Protecting Yourself from COVID-19 (while in the laboratory)

Protecting Yourself from COVID-19 (while in the laboratory) Wendy Hom, Environmental Health & Safety Officer

Training Goals • Increase health and safety awareness around potential exposure to COVID-19 • Understand how to minimize risk to COVID-19 in the laboratory

This training is adapted from NIH’s Training Tools (https://tools.niehs.nih.gov/wetp/covid19worker/index.cfm) Information on COVID-19 is rapidly changing, sometimes daily.

Refer to reliable sources such as the CDC, OSHA, NIOSH, State Health Departments and peer reviewed science publications.

What is SARS-CoV-2?

SARS-CoV-2 is the virus that causes coronavirus disease 2019 (COVID-19) • SARS = severe acute respiratory distress syndrome • Community spread: Spreads easily from person-to-person • Little if any immunity in humans Photo: CDC / Alissa Eckert & Dan Higgins

Detailed information: https://www.cdc.gov/coronavirus/2019-ncov/index.html

How is COVID-19 transmitted?

• Droplet: respiratory secretions from coughing or sneezing landing on mucosal surfaces (nose, mouth, and eyes) • Aerosol: a solid particle or liquid droplet suspended in air • Contact: touching something with SARS-2 virus on it and then touching mouth, nose or eyes • Other possible routes: through fecal matter

COVID-19 is spread from person-to-person mainly through coughing, sneezing, and possibly talking and breathing.

Incubation period • The incubation period is the time between exposure to a virus and the onset of symptoms.

• With COVID-19, symptoms may show 2-14 days after exposure.

• CDC indicates that people are most contagious when they are the most symptomatic.

• Several studies show people may be most contagious before developing symptoms.

• Some people may be asymptomatic carriers.

COVID-19 can cause mild to severe symptoms Most common symptoms include: Fever

Other symptoms may include: Sore throat

Cough

Runny or stuffy nose

Shortness of breath

Body aches Headache Chills Fatigue Gastrointestinal: diarrhea, nausea Loss of smell and taste

Severe symptoms: emergency warning signs for COVID-19 • Most people will have mild symptoms and should recover at home and NOT go to the hospital or emergency room.

• Get medical attention immediately if you have: • Difficulty breathing or shortness of breath • Persistent pain or pressure in the chest • New confusion or inability to arouse • Bluish lips or face This is not an all-inclusive list.

Source: https://www.cdc.gov/coronavirus/2019-ncov/symptomstesting/symptoms.html

How long does SARS-CoV-2 survive outside of the body?

• It is not yet clear how long the coronavirus can live on surfaces, but it seems to behave like other coronaviruses.

• Virus may persist on surfaces for a few hours or up to several days, depending on conditions and the type of surface.

• It is likely that it can be killed with a simple disinfectant on the EPA registered list (https://www.epa.gov/pesticideregistration/list-n-disinfectants-use-against-sars-cov-) • Contact time is important.

There are ongoing investigations to learn more.

Increased risk of severe illness COVID-19 poses a greater risk for severe illness for people with underlying health conditions: • • • •

Heart disease Lung disease such as asthma Diabetes Suppressed immune systems

The elderly have higher rates of severe illness from COVID-19. Children and younger adults have had less severe illness and death. Because COVID-19 is new, there are a lot of scientific unknowns such as the impact on pregnant women and their fetuses. https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html

How can you minimize risk (of exposure) to hazards (COVID-19) in the lab?

You should already be familiar with the Hierarchy of Controls, which can be used to help mitigate the risk of exposure.

The following slides rank the effectiveness of the five areas of control we have.

Exposure Control Methods Hierarchy of Controls Effectiveness Most

Least

Controls

Examples

Elimination

Eliminate the hazards (COVID-19) e.g. If you are considered high risk, work remotely.

Under no circumstances, should you come to campus if you feel unwell.

Exposure Control Methods Hierarchy of Controls Effectiveness Most

Least

Controls

Examples

Elimination

Eliminate the hazards (COVID-19) e.g. If you are considered high risk, work remotely.

Substitution

Replace the hazard or substitute for less hazardous material e.g. it is not possible to replace COVID-19

Exposure Control Methods Hierarchy of Controls Effectiveness Most

Least

Controls

Examples

Elimination

Eliminate the hazards (COVID-19) e.g. If you are considered high risk, work remotely.

