When news was released in January that Wuhan, China was impacted by the coronavirus, EI immediately launched a series of weekly educational blogs highlighting specific occupational health (OH) and industrial hygiene (IH) measures aimed at infection prevention, which inhibit coronavirus transmission. As a result, our base of healthcare, manufacturing, commercial real estate management, banks and retail clients have responded with numerous requests for our OH and IH services, targeted at controlling biological agents within the workplace.These services include on-line medical clearance for respirator wearers through EI’s RespiratorAssessor software; N95 respirator fit testing for healthcare institutions; indoor air quality monitoring to minimize potential indoor air concentrations of COVID-19 and inspection of workplace surfaces for proper disinfection, with recommendations for optimal EPA List N disinfectants and their proper use. In addition to these services, EI has been inundated with requests for planning and execution of medical screening programs of workplace employees to identify potential carriers of COVID-19.
Greg Lathan
President
Is your operation classified as an “essential business” during “Stay at Home” social distancing policies which have been implemented by over 40 states nationwide? Have you identified key employees necessary at the workplace to keep your business viable during the pandemic? If so, your operation is faced with the tremendous responsibility of minimizing the potential for employee-to-employee transmission of the coronavirus. Identification of workers with COVID-19 symptoms or employees who may have been exposed to known carriers is paramount in minimizing viral transmission within your workforce.
The “gold standard” for screening potential coronavirus carriers was recently established by New Rochelle, New York Incident Command in early March, during the rampant spread of the coronavirus in New York City suburbs. Their unique COVID-19 screening and testing model was ingeniously performed by targeting New Rochelle citizens while they remained in their vehicles.
Screening incoming drivers for coronavirus significantly minimized the opportunity for viral transmission between both citizen-to-citizen AND from citizen to the EMTs who executed COVID-19 screening operations.
Due to their limited supply, your operation will most likely not have immediate access to the COVID-19 test kits for confirmation of coronavirus carriers. The medical screening parameters which were used to target New Rochelle citizens who received COVID-19 testing should also be used on employees returning to work. These include temperature scans for elevated body temperature measured from the forehead (using non-contact, infrared thermometers). Forehead testing is performed from the driver side of the vehicle with the driver window partially rolled down. Medical screening questions were also administered in New Rochelle, with questions on pre-printed signs, which were typically answered with “Yes/No” replies from the subjects while they remained in their vehicles. Drivers can easily respond with a nod or a thumb up or down, thereby minimizing verbal communication with the technician and driver, as well as potential viral transmission.
In the event of inclement weather, larger event tents, preferably 20 feet by 20 feet and open on both ends, without a center support pole are ideal, so that adequate room for social distancing is given to employees in their vehicles and medical screening technicians. If routes of entry for employee vehicles are limited, which significantly slows the medical screening process, consider screening the employees while they remain in their parked vehicles.
This in-vehicle method is the most effective infection prevention strategy, as any potential COVID-19 carrier may be instructed to immediately turn around while inside their vehicle and return home without potentially exposing the workforce or screening technicians. Screening incoming employees while in their vehicles is superior to screening a congregation of employees, since the pathogen could be potentially shed by an employee carrying COVID-19 and expose otherwise healthy employees.
Strategic planning for the COVID-19 medical screening process is paramount. If your business elects to draw on internal volunteers from the workforce, these individuals need to be trained in the proper use and disposal of personal protective equipment (PPE), in addition to hazard awareness and infection prevention strategies. Adequate PPE resources must be available for the duration of the screening process. Internal inventory of PPE should include N95 respirators, protective face shields and/or eyewear, gloves and lab coats, Tyvek body suits or surgical gowns. A standard operating procedure should also be developed and implemented for the medical screening process to ensure that procedures for measuring body temperature and administrating the questionnaire are accurate and consistent. Using the same model thermometer imparts consistency in the temperature monitoring process. The non-contact thermometer reading should be compared to body temperature measured with a traditional oral thermometer on the same test subject to determine temperature deviation. All forehead temperature scans should be performed from the same distance from the subject (preferably around 6 inches). Ambient temperature is critical when using infrared body thermometers, as many do not provide accurate reading below 50 degrees Fahrenheit.
The number of screening volunteers is critical to maintain a steady and efficient flow of incoming facility personnel, with a target of between 30-45 minutes to medically screen all employees during a given shift. Remember, your business will need additional personnel for screening during the first several days while the process is being refined. As efficiency is gained during the medical screening process, typically the number of technicians may be decreased. If the facility has greater than 150 employees, multiple entry points should be considered while employees are arriving in their vehicles, with separate teams used to screen each point of entry. The process is also most efficient if body temperature measurements and the medical questionnaire are administered by separate technicians. Employee badge numbers may be used for recordkeeping, rather than recording names to expedite the screening process. Employee badges can be placed under the windshield or held up by the driver for visual access by the technician for rapid processing and improved infection prevention.
Other key procedures should be established during the planning process for COVID-19 employee screening. How will you notify employees before the screening process? What will the body temperature “trigger level” be to designate an elevated temperature or fever? Is it 100.4 degrees established by the Centers for Disease Control (CDC) or should you choose a lower, more conservative temperature trigger? What key questions should be asked and what algorithm will be developed for the responses by employees? If your operation’s COVID-19 Screening Questionnaire algorithm instructs employees to leave work immediately, they should be provided with an “Employee Positive Screening Referral and Instruction Form” referring them to their primary care provider or other licensed health care professional. Notification procedures should be developed to inform the potential coronavirus carrier’s supervisor, so contingency plans can be made for staffing during their absence from work. How long should the potential carrier remain at home in isolation? How often should your Human Resource Department follow-up with the employee? How long before you allow them to return to work if they do not exhibit any symptoms?
Whether your company is currently operating as an “essential” business or if you’re planning to re-open when social distancing guidelines relax, logistics and planning are paramount.
How Can We Help?
The EI Group, Inc. (EI) is prepared to provide employee screening for COVID-19 related symptoms. Learn more about our capabilities at www.ei1.com. If you have questions or concerns regarding employee screening, please contact us at
(800) 717-3472 or ei@ei1.com.