16VAC25-220, FINAL PERMANENT Standard Infectious Disease Prevention of SARS-CoV-2 Virus That Causes COVID-19 As Adopted by the Safety and Health Codes Board

The training required under subsection A shall include:

1. The commonwealth of Virginia requires the following COVID-19 training:
2. The mandatory and non-mandatory recommendations in any CDC guidelines or Commonwealth of Virginia guidance documents the employer is complying with, if any, in lieu of a provision of this standard as provided for in section 16VAC25-220-10 E, F and G
3. What is SARS-COV-2? SARS-CoV-2 is the virus that causes coronavirus disease 2019 (COVID-19)SARS = severe acute respiratory distress syndrome. The Severe Acute Respiratory Syndrome (SARS) coronavirus causes SARS and the Middle East Respiratory Syndrome (MERS) coronavirus causes MERS. The novel coronavirus responsible for the current pandemic, SARS-CoV-2, is one of seven types of known human coronaviruses. SARS-CoV-2, like the MERS and SARS coronaviruses, likely evolved from a virus previously found in animals. The remaining known coronaviruses cause a significant The SARS CoV-2 virus is a novel strain, meaning that it is new.  As a result, humans have not developed immunity to COVID-19, and therefore can be infected. Acquired immunity is when humans have been exposed or vaccinated previously to an infectious agent. An example is when people have measles in childhood or are vaccinated, they develop antibodies and a certain level of protection.
4. The characteristics and methods of transmission of the SARS-CoV-2 virus;

• • COVID-19 is spread from person to person mainly through coughing, sneezing, and possibly talking, and breathing.
  • The virus spreads easily between people – How easily a virus spreads from person-to-person can vary. Some viruses are highly contagious, like measles, while other viruses do not spread as easily. Another factor is whether the spread is sustained, which means it goes from person-to-person without stopping.
  • The virus that causes COVID-19 is spreading very easily and sustainably between people. – Information from the ongoing COVID-19 pandemic suggests that this virus is spreading more efficiently than influenza, but not as efficiently as measles, which is highly contagious. In general, the more closely a person interacts with others and the longer that interaction, the higher the risk of COVID-19 spread.
  • The virus may be spread in other ways – It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes. This is not thought to be the main way the virus spreads, but we are still learning more about how this virus spreads.
  • The spread of SARS-CoV-2 the virus that causes COVID-19, is thought to occur in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing by people with influenza. We will not fully know how it is transmitted until later when scientists have had time to evaluate it.
  • Droplet transmission occurs when respiratory secretions from coughing or sneezing land on mucosal surfaces (nose, mouth, and eyes).
  • Contact transmission is touching something with COVID-19 virus on it and then touching your mouth, nose or eyes.
  • Aerosol transmission means breathing in infectious COVID-19 particles.
  • Keep in mind that the virus particles are not visible to the naked eye. The most harmful particles are sub micron, shorter than one millionth of a meter.
  • It is not likely that SARS CoV-2 is airborne like tuberculosis or measles, but there is strong evidence that it is spread by short range aerosols

5. The signs and symptoms of the COVID-19 disease;

• • People with COVID-19 have had a wide range of symptoms reported – ranging from mild symptoms to severe illness. Symptoms may appear  2-14 days after exposureto the virus.  People with these symptoms may have COVID-19:Most common symptoms

    • Fever or chills
    • Cough
    • Shortness of breath or difficulty breathing

    Other symptoms:

    • Fatigue
    • Muscle or body aches
    • Headache
    • New loss of taste or smell
    • Sore throat
    • Congestion or runny nose
    • Nausea or vomiting
    • Diarrhea

  • Once exposed to this virus, it infects the body by entering healthy cells. From there it spreads to other cells until the infection spreads throughout the body. The virus moves down your respiratory tract. That’s the airway that includes your mouth, nose, throat, and lungs. Your lower airways have more ACE2 receptors than the rest of your respiratory tract. So COVID-19 is more likely to go deeper than viruses like the common cold. Your lungs might become inflamed, making it tough for you to breathe. This can lead to pneumonia, an infection of the tiny air sacs (called alveoli) inside your lungs where your blood exchanges oxygen and carbon dioxide. For most people, the symptoms end with a cough and a fever. More than 8 in 10 cases are mild. But for some, the infection gets more severe. About 5 to 8 days after symptoms begin, they have shortness of breath (known as dyspnea). Acute respiratory distress syndrome (ARDS) begins a few days later. People with this condition may require hospitalization. Not everyone who has COVID-19 has these serious complications. And not everyone needs medical care. But if your symptoms include trouble breathing, get help right away.

