Remove the risk of exposure to communicable disease. The best way to eliminate communicable disease is to prevent it from entering the care home in the first place.

Examples:

• Encourage staff and visitors not to come to the care home when they are ill or have symptoms of illness. Post signage in your workplace.
• Actively screen visitors for symptoms of illness.
• Encourage health care workers to self-monitor for signs and symptoms of illness prior to work.
• Isolate symptomatic residents with suspected or diagnosed communicable disease when possible.
• Eliminate the use of high-touch or shared items.
• Follow BCCDC guidelines for visitors during an outbreak of COVID-19.
• Offer remote communication options for residents and family members if in-person visits are not possible.

Replace the hazard in the workplace with a safer alternative.

Examples:

• Substitute less effective cleaning agents with cleaning and disinfecting agents that are suitable for the task.
• Ensure disinfectants have a Health Canada drug identification number (DIN), or a Natural Product Number (NPN).
• Replace items that are visibly broken, cracked, or cannot be properly cleaned or disinfected.
• Substitute in-person meetings with virtual meetings where possible.
• Substitute high touch or shared items with personal items or items that can be sanitized.

Isolate workers from exposure to communicable disease. These controls involve modifying the environment to reduce the risk of infection transmission.

Examples:

• Use physical barriers to promote physical distancing such as plastic or plexiglass barriers.
• Consider the use of drop curtains to isolate spaces or provide separation in shared rooms.
• Use markers (i.e., tape on the floor) to remind individuals to maintain 2m distance when needing to space apart individuals. · Ensure indoor spaces are adequately ventilated with outside air.
• Use air filtration systems to remove airborne pathogens
• Provide well-stocked hand washing and alcohol-based hand rub stations throughout the home, including at entryways.
• Ensure the use of safety engineered medical sharps or safety-engineered needles.

Change the workflow at your organization. Administrative controls involve policies, procedures, and guidelines to manage risk of infection.

Examples:

• Develop and communicate infection control policies and procedures, such as exposure control plans.
• Encourage respiratory hygiene/cough etiquette, and provide tissues and individual receptacles.
• Provide staff training in hand hygiene, respiratory hygiene/cough etiquette and provide tissues and garbage receptacles. · Provide training in the use of PPE (donning and doffing).
• Increase frequency of disinfecting surfaces and high-touch areas and shared equipment.
• Limit the number of staff in shared spaces (break rooms, change rooms, etc.).
• Assign specific units or cohorts to staff members to minimize movement throughout the home.
• Cohort symptomatic residents when possible.
• Dedicate the use of non-critical care equipment to a single resident where possible.
• Disinfect equipment that is shared between residents.
• Handle and dispose of sharps according to safe work procedures. Follow sharps handling procedures such as discarding any disposable, contaminated sharps in sharps disposal containers as soon as possible after use.

Give the worker something to wear to reduce exposure to communicable disease. PPE should be used when other control measures are not sufficient to reduce the risk.

Examples:

• Direct staff to follow current provincial masking guidance.
• Require staff to conduct a point of care risk assessment before any resident interactions to determine personal protective equipment required.
• Ensure that workers who are required to wear a N95 respirator as indicated by a point of care assessment have been fit tested within the last year.
• Ensure staff perform proper donning and doffing of PPE, and proper hand hygiene (link a huddle here).
• Ensure face masks are replaced if soiled, damaged, or hard to breathe through.
• Assign responsibility ensuring that PPE stock is available and suitable for use.

Physically removing a hazard, such as eliminating a toxic chemical from a workplace, is the most effective way to ensure safety under the elimination portion of the hierarchy of controls.

Replacing the hazard with a safer alternative, such as using a less toxic cleaning agent instead of a harmful chemical, is the essence of substitution in the hierarchy of controls.

Engineering controls involve isolating people from the hazard, such as installing ventilation systems to remove harmful fumes from a workspace.

Administrative controls involve changing the way people work, such as implementing safety training programs and rotating job assignments to minimize exposure to hazards.

Personal Protective Equipment (PPE) serves as the last line of defense by providing barriers, such as gloves, masks, and helmets, to protect workers from hazards when other controls are not feasible or fully effective.