How do you prevent risks?

When someone risks exposure to infectious agents in their line of work, you as employer shall take the necessary protective measures. In order to do so, you must identify the microbiological work environment risks, assess them, and choose effective protective measures based on the risk assessment. Then you need to follow up to check that the measures are working as intended.

First, you as employer shall try to prevent the existence of infectious agents. When this is not possible, it is necessary to ensure that your employees are using sufficient protective measures.

When taking protective measures, this shall be done in a certain order:

1. Completely remove the source of the risks.
2. If this is not possible, take technical and organisational measures to minimise the risk.
3. Use personal protective equipment when other measures cannot be taken or are insufficient.

The specific measures needed depends on the risks you have identified and the state of the specific workplace. In the provisions on risks of infection (AFS 2018:4), there are rules on risk assessment, planning, and protective measures to avoid employees suffering ill-health due to infectious agents.

Risks of infection (AFS 2018:4), Provisions (SWE)

Conduct an investigation and assess risks of infection

All employers shall conduct systematic work environment management. This includes investigating whether infectious agents could cause ill-health in the workplace. The purpose of the investigation and the assessment is to identify the microbiological work environment risks that exist in your business so you can prevent them from occurring. When you as employer has confirmed that risks of infection exist in your business, you shall assess both how serious the risks are and how likely it is that someone will become infected. If you cannot make this assessment yourself, you shall enlist expertise, for example in-house, from the occupational health services, or regional infectious disease control services.

If your investigation shows that there are non-negligible risks of infection, you shall remove the source of infection, if possible. If this is not possible, you must take sufficient protective measures.

One example of a non-negligible risk of infection may be the risk of infection from infectious agents that result in serious illness when receiving patients in emergency healthcare. In this case, one protective measure may be to have an isolation room in the emergency ward for patients with confirmed or suspected serious, infectious diseases.

Another example is when there is a risk of being infected with salmonella or parrot disease when cleaning an area where there are bird droppings. Infectious agents may exist both in visible bird droppings and invisibly in the dust. In this case, protective measures may include using cleaning methods that reduce the risk of dust being stirred up and using personal protective equipment, such as respiratory protective equipment with the correct dust filter.

Rules on risk assessment and documentation of microbiological work environment risks

The employer shall investigate and assess the risks of infection and other microbiological work environment risks. The provisions on risks of infection (AFS 2018:4) and the provisions on systematic work environment management (AFS 2001:1) include regulations on how investigations and risk assessments shall be carried out and how the employer shall document the results.

The identified risks and measures needed to eliminate the risks shall be made clear in the documentation. The investigation and the assessment shall be reviewed regularly and when making changes to the activities that may lead to changes in risk. The documentation shall be made available in the business.

Risks of infection (AFS 2018:4), provisions (SWE)

Systematic Work Environment Management (AFS 2001:1), provisions

You can read more about risks of infection on the page Main risks of infection.

Main risks of infection

Different businesses have different needs for investigation and assessment of risks of infection

Exposure to risks of infection varies from workplace to workplace. In workplaces where there are many infectious agents or great risks of infection, a deeper investigation and risk assessment is necessary to best remedy the risks. For other workplaces where there are no serious risks of infection, a general investigation and assessment may suffice.

Regardless of whether there are great risks of infection or less serious risks of infection, you shall choose the necessary protective measures based on the result of the investigation and risk assessment.

Make sure to have the proper competence for the assessment

When there are risks of infection, it is important that the person performing the risk assessment and assessing which protective measures are necessary is sufficiently competent for this task. If you as employer do not have access to anyone with the proper competence within your own organisation, you may need to hire someone externally. Sometimes the occupational health services provide such competence. For the assessment of specific risks of infection, you may also seek assistance from infectious disease physicians, infection prevention and control expertise, the Public Health Agency of Sweden or the National Veterinary Institute (SVA).

