DECISION

OCCUPATIONAL SAFETY AND HYGIENE GUIDELINES FOR HEALTH WORKERS ENGAGING IN COVID-19 CONTROL

MINISTER OF HEALTH

Pursuant to Law on Prevention of Infectious Diseases dated November 21, 2007;

Pursuant to the Law on Occupational Safety and Hygiene dated June 25, 2015;

Pursuant to the Law on Medical Examination and Treatment dated November 23, 2009;

Pursuant to Decree No. 75/2017/ND-CP dated June 20, 2017 of the Government on functions, tasks, powers, and organizational structure of the Ministry of Health;

At request of Director General of Health Environment Management Agency,

...

...

...

Article 1. The “Occupational safety and hygiene guidelines for health workers engaging in COVID-19 control” is attached hereto.

Article 2. This Decision comes into effect from the day of signing.

In case documents referred to in this Decision are replaced or amended, the replacing and amended documents shall prevail.

Article 3. Chief of the Ministry Office, Chief Ministry Inspectorate, Director General, Directors of General Departments and Departments affiliated to Ministry of Health, Directors of Health Departments in provinces and central-affiliated cities; Directors of hospitals and institutes affiliated to Ministry of Health; heads of medical sector and heads of relevant entities are responsible for implementing this Decision./.

PP. MINISTER
DEPUTY MINISTER




Nguyen Truong Son

OCCUPATIONAL SAFETY AND HYGIENE GUIDELINES FOR HEALTH WORKERS ENGAGING IN COVID-19 CONTROL

...

...

...

I. NECESSITY

Healthcare is a profession characterized by high intensity in all its activities. All employees working in public and non-public medical facilities (hereinafter referred to as “health workers”) must examine, provide treatment, take care of patients, and engage in treating infectious diseases personally and thus are vulnerable to infectious diseases and, as of late, the COVID-19. Health workers may come into contact with risks to occupational safety and hygiene (hereinafter referred to as “OSH”), infection, injuries, and even death while engaging in COVID-19 control. Risks to OSH include (i) COVID-19 infection; (ii) dermatitis and heat stress caused by wearing personal protective equipment (PPE) for too long in hot weather; (iii) increased frequency of contact with disinfectants; (iv) prolonged tiredness; (v) assault and discrimination; (vi) mental stress; (vii) musculoskeletal pain; (viii) insufficient or inadequate hygiene or benefit conditions.

In order to reduce risks to OSH and protect health and safety of health workers, comprehensive solutions regarding infection control and OSH, health workers management, mental health support, and psychological support for health workers must be implemented in a synchronous manner. Failure to adopt OSH solutions will lead to a rise in the rate of work-related diseases and resignation of health workers, a reduction in working capacity, and a reduction in patient care quality.

On February 2, 2021, World Health Organization and International Labor Organization promulgated the Provisional guidelines titled: “Occupational safety and health for health workers”. Currently, most countries worldwide have not developed OSH guidelines for health workers engaging in COVID-19 control. Therefore, the development of Occupational safety and hygiene guidelines for health workers engaging in COVID-19 control appropriate to Vietnam's situations and conditions is crucial so as to protect health and safety of health workers.

The Guidelines aim to provide necessary information on OSH measures, and professional health care activities for health workers during COVID-19. These Guidelines are to be utilized by employers, managers of medical facilities, health workers, individuals engaging in OSH operation, and individuals engaging in infection control in public and non-public medical facilities in order to reduce the risk of OSH and protect health of workers engaging in COVID-19 control.

II. OBJECTIVES

Provide guidelines on OSH measures in order to reduce the risk to health of health workers working in public and non-public medical facilities during COVID-19 control.

III. SCOPE AND REGULATED ENTITIES

1. Scope:

...

...

...

2. Regulated entities:

- Employers/managers of medical facilities, individuals engaging in OSH affairs, and individuals engaging in disinfection affair.

- All employees working in public and non-public medical facilities (hereinafter referred to as “health workers”) and doing tasks relating to COVID-19 control where risks to OSH are present. These health workers shall be grouped based on COVID-19 control as follows:

+ Group 1 - Conducting community epidemiology investigation: consists of health workers who trace infected cases of SARS-CoV-2 (hereinafter referred to as “infected cases”) and suspected cases of SARS-CoV-2 (hereinafter referred to as “suspected cases”) in community.

+ Group 2 - Sampling and conducting rapid test in community: consists of health workers who collect samples from infected and suspected cases and/or conduct on-site rapid test in sampling areas of medical facilities, concentrated isolation, aboard mobile testing units, in community/people’s houses, etc.

+ Group 3 - Conducting tests: consists of health workers working in laboratories, department of microbial sciences, laboratory department, and conduct tests on all specimens (including specimens from upper and lower respiratory tracts, blood specimens, serum, etc.) of infected or suspected cases in public and non-public medical facilities.

+ Group 4 - Personally providing treatment, caring, serving, transporting COVID-19 patients, and transporting, handling, shrouding, and conducting forensic examination on corpses of infected and suspected cases.