Substitution

Replace the hazard or substitute for less hazardous material e.g. it is not possible to replace COVID-19

Engineering Controls

When you cannot remove the hazard, mitigate the hazard. Isolate people from the hazard. e.g. install/use ventilation system like a fume hood

Engineering Controls • Protect workers by removing hazardous conditions or by placing a barrier between the worker and the hazard • Example: local exhaust ventilation capture and remove airborne emissions (fume hood) • They do not interfere with productivity, personal comfort, and usually make it easier to do work

Engineering Controls Chemical Fume Hood • A fume hood is kind of like a closet that provides local ventilation engineered to limit exposure to hazardous or toxic dusts, fumes or vapors.

• Its purpose is to protect workers by removing air out (usually out of the building) • Do not add curtains or barriers inside the fume hood, it will disrupt air flow.

Engineering Controls Chemical Fume Hood • Are designed to change the air in the entire room a specified # of times per hour – so keep the lab door closed!

• Typically have face velocity of 80 - 120 fpm (feet per minute) • Remember: Biosafety cabinets are not fume hoods!

Biosafety cabinet

Fume Hood

Fume Hood Good practices • Don’t clutter the hood with storage! It introduces turbulence and reduces the protection to the user.

• Do store chemicals behind the 6-inch line (if they need to be in there).

• Don’t use if the fume hood does not work or fails inspection.

Bad Practice

X

Good Practice

ü

Fume Hood Good practices • Keep the sash as low as possible when working, maximum height should be at working height.

• Keep the lab door closed, open lab doors introduce turbulence and makes it less safe for the user!

• If the fume hood is not in use, shut the sash to save energy.

Shut the sash.

Save energy.

Remember to always work behind the glass. If the doors open horizontally, you should open the sash doors to the side and keep the glass in front of you.

Exposure Control Methods Hierarchy of Controls Effectiveness Most

Least

Controls

Examples

Elimination

Eliminate the hazards (COVID-19) e.g. If you are considered high risk, work remotely.

Substitution

Replace the hazard or substitute for less hazardous material e.g. it is not possible to replace COVID-19

Engineering Controls

When you cannot remove the hazard, mitigate the hazard. Isolate people from the hazard. e.g. install/use ventilation system like a fume hood

Administrative Controls

Limit exposures by changing the way you work. e.g. staggered work schedules, signage, training, work practices (no food or drink, move instruments to promote physical distancing)

Administrative Controls • Limit personnel exposure based on time, signage, training, work practices (no food or drink) • Staggered work schedules • Reduced lab occupancies • Regular surface cleaning (and documentation of cleaning) • If possible, move instrumentation to promote physical distancing • Use email, phone, teleconferencing instead of meeting in person

Work Practices ü Do wash your hands often for at least 20 seconds with soap and water ü Do wear a mask properly and wash your hands each time you adjust your mask ü Do minimize your exposure to others by staggering work schedules ü Do maximize physical distancing by designating workspaces and moving instruments further apart ü Do maintain routine cleaning and disinfection of surfaces and equipment

Work Practices ✕ Don’t come in when you are not feeling well ✕ Don’t touch your nose, mouth, and eyes ✕ Don’t share phones, desks, work spaces and equipment, whenever possible

Not eating or drinking in the lab minimizes risk to exposure

Which is better: soap and water or hand sanitizer? • Soap and water are more effective! • If no soap and water, use sanitizer that has at least 60% alcohol.

Photo: FDA

More info: https://www.sepsis.org/news/covid-19-infection-prevention-soap-and-water-or-hand-sanitizer/ https://www.cdc.gov/healthywater/hygiene/hand/handwashing.html https://www.vox.com/science-and-health/2020/3/11/21173187/coronavirus-covid-19-hand-washing-sanitizercompared-soap-is-dope

Work Practices: Proper hand washing 1

3

2

First, wet your hands with clean, running water.

4

5

Scrub your hands for at least 20 seconds.

Lather the soap all over your hands (backs of your hands, between your fingers, under your nails).

Apply soap.

6

Rinse your hands under Dry your hands running water. using a clean towel.

7

Be sure to dispose of the towel in a trash bin.

Work Practices: Safe glove removal

Gloves •

Wearing gloves is NOT a substitute for washing your hands.

•

Assume they are contaminated and dispose of them properly.

