Section 1 – Sensible workplace precautions:
– Minimising the presence of the most vulnerable members of the workforce where possible, through working from home or self isolation.
– Appropriate distancing protocols within the workplace, avoiding any unnecessary exposure through working from home and minimising travel / face to face contact.
– Upgraded hygiene and sanitising protocols, using additional personal protective equipment (PPE) where necessary.
– Ensuring self isolation of anyone showing possible signs and symptoms with a 14 day window before returning to work.
– Operate a “no handshake” policy.
– Screening via Coronavirus Testing Kits.
Social distancing guidelines are as follows:
– Avoid contact with someone who is displaying symptoms of coronavirus (COVID-19). These symptoms include high temperature and/or new and continuous cough.
– Avoid non-essential use of public transport when possible.
– Work from home, where possible.
– Avoid large and small gatherings in public spaces, noting that pubs, restaurants, leisure centres and similar venues are currently shut as infections spread easily in closed spaces where people gather together.
– Avoid gatherings with friends and family.
– Keep in touch using remote technology such as phone, internet, and social media.
– Use telephone or online services to contact GP practices or other essential services.
– Everyone should be trying to follow these measures as much as is practicable.
Hand Washing and Respiratory Hygiene:
With regard to hand washing and respiratory hygiene, there are general principles you can follow to help prevent the spread of respiratory viruses, including:
– Washing your hands more often – with soap and water for at least 20 seconds or use a hand sanitiser when you get home or into work, when you blow your nose, sneeze or cough, eat or handle food.
– Avoid touching your eyes, nose, and mouth with unwashed hands.
– Avoid close contact with people who have symptoms.
– Cover your cough or sneeze with a tissue, then throw the tissue in a bin and wash your hands.
– Clean and disinfect frequently touched objects and surfaces.
If anyone develops symptoms of coronavirus (COVID-19), including (but not limited to) high temperature and/or new and continuous cough, they should self-isolate at home immediately and call the NHS on 111 for current guidance. When appropriate care is underway, they should endeavour to notify their employer remotely. Rapid Coronavirus Screening Kits are now available for professional use.
Updated guidance is issued frequently. We recommend that our clients follow advice from the World Health Organisation (WHO), Public Health England (PHE) and The Foreign & Commonwealth Office (FCO), as the situation develops.
Section 2 – Guidance on high risk / low risk testers:
Assuming that sensible workplace precautions are already in place across the business, the drug and alcohol testing staff should ideally be selected from the low risk categories.
The extremely vulnerable will receive a letter by Sunday (March 29) from the NHS informing them that they should stay at home at all times and avoid any face-to-face contact for at least 12 weeks. Given such advice, people with the following health conditions (which put them in the extremely vulnerable category) should not remain in the workplace and should definitely not be tasked with conducting any drug and alcohol testing within the workplace:
– Solid organ transplant recipients.
– People with cancer who are undergoing active chemotherapy or radical radiotherapy for lung cancer.
– People with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment.
– People having immunotherapy or other continuing antibody treatments for cancer.
– People having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors.
– People who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs.
– People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe COPD.
– People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell).
– People on immunosuppression therapies sufficient to significantly increase risk of infection.
– Women who are pregnant with significant heart disease, congenital or acquired.
Beyond the extremely vulnerable cases above, the following individuals are high risk and should also refrain from conducting any testing:
– Those aged 70 or older (regardless of medical conditions).
– Those under 70 with an underlying health condition listed below (ie anyone instructed to get a flu jab as an adult each year on medical grounds):
– Chronic (long-term) respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema or bronchitis.
– Chronic heart disease, such as heart failure.
– Chronic kidney disease.
– Chronic liver disease, such as hepatitis
– Chronic neurological conditions, such as Parkinson’s disease, motor neurone disease, multiple sclerosis (MS), a learning disability or cerebral palsy.
– Problems with their spleen – for example, sickle cell disease or if they have had their spleen removed.
– A weakened immune system as the result of conditions such as HIV and AIDS, or medicines such as steroid tablets or chemotherapy.
– Anyone who is seriously overweight (a body mass index (BMI) of 40 or above).
– Those who are pregnant.
