Guidance for Medium Exposure Risk Occupations

The Occupational Safety and Health Administration (OSHA) defines various levels of risk for exposure to pandemic influenza in the workplace. 

Medium exposure risk occupations are described as jobs that require frequent, close contact (within 6 feet) exposures to known or suspected sources of pandemic influenza virus such as coworkers, the general public, outpatients, school children or other such individuals or groups.

This may include close interactions such as administering first aid to injured persons who are not suspected to have 2009-H1N1. Medium risk workplaces require frequent close contact between individuals. If this contact cannot be avoided, the following practices can reduce the risk of infection:

• Stay at home when sick.
• Wash your hands frequently with soap and water or with hand sanitizer if there is no soap or water available. Also, avoid touching your nose, mouth, and eyes.
• Cover your cough or sneeze with a tissue, or cough or sneeze into your upper sleeve if tissues are not available. Wash your hands or use a hand sanitizer after you cough, sneeze or blow your nose.
• Avoid close contact with your coworkers and customers (maintain a separation of at least 6 feet). Avoid shaking hands and always wash your hands after contact with others. Even if you wear gloves, you should wash your hands upon removal of the gloves in case your hand(s) became contaminated during the removal process.
• Provide visitors with tissues and trash receptacles, and with a place to wash or disinfect their hands.
• Keep work surfaces, telephones, computer equipment and other frequently touched surfaces and office equipment clean. Be sure that any cleaner used is safe and will not harm any person or office equipment. Use only disinfectants registered by the U.S. Environmental Protection Agency (EPA), and follow all directions and safety precautions indicated on the label. More information is available in DHS document Workplace Guidance, Appendix B, Workplace Guidance, Disinfection Guidance for Workplace Surfaces Potentially Contaminated with 2009 H1N1 or Seasonal Influenza.
• Try to avoid using other employees' phones, desks, offices or other work tools and equipment.
• Minimize situations where groups of people are crowded together, such as in a meeting. Use e-mail, phones and text messages to communicate with each other.  When meetings are necessary, avoid close contact by keeping a separation of at least 6 feet, where possible, and assure that there is proper ventilation in the meeting room.
• Reduce or eliminate unnecessary social interactions by reconsidering all situations that permit or require employees and visitors to enter the workplace. Workplaces which permit family visitors on site should consider restricting/eliminating that option during an influenza pandemic. 

Personal Protective Equipment:  Employees who have high-frequency, close contact with the general population that cannot be eliminated by other controls and where contact with symptomatic ill persons is not expected should use personal protective equipment to prevent sprays of potentially infected liquid droplets from contacting their nose or mouth. A surgical mask will provide such barrier protection. An N-95 respirator is recommended if there is an expectation of close contact with persons who have symptomatic influenza infection or if protection against airborne transmission is needed.

Therefore, if you are in close contact with the general public but don’t have a specific suspected or known source, you can choose to wear a surgical mask.  However, if you are in close contact with the general public and expect contact with a symptomatic individual, you should consider putting on an N-95 respirator, or switching from a surgical mask to an N-95 respirator.

DHS employees choosing to voluntarily wear N-95 respirators as a precaution should be aware of the proper use and limitations of respirators. Before wearing an N-95 respirator, consider the following:

• Use only a National Institute for Occupational Safety and Health (NIOSH) approved respirator; a NIOSH approval label will appear on or in the respirator packaging.
• Read and follow all instructions provided by the manufacturer about the use, maintenance, and warnings regarding the respirator's limitations.
• Use an N-95 only for tasks that have been evaluated as appropriate by a safety and health professional.
• Only one person should use a single N-95 respirator; do not share respirators.

Medical Evaluation
Using a respirator makes your lungs and heart work harder. A medical evaluation is not required to voluntarily wear an N-95 respirator on the job. If you have a medical condition that might preclude the use of a respirator you should consult with your physician.

Respirator Fit Testing
Respirator fit-testing is also not required for voluntary respirator use. The purpose of respirator fit testing is to verify that the selected make, model and size of the respirator facepiece adequately accommodates an individual's facial characteristics, and that the wearer can don the facepiece properly and can achieve the anticipated protection during use. 

If you would like information regarding surgical masks and respirators, contact your occupational safety and health officer. 

Components may consider incorporating additional or existing protective measures in their internal guidance if it has been determined through an occupational exposure risk assessment by the Component Occupational Safety and Health Office, in consultation with supervisors, that personnel are at a higher risk due to the nature of required work activities and/or the work environment. Such additional measures and controls should be communicated to employees in the context of the safety and health plan. Employees who wish to use personal protective equipment may do so as long as doing so does not create an adverse safety condition and the employee can still perform assigned duties.

This document provides general guidance only for employees covered by Title 5, United States Code, and does not, and is not intended to create or violate any legal rights.