ANSES issued an internal request with a view to providing scientific support to improve prevention of exposure to SARS-CoV-2 in the workplace, outside the healthcare sector. This mainly concerns occupational activities in the agri-food sector and its supply chain, sanitation and waste management, equipment maintenance to ensure the continuity of utilities supplying the entire population (water, gas, electricity, etc.), shops, transport and law enforcement.
ANSES’s recommendations draw on the Agency's previous expert appraisals in occupational health, and on the reports and official websites of recognised French and international institutions in this field, in particular the US Occupational Safety and Health Agency (OSHA) guide "Guidance on preparing workplaces for COVID-19" published in March 2020.
The guidelines proposed by the Agency are general principles to be implemented by employers. They are supplemented by the Ministry of Labour's practical data sheets on preventive measures to be taken for specific occupations or sectors.
General guidelines recommended by ANSES
According to the French Labour Code (Article R4421-1 et seq.), if there is a risk to the health or safety of workers, any exposure to the biological agent in question must be avoided. When exposure cannot be avoided, it should be reduced by taking a series of incremental measures.
When it is not possible to eliminate the hazard, as is the case with a number of work situations in the current epidemic context, measures to limit the risks of exposure to the SARS-CoV-2 virus must take into account the main transmission routes identified: direct transmission via expelled droplets and indirect transmission via hand-to-mouth or hand-to-face contact after touching contaminated items.
Before implementing any specific technical or organisational preventive measures, the employer must ensure strict application of the basic principles of preventing infection by the SARS-CoV-2 virus, namely social distancing measures and the "barrier gestures" recommended by the health authorities (frequent hand washing with soap or an alcohol-based solution, sneezing into your elbow or into a disposable tissue).
There are four types of specific protective or risk reduction measures that the employer can put in place:
- technical measures, which aim to reduce the risks associated with the employees’ work situation. These include limiting the quantity of droplets in a given space by implementing dilution measures such as aeration and/or ventilation, or installing physical barriers such as "sneeze guards" for activities in contact with the public;
- organisational measures, which generally involve adapting work policy or procedures to reduce or minimise exposure to a hazard. When organisational measures cannot be implemented for every work situation, particularly outside the employer's premises (e.g. home visits or deliveries), the protective provisions from the other categories of measures should be strengthened;
- adoption of practices that promote safety at the work station, in order to reduce the duration, frequency or intensity of exposure to a hazard, and including the "barrier gestures" that constitute an essential basis for the prevention of transmission risks;
- use of personal protective equipment or adapted work equipment: in the current epidemic context, this may include gloves, goggles, face shields or masks.
ANSES stresses that none of the measures taken in application of these principles is effective by itself. Observing all of the provisions, especially the barrier gestures, will help achieve a satisfactory overall level of protection.
Masks: an additional source of protection if used correctly
Regarding personal protective equipment (PPE) and work equipment, ANSES stresses that although these can help prevent certain types of exposure if used correctly, they should not replace the other measures defined in the prevention strategy.
Masks may have high theoretical effectiveness when tested in a laboratory, but this does not necessarily reflect their performance in real conditions of use, which may be limited. To ensure that wearing a mask effectively supplements the other measures to be taken to reduce the risk of exposure, ANSES reiterates that the mask must fit snugly on the face, be worn correctly according to the instructions for use, and be handled, stored and disposed of properly, according to the manufacturer's instructions. Particular care should be taken to avoid any gestures towards the face that may arise from wearing the mask.
The government has turned to French industry for a supply of alternative masks. Such devices, designed in the emergency context of the current epidemic, are not considered as PPE under the regulatory definition, but rather as work equipment. However, if they are worn by workers in sectors other than healthcare, they may reduce the risk of exposure to SARS-CoV-2. As with any mask, correct use will also require rigorous compliance with "barrier gestures" and careful handling to avoid soiling the mask.