Covid-19: risk assessment and mitigation measures in healthcare and non healthcare workplaces
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The document discusses the COVID-19 pandemic, emphasizing the risks and mitigation measures necessary in healthcare and non-healthcare workplaces. It highlights the need for risk assessment using methods like Failure Mode and Effects Analysis (FMEA) to evaluate COVID-19 transmission and suggest controls to reduce infection rates. The ongoing challenges related to the pandemic's spread and impact on health systems, particularly in resource-limited settings, are also addressed.
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Covid-19: risk assessment and mitigation measures in healthcare and non healthcare workplaces
- 1. See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/356978589 COVID-19: Risk assessment and mitigation measures in healthcare and non- healthcare workplaces Article · December 2021 DOI: 10.51585/gjm.2021.2.0007 CITATIONS 2 READS 113 5 authors, including: Some of the authors of this publication are also working on these related projects: Avian pathogen recognition receptors View project Development and evaluation of Avian Vaccines View project Mohamed Fawzy Suez Canal University, Egypt, Ismailia 44 PUBLICATIONS 628 CITATIONS SEE PROFILE Ahmed Hasham Suez Canal University 17 PUBLICATIONS 9 CITATIONS SEE PROFILE Muhammed Houta Beni Suef University 6 PUBLICATIONS 12 CITATIONS SEE PROFILE Mostafa Hasham Al-Azhar University 5 PUBLICATIONS 3 CITATIONS SEE PROFILE All content following this page was uploaded by Muhammed Houta on 12 December 2021. The user has requested enhancement of the downloaded file.
- 2. German Journal of Microbiology eISSN: 2749-0149 Review COVID-19: Risk assessment and mitigation measures in healthcare and non-healthcare workplaces Mohamed Fawzy1,2 , Ahmed Hasham2,3∗ , Mohamed H. Houta2,4 , Mostafa Hasham5 and Yosra A. Helmy6∗ 1 Department of Virology, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt 2 Middle East for Vaccines (MEVAC), El-Salihya El-Gededa, El-Sharkia, 44671, Egypt 3 Department of Chemistry, Faculty of Science, Suez Canal University, Ismailia, Egypt 4 Department of Poultry Diseases, Faculty of Veterinary Medicine, Beni-Suef University, Beni-Suef, Egypt 5 Department of Agronomy, Faculty of Agriculture, Al-Azhar University, Cairo, Egypt 6 Department of Animal Hygiene, Zoonoses and Animal Ethology, Faculty of Veterinary Medicine, Suez Canal University, Ismailia 41522, Egypt This article is published in the special issue: Existence Battle: Viruses vs. Creatures Article History: Received: 18-Oct-2021 Accepted: 30-Nov-2021 *Corresponding authors: Ahmed Hasham [email protected] Yosra A. Helmy [email protected] Abstract The coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is the third emerging human coronavirus, leading to fatal res- piratory distress and pneumonia. The disease originated in December 2019 in Wuhan City, Hubei province, China. As of 23 November 2021, over 258 million cases and 5.1 million deaths have been reported in more than 222 countries and territories worldwide. The COVID-19 is under biological hazards group 4 of high risk of spreading to the community with the poten- tial to overwhelm the health system, especially in resource limited countries. Transmission of COVID-19 within healthcare and non-healthcare facilities has been recorded. Therefore, several authorities such as the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), and other global partners issued guidance to mitigate the COVID-19 pandemic in these facilities. A global emergency due to the COVID-19 pandemic requires various studies of mitigation measures and risk assessment. The Failure Mode and Effects Analysis (FMEA) was used as a tool for risk assessment in healthcare and clinical fields that assigns a numerical value to each risk associated with failure. Therefore, in this review, the FMEA procedure was used to evaluate the COVID-19 risks and risk groups in health care and non-healthcare workplaces. Proposed mitigation measures and risk ranking tools were also summarized. The COVID-19 transmission risk should be theoretically and practically reduced by applying the best hygienic practices. However, providing safe work practices must be improved for infection control measures in healthcare and non-healthcare workplaces. Additionally, it is recommended to reassess the risk of COVID-19 infection from time to time, especially after vaccines availability. Keywords: COVID-19; Healthcare; Mitigation; Risk Assessment; SARS-CoV-2; Workplaces, FMEA Citation: Fawzy, M., Hasham,A., Houta, M. H., Hasham, M., Helmy, Y. A. COVID-19: Risk assessment and mitigation measures in healthcare and non-healthcare workplaces. Ger. J. Microbiol. 