers are critical elements to keeping health care facilities safe for patients and other HCWs. Preventing exposure to HCWs reduces the frequency of quarantine and ensures adequate staffing. If exposure occurs, removing the HCW from the workplace prevents any additional exposures. Just as airlines remind us to put our oxygen mask on first before assisting others, we must prioritize the safety of HCWs to continue delivering optimal care to patients. HCW safety and patient safety are inseparable. Certainly, the safety of HCWs is critical during this pandemic, but we must not forget that HCW safety is equally important during normal operations. For the duration of the COVID-19 pandemic and beyond, support for flexible, scalable, robust occupational health and safety programs will be critical in ensuring optimal health care delivery. To Err Is Human: Building a Safer Health System Chart 2: distribution of nonfatal occupational injuries and illnesses by private industry sector Nonfatal occupational injury and illness incidence rates for cases involving days away from work for selected healthcare and protective service occupations, by ownership Centers for Disease Control and Prevention. COVID-19 travel recommendations by country Characteristics of Health Care Personnel with COVID-19 -United States The National Institute for Occupational Safety and Health. Hierarchy of controls Rational use of personal protective equipment for coronavirus disease (COVID-19) and considerations during severe shortages Occupational Safety and Health Administration. 1910.134 Respiratory protection A framework for sustainable contact tracing and exposure investigation for large health systems Editing, proofreading, and reference verification were provided by Scientific Publications, Mayo Clinic.