The Public Health Agency of Sweden’s website, opens in a new window

National Veterinary Institute’s website, opens in a new window

How to conduct the investigation and assessment

You who are to investigate risks of infection shall do so systematically. Start by identifying whether there are any work environment risks due to occurrence, increase, or previous occurrence of infectious agents. In Section 6 of the provisions on risks of infection (AFS 2018:4), there are questions to start off your investigation.

You as employer shall review the investigation and assessment on a regular basis. When you make changes to the business that may impact the risks, you shall have the risk assessment updated.

Document the investigation and the assessment

The result of the risk assessment shall be documented. How comprehensive the documentation needs to be depends on the business activities and the identified work environment risks. The same applies for risk of infection.

You shall document:

• when the risk assessment was completed
• who participated
• what was assessed
• what measures are needed.

Also make sure to incorporate the investigation and assessment of microbiological work environment risks into the organisation’s systematic work environment management.

Risks of infection (AFS 2018:4), provisions (ENG)

Systematic Work Environment Management (AFS 2001:1), provisions

You will find more information on systematic work environment management on the page Working on the work environment.

Working on the work environment   

Industries with many similar workplaces may make general risk assessments

In certain industries, there are many workplaces with similar microbiological work environment risks. Examples include infection clinics and emergency wards in hospitals, sewage treatment plants, and laboratories for microbiological or chemical diagnostics of samples from humans. For each of these operations, it is usually possible to make general risk assessments of common risks. At the same time, you must consider local conditions in your own risk assessment.

Variations between workplaces or localities may include methods, technical equipment, and the frequency of infections among the population. Trade associations often have unique know-how and competence within their industry and know which microbiological work environment risks are common and how to best protect yourself. Therefore, we prefer for trade associations to prepare guidelines or information material on the microbiological work environment risks and how to prevent them in such industries. This facilitates the work on preparing good assessments for sufficient protective measures. Normally, the Swedish Work Environment Authority cannot participate in such work, but we can review the finished product with respect to the interpretation of our rules and regulations in certain cases.

The Action Plan – plan your work

Once you have investigated the work environment and confirmed that there are risks of infection in the workplace, you as employer shall remedy the risks. Primarily, you shall try to eliminate the cause of the risk of infection. If this is not possible, you must take the preventive protective measures necessary.

A certain order shall be followed when considering which protective measures to take. We call this order an action plan.

The various steps are described below.

Sometimes it is not possible to completely eliminate the risks at a certain stage. Still, it is important to go through the list in order, without skipping any of the steps, and choose measures from later steps as a complement.

1. Choose a less harmful infectious agent or microorganism, if possible

In most cases, it is not possible to choose which infectious agents exist in the workplace. It is basically only possible to choose which infectious agents occur in cases of intentional use of microorganisms.

When analysing infectious agents for diagnostic purposes, you may sometimes use less hazardous infectious agents as controls. For all intents and purposes, they are similar to the pathogenic infectious agents but are less harmful.

2. Prevent unwanted occurrence and growth

By removing the conditions for growth, you can prevent the occurrence of infectious agents. Important conditions for growth include moisture, organic material for easily accessible nutrition, and the right temperature. Thus, cleaning and good order are also ways to reduce the risk of occurrence and growth, especially of bacteria but also of strong viruses.

The methods used to prevent unwanted occurrence and growth must be adapted to the operations. Common cleaning may not suffice if various infectious agents occur in great numbers, for example in care facilities or if anyone has had a stomach virus.

3. Choose work methods, procedures, and technical devices that counteract the development of microbiological work environment risks.

If risk of infection exists, you may also need to review the work methods, procedures, and technical devices used in the operations. If it turns out that a certain method, procedure, or device is creating problems, this needs to be remedied. 

Cleaning contaminated floors and walls using compressed air or pressurised water may result in creating clouds of tiny, fine water droplets (aerosols) with infectious agents that spread easily. You should choose a different cleaning method if there is risk of ill-health.

To the extent possible, choose work methods that reduce the risk of sharps injuries when the work involves handling bodily fluids or other samples from humans or animals. Use puncture-proof products when there is a risk of coming into contact with blood or other human bodily fluids.