+ Group 5 - Working in regular medical examination and treatment; screening examination, consultation sections; concentrated isolation; transportation of suspected cases.

+ Group 6 - Working in mobile medical stations of communes/wards/townlets (hereinafter referred to as “mobile medical stations”): consists of health workers responsible for managing and monitoring COVID-19 cases at home and in community; conducting COVID-19 tests; vaccinating against COVID-19; disseminating information regarding COVID-19; examining, treating, and dispensing medicine for patients with other diseases.

...

...

...

In these Guidelines, the following terms are construed as follows:

- “occupational risk factor” refers to a factor that occurs in the performance of a task or an affair relating to COVID-19 control and potentially affects health of health workers.

- “potential OSH hazards in COVID-19 control” refers to the ability to inflict diseases and/or injuries as a result of making contact with occupational risk factor at workplace during the performance of COVID-19 control.

- “level of SARS-CoV-2 infection risk” shall conform to applicable regulations of Ministry of Health.

+ Very high infection risk: Making direct contact with an infected case subject to invasive ventilation, an invasive procedure, or an aerosol-generating procedure; working in corpse handling, shrouding area; conducting forensic examination of a corpse of an infected or suspected case.

+ High infection risk: Making direct contact with an infected case not subject to invasive ventilation, an invasive procedure, and an aerosol-generating procedure; making direct contact with a respiratory tract specimen serving COVID-19 testing.

+ Moderate infection risk: Potentially making direct contact with an infected or suspected case.

 + Low risk infection: Not making direct contact with any infected and suspected cases.

- “other potential OSH risks in COVID-19 control” consist of:

...

...

...

+ High risk: making frequent contact with an occupational risk factor and potentially suffering from serious health consequences.

+ Moderate risk: making infrequent contact with an occupational risk factor and potentially suffering from health consequences.

+ Low risk: rarely making contact with an occupational risk factor and suffering from mild health consequences.

V. POTENTIAL OSH HAZARDS IN COVID-19 CONTROL FOR HEALTH WORKERS

1. Primary potential OSH hazards in COVID-19 control

- SARS-CoV-2 infection during work;

- Dermatitis caused by wearing PPE for too long under hot weather.

- Heat stress caused by wearing PPE for too long under hot weather.

- Contact with disinfectants due to increased frequency of use;

...

...

...

- Assault, discrimination, or harassment at workplace.

- Psychological health disorder (depression, anxiety, emotionally tense, job burnout, etc.) caused by mental strain.

- Musculoskeletal fatigue caused by lifting, transporting, taking care of patients, and heavy objects while engaging in COVID-19 control.

- Inadequate or insufficient hygiene and benefit infrastructure.

2. Summary of potential OSH hazards in COVID-19 based on grouping of health workers

No.

Health worker group

SARS- CoV-2 infection

Dermatitis risk

...

...

...

Disinfectant contact risk

Tiredness risk

Assault, harassment

Psychological health disorder risk

Musculoskeletal tiredness or pain risk

Inadequate or insufficient hygiene and benefit infrastructure

1.

Group 1 - Conducting community epidemiology investigation

++

...

...

...

++++

++

++++

++++

++++

+++

++++

2.

Group 2 - Sampling and conducting rapid test in community

...

...

...

++++

++++

++

++++

++++

++++

+++

++++

3.

...

...

...

+++

++++

+

++++

++++

+

++++

+++

++

...

...

...

Group 4 - Personally providing treatment, caring, serving, transporting COVID-19 patients

++++

++++

+++

++++

++++

+++

++++

++++

...

...

...

5.

Group 5 - Working in regular medical examination and treatment; screening examination, consultation sections; concentrated isolation; transportation of suspected cases.

++

++++

+++

++++

++++

++++

++++

...

...

...

+++

6.

Group 6 - Mobile medical stations

+++

++++

++++

++

++++

++++

...

...

...

+++

++++

Note: Very high risk: (++++); High risk (+++); Moderate risk: (++); Low risk: (+)

VI. OCCUPATIONAL SAFETY AND HEALTH MEASURES FOR HEALTH WORKERS ENGAGING IN COVID-19 CONTROL

1. General measures:

In order to ensure professional safety and health for health workers in COVID-19 control, in addition to measures specific to risk hazards, medical facilities must implement the following general preventive measures:

1.1. Develop and implement OSH program integrated with SARS-CoV-2 infection control and prevention program at medical facilities. Assign specific tasks and responsibilities to enable implementation. Develop regulations regarding OSH during COVID-19 control in order to ensure safe working conditions, health, and infection prevention for health workers. Mandate employees to comply with professional procedures, techniques, and safe operation in order to minimize OSH risks in COVID-19 control and highlight: washing hands by standards procedures; keeping respiratory tract clean; cleaning working environment, and treating medical waste; properly and safely lifting patients, heavy objects. Allow employees to stay at home if they are suspected of COVID-19 infection with symptoms such as fever, coughing, difficulty breathing, etc.;

1.2. Organize reasonable work in order to minimize OSH risk in COVID-19 control, including:

- Arrange remote work, provision of remote healthcare services;

...