Assuming that your designated testers do not fall into the higher risk groups (listed prior), then we recommend that they follow the government advice detailed in section 3.
Section 3 – Current Guidance on best practice when testing:
Assuming the business is adopting appropriate protocols listed in sections 1 and 2 of this bulletin, staff involved in workplace drug and alcohol testing are not in the same position as primary care workers, (in that they are not dealing with symptomatic patients), but we recommend, where possible, taking the same precautions due to their level of interaction with the donor.
Testers will only be working with donors who are not showing any physical symptoms. Assessment of the clinical and epidemiological characteristics of SARS-CoV-2 cases (a similar infection) suggests that patients will not be infectious until the onset of symptoms.
Therefore, if the donor is displaying symptoms, isolation protocols would apply and the TESTING MUST NOT PROCEED to ensure the safety of the tester and to minimise exposure to the business. Health and safety considerations would be satisfied, because the donor would be removed from the workplace. Drug and alcohol testing would have to be conducted at, or prior to, return to work, but not at the point where the donor is displaying symptoms.
The transmission of COVID-19 is thought to occur mainly through respiratory droplets generated by coughing and sneezing, and through contact with contaminated surfaces.
Initial research has identified the presence of live COVID-19 virus in the stools and conjunctival (eye) secretions of confirmed cases. All secretions (except sweat) and excretions, including stools from patients with known or suspected COVID-19, should be regarded as potentially infectious.
With this in mind, given that the tester may briefly occupy distances of less than 1 metre from the donor, disposable gloves and a fluid-resistant (Type IIR) surgical mask (FRSM), along with a disposable apron is a sensible precaution. This would be the recommended level of protection for medical staff interacting with confirmed cases of the virus, so it would ensure tester safety if conducting testing on apparently healthy employees.
Personal Protective Equipment (PPE):
Before undertaking any procedure, staff should assess any likely exposure and ensure PPE is worn that provides adequate protection against the risks associated with the procedure or task being undertaken. It is recommended that staff are trained in the proper use of all PPE that they may be required to wear.
All PPE should be:
– Compliant with the relevant BS/EN standards (European technical standards as adopted in the UK);
– Located close to the point of use;
– Stored to prevent contamination in a clean/dry area until required for use (expiry dates must be adhered to);
– Single-use only;
– Changed immediately after each patient and/or following completion of a procedure or task;
– Disposed of after use into the correct waste stream i.e. healthcare/clinical waste (this may require disposal via orange or yellow bag waste; local guidance will be provided depending on the impact of the disease).
– Disposable plastic aprons are recommended to protect staff uniform or clothes from contamination when providing direct patient care and during environmental and equipment decontamination.
– Disposable aprons and gowns must be changed between donors and immediately after completion of a procedure/task.
– Disposable gloves must be worn when testing, and during equipment and environmental decontamination. Gloves must be changed immediately following the task undertaken and certainly between donors.
Fluid-resistant (Type IIR) surgical masks (FRSMs):
Fluid-resistant (Type IIR) surgical masks (FRSMs) are worn to protect the wearer from the transmission of COVID-19 by respiratory droplets.
In all healthcare settings:
– A FRSM must be worn when working in close contact (within 1 metre) of a patient with COVID-19 symptoms. This provides a physical barrier to minimise contamination of the mucosa of the mouth and nose. Bearing in mind that the donors who are being drug and alcohol tested are believed to be healthy, this protocol is designed to err on the side of caution.
– In an area where pandemic COVID-19 patients have been cohorted together, it may be more practical for staff to wear a FRSM at all times, rather than only when in close contact with a patient. Similarly, in primary care/outpatient settings it may be more practical for staff working in a segregated (COVID-19 patient) area to wear a FRSM for the duration they are in the patient area.
A FRSM for COVID-19 should:
– be well fitted covering both nose and mouth;
– not be allowed to dangle around the neck of the wearer after or between each use;
– not be touched once put on;
– be changed when they become moist or damaged;
– be removed outside the patient room, cohort area or 1 metre away from the patient with possible/confirmed COVID-19; and
– be worn once and then discarded as healthcare (clinical) waste (hand hygiene must always be performed after disposal).