4. Take measures as close to the source as possible

If it is not possible to prevent unwanted occurrence of infectious agents and if methodological choices or technical solutions are not sufficient or even possible, you must take other measures. That includes trying to render infectious agents harmless as close to the source as possible.

One example is using disinfectants in laboratories that analyse samples from humans or animal in order to render any infectious agents in the sample harmless once the tests are completed.

Another example is to dispose of used hypodermic needles or scalpel blades using a special waste container directly after use on humans or animals, instead of temporarily storing the sharps in a kidney dish or alike.

5. Limit the number of individuals in risk of being affected

By preventing the occurrence of infectious agents, having appropriate work methods, procedures, technical equipment, and taking measures as close to the source as possible, you also limit the number of people who may be affected by infectious agents.

Example of additional measures to keep the number of exposed individuals down may be to limit the work to a particular time or place and only have the employees necessary to carry out the work present. This may for example mean limiting the number of persons caring for patients with serious infectious diseases or present in laboratories where infectious agents are diagnosed.

6. Use personal protective equipment

When other protective measures are insufficient, it is necessary to also use personal protective equipment. On the other hand, it is not acceptable to use personal protective equipment in lieu of other protective measures.

You may need to complement the preventive measures taken with personal protective equipment such as smock overalls and gloves, especially within healthcare and social care.

Good hygiene practices reduce the risks of infection

The provisions include detailed rules on what is considered good hygiene practices. The work method shall be applied in case of risk of infection and within certain industries. There are also training requirements on which hygiene practices to apply, see Section 13 in the provisions on risks of infection (AFS 2018:4).

Risks of infection (AFS 2018:4), provisions (SWE)

The National Board of Health and Welfare has regulations on basic hygiene practices within healthcare and certain care activities. Basic hygiene is primarily intended to protect patients and care recipients. The Swedish Work Environment Authority’s provisions on preventive hygiene measures are similar to the basic hygiene practices, but are primarily intended to protect the employee.

When shall specific hygiene measures be applied?

You shall always practice good hygiene when there is a risk of infection. In activities where you may come into contact with blood and other bodily fluids from humans, specific hygiene measures shall be taken. This is the case with respect to healthcare and care services, but also for other employees who may come into contact with bodily fluids, such as security guards, police, and preschool staff.

Specific hygiene measures shall also be observed when working in veterinary care.

The slaughterhouse and food industries are not covered by the stipulation on specific hygiene measures. Nonetheless, the other stipulations in the provisions on risks of infection (AFS 2018:4) are applicable for these industries.

What are specific hygiene measures?

Working with specific hygiene measures means, inter alia, that, when working, you:

• use gloves, protective clothing, and other protective equipment when necessary
• disinfect and wash your hands
• handle hypodermic needles and sharp objects safely
• know the routines in place for spillage, puncture wound, and alike.

You will find the exact stipulations in Section 14 of the provisions on risks of infection (AFS 2018:4). The employer shall ensure that the instructions and routines in the workplace comply with the stipulations. The employer shall also ensure that there is necessary equipment and that the employees comply with the workplace instructions and routines.

What type of training does the employee need?

The employee shall follow the oral and written instructions provided by the employer, but it is also important that the person who may be exposed to infection will have suitable training and practice. The training should include several different elements:

• information on which infectious agents may occur in the line of work
• the meaning of the specific hygiene measures
• routines for preparedness and measures to reduce risks in case of incidents and accidents, such as spillage of blood/urine samples
• how to handle sharp objects
• handling of refuse containing sharp objects
• the importance of vaccination
• practice and practical management.

In the event of an acute risk of infection, employees with training and experience are better equipped to protect themselves against the infection. Therefore, the provisions require that employees who may come in contact with blood or other bodily fluids from humans or animals shall be provided training. These requirements are set out in Section 13 of the provisions on risks of infection (AFS 2018:4).

Different transmission routes require different types of measures

In the following, we describe a few important measures to protect employees against infectious agents with different transmission routes. We describe the various transmission routes on the page Main risks of infection.