1 (2): 19-28. https://doi.org/10.51585/gjm.2021.2.0007 Introduction The coronavirus disease-2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was announced as a public health emer- gency of international concern on 30 January 2020 (WHO, 2020a). The COVID-19 has a significant public health concern causing high morbidity and mortalities in humans. Also, the virus crosses the species barriers and is transmitted from bats and pangolins to humans (Elaswad et al., 2020; Elaswad and Fawzy, 2021; Sala- jegheh Tazerji et al., 2020; Wu et al., 2020; Sharun et al., 2021). The infection is spread by direct and indirect con- tact via respiratory droplets and/or fecal-oral routes. The basic reproduction number (R0) of COVID-19 is the number of cases directly caused by an infected indi- vidual throughout his infectious period. The transmis- sibility of a disease is determined by R0, which is used to determine a disease’s potential to spread within a specific population. The SARS-CoV-2 can spread up to 6 feet, and the R0 was calculated to be 2-4, meaning that one infected person can spread the virus to 2-4 in- dividuals (Zhang et al., 2020). Transmission of COVID-19 within healthcare and non-healthcare facilities has been reported in several countries worldwide. In the United States, more 19
- 3. than 62,000 nurses, physicians, and other healthcare providers have been infected with COVID-19, and at least 291 persons have died. Since currently, no specific treatment for COVID-19 is available, mitiga- tion measures are the only way to prevent or reduce virus transmission (CDC, 2020a). The COVID-19 pan- demic can overwhelm the health systems in different countries, particularly those in resource-limited set- tings. Therefore, the safety of individuals, including patients, healthcare workers, and non-healthcare work- ers in workplaces, is a topic of concern. The risk as- sessment procedures aim to eliminate the hazard or re- duce it using physical controls such as personal protec- tive equipment (PPE) and application of occupational health and safety (OH&S) management system (CWA, 2011; Demircan Yildirim, 2021). Therefore, the WHO issued guidance of required risk assessment for commu- nity health events. The risk assessment can be addressed using the Failure Mode and Effects Analysis (FMEA) procedure which was developed in 1960 in the aerospace industry (Zhou et al., 2016; Certa et al., 2017; WHO, 2020c). The FMEA has been modified for the healthcare risk assessment purposes to be Health Care Failure Mode and Effects Analysis (HFMEA) (DeRosier et al., 2002; Faiella et al., 2018; Liu et al., 2017). This review aims to provide insights on COVID-19 epidemiology, a trial to assess the risk of COVID-19 and investigate the efficacy of strategies applied globally to control the pandemic in either health care or non-healthcare work- places. Epidemiological characteristics of COVID-19 Source, persistence, and transmission dynamics of COVID-19 Up to date, the main source and the definitive inter- mediate hosts of SARS-CoV-2 are still unclear, and different theories are still under investigation. At the beginning of the COVID-19 outbreak, the infected pa- tients with SARS-CoV-2 were associated with the Hua- nan Seafood Wholesale Market in the Wuhan province of China, suggesting transmission of the disease from animals (Helmy et al., 2020). However, the continuous increase in the number of infected people who did not have any link to this market indicated disease trans- mission from person-to-person (CDC, 2020a). Further- more, it was reported that the virus transmitted from bats to humans due to the high identity (96.3%) with bat coronavirus RaTG13 (Zhou et al., 2020). The SARS-CoV-2 can replicate well in ferrets and cats and poorly in dogs, pigs, chickens, and ducks (Shi et al., 2020) (Figure 1). Also, the virus has been iso- lated from cats, dogs, lions, mink, and tigers (Shi et al., 2020; Salajegheh Tazerji et al., 2020). Asymptomatic infected people with the SARS-CoV-2 virus are consid- ered a potential source for the virus spread to healthy individuals, consequently resulting in an increased