Iran Occupational Health Journal
سلامت كار ايران
ioh
Medical Sciences
http://ioh.iums.ac.ir
136
journal136
1735-5133
2228-7493
10.61186/ioh
fa
jalali
1399
8
1
gregorian
2020
11
1
17
1
online
1
fulltext
fa
بازگشت به کار در بیماران کوید-19: مروری بر دستورالعملهای موجود
Return to Work in COVID-19: Review of Current Guidelines
بیماریهای تنفسی
Respiratory disease
مروری
Review Article
<a name="_Hlk54178772"><strong>زمینه و هدف:</strong></a> با شروع پاندمی کرونا ویروس2019 (کوید-19) محدودیتهای وسیعی در سراسر دنیا به منظور مهار گسترش این ویروس وضع شده اند. بدیهی است محیط های کاری از این محدودیتها مستثنی نبوده اند. هزینه ضرر و زیان اجتماعی – اقتصادی این بیماری به طور دقیق قابل تخمین زدن نیست اما مسلما این بیماری می تواند به سلامت شاغلین چه افرادی که در این شرایط مجبور به حضور در محیط کار خود هستند و چه افرادی که مجبور به ماندن در خانه هستند لطمات فراوانی را وارد کند<span dir="LTR">.</span> با توجه به اثرات مستقیم و غیرمستقیم این مسئله بر فعالیتهای اقتصادی ، تعیین زمان بازگشت به کار شاغلین - به گونه ای که روند قطع زنجیره انتقال هم چنان حفظ گردد- از اهمیت ویژه ای برخوردار است. درواقع ارزیابی تخصصی بازگشت به کار شاغلین می بایست هم جنبه اطمینان از پایان سرایت پذیری عفونت به سایرین را مورد توجه قرار دهد و هم فرد را از نظر عوارض بیماری که می تواند عملکرد وی را تحت تاثیر قرارداده یا او را نسبت به مواجهات محیط کاری آسیب پذیرتر می کند بررسی نماید. هدف ما از نگارش این مقاله مروری، بررسی دستورالعمل های موجود درمورد چگونگی تعیین زمان اتمام قرنطینه و بازگشت به کار شاغلین مبتلا به کوید-19 می باشد.<br>
<strong>روش بررسی:</strong> پایگاههای اطلاعاتی <span dir="LTR">Google Scholar, PubMed, Scopus</span> از سال 2019 تا 2020 و همچنین دستورالعمل های مرکز کنترل بیماریها، سازمان ایمنی و سلامت شغلی آمریکا، سازمان ملی بهداشت انگلستان و وزارت بهداشت ایران با روش جستجوی موضوعی بررسی شد. <br>
<strong>یافته ها:</strong> بر اساس بررسی انجام شده، تصمیم گیری جهت تعیین بازگشت به کار افراد بهبود یافته از بیماری کوید19 ، بر دو محور اصلی علائم بالینی فرد و تست واکنش زنجیرهای پلیمراز ترانسکریپتاز معکوس (<a name="_Hlk43036342"><span dir="LTR">RT-PCR</span></a><span dir="LTR">: Reverse Transcription Polymerase Chain Reaction</span>) استوار است. در مورد انتخاب یکی از دو رویکرد مبتنی بر علائم یا مبتنی بر تست، باید مورد به مورد تصمیم گیری شود چرا که هر یک محدودیتهای مربوط به خود را دارد. اخیرا استفاده از تست های سرولوژی بررسی کننده سطوح آنتی بادی ها نیز مورد توجه قرار گرفته اند. اما بنابر محدودیتهایی که در مورد این تست ها مطرح شده است نتایج تست های سرولوژی بایستی در کنار تست <span dir="LTR">RT-PCR</span> تفسیر گردند در غیراینصورت گمراه کننده خواهند بود. مسئله دیگری که علاوه بر تستهای آزمایشگاهی فوق در تعیین بازگشت به کار حائز اهمیت است درنظر داشتن مواجهات شغلی در افراد بهبود یافته ای است که باید به وظایف شغلی پیشین خود بازگردند. بدین منظور، انجام خطرسنجی از ملزومات حیاتی پیش از شروع به کار مجدد این افراد است.<br>
<strong>نتیجه گیری:</strong> بر مبنای دستورالعمل های موجود، اتفاق نظرکلی جهت بازگشت به کار فرد بهبودیافته در یک بازه زمانی 14-10روزه پس از شروع علائم و بهبود وضعیت بالینی در رویکرد مبتنی بر علائم وجود دارد. در مورد رویکرد مبتنی بر تست نیز وجود دو تست <span dir="LTR">RT-PCR</span> منفی به فاصله حداقل 24 ساعت به عنوان شاخص قابل قبول جهت از سرگیری فعالیتهای شغلی ذکر شده است. در حال حاضر تستهای سرولوژی به عنوان معیاری جهت تصمیم گیری در مورد بازگشت به کار افراد توصیه نمی گردند.<span dir="LTR"></span><br>
<a name="_Hlk54178833"><strong>Background and aims: </strong></a>Coronavirus Disease 2019 (COVID-19) is mainly a respiratory disease which is caused by the SARS-CoV-2 Virus. The outbreak first began in Wuhan, China, in December 2019 and then expanded globally. COVID-19 can result in illness ranging from mild to severe. However, some of the affected individuals might be asymptomatic. Symptoms of the disease may appear in<br>
as few as 2 days or as long as 14 days after exposure. The main rout of disease transmission is person to person contacts. Nevertheless, touching contaminated surfaces is also asserted to be the alternative way of transmitting the virus. Since the emergence of COVID-19 pandemic, due to the high rate of person to person transmission of SARS-CoV-2, widespread restrictions have been introduced all over the world to prevent the disease expansion. Apparently, work settings have not been exempted from these restrictions as well. The precise socioeconomic burden of the pandemic has not been precisely estimated so far, however, it apparently contributes to many adverse health- related issues in either the individuals who have to be present in their workplaces in this circumstance or the ones who must stay home. A considerable proportion of the affected individuals are working people who have to return to their workplace after the end of the isolation period. Considering the direct and indirect impacts of this situation on economic activities, it is crucial to decide on employees’ returning to work in a way that cutting the chains of transmission is maintained. In other words, while evaluating an individual’s return to work the duration of the disease transmission ought to be taken into consideration. Furthermore, this should assess the individual in terms of the disease complications which may have an impact on his performance or might make him more vulnerable to hazardous occupational exposures. The objective of this article is to carry out a review of the current guidelines about deciding on the end of the isolation and return to work of employees recovered from COVID-19.<br>
