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In this Issue
Volume 2 , Issue 6
September 2009

HIN1: The Hype Behind the Swine Flu

Flu Season Issue

i. H1N1

ii.   Background and Epidemiology

iii. Transmission and Signs of Infection

iv. Implementing Workplace Planning
    a. Workplace Controls
    b. Engineering and Administrative Controls
    c. Personal Protective Equipment (PPE)
v. What is the difference between       surgical masks and respirators?

vi. Quantitative N95 Mask Fit Testing

vi.. Prepare Now

Unless you have been living in a remote area with all forms of communication turned off, you should be well aware of the recent H1N1 influenza or “swine flu” outbreak. While seasonal epidemics of the influenza happen each year, the novel H1N1 virus is causing serious illness and even death in both young and older people with other contributing health problems.

Flu season will be here again this fall/winter and transmission of the virus can be anticipated in the workplace. A pandemic of the H1N1 virus will directly affect employers. It is estimated that work absenteeism may rise to as much as 40% because of ill employees, workers staying home to care for other family members and those employees who may fear getting sick by coming to work. Employee absenteeism directly affects the economics and ability to carry out day-to-day operations of a business.

During an influenza pandemic, employers will play an important role in protecting employees’ health and safety; from educating workers about proper hand washing techniques to ensuring employees are using a properly fitted respirator. Early planning and preparation will allow employers to better protect their employees and minimize the impact of a pandemic on the economy and their business.

Background and Epidemiology

Transmission and Signs of Infection

According to the Centre for Disease Control, the seasonal flu is a highly contagious disease that causes, on average, more than 200 000 hospitalizations and 36 000 deaths from associated respiratory complications in the United States every year. In addition, Health Canada estimates that between 700 – 2500 Canadian deaths may be attributed to the influenza every year. There are three different classes of the flu that each can be further subclassified. Influenza A and B viruses are responsible for the majority of seasonal flu epidemics, while type C produces very mild symptoms and is not known to produce seasonal epidemics.
Influenza A is divided into subtypes based on the structure of two proteins, hemagglutinin (H) and neuraminidase (N). There are 16 different hemagglutinin subtypes and 9 different neuraminidase subtypes. There are also different strains of the influenza B virus. Each year’s influenza vaccination includes strains of influenza A and B, but does not protect against influenza C.

The H1N1 virus is a strain of the influenza A class. It was originally called the swine flu because scientific analysis revealed that certain genes in the new virus were similar to those found in a flu strain that normally circulates in pigs. In addition, the novel strain of the H1N1 virus also contains genes from the human and avian versions of the influenza virus. The H1N1 virus demonstrates the remarkable ability of the virus to mutate and restructure itself. Humans have no natural immunity to the virus because we have never been exposed to this strain before.

The influenza virus is primarily transmitted through large droplets and small aerosols (mist) that directly contact the nose, mouth or eyes.

Occasionally, people can be infected by touching surfaces containing the flu virus and then touching their mouth or nose.

The large droplets are produced when infected people cough, sneeze or talk. Large droplets travel less than 2 metres and aerosols only affect the immediate area.

Implementing Workplace Planning

There are a variety of control measures that can be taken to help substantially reduce the workplace transmission of the H1N1 virus. Implementation of a variety of measures will be much more effective than relying on any one control measure. Implementation also requires that all employees, managers and supervisors be involved in the process.

Workplace Controls

Workplace controls are established procedures for reducing employee frequency and duration of exposure to specific hazards and are less reliant on the employee to implement. The following is a small list of examples:

a) Employers can promote personal hygiene in the workplace by providing tissue, no-touch garbage cans, hand sanitizer and/or soap, and disinfectant wipes for employees to clean their work surfaces.

b) All employees, including supervisors and managers, need to be educated about how the H1N1 virus is transmitted, signs of infection and instruction on use and care of personal protective equipment. This may come in the form of education pamphlets, staff meetings and one-on-one sessions.

c) Instruction on proper cough etiquette:

o Cover your mouth and nose with a tissue when coughing or sneezing; used tissues should be immediately disposed in a waste basket

o Ensure you properly wash your hands every time you cough or sneeze

d) Instruction on proper hand washing techniques

o Hands can be washed with soap and water, or alcohol-based hand cleaners (Handwashing Handouts)

Engineering & Administrative Controls

Personal Protective Equipment

Engineering controls include those changes made to the work environment to reduce exposure to hazards. Examples include putting up physical barriers between employees and customers such as clear plastic sneeze guards or installing negative pressure ventilation in some health-care settings.

