In our recent webinar, Getting Back to Work Safely: Experts Discuss Facility & Operational Planning for COVID-19, participants submitted many great questions reflecting the state of uncertainty and the desire for pragmatic answers from our experts. We developed this FAQ resource to help.
What are the symptoms of COVID-19?
What are the incubation period and infectiousness timeframe for COVID-19?
What is the difference between cleaning and disinfecting procedures?
Can you recommend a facility cleaning protocol?
What do OSHA and the CDC say about cleaning protocols?
How do we disinfect our workspace?
Before returning to work, should we have a professional cleaning of our office?
What surface testing is currently available to determine the presence of the COVID-19 contagion?
Can the virus spread in buildings through the HVAC system? And what should we do about that?
What extra steps can be taken when the building has restrooms shared with the public?
Is there a protocol for using confined spaces like elevators or stairs?
What is temperature screening? At what temperature do people need to be sent home?
Are there any Health Questionnaires available for employers to use?
Are there guidelines for performing contact tracing?
How can we maintain social distancing in the workplace?
How do we manage construction during COVID-19?
How can public schools sustain clean facilities during a typical school day?
What will be new considerations for the new path forward given public safety necessities?
What should public schools contemplate or be prepared for to re-open successfully?
What % of budget increase should organizations expect on a per person basis?
The best way to think about transmission of SARS-CoV-2, the virus that causes COVID-19, is the three Ps: prolonged, proximate contact with a patient.
A large percentage of people who have COVID-19 may be asymptomatic. These individuals appear healthy and do not know they are infected. The U.S. Centers for Disease Control estimates that 35% of COVID infections may be asymptomatic. It is estimated that 40% of transmission occurs while individuals are pre-symptomatic with an average period of six days between exposure and symptom onset.
Known symptoms:
This list does not include all possible symptoms. Other less common symptoms have been reported, including gastrointestinal symptoms like nausea, vomiting, or diarrhea.
The U.S. Centers for Disease Control reports an incubation period (how long it takes to become sick after being exposed to enough virus to be infected) of up to 14 days for COVID-19. The onset and duration of viral shedding and the period of infectiousness for COVID-19 are not yet known.
Routine cleaning protocols will vary depending upon the specific type and use of a facility, layout, interior furnishings, occupant population, etc. The following are some general recommendations that may be helpful when developing your site-specific protocol for cleaning and disinfection:
Focus on high-touch surfaces
Focus on cleaning high-touch surfaces like workstations, handrails, doorknobs, faucets, etc. Clean dirty surfaces first using a detergent or soap and water before disinfection and make sure to maintain minimum contact time for cleaning products. Use disinfectants registered with the U.S. Environmental Protecting Agency (EPA) and approved for use against SARS-CoV-2.
Cleaning areas used by an ill person
Close off the area for as long as practical before cleaning and disinfecting, ideally at least 24 hours. Open outside doors and windows to increase air circulation if possible. Focus cleaning and disinfecting on high-touch surfaces like workstations, doorknobs, bathroom faucets, etc.
If the area cannot remain unoccupied for 24 hours, consider appropriate respiratory protection for cleaning staff.
For soft (porous) surfaces such has carpeted floor, rugs, and drapes
Remove visible contamination if present and clean with appropriate cleaners indicated for use on these surfaces. If the items can be laundered, do not shake them. Launder items in accordance with the manufacturer’s instructions using the warmest appropriate water setting for the items and then dry items completely.
If it's not possible to launder the items, use products with the EPA-approved emerging viral pathogens claims that are suitable for porous surfaces. Then clean and disinfect hampers or other carts used for transporting laundry according to the guidance above for hard or soft surfaces.
Ensure your cleaning staff is trained and protected
Employers should develop a comprehensive training program specific to your facility’s cleaning and disinfection policy. Training content should include a detailed review of the specific cleaning and disinfection tasks for which they are responsible and an orientation to the facility layout and specific areas to be cleaned.
Employers must also train their cleaning staff in accordance with the U.S. Occupational Safety and Health Administration’s (OSHA) hazard communication (HAZCOM) and personal protective equipment (PPE) standards. Employees should be trained on when and how to safely prepare and use different detergents, disinfectants, and cleaning solutions and what to do in an emergency.
Personal protective equipment (PPE)
Our recommendations are based on U.S. Occupational Safety and Health Administration (OSHA) and the U.S. Centers for Disease Control (CDC) frameworks for preventing the spread of an infectious disease in the workplace. In addition, there are a variety of state and local requirements to be aware of, based on location and the current level of community spread of COVID-19.
