Procedure to contain spread of COVID-19 in workplace settings

1. SUMMARY

1. Coronavirus Disease 2019 (COVID-19) is a respiratory disease caused by the SARS-CoV-2 virus.
2. Infection with SARS-CoV-2, the virus that causes COVID-19, can cause illness ranging from mild to severe and, in some cases, can be fatal. Symptoms typically include fever, cough, and shortness of breath. Some people infected with the virus have reported experiencing other non-respiratory symptoms. Other people, referred to as asymptomatic cases, have experienced no symptoms at all.
3. According to the CDC, symptoms of COVID-19 may appear in as few as 2 days or as long as 14 days after exposure.

2. REVISION AND APPROVAL

Rev.	Date	Nature of Changes	Approved By
00	04/06/2020	Original issue.	CEO

3. INTRODUCTION

Offices and other workplaces are relatively close setting, with shared spaces like (corridors, elevators & stairs, parking places, cafeteria, meeting rooms and conference halls etc.) and thus COVID-19 infection can spread relatively fast among employees, staffs and visitors. Thus there is a need to prevent importation of infection in workplace settings and to respond in a timely and effective manner in case suspect case of COVID-19 is detected in these settings, so as to limit the spread of infection.

4. SCOPE

This Procedure outlines the preventive and response measures to be observed to contain the spread of COVID-19 in workplace settings. The HR and Admin Manager along with Department Head are responsible for implementation of the Procedure.

5. BASIC PREVENTIVE MEASURES

The basic preventive measures include simple public health measures that are to be followed to reduce the risk of infection with COVID-19. These measures need to be observed by all (employees and visitors) at all times. These include:

1. Physical distancing of at least one meter to be followed at all times.
2. Use of face covers/masks to be mandatory.
3. Practice frequent hand washing (for at least 40-60 seconds) even when hands are not visibly dirty and use of alcohol based hand sanitizers (for at least 20 seconds).
4. Respiratory etiquettes to be strictly followed. This involves strict practice of covering one’s mouth and nose while coughing/sneezing with a tissue/handkerchief/flexed elbow and disposing off used tissues properly.
5. Self-monitoring of health by all and reporting any illness at the earliest

6. PREVENTIVE MEASURES FOR OFFICES/SITES:

The HOD  and HR & Admin Manager will ensure that Guidelines with respect to preventive measures specific to offices that has been/will be issued by Minister of Heath Kuwait is being followed. Any staff reportedly suffering from flu-like illness should not attend office and seek Medical advice from local health authorities. Such persons, if diagnosed as a suspect/confirmed case of COVID-19 should immediately inform the office authorities. Any staff requesting home quarantine based on the containment zone activities in their residential areas should be permitted to work from home. MOH guidelines with respect to organizing meetings, coordinating visitors shall be scrupulously followed.

All the Departments are advised to take all necessary measures such as :-

1. Install thermal scanners at the entry of buildings and Sites as feasible. Mandatory placing of hand sanitizers at the entry of buildings/Sites. Those found having flu-like symptoms may be advised to take proper treatment/quarantine etc.
2. Discourage, to the maximum extent, entry of visitors in the office/ Sites. Routine issue of visitors/temporary passes should be suspended with immediate effect. Only those visitors whom have proper permission of the Deputy Director or above who they want to meet should be allowed after being properly screened.
3. Meetings, as far as feasible, should be done through video conferencing. To minimize or reschedule meetings involving large number of people unless necessary.
4. Avoid non-essential official travel.
5. Undertake essential correspondence on official email and avoid sending files and documents to other offices, to the extent possible.
6. Facilitate delivery and receipt of Courier at the entry point itself of the office building, as far as practicable.
7. Ensure proper cleaning and frequent sanitization of the workplace, particularly of the frequently touched surfaces.
8. Ensure regular supply of hand sanitizers, soap and running water in the washrooms.
9. All employees may be advised to take care of their own health and look out for respiratory symptoms/fever and, if feeling unwell, should leave the workplace immediately after informing their reporting Managers.
10. The leave sanctioning authorities are advised to sanction leave whenever any request is made for self-quarantine as a precautionary measure.
11. Advise all employees who are at higher risk i.e. older employees, pregnant employees and employees who have underlying medical conditions, to take extra precautions. The Departments may take care not to expose such employees to any front-line work requiring direct contact with the public.