Eye protection / Face visor:
Eye / face protection should be worn when there is a risk of contamination to the eyes from splashing of secretions (including respiratory secretions), blood, body fluids or excretions. This is very unlikely when collecting specimens, but it is possible when collecting breath samples using a breathalyser.
Disposable, preferably single-use, eye/face protection is recommended.
Eye / face protection can be achieved by the use of any one of the following:
– Surgical mask with integrated visor;
– Full face shield / visor;
– Polycarbonate safety spectacles or equivalent;
Regular corrective spectacles are not considered adequate eye protection.
Guidance for the correct procedure for washing hands and the correct procedure for using hand sanitiser are provided at the end of this document.
Additional safeguards to be added to current procedures:
Make sure your hands are clean before commencing the process. Put on one pair of gloves and remove a further 3 pairs from the box. The first pair will be for the donor to use the breathalyser, the second and third pairs are a change of gloves for the tester (without the need to touch the clean box again). Lay them out in separate pairs. This is to enable a change of gloves between handling the urine sample and the breathalyser and a change during the packaging of the laboratory pack, as described below. Having hand sanitiser available is very helpful, where hand washing facilities are a distance from where the testing is being conducted.
When completing the paperwork, using disposable, low cost pens (or the donor using their own pen) is a sensible precaution. This minimises the risk of staff sharing an infected pen. This can be further minimised by asking the donor to wash their hands after the process.
We would recommend that the donor is asked to wear a pair of disposable gloves when handling the breathalyser. This protects them and any further donors from the equipment itself. The breathalyser can be sanitized between uses but gloves would be an additional safeguard.
Drug tests are single use and disposable, so these will not need to be sanitised. However, please bear in mind that used cups, saliva tests and mouthpieces fall into the same category as feminine hygiene waste and should not be disposed of in general waste.
When using the breathalyser, we would advise against the tester holding the unit to the donor’s mouth. The donor should be asked to collect their own sample, so the tester can better establish a greater than 1 metre distance from the donor. They should also avoid being in the direct flow of breath sample when the donor provides their sample. This is easily achieved by asking the donor to face a particular direction when providing their sample, as a safeguard.
We would also recommend that the donor detach and dispose of their own mouthpiece, placing the breathalyser down on to a sanitary disposable surface (ready to be sanitised between uses). This could be a tray lined with foil or something similar.
In the case of saliva testing, asking the donor to wear gloves will reduce the chance of them having contact between their hand and their mouth. The more the tester can ask the donor to do, the less physical interaction is necessary.
In the event of a positive result, when a laboratory sample is being packaged and sent to the laboratory, we recommend a change of gloves in between sealing the biohazard bag and placing the biohazard bag into the external transportation envelope. This will minimise any possible contact contamination and ensures maximum safety for all when handling the transportation envelope after collection has been completed.
We must reiterate the need for frequent hand washing or sanitising.
Management of equipment and the care environment:
Decontamination of equipment and the care environment must be performed using either:
– A combined detergent/disinfectant solution at a dilution of 1,000 parts per million available chlorine (ppm available chlorine (av.cl.)); or
– A general purpose neutral detergent in a solution of warm water followed by a disinfectant solution of 1,000ppm av.cl.
Only cleaning (detergent) and disinfectant products supplied by employers are to be used. Products must be prepared and used according to the manufacturers’ instructions and recommended product “contact times” must be followed. If alternative cleaning agents/disinfectants are to be used, they should conform to EN standard 14476 for virucidal activity.
Aside from this, provided the donor shows no symptoms, and that the tester wears appropriate personal protective equipment and maintains the hygiene practices as described within this bulletin, all other aspects of the usual collection process remain the same.
To follow are “Guidance for the correct procedure for washing hands”, the correct “procedure for using hand sanitiser” and “PPE requirements depending upon activity”.
UPDATE – Please also see our Rapid COVID-19 Coronavirus Test Kit, which is now available for sale in the UK.
This is a living document, subject to continual development and renewal. Please share any improvements with us, for the benefit of all.
We look forward to continuing to support you with your drug testing, training and policy requirements.
Christopher Evans – Director
Medical, Health and Education Ltd