risk of disease transmission between humans (Helmy et al., 2020). Besides, the virus is highly resistant and can survive on several surfaces, including plastic, dispos- able gowns, surgical gloves, masks, paper, steel, glass, wood, ceramic, and aluminum for 2 to 9 days as well as at low temperature (4°C) for 28 days (Kampf et al., 2020). This explains the high infection rates among health and non-health workers. SARS-CoV-2 is similar to other coronaviruses that can be transmitted from human to human by direct and indirect contact (Helmy et al., 2017). The virus can be transmitted through coughing or sneezing of the res- piratory droplets from an infected person. It can also be transmitted after touching surfaces contaminated with the virus, then touching the eyes or mouth with contaminated hands (CDC, 2020b). There is also a possibility for the virus to be transmitted through the fecal-oral route, fomites, blood-borne, from mother to child, and from animal to humans (Holshue et al., 2020; Lai et al., 2020; WHO, 2020d). Clinical features and high-risk groups for COVID-19 The COVID-19 infection in humans is characterized by flu-like symptoms: dry cough, fever, fatigue, headache, chills, shortness of breath, sore throat, chest pain, and muscle pain. In some cases, patients also experienced nausea, runny nose, vomiting, and diarrhea (Wang et al., 2020). Fever has been reported in 83% of the patient, cough in 82%, shortness of breath in 31%, mus- cle ache in 11%, confusion in 9%, headache in 8%, sore throat in 5%, runny nose in 4%, chest pain in 2%, di- arrhea in 2%, and nausea and vomiting in 1% (Huang et al., 2020) (Figure 2). Mostly, mild infections can last up to 2 weeks. This is considered the main reason for virus dissemination and transmission on a large scale from person to person. Complications such as pneumonia, kidney failure, and death can occur in severe cases (disease can last 3 to 6 weeks) (Huang et al., 2020). Some patients also suffer from ischemic changes in the fingers and toes (Lin et al., 2020). The onset of the disease symptoms to death ranges between 2 and 8 weeks (Wang et al., 2020). The incubation period ranges between 2 days to 2 weeks and, in some cases, can reach up to 27 days (Bai et al., 2020). It has been reported that 80.9% of the patients suffering from the mild phase of the dis- ease (flu-like symptoms) and recovered at home, 13.8% of the patients have developed shortness of breath and pneumonia, 4.7% of cases are severe and suffered from respiratory failure and septic shock which leading to organs failure, and about 2% of the cases were fatal (Bai et al., 2020). Many factors can affect the spread of COVID-19 between individuals and increase the risk of transmis- sion and the number of infected cases, including con- tact with healthcare workers caring for patients with COVID-19 and contact with patients who are diag- nosed positive for SARS-CoV-2 virus infection (Helmy et al., 2020). The workplaces are classified as very high-risk group (e.g., health workers), high-risk group (health- care supportive team), medium and low-risk groups who represent the vast majority of workplace types (Koh, 2020; Semple and Cherrie, 2020; Yen et al., 2020a). The high-risk groups with high COVID-19 20
- 4. Figure 1: The proposed mode of transmission of SARS-CoV-2 between different hosts. fatality rates within each category include older peo- ple and immunocompromised patients suffering from cardiovascular disease, hypertension, diabetes, and chronic respiratory disease (CDC, 2020a). The fatality rate was higher (14.8%) in older patients (>80 y), 8% in patients between 70-79 y, 3.6% in patients between 60-69 y, 1.3% in patients between 50-59 y, 0.4% in pa- tients between 40-49 y, 0.2% in patients between 10-39 y. However, until now there are no fatalities reported in patients under 10-year-old. Furthermore, a higher fatality rate was reported in males (2.8%) compared to females (1.7%) (Wang et al., 2020; WHO, 2020a). Current status of COVID-19 pandemic In-mid January 2020, the disease began to transmit to other Asian countries such as Thailand and Japan through people visiting the Huanan Seafood Whole- sale Market, then it spread to more than 18 coun- tries. Therefore, the WHO announced the COVID-19 as a Public Health Emergency of International Con- cern (CDC, 2020a; WHO, 2020a). In mid-March 2020, more than 73% of the confirmed cases globally have been reported in mainland China (WHO, 2020c). Thereafter, the globally reported cases outside China have shown a drastic increase within a short time. Consequently, on 11 March 2020, the WHO an- nounced COVID-19 as a pandemic disease. Two days later, the WHO stated Europe to be the new center of the pandemic due to the increasing number of con- firmed cases and deaths in Italy (WHO, 2020a). On 23 March 2020, the highest number of deaths was re- ported in Italy, followed by China, while on 30 March 2020, the highest number of cases reported in the USA, followed by Italy. Notably, on 13 April 2020, the num- ber of confirmed cases of SARS-CoV-2 increased 1.7 times, while the number of deaths increased 2.5 times in the USA (Helmy et al., 2020). As of 23 November 2021, the virus spread to 222 countries and territories with 258,479,352 confirmed cases, 233,966,967 recov- ered cases, and 5,176,216 deaths worldwide with the higher occurrence and fatalities in the USA (WHO, 2020e). Starting from 23 November 2021, the virus spread to approximately 222 countries and territories with 258,479,352 confirmed cases, and 5,176,216 deaths worldwide with higher prevalence and deaths in the United States. Risk assessment and expected hazards of COVID-19 in different workplaces Risk assessment in different workplaces One of the appropriate tools to control the introduction and spread of infectious diseases is performing a risk assessment to stratify community safety threats and to monitor agencies’ responses (Ostrom and Wilhelmsen, 2012; Settembre-Blundo et al., 2021). The WHO guid- ance for conducting the required risk assessment for community health events is a helpful tool for identify- ing risks. Wherever potential, risks should be removed through the choice of control measures and dealing with bio-agents. If risks cannot be eliminated, they should be reduced by using physical controls and/or through systems of work and PPE (CWA, 2011). Additionally, occupational health and safety man- agement systems are intended to empower the or- ganization to be responsible for safe and healthy workplaces, avoid work-related injury and disease (Darabont et al., 2018). The European directive 2000/54/CE and WHO classify the biological hazards 21
- 5. Figure 2: Clinical features of COVID-19 infection (pathogens) into four groups according to the level of infection risk and the characteristic hazards of the or- ganism (Băbuţ et al., 2020). The COVID-19 was cat- egorized under “Biological hazards–Group 4” which means a high risk of spread to the community. Inhibiting bio-agents risks is obligatory by law ac- cording to Directive 2000/54/EC of the European Par- liament and of the Council of 18 September 2000 on the protection of workers from risks related to expo- sure to biological agents at work (EU, 2020). The basic tool of COVID-19 infection is the transmission chain between the reservoirs, the source of infection, and the host (including health and non-healthcare workers) (Kelvin and Halperin, 2020). Avoidance will focus on transmission dynamics and cutting one or several links in the transmission chain. Infection at the workplace can occur via different sources like using shared office tools (copying machines, whiteboards, pens, rollers, etc.) (Gibbins and MacMahon, 2015). According to the workplace, both hazard and exposure potential to COVID-19 will significantly differ (Rocklöv and Sjödin, 2020). For instance, the hazards and potential of ex- posure will be maximum in hospitals and airports. The Failure Mode and Effects Analysis (FMEA) ap- plication to different workplaces The governmental organizations, business owners, and employees are responsible for deciding the required ac- tions to continually monitor and adapt the risk man- agement framework to address exterior and interior risks. For many years, FMEA was used as a tool for risk assessment in many fields and recently used in clin- ical, healthcare, and clinical fields (Bonfant et al., 2010; Liu et al., 2018). To simplify the FMEA, the risk as- sessment can be conducted using the FMEA procedure that assigns a numerical value to each risk associated with failure. A 5-points rating system to evaluate the following 3 categories; severity “S”, occurrence “O” and the ability for detection “D” of each failure was rated (Table 1), which was modified by Duwe et al. (2005) to high- light reasonability in the simplest way to avoid con- fusion in evaluation, also to have accurate risk priority number (RPN) grade evaluation to be able to take the necessary control measures. The risk priority number “RPN” was then obtained by multiplying the assigned numerical values of the 3 evaluated risks “RPN= S x O x D” (Duwe et al., 2005) as shown in Table 2. Mitigation measures of COVID-19 pandemic To reduce the potential risks of COVID-19 in various workplaces, preparedness and response plans must be applied to control the transmission of infection between individuals and subsequently reduce the impact on the business (Bruinen de Bruin et al., 2020; Ebrahim et al., 2020). COVID-19 preparedness and response plans To assure that all the foremost necessary measures to control the infection in workplaces are applied, guid- ance must be developed by both labor and health agen- cies (Carinci, 2020; Koonin, 2020; Watkins, 2020). The prepared plans should consider and address the level(s) of risk of exposure to COVID-19 infection associated with various work sites and job tasks. For instance, the worker’s individuals with high risk associated with age, pregnancy, or immunocompromising factors need to be addressed (Gilbert et al., 2020; WHO, 2020a). Pre- paredness should include three main preventive mea- sures; basic preventive measures, prompt identification and isolation of infected persons, and increased work- place flexibilities and protection. The basic preventive measures include strict per- sonnel hygienic measures, social hygienic measures (e.g., social distancing), education of the public for the 22
- 6. Table 1: Disease severity, occurrence, and detection rating scale of COVID-19. Weight Severity Occurrence Detection 1 No symptoms <1 in 500,000 Can be detected in the time of adequate intervention 2 Light symptoms 1 in 5000 High chance to be detected in the time of adequate inter- vention 3 Moderate symptoms 1 in 500 Low chance to be detected in the time of adequate inter- vention 4 High symptoms 1 in 50 Remote chance to be detected in the time of adequate in- tervention 5 Very high/Death 1 in 5 Cannot be detected best personnel and hygienic social practices, and fre- quent cleaning and disinfection of workplaces appropri- ately using the United States Environmental Protec- tion Agency (US EPA) approved disinfectants (Abel and McQueen, 2020; Adhikari et al., 2020; Fathizadeh et al., 2020). Of utmost importance, the plan should include the identification and appropriate isolation of infected people. For example, encouraging the em- ployees to be aware of self-monitoring for symptoms of COVID-19, isolating themselves, or even reporting potential contact to COVID-19 suspected cases. How- ever, this is not well applied, especially in developing and poor countries (Fathizadeh et al., 2020). Additionally, the restrictions being applied on COVID-19 testing (i.e., not allowed by the private sec- tor in many countries) are limiting the monitoring of COVID-19 spread and probably conceal the numbers of reported new cases (Fanidi et al., 2020; Hopman et al., 2020; Kapata et al., 2020; Koo et al., 2020; Ling et al., 2020). The workplace policy needs to include specific isolation rooms until relocating suspected persons to specialized healthcare places. However, restricting the entry to isolation rooms to well-trained persons with appropriate PPE is critical, considering the need for technical team training on the best practices in such situations (Rahimi and Talebi Bezmin Abadi, 2020; Tang et al., 2020). Likewise, increasing workplace flex- ibilities and protections via ensuring risk-based non- punitive leave policies are consistent with public health guidance. Moreover, reducing the number of work- force occupancy in workplaces and supporting work from home are widely applied. Unfortunately, in the developing countries, these flexibilities are not always possible due to three main causes; the dependence of workplaces on a large number of workers (manual pro- cesses), poverty levels and temporary or daily employ- ment systems requiring daily work, and finally, the lack of the necessary infrastructure and training for home- based work (Ling et al., 2020; WHO, 2020c; Yelin et al., 2020). Selection of control measures with special focus on healthcare workplaces The infectious agents’ controls hierarchy includes en- gineering controls, administrative controls, safe work- place practices, and PPE. Addressing these controls in workplaces other than healthcare places, especially to control COVID-19 spread, is not an easy