Main risks of infection

Because infectious agents are transmitted in different ways and have various traits, employers need to consider what the infectious agents are in order to determine the necessary protective measures. When there is a risk of infection at work, you shall practice good hygiene. 

You should not have to fall ill due to exposure to infectious agents in your line of work. But with respect to infectious agents that are common in society, such as cold viruses, it may be difficult to determine whether you became infected at work or during your leisure time. The employer is normally not responsible for investigating and assessing the risks of employees becoming infected with common flu viruses. It is when your duties involve close contact with humans that you especially need to consider and prevent such risks of infection. This may include work at preschools, social care, or healthcare. In several cases, it has been proven that good hand hygiene reduces the risk of catching many common infectious agents.

If employers, in the course of their work environment management, comply with the provisions and advice on design and maintenance of workspaces and staff rooms in the Swedish Work Environment Authority’s provisions on workplace design (AFS 2009:2), the risk of employees catching infectious diseases or being exposed to other microbiological health risks is reduced. In workplaces where you risk exposure to severe health risks due to infectious agents, additional measures are often needed to protect the employees.

Workplace design (AFS 2020:1), provisions

Prevent direct and indirect contact infection

Contact infection is common in many workplaces. Within healthcare and social care, it may be the most common transmission route.

When employees risk becoming infected via contact infection, the following measures are important to reduce the risks of infection:

• maintaining good hand hygiene and using hand disinfectant (hand sanitizer)
• not touching your face with your hands
• having good cleaning routines in the workplace
• equipping and organising the workplace to prevent infection
• that the staff is trained with respect to the risks and have received the necessary instructions in case of a major risk of becoming infected with serious infectious agents
• using safety gloves if the risk assessment shows it is necessary.

Prevent infection from bodily fluids

In professions where you may come into contact with human bodily fluids, special regulations apply. You shall then follow specific hygiene measures. The same applies to activities within veterinary care. This means using, amongst other things:

• gloves when there is a risk of contact with bodily fluids
• protective clothing in close-contact care work
• face shield when there is a risk of bodily fluids splashing
• respiratory protection equipment if there is a risk of serious airborne infection
• puncture-proof sharp objects to be used on humans and disposing of the sharps refuse safely.

Prevent droplet infection and airborne infection

Droplet infection is a common transmission route for respiratory infections. Many of the protective measures that are important for avoiding contact infection are also appropriate in cases of droplet and airborne infection. However, sometimes several measures may be needed, for example respiratory protection equipment and masks. There is a difference in function between masks and respiratory protection equipment. Masks often only protect against splashes. In order to protect yourself against the small droplets and dust particles that are tied to airborne infection, respiratory protection equipment must be used. The respiratory protection equipment necessary to protect against airborne infection shall have dense filters.

To reduce risks of infection, specifically for risk of infection via dust particles, additional measures are needed, such as:

• avoiding stirring up dust that has been contaminated by rodents and birds
• applying moisture to dust that has been contaminated by rodents and birds before cleaning up
• using respiratory protection equipment with the correct particle filter if it is not possible to avoid contaminated dust in the air.

Prevent blood-borne infection

Blood-borne infectious agents do not only occur in blood but also in other bodily fluids. Blood-borne infection may also occur on used hypodermic needles and other sharp objects that have been used on humans or animals. As both humans and animals may carry various blood-borne infectious agents but be asymptomatic, it is important to always consider blood and other bodily fluids as contagious.

These measures may reduce the risk of blood-borne infection:

• Use safety gloves.
• Only use puncture-proof products.
• Never put the protective sleeve back on a used hypodermic needle.
• Dispose of used sharp objects immediately after use into a special waste container for sharps.
• Never hand over a used sharp object to another person.

Prevent vector-borne infection

In order to avoid vector-borne infection, it is important to avoid the insects or ticks that may carry infectious agents.