Administrative controls involve changing work schedules to minimize exposure levels. Examples include:

Developing a sick leave policy that does not penalize employees, encouraging those with flu-like symptoms to stay home and not infect other employees

Encouraging more internet-based communications and less face-to-face meetings

Establishing a central group in your company responsible for communicating updates about the influenza pandemic to employees

Personal protective equipment (PPE) is often thought as the primary method of protecting against hazards. However, it is the most difficult type of measure to control because it is heavily reliant on each individual employee to implement. It should be used as an adjunct to all previous measures discussed. Examples of PPE include gloves, goggles, face shields, surgical masks and respirators (e.g. N95 masks). It is very important that PPE are:

Properly fitted and worn

Maintained and replaced as necessary

Disposed of correctly to avoid infecting oneself and others

.	What is the difference between surgical masks and respirators?		.
.	.		.
.	It is important for employers and employees to understand the difference between surgical masks and respirators. Respirators are designed to reduce a person’s exposure to airborne particles that are small enough to be inhaled (less than 100 microns or μm) by tightly sealing against a user’s face. These particles may contain biological hazards such as mould, Bacillus anthracis (anthrax) and tuberculosis. The user must undergo a fit testing procedure to ensure there is a high fit factor and seal while performing a series of maneuvers. The N95 model is one classification of respirators. The “N” means that the respirator is not resistant to oil. The “95” means that the mask has a Particle Filtration Efficiency (PFE) of >95% at 0.3 μm. This is smaller than the 5 μm size of large droplet that is created during talking, coughing, and sneezing. In comparison, surgical masks do not have adequate filtering or fitting characteristics to protect the user from particles this small. Surgical masks are designed to prevent contamination of the environment by the person wearing it stopping droplets from being exhaled by the user during coughing, sneezing or talking. These types of masks may also be effective in stopping splashes of bodily fluids from reaching the wearers mouth and/or nose.	.	.
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	Quantitative N95 Mask Fitting
.	.	.
.	SureHire offers quantitative mask fit testing specifically for the N95 model of respirator. Quantitative mask testing produces a numerical measurement of the 'fit factor' of a particular respirator. A particle counting devices (such as a TSI Portacount Plus) measures the concentration of microscopic particles that exist in ambient air to measure the 'fit factor' directly. The measurement is made while the person performs dynamic movements and/or breathing exercises resembling those experienced in the workplace in order to stress the respirator seal. A proper seal between the user’s face and the respirator ensures that inhaled air passes through the respirator’s filter material and not through gaps between the face and respirator.	.
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.	Prepare Now	...
.	.	.
.	This flu season, the H1N1 virus is predicted to spread rapidly causing serious illness. Workplaces will be a breeding ground for transmission of the virus. The effects of the influenza will have a widespread effect on business because of employee absenteeism and the associated health costs. It is in the best interest of employers to be prepared before this time in order to minimize the effects of the H1N1 virus on their business. Preparation should include workplace controls (e.g. cough etiquette, hand-washing protocols), engineering controls, administrative controls and personal protective equipment. SureHire recommends that employers implement the use of N95 respirators especially in occupations involving close contact of employees with other employees or the public. It is very important that employees using the N95 respirators have their masks properly fitted using quantitative mask fitting standards. For more information about quantitative mask fit testing, please contact SureHire at 1-866-944-4473. In addition, the following are some useful links that can be used to track information regarding the spread of the H1N1 virus and workplace planning. Centre for Disease Control Toolkit for Businesses and Employers Public Health Agency of Canada United States Occupational Health and Safety Administration Handwashing Handouts	.
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