Guidance for Managers: COVID-19 health risk assessment ...
Guidance for Managers: COVID-19 health risk assessment Version 4 (22/05/2020)This guidance may be updated daily please download the most up to date form.Risk categories: This form is intended to assist managers with assessing and recording staff with increased risk of severe illness due to COVID 19Name of EmployeeDirectorateContact DetailsManagerJob TitleDate CompletedLocationIncreased Risk categoryCondition (group)Yes/NoWork adviceHIGH RISKSolid organ transplant recipientsPeople with specific cancers:People with cancer who are undergoing active chemotherapy or radical radiotherapy for lung cancerPeople with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatmentPeople having immunotherapy or other continuing antibody treatments for cancerPeople having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitorsPeople who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugsPeople with severe respiratory conditions including all cystic fibrosis, severe asthma* (requiring regular hospital admission) and severe COPD.*Severe asthma: Anyone receiving high dose long term steroid (see appendix 1 in risk assessment), methotrexate, azathioprine, MMF, omalizumab, mepolizumab or benralizumab, or three times a week azithromycin; or has had 3 or more short courses of steroids for exacerbations in the past year.People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell).People on immunosuppression therapies sufficient to significantly increase risk of infection.People with HIV with a CD4 count less than 50, or who have had an opportunistic illness within the last 6 monthsWomen who are pregnant with significant heart disease, congenital or acquired.Health care workers at high risk should: Work at home if possible; or,Remain away from work (and practice shielding) until outbreak abated. This will be recorded as special leave. GROUP 2Moderate RISKChronic (long-term) respiratory diseases, e.g. chronic asthma, * Note- Those with stable asthma should continue to take their regular medication and do not require any additional precautions beyond maintaining strict hygiene measures and can work with patients with confirmed or suspected COVID-19.*chronic obstructive pulmonary disease (COPD), emphysema or bronchitis chronic heart disease, such as heart failure chronic kidney diseasechronic liver disease, such as hepatitis chronic neurological conditions, such as Parkinson’s disease, motor neurone disease, multiple sclerosis (MS), learning disability *Note- Those with learning disabilities and no other comorbidity that increases risk and ARE able to comply with strict hygiene measures can work with patients with confirmed or suspected COVID-19.* cerebral palsy Those with epilepsy need not be excluded from workand can work with patients with confirmed or suspected COVID-19.*diabetes- *Note- Diabetes has clearly been identified as a risk factor but potential variations between Type I and type II diabetes and age are not clear. Individual risk assessment for staff with diabetes is required- seek occupational health advice if required.*Hypertension *Note- Those who have well controlled hypertension on one medication and no other chronic health conditions described in this list do not require any additional precautions beyond maintaining strict hygiene measures and can work with patients with confirmed or suspected COVID-19.*problems with spleen – for example, sickle cell disease or if individual has had spleen removed *Note-Those with splenic dysfunction or asplenia do not require any additional precautions beyond maintaining strict hygiene measures can work with patients with confirmed or suspected COVID-19-seek occupational health advice if required.*a weakened immune system as the result of conditions such as HIV and AIDS with a CD4 count less than 200 and detectable viral loads, or medicines such as steroid tablets or chemotherapy seek occupational health advice if required.*being seriously overweight (a BMI of 40 or above) *Note- Those with a BMI > 40 but no other chronic health conditions described above do not require any additional precautions beyond maintaining strict hygiene measures and can work with patients with confirmed or suspected COVID-19*aged over 70 years, regardless of health conditions Health care workers at moderate risk can continue to work as long as they practice strict hygiene measures but are NOT suitable for work in COVID-19 cohort areas (including medical, nursing, clinical and support roles).The following measures should be considered:-Stringent measures should be in place to minimise face-to-face patient contact as far as possible. Make use where possible of remote or home working, telephone and video consultations, remote desk-top login.Avoid face-to-face meetings. Use telephone or video conferencingStringently minimise social contact with co-workers. Minimise open plan offices or hub environments. Enable other team members with admin duties to access homeworking to reduce numbers in work.Outpatient clinics, maintain 2m distance except for examination. Wash hands. Screen patients for symptoms.Use of screens/ distancing in reception areas.Avoid use of public transport.Staff aged over 70 years, regardless of health conditions, should:Work at home if possible;Transferred to duties that could be undertaken at home, or,Remain away from work (and practice social distancing and/or self-isolation) until outbreak abated. This will be recorded as special leave. all pregnant healthcare workers Pregnant women up to 28 weeks gestationPregnant women after 28 weeks, or with underlying health conditionsNew mothers wanting to return to the workforceEvery pregnant worker should have a risk