•

Your hands can still get contaminated while wearing or removing gloves.

•

Always wash your hands after removing gloves.

Cleaning •

Establish a cleaning procedure using disinfectants that deactivate the virus (see EPA’s registered list)

•

Wear gloves when cleaning and make sure there is adequate ventilation

•

Document when cleaning is performed

•

Use alcohol-based sanitizer if hand washing is not readily available

CDC cleaning guidelines (non-healthcare) • First, clean: Cleaning removes dirt, including germs, from surfaces. Cleaning alone does not kill germs. • Then, disinfect: Disinfection works by using chemicals, for example EPA-registered disinfectants, to kill germs on surfaces. https://www.cdc.gov/coronavirus/2019-ncov/community/organizations/cleaning-disinfection.html

Contact time for disinfection is important!

• Contact time is the time the product must remain wet to kill the virus.

• Observe that the area is visibly wet for the entire contact time.

• The EPA list and product labels include contact time.

• Follow manufacturer’s instructions for dilution and use.

• Check expiration dates! Disinfectants breakdown and expired disinfectants should not be used.

Health effects of disinfectants may include….

• Skin rashes or dermatitis.

• Irritation of the nose, eyes, mouth.

• Occupational asthma: • Sodium hypochlorite (bleach) • Quaternary ammonium • Glutaraldehyde Remember to not mix products.That can be deadly!

Safety Data Sheet (SDS) • Recall that SDSs provide helpful information on health effects in addition to information on the chemicals themselves. • It is highly recommended to check the SDS of a chemical before you start working.

Additional options are available

36

Use the search function on the EPA site to look for Use the search function on the EPA site to look for safer saferalternatives alternatives

Additional options are available If possible, choose products that have these ingredients, as they are not known to cause asthma: •

Hydrogen peroxide [but without Peroxyacetic acid (peracetic acid)]

•

Products with alcohol (ethanol, isopropanol)

•

Lactic acid

•

Citric acid

Exposure Control Methods Hierarchy of Controls Effectiveness Most

Least

Controls

Examples

Elimination

Eliminate the hazards e.g. If you are high risk, work remotely.

Substitution

Replace the hazard or substitute for less hazardous material e.g. it is not possible to replace COVID-19

Engineering Controls

When you cannot remove the hazard, mitigate the hazard. Isolate people from the hazard. e.g. install/use ventilation system like a fume hood

Administrative Controls

Limit exposures by changing the way you work. e.g. staggered work schedules, signage, training, work practices (no food or drink, move instruments to promote physical distancing)

PPE

PPE does not eliminate risks but must be used. e.g. safety glasses, face shields, gloves, hearing protection, lab coats, etc.

Using PPE (Personal Protective Equipment) sometimes gives us the false sense of invincibility, which can be very dangerous.

Remember that PPE is the least effective of all the controls but must be worn if it provides the appropriate additional protection.

PPE Considerations • If normally used in the lab, wear lab coat, gloves, safety glasses/googles for more protection • As always, specific PPE should be selected based on hazard of work • Reduce contamination, gloves should not touch your belongings or other objects like door handles, or your face or face mask Good glove-selection resource: http://www.ansellpro.com/specware/guide.asp

Face covering To protect others that you work with, mask wearing is required in all Hofstra buildings, including in all of the laboratories.

Protect Our Community

To be clear, a cloth mask is not considered PPE (personal protective equipment) as it is not meant to protect the wearer; it is intended to protect those around you.

Face Shields • If you want to use a face shield, you still need to wear a mask.

• This is similar to if you are using a face shield in the lab, you still need to wear the appropriate safety glasses or goggles.

X

ü

X

Face shields do not provide adequate protection when worn alone.

Respirators • Under most situations, you do not need to wear a respirator in the lab, unless you are working with hazards that require the use of a respirator. • Fit testing prior to use is required if you use a respirator/respirator mask and a user seal check is required each time the respirator is donned.

Surgical Mask/Procedure Mask/Cloth Mask

N95 Respirator

Respirator Mask

https://www.cdc.gov/niosh/npptl/pdfs/understanddifferenceinfographic-508.pdf

Key Takeaways • The Hierarchy of Controls can be used to help mitigate the risk of exposure.

• Wear an acceptable face covering to protect others.

• Clean and document cleaning of workspaces and equipment.

• Wash your hands frequently and properly.

Stay safe!