These measures may reduce the risk of vector-borne infection, but which ones you choose depend on which infectious agents are the problem:

• Use appropriate insect repellent.
• Wear protective clothing and boots when working in forests and soil and in park areas.
• Always check for ticks and remove them directly after spending time in areas where there are ticks.
• Get vaccinated against tick-borne encephalitis virus (TBE).

Prevent foodborne infection

The risk of being infected by foodstuffs at work is relatively small. However, employees at slaughterhouses have on occasion been infected in their line of work. It is therefore important to pay close attention to hand hygiene and to have access to hand washing. There is food legislation aimed at preventing humans from falling ill from foodstuffs. It is important to also comply with this legislation if you work with foodstuffs and especially if you handle or taste raw or insufficiently heated foodstuffs.

Prevent waterborne infection

Infection from sewage water may be avoided through various measures. Examples of measure may include:

• technical measures to prevent splashing from uncovered pools
• elimination of infectious agents through heating, chemical agents, or a purification process
• reducing the concentration of infectious agents through dilution (the process)
• measures needed to avoid aerosols (small water droplets in the air that you may inhale)
• offering employees vaccine for hepatitis A, tetanus, and other infectious agents that may be relevant.

See more on microbiological work environment risks in IVL’s and the Swedish Water & Wastewater Association, SWWA, guidelines on their website.

ArbetsmiljöVA, opens in a new window

The measures necessary to avoid growth of Legionella bacteria in a water system may be some of the following:

• sufficiently high temperature in the system
• construction of pipe system so water does not become stagnant
• frequent flushing of the systems.

See also the knowledge compilation on Legionella in the environment – managing risks of infection on the Public Health Agency of Sweden’s website.

The Public Health Agency of Sweden’s website, opens in a new window

Measures to prevent sharps injuries

The following is information on how to protect yourself against blood-borne infections due to sharps injuries.

Blood-borne infectious diseases are not always visible

Among the blood-borne infectious agents, there are many that may result in serious and sometimes chronic illnesses. Most are uncommon, but not all. Examples of blood-borne infectious agents that are not entirely uncommon in Sweden include hepatitis B, hepatitis C, and human immunodeficiency virus (HIV). Both humans and animals may carry blood-borne infectious diseases without presenting symptoms. This is why you should always work with blood or other bodily fluids as if they are contaminated.

Work environments where blood-borne infection may occur

There are many different activities where employees may risk coming into contact with blood and other bodily fluids and where you may have a sharps injury from sharp objects. Examples of such activities include:

• healthcare
• eldercare
• childcare
• dental care
• police
• care of the deceased
• tattooing and beauty care
• veterinary care activities.

Work in a puncture-proof way

To avoid being infected by blood-borne infectious agents, it is important to work in a puncture-proof way. A puncture-proof work method means that those who use sharp objects such as hypodermic needles and scalpels must always handle these objects as if they are contagious after being used on humans or animals.

The employer shall ensure that the handling and safety instructions that shall be followed also include instructions on how to handle sharp objects. The employer shall also ensure that the products to be used on humans are puncture-proof.

The following measures are important for working in a puncture-proof way:

• All sharp objects shall be equipped with an integrated protective function.
• After use, sharp objects shall immediately be placed in a sharps container.
• You shall never put the protective sleeve back on a used hypodermic needle.
• Employees shall be trained in how to work in a puncture-proof way and how to handle sharp objects with a protective function and other safe products.

Use objects with an integrated protective function – needle guard

Sharp objects, such as hypodermic needles or lancets, shall be equipped with a protective function, a so-called needle guard, attached to the sharp object. The protective function shall be activated directly after use so you cannot prick or cut yourself on the sharp end. If employees are to handle an insulin syringe with a hypodermic needle or pen cannula for insulin treatment, such products shall also be equipped with an integrated protective function.

Puncture-proof sharp objects shall also be disposed of in a special waste container intended for sharps.

Puncture-proof sharp objects shall be used in all activities where there is a risk of coming into contact with blood or other human bodily fluids.