assessment with their manager, which may involve occupational health. Employers should modify the working environment to limit contact with suspected or confirmed COVID-19 patients to minimise the risk of infection as far as possible. Where possible, pregnant women are advised to avoid working in these areas with patients with suspected or confirmed COVID-19 infection.The risk assessment for new and expectant workers, which must be completed, is included as Appendix 2 to this document.Following risk assessment, if a pregnant worker chooses to work in patient facing roles, they should be supported to do so by minimising risk of transmission through established methods. As for all healthcare workers, use of personal protective equipment (PPE) and risk assessments according to current guidance will provide pregnant workers with protection from infection. Some working environments, such as operating theatres, respiratory wards and intensive care/high dependency units, carry a higher risk for all pregnant women of exposure to the virus and all healthcare workers in these settings are recommended to use appropriate PPE.For pregnant women from 28 weeks’ gestation, or with underlying health conditions such as heart or lung disease at any gestation, a more precautionary approach is advised. Women in this category should be recommended to stay at home. For many healthcare workers, this may present opportunities to work flexibly from home in a different capacity, for example by undertaking telephone or videoconference consultations, or taking on administrative duties.Any mother thinking of returning early from maternity leave should be facilitated to do so provided she is fit and healthy to work, subject to any employment law restrictions, and following the same infection control and strict hygiene measures.Staff from BAME backgrounds Emerging evidence suggests that covid-19 is having a disproportionate effect on people from BAME backgrounds. In view of this, the recommendations for staff with any of the above underlying medical conditions above must take on heightened importance. Whilst important for all staff, managers should pay particular attention to reinforce the following for BAME staff:Ensure that social distancing is being observed wherever it is practicable to do so. Review PPE use to ensure availability, fit, correct donning and doffing etc.Ensure that BAME staff are aware of the actions to take if they feel unwell with COVID symptoms.Ensure staff know about testing arrangements and include them in priority list for testing particularly during first 5 days of symptoms appearing. *This is not an exhaustive list. Consider other long term health conditions that might impact immunity*Immediate actions agreed:If social distancing work advice cannot be achieved consider redeployment. Further health related advice may be obtained through Occupational Health.Appendix 1 Level of Immunosuppression Assessing the degree of immunosuppression is difficult. The information below is for guidance only. The infectious Diseases Society of America have defined different levels of immunosuppression: HIGHHigh level of immunosuppression is receiving: Chemotherapy. Daily corticosteroid (see below). Biologics Haematopoietic stem cell transplant. Prednisolone There is no consensus as to what constitutes a low dose of steroid, but in general: High dose steroid: o A dose of 20mg of prednisolone daily for > 14 days or 40mg daily for > 1 week is considered to cause significant immunosuppression.LOWLow level of immunosuppression is receiving: Low dose corticosteroid (see below). Methotrexate < 0.4mg/kg/week. Azathioprine < 3mg/kg/day. 6-mercaptopurine < 1.5mg/kg/day. Prednisolone There is no consensus as to what constitutes a low dose of steroid, but in general: Low dose steroid: <20mg prednisolone for <14 days. Alternate day treatment with short-acting steroids. Topical//intraarticular/soft tissue injection of steroid. Replacement treatment at physiological doses. Long term low dose steroid, <10mg/day prednisolone. Appendix 2 COVID-19 pandemic – New and Expectant Mother Risk AssessmentAnswerY:N:N/ADetails / Comments / RecommendationsRisk (H/M/L)Stage of pregnancy 1sttrimester< 28 weeks gestation> 28 weeks gestationLikelihood or presence of multiple pregnancy?Is the pregnant HCW from the BAME community?Underlying health conditions*Is the pregnancy considered to be higher risk due to underlying health conditions?Referral to Occupational Health may be consideredWork environment Clinical or nonclinical (non-patient facing)?Is it possible to socially distance* at work?Work with confirmed COVID-19 patients?Work with suspected COVID-19 patients?Is there a risk of mental and physical fatigue from any of the above?* = .uk/articles/coronavirus-covid-19-staying-home-and-self-isolation Answer Y:N:N/ADetails / Comments / RecommendationsRisk (H/M/L)Has fit testing been carried out?If appropriate, can PPE continue to be worn correctly as pregnancy progresses?Support provided by employerIs there an opportunity to take regular breaks?Are there adequate accessible facilities and opportunities for person to take refreshments at regular intervals?Involvement of pregnant HCW in the risk assessmentAre there any other areas, which the employee feels are relevant, which have not been covered or about which they would like further information?Guidance - Occupational health and staff deployment - 03 May 2020 Staying alert and safe (social distancing) - 11 May 2020.uk/articles/coronavirus-covid-19-staying-home-and-self-isolation Occupational health advice for employers and pregnant women during the COVID-19 pandemic - 27 April 2020 ................
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