The CDC recommends normal routine cleaning with soap and water to decrease how much of the virus is on surfaces and objects. More details and a cleaning and disinfecting tool checklist are available in their “Reopening Guidance for Cleaning and Disinfecting Public Spaces, Workplaces, Businesses, Schools, and Homes.” Many states are also establishing industry specific requirements for reopening that should be reviewed and implemented as protocol are developed.
It is important to clean surfaces first as a disinfectant cannot penetrate through dirt and therefore will not be effective. After cleaning, use EPA-approved disinfectant for use against SARS-CoV-2. This can include diluted household bleach solution or alcohol solutions with at least 70% alcohol. Select disinfectants with the lowest possible contact time to prevent drying (ideally 1-3 minutes).
The Centers for Disease Control has issued Reopening Guidance for Cleaning and Disinfecting Public Spaces, Workplaces, Businesses, Schools, and Homes
The key to cleaning and disinfecting high-touch surfaces is to establish a routine and clean and disinfect them regularly, using standard protocols above. At a minimum, it's a good idea to clean and disinfect high touch surfaces at least once a day, more frequently if feasible. This is now a requirement in some states, and surfaces should be prioritized based upon the frequency and likelihood of contact. The more frequently you clean and disinfect surfaces with a high probability of contact, the more effective your protocol will be at limiting surface transmission.
If an ill person has been in the workplace within the last seven days, cleaning the workplace before employees return to work is a good idea. If your workplace has been empty, it is more important to establish a protocol for cleaning the workplace once you return to normal operations. A thorough cleaning of soiled or cluttered surfaces prior to the return of your workforce may also help make daily disinfection easier and more effective.
Some environmental laboratories are offering molecular testing using quantitative polymerase chain reaction (qPCR) analysis for SARS-CoV-2 on surface swab samples. These samples should be interpreted with caution. These testing techniques only detect the presence or absence of the virus’s genetic material (including fragments) on surfaces and may still show positive results after proper disinfection has occurred. Because this test method does not assess whether the virus is viable and able to transmit disease, it is not a suitable indicator for disinfection effectiveness.
Additionally, the high cost of these environmental samples and the large number of samples that are required to evaluate the complete removal of virus from a facility with any confidence may be cost prohibitive with little practical benefit. It is CCA's position that although there are novel and surrogate surface sampling methods available, these techniques are not a substitute for a structured monitoring program to ensure that cleaning and disinfection are conducted in accordance with the facility protocol. Proper training of cleaning staff, regular performance observations using a standardized methodology, and post-cleaning visual inspections should be the primary measure of protocol effectiveness.
Surface testing for COVID-19
By testing surfaces in areas where there are high volumes of human interactions, facility managers can better coordinate their cleaning activities, reduce the levels of COVID-19 on surfaces, and verify that existing cleaning was effective. Surface samples (counters, floors, tables, knobs, appliances, computers) can be done quickly using environmental swabs, with the samples sent to a laboratory for analysis. Although there are different analytical methods, one test looks for the RNA of Coronavirus (COVID-19).
SARS-CoV-2 is an airborne virus and it can be transmitted from respiratory droplets and expiratory particles from coughing, sneezing, breathing, and speaking. These microscopic aerosols may be suspended in the air for long periods of time and can become entrained in a building's HVAC system. It's important to note that the greatest risk for becoming ill remains close contact with an infected individual.
To decrease the risk of infection, workplaces should take a multifaceted approach to minimize the number of building occupants in a space, maintain physical distancing, establish cleaning protocols, promote personal hygiene and hand washing, and require face coverings when physical distancing cannot be maintained. To supplement these practices, an engineering evaluation of a building’s environmental systems should be conducted to increase outside air, decrease indoor air recirculation, and increase air cleaning capabilities. This may include optimization of existing systems and/or system redesign and improvement.
Face coverings may help prevent a person from spreading respiratory droplets when talking, sneezing, or coughing. This may be particularly important when physical distancing cannot be maintained and with asymptomatic or pre-symptomatic individuals who aren't aware they are ill and can transmit the virus, and are not isolating. Cloth face coverings may not protect the wearer but may keep the wearer from spreading the virus to others.
The use of face coverings is currently required by many states and localities and is recommended by the U.S. Centers for Disease Control where physical distancing is difficult to maintain. Businesses that do not require employees to wear face coverings may open themselves up to additional liability. Requiring employees and visitors to wear a face covering when it's not possible to maintain physical distancing is a valuable component of an overall infectious disease preparedness plan. Face coverings should be used in addition to other workplace controls such as physical distancing, cleaning protocols, and personal hygiene and hand washing.