6. Risk factors of severe COVID-19 illness with underlying health conditions;

People of any age with  certain underlying medical conditions  are at increased risk for severe illness from COVID-19:

People of any age with the following conditions  are at increased risk  of severe illness from COVID-19:

• • Cancer
  • Chronic kidney disease
  • COPD (chronic obstructive pulmonary disease)
  • Immunocompromised state (weakened immune system) from solid organ transplant
  • Obesity (body mass index of 30 or higher)
  • Serious heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies
  • Sickle cell disease
  • Type 2 diabetes mellitus

COVID-19 is a new disease. Currently there are limited data and information about the impact of underlying medical conditions and whether they increase the risk for severe illness from COVID-19. Based on what we know at this time, people with the following conditions  might be at an increased risk  for severe illness from COVID-19:

• • Asthma (moderate-to-severe)
  • Cerebrovascular disease (affects blood vessels and blood supply to the brain)
  • Cystic fibrosis
  • Hypertension or high blood pressure
  • Immunocompromised state (weakened immune system) from blood or bone marrow transplant, immune deficiencies, HIV, use of corticosteroids, or use of other immune weakening medicines
  • Neurologic conditions, such as dementia
  • Liver disease
  • Pregnancy
  • Pulmonary fibrosis (having damaged or scarred lung tissues)
  • Smoking
  • Thalassemia (a type of blood disorder)
  • Type 1 diabetes mellitus

7. Awareness of the ability of persons pre-symptomatically and asymptomatically infected with SARS-CoV-2 to transmit the SARS-CoV-2 virus

COVID-19 can be deadly
People of any age with the following conditions are at increased risk of severe illness from COVID-19: chronic
kidney disease; COPD (chronic obstructive pulmonary disease); immunocompromised state (weakened
immune system) from solid organ transplant; obesity (body mass index of 40 or higher); serious heart
conditions, such as heart failure, coronary artery disease, or cardiomyopathies; sickle cell disease; type 2
diabetes mellitus.

The ability of pre-symptomatic and asymptomatic COVID-19 persons to transmit the SARS-CoV-2 virus
Some infected people may not exhibit signs or symptoms of COVID-19. There is evidence that pre-symptomatic
(SARS-CoV-2 detected before symptom onset) and asymptomatic people (SARS-CoV-2 detected but
symptoms never develop) can unknowingly spread COVID 19 to others.

8. Safe and healthy work practices, including but not limited to, physical distancing, disinfection procedures, disinfecting frequency, ventilation, noncontact methods of greeting, etc.;

Avoid physical contact with others (maintaining a distance of at least 6 feet from employees, customers and
other individuals).Utilize face coverings or appropriate personal protective equipment (PPE) (surgical/medical
masks or N95 respirators as indicated by hazard assessment) whenever 6 feet distancing cannot be achieved
and/or maintained.

Wash hands frequently with soap and water for at least 20 seconds, if soap and water are not immediately
available, use alcohol-based hand sanitizer that contains at least 60% alcohol and rub hands until they are
completely dry

Ensure that frequently touched work tools, equipment, vehicles, and contracted equipment is routinely
cleaned and disinfected. Cleaning can be achieved utilizing soap and water. Disinfecting can be achieved
utilizing bleach intended for disinfection and has a sodium hypochlorite concentration of 5%–6% or a
disinfectant listed on the EPA “N” list.

Ensure appropriate respiratory etiquette, cover coughs and sneezes.

Avoid touching your eyes, nose, or mouth (face in general) with unwashed hands.

Where feasible, ensure proper ventilation and/or increase ventilation rates in shared spaces

Where feasible install physical barriers, clear plastic (Plexiglas). Display signage on the worksite detailing hand
hygiene, cleaning and disinfecting, and PPE requirements on your worksite aimed at preventing the spread of
COVID-19 at your worksite.

9. PPE:

How to Put On (Don) PPE Gear (Video: How to safely put on (don) PPE)

More than one donning method may be acceptable. Training and practice using your healthcare facility’s procedure is critical. Below is one example of donning.