process considering the limited time to achieve such measures (Berger et al., 2020; WHO, 2020b). However, achiev- ing some level of these measures probably can help in minimizing the spread of the infection. For instance, engineering controls may include but are not limited to improving ventilation, increasing physical barriers between workers and between workers and clients. In addition, the top management decisions to change the work policy also are important as administrative con- trol measures that may include establishing alterna- tive days or extra work shifts, encouraging work from home, and training workers, and providing up to date information about COVID-19 (Bruinen de Bruin et al., 2020; Ebrahim et al., 2020; Lee et al., 2020; Yen et al., 2020a,b). Different workplace risk groups, risk fac- tors, and the main engineering and administrative con- trol measures proposed for COVID-19 according to the WHO (WHO, 2020b) are summarized in Table 3. Nosocomial COVID-19 infections are a big problem facing all healthcare providers; therefore, implement- ing restrictive mitigation measures by applying the in- fection control hierarchy principle is needed (Cheng et al., 2020; Ochoa-Leite et al., 2021). First of all, en- hancement of ventilation systems efficacy by addition of ”High-Efficiency Particulate Air (HEPA)” filters on inlet and exhaust of contaminated rooms (Lynch and Goring, 2020; Azimuddin et al., 2020). Intensive care units (ICU) must be upgraded to be of the same bio- logical containment features of negative pressure AIIR (Wong et al., 2020). The recommendations and strate- gic actions of the WHO to surge the hospital’s capacity are needed on the administrative level. These involve a comprehensive approach linking the 4 S’s of surge ca- pacity (Space; to be expanded for COVID-19 patients, Staff; to be identified to meet expanded capacity de- mands, Supplies; adequate supplies to be ensured, and Systems; via establishing systems to manage and align policies to meet the surge in demand). 23
- 7. Table 2: The risk priority number “RPN” of COVID-19 infection in workplaces. Activity Risk analysis RPN interpretation Severity (S) Occurrence (O) Detection (D) RPN= (S*O*D) 1. Non-healthcare workplaces Shared tools (Fingerprint ma- chine, fax, copying machine, phones, etc.) 5 5 5 125 Very high Doors lockers, elevator buttons 5 5 5 125 Very high Gowning rooms 5 5 5 125 Very high Contact with infected cases 5 5 5 125 Very high Liquid waste treatment 5 5 5 125 Very high Travelling to/from pandemic area 5 5 5 125 Very high Authorized person to enter all ar- eas 5 5 5 125 Very high Shared services (toilets, restau- rant, meeting rooms, etc.) 5 4 5 100 High Solid waste handling 5 4 5 100 High Working in goods delivery 5 4 5 100 High Using public transportation 5 4 4 80 High Check hands 5 4 4 80 High 2. Healthcare workplaces Using public transportation 5 5 5 125 Very high Check hands 5 5 5 125 Very high Shared medical devices (trol- leys, blood pressure devices, ther- mometers, surgical tools, ECG., etc.) 5 5 5 125 Very high Shared office tools (Fingerprint machine, fax, copying machine, telephones. etc.) 5 5 5 125 Very high Doors lockers, elevator buttons 5 5 5 125 Very high Gowning rooms 5 5 5 125 Very high Shared services (toilets, restau- rant, meeting rooms, workspace. etc.) 5 5 5 125 Very high Infected cases isolation units 5 5 5 125 Very high Intensive care unit (ICU) 5 5 5 125 Very high Solid waste handling 5 5 5 125 Very high Liquid waste treatment 5 5 5 125 Very high Authorized person to enter all ar- eas 5 5 5 125 Very high Visitors/ External workforce/ sub-contractors 5 5 5 125 Very high Dealing with asymptomatic carri- ers 5 5 4 100 high Suspected cases isolation units 5 4 5 100 High Patient sampling units and labo- ratories 5 4 4 80 High Dealing with COVID-19 death cases 5 4 4 80 High Other patients’ units 5 3 5 75 Moderate Administrative and supporting teams (security, restaurants, pharmacies) 5 3 5 75 Moderate 24
