One of the most critical health and safety obligations an employer has is to ensure that workers have access to sufficient personal protective equipment (PPE). Among workplaces with higher levels of risk of COVID-19 transmission in certain workplaces, hospitals and long-term care homes are some of the most prominent. During the 2003 SARS outbreak, nearly half of the people who contracted SARS were health care workers who got it on the job.
The appropriate level of PPE depends on the work performed and the risk of exposure, but some examples include the following:
- Isolation gowns
- Eye protection
- N95 respirator masks (which must be properly fit-tested and seal-checked)
- Surgical masks
In addition to ensuring that workers have access to the appropriate PPE, healthcare employers must train their workers on how to properly use PPE.
The Ontario government’s directives about appropriate levels of PPE have varied over the course of the COVID-19 outbreak. One of the more controversial topics has been the circumstances in which N95 respirators, which significantly reduce the risk of inhaling airborne particles, are necessary.
The Ontario government initially recommended use of N95 respirators in a wide range of circumstances. Subsequently, Ontario revised its position, only recommending N95 respirators for healthcare workers engaged in certain “aerosol-generating” procedures.
A welcome new directive for workers in public hospitals
On March 30, 2020, the Ontario Chief Medical Officer of Health issued a welcome new directive requiring public hospitals to implement more stringent PPE measures, which include the following:
- Before interacting with a patient, a health care worker must perform a Point-of-care risk assessment. If the worker determines that a certain health and safety measure is required (e.g. an N95 respirator), the Hospital will not unreasonably deny them access.
- Workers who are within two metres of suspected, presumed or confirmed COVID-19 patients must have access to N-95 respirators (fit tested and NIOSH-approved), surgical/procedure masks, gloves, face shields with side protection or goggles, and impermeable or at least fluid resistant gowns.
- Workers who are in a room where aerosol generating medical procedures are being performed, are frequent or probable, or with any intubated patients must be provided with N95 respirators.
The directive also addresses issues related to the supply of PPE, requiring that:
- Hospitals assess PPE supply on an ongoing basis
- Hospitals explore all available avenues to obtain and maintain a sufficient supply
- In the event of a shortage (defined as occurring when supplies are anticipated to last only 30 days), government and employers will be responsible for developing contingency plans in consultation with the Ontario Nurses’ Association.
This directive applies to public hospitals within the meaning of the Public Hospitals Act, but not other health care contexts such as long-term care facilities or first response. Workers in long-term care homes remain subject to an earlier directive which only requires employers to provide them with N95 respirators during aerosol-generating procedures.
The “precautionary principle” should guide all decisions about PPE in the COVID-19 crisis
Many healthcare unions continue to advocate tirelessly for the provision of N95 masks to all healthcare workers who are screening and/or coming into proximity with known or suspected COVID-19 patients. This position is consistent with the “precautionary principle”, which is the notion that we should not always need to wait for scientific certainty that a PPE measure is effective before putting it into widespread use.
For example, during the SARS outbreak, there was some scientific debate about whether SARS was transmitted by large droplets or through airborne particles. The SARS Commission Report noted that in such situations, we should not wait for scientific certainty to take steps to protect worker safety in hospitals but should rather apply the precautionary principle.
In our view, employers in all healthcare contexts, including long-term care facilities and first response, ought to err on the side of caution. They should heed the recommendations of the SARS Commission Report and let the precautionary principle guide all of their worker health and safety decisions, including the provision of appropriate PPE.