7. DO’s AND DON’Ts FOR ALL EMPLOYEES

1) Do’s

• To maintain personal hygiene and physical distancing.
• To practice frequent hand washing. Wash hands with soap and water or use alcohol-based hand rub. Wash hands even if they are visibly clean.
• To cover your nose and mouth with handkerchief/tissue while sneezing and coughing.
• To throw used tissues into closed bins immediately after use.
• To maintain a safe distance from persons during interaction, especially with those having flu-like symptoms.
• To sneeze in the inner side of your elbow and not to cough into the palms of your hands.
• To take their temperature regularly and check for respiratory symptoms.
• To see a doctor if you feel unwell (fever, difficulty in breathing and coughing). While visiting doctor, wear a mask/cloth to cover your mouth and nose.

2) Don’ts

• Shake hands.
• Have a close contact with anyone, if you’re experiencing cough and fever.
• Touch your eyes, nose and mouth.
• Sneeze or cough into palms of your hands.
• Spit in Public.
• Travel unnecessarily, particularly to any affected region.
• Participate in large gatherings, including sitting in groups at cafeteria.
• Visit gyms, clubs and crowded places etc.
• Spread rumors or panic.

8. MEASURES TO BE TAKEN ON OCCURRENCE OF CASE OF COVID-19:

Despite taking the above measures, the occurrence of cases among the employees working in the office cannot be ruled out. The following measures will be taken in such circumstances:

1. 1. When one or few person(s) who share a room/close office space is/are found to be suffering from symptoms suggestive of COVID-19:
      1. Place the ill person in a room or area where they are isolated from others at the workplace. Provide a mask/face cover till such time he/she is examined by a doctor.
      2. Report to concerned health authorities will be immediately informed.
      3. A risk assessment will be undertaken by the departmental Head along with Safety manager and accordingly further advice shall be made regarding management of case, his/her contacts and need for disinfection.
      4. The suspect case if reporting very mild / mild symptoms on assessment by the health authorities would be placed under home isolation, subject to fulfillment of criteria laid down in MOH guidelines
      5. Suspect case, if assessed by health authorities as moderate to severe, he/she will follow the MOH guidelines.
      6. The rapid response team consisting of Admin and Hr. Manager, safety manager and the Dept. Head of the concerned department shall be requisitioned and will undertake the listing of contacts.
      7. The necessary actions for contact tracing and disinfection of work place will start once the report of the patient is received as positive. The report will be expedited for this purpose.
   2. If there are large numbers of contacts from a pre-symptomatic/asymptomatic case, there could be a possibility of a cluster emerging in workplace setting. Due to the close environment in workplace settings this could even be a large cluster (>3 cases). The essential principles of risk assessment, isolation, and quarantine of contacts, case referral and management will remain the same. However, the scale of arrangements will be higher.
   3. Management of contacts:
      The contacts will be categorized into high and low risk contacts by the Safety Manager. The high risk exposure contacts shall be quarantined for 14 days. They will follow the guidelines on home quarantine as given by MOH, Kuwait. These persons shall undergo testing as per MOH, Kuwait protocol. The low risk exposure contacts shall continue to work and closely monitor their health for next 14 days.
   4. Risk profiling of contacts
      Contacts are persons who have been exposed to a confirmed case anytime between 2 days prior to onset of symptoms (in the positive case) and the date of isolation (or maximum 14 days after the symptom onset in the case).
      1. High-risk contact
         • Touched body fluids of the patient (respiratory tract secretions, blood, vomit etc; e.g. being coughed on, touching used paper tissues with a bare hand)
         • Had direct physical contact with the body of the patient including physical examination without PPE
         • Touched or cleaned the linens, clothes, or dishes of the patient.
         • Lives in the same household as the patient.
         • Anyone in close proximity (within 1 meter) of the confirmed case without precautions.
         • Passengers in close proximity (within 1 meter) in a conveyance with a symptomatic person who later tested positive for COVID-19 for more than 6 hours.
      2. Low-risk contact
         • Shared the same space (worked in same room/similar) but not having a high-risk exposure to confirmed case of COVID-19.
         • Travelled in same environment (bus/train/flight/any mode of transit) but not having a high-risk exposure.

9. CLOSURE OF WORKPLACE

If there are one or two cases reported, the disinfection procedure will be limited to places/areas visited by the patient in past 48 hrs. There is no need to close the entire office building/halt work in other areas of the office and work can be resumed after disinfection as per laid down protocol (see para 10).
However, if there is a larger outbreak, the entire building will have to be closed for 48 hours after thorough disinfection. All the staff will work from home, till the building is adequately disinfected and is declared fit for re-occupation.