1. 1. Identify and gather the proper PPE to don. Ensure choice of gown size is correct (based on training).

   2. Perform hand hygiene using hand sanitizer.

   3. P ut on isolation gown.  Tie all of the ties on the gown. Assistance may be needed by other healthcare personnel.

   4. Put on NIOSH-approved N95 filtering facepiece respirator or higher (use a facemask if a respirator is not available). If the respirator has a nosepiece, it should be fitted to the nose with both hands, not bent or tented. Do not pinch the nosepiece with one hand. Respirator/facemask should be extended under chin. Both your mouth and nose should be protected. Do not wear respirator/facemask under your chin or store in scrubs pocket between patients.*

      • Respirator: Respirator straps should be placed on crown of head (top strap) and base of neck (bottom strap). Perform a user seal check each time you put on the respirator.
      • Facemask: Mask ties should be secured on crown of head (top tie) and base of neck (bottom tie). If mask has loops, hook them appropriately around your ears.

   5. Put on face shield or goggles. When wearing an N95 respirator or half facepiece elastomeric respirator, select the proper eye protection to ensure that the respirator does not interfere with the correct positioning of the eye protection, and the eye protection does not affect the fit or seal of the respirator. Face shields provide full face coverage. Goggles also provide excellent protection for eyes, but fogging is common.

   6. Put on gloves. Gloves should cover the cuff (wrist) of gown.

   7. Healthcare personnel may now enter patient room.

How to Take Off (Doff) PPE Gear (Video: How to safely take off (doff) PPE)

More than one doffing method may be acceptable. Training and practice using your healthcare facility’s procedure is critical. Below is one example of doffing.

1. 1. Remove gloves. Ensure glove removal does not cause additional contamination of hands. Gloves can be removed using more than one technique (e.g., glove-in-glove or bird beak).

   2. Remove gown. Untie all ties (or unsnap all buttons). Some gown ties can be broken rather than untied. Do so in gentle manner, avoiding a forceful movement. Reach up to the shoulders and carefully pull gown down and away from the body. Rolling the gown down is an acceptable approach. Dispose in trash receptacle. *

   3. Healthcare personnel may now exit patient room.

   4. Perform hand hygiene.

   5. Remove face shield or goggles. Carefully remove face shield or goggles by grabbing the strap and pulling upwards and away from head. Do not touch the front of face shield or goggles.

   6. Remove and discard respirator (or facemask if used instead of respirator). Do not touch the front of the respirator or facemask.*

      • Respirator: Remove the bottom strap by touching only the strap and bring it carefully over the head. Grasp the top strap and bring it carefully over the head, and then pull the respirator away from the face without touching the front of the respirator.
      • Facemask: Carefully untie (or unhook from the ears) and pull away from face without touching the front.

   7. Perform hand hygiene after removing the respirator/facemask and before putting it on again if your workplace is practicing reuse.*

* Facilities implementing reuse or extended use of PPE will need to adjust their donning and doffing procedures to accommodate those practices.

1. The anti-discrimination provisions in 16VAC25-220-90; and

You will not be discriminated against for any of the following:

• • Exercising your rights under the safety and health provisions of Title 40.1 of the Code of Virginia and implementing regulations under 16VAC25-60-110 for yourself or others.
  • Voluntarily providing and wearing your own personal protective equipment, including but not limited to a respirator, face shield, or gloves, or face covering if such equipment is not provided by the employer, provided that the PPE does not create a greater hazard to yourself or create a serious hazard for others.
  • Raising a reasonable concern about infection control related to the SARS-CoV-2 virus and COVID-19 disease to your employer, the employer’s agent, other employees, a government agency, or to the public such as through print, online, social, or any other media.
  • Refusing to do work or enter a location that you feel is unsafe. 16VAC25-60-110 contains the requirements concerning discharge or discipline of an employee who has refused to complete an assigned task because of a reasonable fear of injury or death.

1. If your employer has a separate Infectious Disease Preparedness and Response Plan, that will be provided to you.

RESOURCES

https://www.doli.virginia.gov/vosh-programs-coronavirus-covid-19-resources https://www.doli.virginia.gov/wp-content/uploads/2021/09/VOSH-standard-clean-version-09.7.21.pdf

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