If your employees must interact with each other, or with customers, within six feet, consider physical barriers like plexiglass and additional respiratory protection such as N95 masks or other U.S. National Institute of Occupational Safety and Health certified respirators. The U.S. Occupational Safety and Health Administration has specific requirements to train and protect employees using this specialized personal protective equipment.
Sharing bathrooms with the public has always been a hygiene challenge. Training staff on the heightened need for hand sanitation in this setting may help. Considering that the primary concern is COVID-19 spreading through the air, requiring the public to wear face coverings, even when using bathrooms, can reduce risks.
Longer-term measures include ventilation improvements and use of physical barriers to minimize airborne transmission, and the installation of touch-free sinks, hand driers and toilets to reduce surface transmission risks. Buildings should also consider posting occupancy limits on restrooms to make physical distancing more feasible.
Clean and disinfect high-touch surfaces in shared spaces like elevators or stairs as frequently as possible. Also, minimize traffic in these spaces to make physical distancing possible to the greatest degree feasible. This may include limiting the number of people on an elevator at one time and making stairwells or hallways one directional. Employees and visitors should use a face covering whenever physical distancing cannot be maintained to prevent spreading the virus to others in these confined spaces.
The U.S. Centers for Disease Control (CDC) defines a fever as a measured temperature of at least 100.4 degrees Fahrenheit, though many employers are using a threshold temperature of 100.0 degrees Fahrenheit for employee screening. Testing temperature is only one part of a complete screening. Employers should also confirm verbally and through visual inspection that employees are not experiencing other signs or symptoms of illness, which could include flushed cheeks or fatigue.
According to the U.S. Equal Employment Opportunities Commission and the CDC, employees who become ill with symptoms of influenza-like illness at work during a pandemic should leave the workplace. Advising these workers to go home because of suspected or confirmed cases of COVID-19 is not a disability-related action. Remember that all employee health information is subject to Americans with Disabilities Act (ADA) and Health Insurance Portability and Accountability Act (HIPPA) confidentiality requirements.
Employers should also take steps to protect their employees conducting the screening. This should include methods that incorporate social distancing, physical barriers, and personal protective equipment.
Many questions have been raised about the effectiveness of temperature screening, but several infectious diseases experts say that it remains a useful precautionary measure, especially when carried out as part of a question-based COVID-19 symptom process. Temperature screening may not be totally effective at picking up or detecting COVID cases, in particular when infected persons have not developed symptoms of illnesses. Generally, the consensus is that having such a practice in occupational settings is still better than nothing, because it would help detect febrile or feverish workers or visitors.
Professor Ooi Eng Eong, deputy director of the emerging infectious diseases program at Duke-NUS Medical School, explained that while temperature checks are not foolproof, they are the “most objective test” that most public spaces can administer and, therefore, should not be discounted. “There is no one single thing that we can do that will 100 percent, accurately identify all the COVID-19 cases. Fever screening is probably the most objective test because it’s something that we can measure.”
Employers may ask employees who report feeling ill at work or who call in sick questions about their symptoms to determine if they have or may have COVID-19. Currently, these symptoms include fever, chills, cough, shortness of breath, or sore throat. Employers should follow the advice of the U.S. Centers for Disease Control and state and local public health authorities regarding the information they need to permit an employee to return to the workplace after confirmed or suspect COVID-19.
There are several options for choosing who should perform the screening at your workplace.
Ensure assigned screeners are trained on proper screening procedures and confidentiality requirements. Employers should establish site specific screening guidelines and protocols to separate ill employees from others and send them home. These policies should be consistent and non-discriminatory.
Employers should also take steps to protect their employees conducting the screening. This should include methods that incorporate social distancing, physical barriers, and personal protective equipment.
Contact tracing is a key strategy for preventing further spread of COVID-19. During contract tracing, public health workers work with ill individuals to identify every person with whom they had close contact while they may have been infectious. This allows exposed individuals to be informed and to take appropriate precautions to separate themselves from others and monitor themselves for illness.
The U.S. Centers for Disease Control offers guidance on contract tracing plans and introductory training topics that may be helpful when developing a workplace contact tracing plan for your workplace. All employers should incorporate requirements and guidance from their state and local public health jurisdictions when establishing their plans and reporting criteria.
To institute physical distancing requires limiting access to spaces, reducing the density of workers in a space, such as separating people into work teams, managing use of the break room and cafeteria, or making certain spaces one way.