...

...

- Arrange separate areas to isolate COVID-19 patients; utilize curtains and partitions for small spaces; utilize sampling rooms; utilize protective partitions made from transparent plastic, etc.

- Adequately and conveniently arrange hygiene and benefit infrastructures for health workers. Equip faucets with running clean water and soap or hand washing liquid at every patient care location, PPE donning/doffing area, hygiene area, waste treatment location, etc. ‘touchless’ hygiene systems are recommended at hygiene and benefit quarters.

- Research, design, and alter ventilation system accordingly: Install specialized sound pressure ventilation system in treatment area of COVID-19 patients, areas where aerosol-generating procedures are performed, and in rooms where post-mortem examination is conducted in the morgue; Install high-efficiency particulate absorbing filter in COVID-19 treatment facilities. Maximize natural ventilation by opening doors and windows.

- Utilize robots to transport medicine, food, and to disinfect, etc.

- Reduce working hours, increase break time for health workers who are properly donning PPE and working in hot environment; relieve stress and tiredness of health workers by rotating working shifts, and rotating health workers from more-intense positions to less-intense positions, etc.

1.3. Identify risk factors, assess OSH risk factors in COVID-19 control. Monitor risk factors in accordance with the Law on Occupational Safety and Hygiene.

1.4. Organize training for health workers regarding SARS-CoV-2 infection prevention and control; use of household and medical disinfectants; psychological health; prevention of abuse, discrimination, tiredness, mental strain, musculoskeletal pain or fatigue, and diseases caused by heat stress; donning, doffing, cleaning, storing, and disposing PPE properly and safely, etc.

1.5. Adequately and sufficiently equip health workers with PPE in order to prevent and control SARS-CoV-2 infection in accordance with Decision No. 4159/QD-BYT dated August 28, 2021, applicable regulations of Ministry of Health, and prevent harmful effects of disinfectants according to chemical safety guidelines of manufacturers. PPE must: Be selected based on risk factors to health workers. Be properly equipped and replenished periodically, if any. Be regularly inspected, maintained, and replaced if necessary. Be donned, doffed, cleaned, stored, discarded and disposed properly and safely. Be segregated and treated as hazardous waste after being doffed in order to prevent infection for themselves, others, and prevent environmental pollution.

1.6. Assign health workers with sufficient health according to regulations of Ministry of Health to engage in COVID-19 control. Screen and test SARS-CoV-2 for health workers according to regulations of Ministry of Health. Vaccinate health workers prior to assigning them to COVID-19 control and prevent other infectious occupational diseases such as hepatitis B., occupational tuberculosis, etc. Organize periodic health examination and screening for occupational diseases for health workers as per applicable laws, especially health workers with high risk of exposure to SARS-CoV-2 and other occupational risks.

...

...

...

1.8. Adequately implement policies on labor protection for health workers engaging in COVID-19 control as per applicable laws (policies regarding occupational accidents, occupational diseases; working hours, resting hours; allowances for toxic and hazardous working environment; epidemic control allowances; perquisites for arduous, toxic, and dangerous jobs and extremely arduous, toxic, and dangerous jobs; equipping of PPE, etc.).

1.9. Regularly update, disseminate, and popularize guidelines regarding OSH in COVID-19 control, SARS-CoV-2 infection prevention and control of Ministry of Health and the National Steering Committee for COVID-19 control.

1.10 Promote activities which serve to improve health of health workers at workplace (nutrition, sports, healthy lifestyle, etc.).

2. Preventive measures specific to risks.

In addition to general preventive measures, preventive measures specific to potential OSH hazards for 6 groups of health workers engaging in COVID-19 control are described in details under Appendix 1.

VII. ORGANIZATION FOR IMPLEMENTATION

1. Employers/Heads of medical facilities shall:

a) produce plans, assign personnel and funding in order to organize implementation hereof;

b) adopt necessary preventive and protective measures in order to reduce potential OSH hazards for health workers engaging in COVID-19;

...

...

...

d) submit reports on implementation result if requested.

2. Health workers in medical facilities shall:

a) strictly comply with regulations, rules, procedures, and requirements regarding general OSH and OSH in COVID-19 issued by employers or the authorities related to the assigned affairs and tasks.

b) comply with regulations and law, obtain knowledge and skills regarding OSH measures at workplace and in during COVID-19 control; use and preserve issued PPE, OSH equipment at workplace during the performance of assigned tasks and affairs.

c) prevent any direct risk to OSH, violation to OSH regulations at workplace and during COVID-19 control; promptly report to competent individuals upon discovering any potential OSH hazard at workplace and during COVID-19 control or potential occupational incidents, accidents, or diseases.

d) participate in all training courses regarding OSH in COVID-19 control organized by the employers;

e) Conduct self-assessment regarding implementation of OSH measures in COVID-19 control in accordance with Appendix 3.