10. DISINFECTION PROCEDURES IN OFFICES

1. Indoor areas including office spaces

• Office spaces, including conference rooms should be cleaned every evening after office hours or early in the morning before the rooms are occupied. If contact surface is visibly dirty, it should be cleaned with soap and water prior to disinfection. Prior to cleaning, the worker should wear disposable rubber boots, gloves (heavy duty), and a triple layer mask.
• Start cleaning from cleaner areas and proceed towards dirtier areas.
• All indoor areas such as entrance lobbies, corridors and staircases, escalators, elevators, security guard booths, office rooms, meeting rooms, cafeteria should be mopped with a disinfectant with 1% sodium hypochlorite or phenolic disinfectants. High contact surfaces such elevator buttons, handrails / handles and call buttons, escalator handrails, public counters, intercom systems, equipment like telephone, printers/scanners, and other office machines should be cleaned twice daily by mopping with a linen/absorbable cloth soaked in 1% sodium hypochlorite. Frequently touched areas like table tops, chair handles, pens, diary files, keyboards, mouse, mouse pad, tea/coffee dispensing machines etc. should specially be cleaned.
• For metallic surfaces like door handles, security locks, keys etc. 70% alcohol can be used to wipe down surfaces where the use of bleach is not suitable.
• Hand sanitizing stations should be installed in office premises (especially at the entry) and near high contact surfaces.
• In a meeting/conference/office room, if someone is coughing, without following respiratory etiquettes or mask, the areas around his/her seat should be vacated and cleaned with 1% sodium hypochlorite.
• Carefully clean the equipment used in cleaning at the end of the cleaning process.
• Remove PPE, discard in a disposable PPE in yellow disposable bag and wash hands with soap and water.
• In addition, all employees should consider cleaning the work area in front of them with a disinfecting wipe prior to use and sit one seat further away from others, if possible

2. Outdoor areas

Outdoor areas have less risk then indoor areas due to air currents and exposure to sunlight. These include bus stops, railway platforms, parks, roads, etc. Cleaning and disinfection efforts should be targeted to frequently touched/contaminated surfaces as already detailed above.
3. Public toilets

Sanitary workers must use separate set of cleaning equipment for toilets (mops, nylon scrubber) and separate set for sink and commode). They should always wear disposable protective gloves while cleaning a toilet.

• 70% Alcohol can be used to wipe down surfaces where the use of bleach is not suitable, e.g. metal. (Chloroxylenol (4.5-5.5%) / Benzalkonium Chloride or any other disinfectants found to be effective against coronavirus may be used as per manufacturer’s instructions)
• Always use freshly prepared 1% sodium hypochlorite.
• Do not use disinfectants spray on potentially highly contaminated areas (such as toilet bowl or surrounding surfaces) as it may create splashes which can further spread the virus.
• To prevent cross contamination, discard cleaning material made of cloth (mop and wiping cloth) in appropriate bags after cleaning and disinfecting. Wear new pair of gloves and fasten the bag.
• Disinfect all cleaning equipment after use and before using in other area
• Disinfect buckets by soaking in bleach solution or rinse in hot water

4. Personal Protective Equipment (PPE):

Wear appropriate PPE which would include the following while carrying out cleaning and disinfection work.

• Wear disposable rubber boots, gloves (heavy duty), and a triple layer mask
• Gloves should be removed and discarded damaged, and a new pair worn.
• All disposable PPE should be removed and discarded after cleaning activities are completed.
• Hands should be washed with soap and water immediately after each piece of PPE is removed, following completion of cleaning.
• Masks are effective if worn according to instructions and properly fitted. Masks should be discarded and changed if they become physically damaged or soaked.

5. Guidelines for use of mask

The correct procedure of wearing triple layer surgical mask

1. Perform hand hygiene
2. Unfold the pleats; make sure that they are facing down.
3. Place over nose, mouth and chin.
4. Fit flexible nose piece over nose bridge.
5. Secure with tie strings (upper string to be tied on top of head above the ears –lower string at the back of the neck.)
6. Ensure there are no gaps on either side of the mask, adjust to fit.
7. Do not let the mask hanging from the neck.
8. Change the mask after six hours or as soon as they become wet.
9. Disposable masks are never to be reused and should be disposed off.
10. While removing the mask great care must be taken not to touch the potentially infected outer surface of the mask
11. To remove mask first untie the string below and then the string above and handle the mask using the upper strings.
12. Disposal of used masks: Used mask should be considered as potentially infected medical waste. Discard the mask in a closed bin immediately after use.

10. HAND WASHING TECHNIQUE WITH SOAP AND WATER

11. Management of the cases and Contact

12. Disinfection of workplace