Sunday May 24, 2009
Keeping the office flu-free
By LEE TSE LING
Office environments present excellent opportunities for flu transmission. So let’s keep our workplaces healthy by keeping flu out of them.
QUARANTINE and isolation measures effectively limit the transmission of communicable diseases like the flu, and are the cornerstone of most prevention strategies, says consultant physician and Hospital Sungai Buloh head of infectious diseases Dr Christopher Lee.
While they have a positive impact on public health, they can also have a negative impact on productivity when too many staff members stay home to see if their sniffles get worse.
If A (H1N1) makes an appearance in your office, it will transmit from person to person easily.Both you and your employer/employeees need to know to deal with it.- Reuters However, the benefits of doing so far outweigh any loss to the bottom line, so such measures should be respected when indicated. That is, when flu-like symptoms appear, workaholic employees should not insist on remaining at work and hard-driving employers should not insist on their physical presence either.
“Employees and employers need to be enlightened of the adverse effects of their actions,” says Malaysian Medical Association Society for Occupational and Environmental Medicine president, Dr Jayakumar Gurusamy. “They need to be reminded that A(H1N1) is highly infectious. Once an epidemic occurs at their workplace, the business as a whole will be affected badly.”
How does flu spread in offices?
Two ways, in general. First, infected persons who cough/sneeze without covering their noses/mouths spray viruses into the air. These travel on air currents before dropping onto nearby surfaces. Secondly, infected persons smear virus-containing droplets from their noses/mouths on surfaces they touch directly with unwashed hands. And guess what?
> You share the air you breathe with them intimately
Central air-conditioning is a blessing in our climate, but a bit of a curse when it comes to airborne infections. If you work in an enclosed office space that is 20m long, 10m wide, and 3m tall, the total volume of air there would be 6,000 cubic metres, or litres. A normal person breathes in and out about 15-18 times a minute, with half a litre to one litre of air passing in and out of the lungs each time.
If you breathe 600ml of air in and out of your lungs 16 times a minute on average, you could theoretically pass all the air in your office through your lungs in 10 hours. Less, if you breathe hard and fast eg if you get excited or exert yourself.
When you factor in poor air circulation and how many colleagues share this space with you, it’s easy to see you are all breathing in what everyone else is breathing out, many times over: minty-fresh breath, burps, and, of course, flu viruses.
> You share common contact points with them
Doorknobs and handles, elevator buttons, and computer keyboards are particularly well fingered. Then there are documents you pass around, newspapers you share, and that security tag you touch ten times a day, but have never washed since the day you got it (just like doctors’ neckties, those tags brush against everything – clothes, tables, and bathroom countertops).
How many of your colleagues take matters into their own hands (literally) when they cough, sneeze, or visit the bathroom, without washing their hands afterwards? And then open the door to your office or tap on your keyboard? That’s how many colleagues you can catch the flu from.
Two flu home
Of course, what sparked this discussion off was the fact that A(H1N1) flu finally arrived in Malaysia this week on AirAsia flight AK5358 and Malaysia Airlines flight MH091. To date, 222 passengers, crewmembers, and family members in direct contact with the passengers and crew have been reportedly identified, quarantined, and released unscathed. However, a small number remain at large.
On 20 May, 169 were reportedly released while 70 remained unaccounted for (total, 239). On 21 May, the tally was 222 with 11 unaccounted for (total, 233). However, the 222 figure included 19 additional family members who were in direct contact with the passengers, but not passengers themselves (233 minus 19 equals 214). Which means at least 25 people (239 minus 214) remain unaccounted for, if the reported figures are accurate.
Is this an issue? Probably not, as more than 10 days (more than double the average flu incubation period) have passed. If A(H1N1) flu has not yet made its presence felt in these remaining passengers, it is likely they are A(H1N1)-free.
Having said that, the number of people bringing A(H1N1) into Malaysia does not stop there as international traffic is still arriving daily. As such, the possibility of A(H1N1) making an appearance in your office is real, and both you and your employer/employees need to know how to deal with it.
Here’s how
For those directly exposed to A(H1N1), including those who share flights with confirmed infected persons (flu also transmits easily in airplane cabins as they are confined environments with a low level of air exchange and passengers sit in close proximity to one another).
If you are such a person, you will be issued a Home Observation and Surveillance Order by a Health Ministry-authorized physician and given detailed instructions to:
>Remain home during the quarantine period, along with any school-going children living in the same house
>Minimise contact with visitors
>Check for fever daily
> Maintain good personal hygiene
If flu-like symptoms develop during this period, you should inform your district health office and go to one of the 28 designated government hospitals while taking the necessary precautions:
>Both you and your accompanying person should wear facemasks
>Maintain a minimum one-metre distance from others
>Avoid touching common surfaces or others with soiled hands
>Cover mouth / nose with a tissue when coughing / sneezing, dispose of tissue immediately after use in a bin
>Wash hands with soap and water frequently
To enforce compliance, spot checks may be carried out. If you are caught violating the Order, you may be liable on conviction to imprisonment (not exceeding two years’ imprisonment for the first offence) and/or fine under Section 24 of the Prevention and Control of Infectious Disease Act 1988. (For details, read Recommendations on Influenza Pandemic Preparedness for Industry in Malaysia at moh.gov.my/MohPortal/newsFull.jsp?action=load&id=452)
Why do school-going children need to be quarantined too? Because “children are the most sociable beings and have the most physical contact between people,” Dr Jayakumar points out. “The greatest potential for preventing A(H1N1) from spreading is by focusing on children, not adults.”
As such, school-going children should be taught and reminded to frequently wash their hands, practise cough / sneeze etiquette, and to refrain from touching surfaces and their faces with unwashed hands.
For those in close contact with persons directly exposed to A(H1N1), including those living with persons exposed to A(H1N1) or who otherwise come in regular, close contact with them (within one metre).
Home Observation and Surveillance Orders may be issued to such persons on a case-to-case basis, depending on the level of contact and condition of the A(H1N1)-exposed person (as was the case with the 19 family members in contact with passengers from flight AK5358).
If you are such a person but not issued an Order, you can go about your normal routine at work but should remain alert for flu-like symptoms. If these appear, you should visit a designated hospital while taking the precautions listed above.
If you are an employer/employee concerned about “silent” infectious periods (according to the US Centers for Disease Control and Prevention, flu patients can be contagious from one day before and up to five days after symptoms appear), suggest working from home for a couple of days while you both “wait and see”.
This is especially relevant with staff who frequently travel internationally. Is there potential here for abuse? A senior occupational health practitioner opines: “Yes, there will be malingers, but in case of Pandemic the benefit of the doubt has to be given to prevent any unforeseen spread of the disease.”
For those with no clear link whatsoever to A(H1N1) flu, but develop flu-like symptoms, it probably means you have been infected by the normal, or seasonal, circulating flu.
As Malaysia is currently in the middle of the April-June seasonal flu peak, this will not be an uncommon occurrence (another seasonal peak occurs from October to January; both peaks coincide with the beginning of the inter-monsoon periods).
These cases should not cause undue worry and can be treated by your normal healthcare provider, who, “based on a comprehensive history from the patient and detailed examination, may treat you, offer sick leave, advise you on appropriate preventive measures, and review your condition after three to four days if the problem persists,” says Dr Jayakumar.
You physician may also direct you to stay home until you are well and no longer contagious. In which case, you should obtain the necessary medical leave from him.
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