Protection of workers involves a hierarchy of control.
Policies and procedures do need to be updated, but this may not require a complete update of all your policies and operational procedures. It is recommended that employers develop a COVID-19 management plan consistent with the U.S. Occupational Safety and Health Administration’s Guidance on Preparing Workplaces for COVID-19. Because guidance on this virus is continually changing, this should be a living document that is updated regularly.
CCA also recommends establishing a COVID-19 team comprised of upper management, subject matter experts, front-line leaders and employees. This team should have overall responsibility for the development, implementation, and maintenance of this plan as well as establishing an overall communication plan and addressing employee concerns.
Without an effective vaccine, any return to work will include some risk of exposure. Although we can mitigate these risks to some degree, remote work is the only control that will eliminate the potential for direct workplace exposure to the virus. Working from home will also help to minimize the density of your workplace population making it easier to social distance and minimize virus spread and is therefore preferred, if feasible.
Work-at-home options should be maximized for all staff while balancing the business needs of on-site work. Set clear expectations with written policies that discuss the criteria for working from home. Keep lines of communication about these policies open with employees, customers, and clients. The White House guidelines for opening up recommend that all employers continue to encourage working from home whenever feasible during phases one and two of the reopening plan. Vulnerable individuals are encouraged to shelter in place until community spread is limited. Many states and localities may have additional requirements for employers that should also be considered.
The U.S. Occupational Safety and Health Administration requires places of employment to be free from recognized hazards likely to cause death or serious physical. With that in mind, businesses need to evaluate COVID-19 hazards and identify ways (controls) to manage these hazards. Businesses must take the time to get the resources (like face coverings) and put in place the work practices (e.g., pre-screening, social distancing, disinfection) that they have identified as necessary for safe operation. Many states are requiring implementation of industry specific protocols prior to the return to work.
Some essential construction projects have continued, like road construction and other exterior work. Work on those projects must be consistent with U.S. Occupational Safety and Health Administration, state, and local requirements. In some locations (like Massachusetts), contractors must assign a site-specific COVID-19 officer and for large, complicated construction projects a city or town may additionally require the owner to develop and submit a site-specific risk analysis and enhanced COVID-19 safety plan.
Other projects have been greatly impacted or even stopped. Turnaround of such projects may be a challenge because you may need to rework schedules and revise cost estimates or renegotiate contracts. In cases where contractors or sub-contractors have defaulted or gone out of business, you will need to engage new contractors. Remember that bonding or insurance companies may be on the hook to help off-set some of the financial burdens.
Schools can increase custodial staffing and the frequency of cleaning and improve communication to accelerate the cleaning of high-traffic areas. We recommend that schools develop a schedule for increased, routine cleaning and disinfection in accordance with U.S. Centers for Disease Control guidelines. Schools should also discourage the use of shared objects, consider closing close communal shared spaces, and serve food in classrooms instead of a shared cafeteria.
However, many schools are struggling with staffing and costs and it's not possible to burden the administration and janitorial staff to do a complete cleaning every night. You can get creative and use teachers and even students to help with cleaning efforts. For example, you can ask people to clean their own personal desks and lockers; ask them to wipe down vending machines or other common touchpoints after using them. This will take communication so students and faculty understand the reasons and their roles in keeping the school clean.
A major step in managing COVID-19 risks is the development of a school-specific COVID-19 management plan that gives direction and guidance to help mitigate the transmission of COVID-19 and provide safe and healthy environments for students and staff. This plan should include direction for managing school operations in a way that is consistent with requirements of local, state, and federal agencies and tailored to the specific advantages and challenges of each school, recognizing that risks may vary significantly between regions and types of schools. The plan should be a living document and updated as conditions change or additional information is obtained.
A school- or system-specific COVID-19 management plan should be developed by a team led by the president, superintendent, or principal and including teachers, facilities staff, union representatives, coaches, and other key members of the school program. The team should consider the ALARA principle—to ensure that coronavirus transmission risks are As Low As Reasonably Achievable. There are many approaches to managing the risk of COVID-19 transmission in schools including:
The financial impact of reopening will differ for each school system and individual school. Schools may need to do a line-by-line budget review, as there may be both increases and decreases in expenditures for staffing, buses, materials, and services.
Examples of costs that may increase:
Examples of costs that may decrease:
U.S. Occupational Safety and Health Administration
U.S. Centers for Disease Control
U.S. Environmental Protection Agency
U.S. Equal Opportunity Commission (EEOC)
White House
Other