- 8. Table 3: Workplaces risk groups, risk factors, and the main engineering and administrative control measures for COVID-19 in different groups (WHO, 2020b) Example Risk factors Engineering controls Administrative controls Very high risk - Healthcare workers - Healthcare or laboratory personnel - Performing aerosol-generating procedures (e.g., intubation, or invasive specimen collection) on known or suspected COVID-19 patients. - Collecting or handling specimens from known or suspected COVID-19 patients. - Aerosol-generating procedures, on known or suspected COVID-19 dead bodies. 1. Ensure appropriate air-handling systems in- stallation and maintenance in healthcare facili- ties. 2. Patients with known or suspected COVID-19 should be placed in an AIIR. 3. Using isolation rooms for performing aerosol- generating procedures on patients with known or suspected COVID-19. 1. Implementation of policies to reduce exposure (e.g. cohorting COVID-19 patients when single rooms are not available). 2. Posting of advisory signs (e.g. patients and family members to immediately report symp- toms of respiratory illness and use disposable face masks). 3. Offering enhanced medical monitoring of workers during COVID-19 outbreaks. High Risk - Healthcare support staff - Medical transport workers - Funeral parlor workers - Exposure to known or suspected COVID-19 pa- tients. - Moving known or suspected COVID-19 patients in enclosed vehicles. - Funerals of people who are known to have, or suspected of having COVID-19. 4.Use special precautions associated with Biosafety Level 3 when handling specimens from known or suspected COVID-19 patients. 4. Provide all workers with job-specific educa- tion and training. 5. Ensuring psychological and behavioral sup- port is available for employees. Medium risk Workers have contact with the public (e.g., schools, high-population-density work environments, high- volume retail settings). Frequent and/or close contact with (i.e., within 6 feet of) people who may be infected with COVID-19, but who are not known or suspected COVID-19 patients Installation of physical barriers, such as clear plastic sneeze guards, where feasible. 1. Offering face masks to all employees and cus- tomers. 2. Keeping customers informed about symptoms of COVID-19. 3. Limiting or restricting customers’ and the public’s access to the worksite. 4. Applying strategies to minimize face-to-face contact (e.g., drive-through windows and tele- work). 5. If available, on-site medical screening and care (e.g., on-site nurse; telemedicine service). Low risk Workers in this category have minimal occupational contact with the public and other coworkers. No contact with people known to be, or sus- pected of being, infected with COVID-19 nor fre- quent close contact with the public. (i.e., within 6 feet of) Not Required Monitor public health communications about COVID-19 recommendations 25
- 9. Safe work practices must be enhanced specifically for infection control measures during various activities with suspected or confirmed cases, samples, material, and waste. Special care should be implemented while performing any aerosol-generating procedures such as intubation, extubation, and related procedures (Asadi et al., 2020; Tseng and Lai, 2020; Irons et al., 2021). The PPE that fits the nature of work is required (Yu et al., 2020). For instance, PPE, including long- sleeved disposable fluid repellent gowns, higher protec- tion masks such as N95/FFP3 masks, full-face shields, or visor and gloves, are required for sampling from suspected or confirmed COVID-19 cases (Ağalar and Öztürk Engin, 2020). Conclusion and recommendations In our study, we go through the COVID-19 virus’s epidemiological characteristics, as well as its source, persistence, and transmission dynamics. The FMEA method was used to evaluate the hazards of COVID- 19 infection in various workplaces. COVID-19 infection risks are higher in healthcare workplaces than in non- healthcare workplaces, according to this study. The COVID-19 transmission risk should be reduced both conceptually and practically by implementing the best sanitary standards. As a result, it will have a good im- pact on the global control of COVID-19 transmission. Additionally, many factors, including contact with health care workers caring for COVID-19 patients and contact with patients diagnosed positive for SARS- CoV-2 virus infection, can affect the spread of COVID- 19 and increase the risk of transmission and the num- ber of infected cases. Our review provides safe work practices which must be explicitly enhanced for infec- tion control measures during various activities with suspected or confirmed cases, samples, material, and waste. Finally, it is recommended to repeat the COVID-19 infection risk assessment from time to time, especially after vaccines availability worldwide. Article Information Funding. 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