Use other aids if there is no protective function

There may occasionally be products that cannot be bought with a needle guard. If you need to use a sharp object lacking a protective function, you must use other technical aids to avoid sharps injuries. One example of this is needle magnets for suture needles.

There are requirements on waste containers

There shall be a special waste container for sharp objects. The container shall be designed in such a way that sharp objects cannot penetrate the wall of the container. The waste container shall be labelled with the words ‘skärande och stickande avfall’, but it can be combined with the word ‘sharps’ in English. The waste container must not be reused.

In case of an accident

If you, despite the protective measures, accidentally prick or cut yourself, there must be written instructions near the workspace. The instructions shall detail where and to whom you shall turn for help.

You need to quickly make a risk assessment on the likelihood of infection being transmitted to the person with the sharps injury. After that, assess whether medication or preventive vaccination is necessary. Treatment must be initiated as soon as possible after the incident in order to have a sufficient effect. If you are experiencing anxiety and discomfort over your sharps injury, you are entitled to psychological support.

Medical preventive measures

Vaccinations may protect against certain diseases

Vaccination may be used as a prophylactic but cannot replace other protective measures such as good work practices, good hygiene practices, or personal protective equipment. When working with special risks of infection, vaccination may provide added safety to the individual employee. Examples of such infectious agents include measles, rubella, and hepatitis B. Available vaccines against various infectious agents vary both in terms of efficiency and how long they provide immunity. Appendix 1 to the provisions on risks of infection (AFS 2018:4) lists whether there are effective vaccines.

Risks of infection (AFS 2018:4), provisions (SWE)

The employer shall provide vaccination to employees free of charge if the risk assessment indicates a need for this. The employer cannot, however, with the support of the Work Environment Act demand that an employee gets vaccinated if the employee does not want to get vaccinated. In connection with the vaccination, it is important for the employer to inform the employee of the importance of continuing to work in a safe manner, as the vaccine only protects against certain diseases and that there are vaccines that do not provide full protection. Students attending healthcare and nursing programmes are also entitled to vaccination free of charge if the risk assessment indicates a need for this.

Preventive treatments or pharmaceuticals

In cases of suspected exposure to infectious agents that lead to serious illness, you may sometimes need to administer preventive treatment with antibodies, antibiotics, vaccinations, or other medication. In workplaces where there is a significant risk of exposure to a certain infectious agent and there is a reasonable opportunity to administer preventive treatment, there should be written instructions for employees detailing this and where to turn in case of exposure. Examples of such workplaces include diagnostic or research laboratories or care facilities.

In rare cases, you may need to administer antibiotics as a prophylactic to laboratory workers, for example when you find brucella bacteria upon diagnostics in routine laboratories that use protective measures on biosafety level 2.

When are medical procedures necessary?

Examples of medical procedures that may be necessary due to microbiological work environment risks include:

• Examination of allergic reactions and pulmonary function tests may be necessary when employees are or are suspected to be exposed to microbiological air pollution.
• Immunocompromised individuals or individuals with hypersensitivity to specific biological agents may require examination if they react to something in the work environment.
• Screening for immunity against various infectious agents such as tuberculosis bacteria or rubella virus.

The employer shall cover the cost of medical procedures and screenings

The employee shall be offered all necessary medical tests and procedures required according to the risk assessment free of charge. See Section 10 of the provisions on risks of infection (AFS 2018:4).

Risks of infection (AFS 2018:4), provisions (SWE)

Regulations on occupational medical check-ups and health screenings are included in the Swedish Work Environment Authority’s provisions (AFS 2019:3) on occupational medical screenings.

Medical check-ups (AFS 2019:3), provisions (SWE)

Occupational health services may provide guidance on the work environment

Occupational health services are focused on providing support for workplaces with respect to health screening and investigations of the work environment. They may also often provide advice on how to improve the work environment based on assessments of the risks occurring in the workplace.

Anyone infected with or suspected to have been infected with certain diseases is obligated to allow themselves to be examined by doctors according to the stipulations in the Communicable Diseases Act.