<strong>Methods:</strong> The Google Scholar, PubMed, and Scopus databases were reviewed from 2019 to 2020. Furthermore, other relevant websites were also scrutinized including Centers for Disease Control and Prevention (CDC), Occupational Safety and Health Administration (OSHA), National Health Service (NHS) and Iran Ministry of Health and Medical Education guidelines.<br>
<strong>Results:</strong> Based on this review different strategies may be pursued regarding work resumption. In many countries making decision is mainly based on CDC guidelines. However, national health policy has been the major contributing factor in defining the return to work strategies in other parts of the world. <span dir="RTL"></span><br>
Generally, determining the timing of return to work in employees recovered from COVID-19 is mainly based on clinical symptoms (symptom-based strategy) and or Reverse Transcription Polymerase Chain Reaction<span dir="RTL">) </span>RT-PCR<span dir="RTL"> (</span>test (test-based strategy). In the light of the potential limitations, deciding on choosing either symptom-based or test-based strategy should be made on a case-by-case basis. For instance, considering that RT-PCR test may remain positive for even three months after the onset of the symptoms it is likely that test-based strategy unnecessarily prolongs the period of isolation and work absence. In other words, prolonged virus shedding might not necessarily be an indicator of contagiousness or transmissibility. On the other hand, relatively high price of this molecular test alongside its inconclusive sensitivity are other factors limiting RT-PCR test.<span dir="RTL"></span><br>
Recently, <a name="_Hlk54177914">serology</a> tests investigating antibodies (immunoglobulin G and M) have also been addressed in addition to the aforementioned assessments. Immunoglobulin G and immunoglobulin M (IgG and IgM) are usually detectable in serum after the second week of the disease but the exact duration in which these antibodies can be found following infection is not known. Notably, due to the fact that some individuals do not develop detectable IgG or IgM at all, negative serology test result does not necessarily rule out that they have previously been infected. It is noteworthy to mention that some cross reactions have been determined between SARS-CoV-2 and other types of coroviruses which might contribute to false positive serology test results. On account of current limitations of such tests, their results should be interpreted alongside RT-PCR test, otherwise they would be challenging and misleading.<br>
In the light of the fact that the risk of Covid-19 transmission is not similar for all job categories, as well as different tasks in one work setting, another factor which should be taken into account is occupational exposures. Hence, performing detailed risk assessment by experts has a vital role in deciding on work resumption. This process should be meticulously carried out on an individual basis for all specific work places and also for each job or group of jobs within a work setting. Each risk assessment should consider the environment, the task, the threat, and the available resources, as well as ongoing preventive measures such as risk elimination strategies, engineering controls (such as physical barriers or proper ventilation) and personal protective equipment. On top of that, employers should be informed about the significance of the employees’ participation in this process which can apparently guarantee the success of implementing preventive measures in the workplace. It is noteworthy that while deciding on an individual’s return to work, the severity of the disease should also be taken into consideration since a severe illness can have a considerable impact on the person’s work ability and performance. This is specially the case for those who were admitted to intensive care units (ICU) due to their critical illness. Therefore, gradual return to the previous tasks and activities, in terms of work intensity and duration, should be encouraged in such cases.<br>
<strong>Conclusion:</strong> There is a general consensus on ending isolation and return to work of the recovered individuals in a 10 to14-day period after the onset of symptoms and clinical improvement in the non-test-based strategy. Regarding test-based strategy, current guidelines require two consecutive negative RT-PCR tests with at least 24-hour interval. Presently, serologic tests are not recommended for making decision about returning persons to the workplace in the guidelines. Other important factors that ought not be overlooked include detailed risk assessment and the disease severity.
کروناویروس2019(کوید-19) , بازگشت به کار , شاغلین بهبودیافته
Coronavirus disease 2019 (COVID-19), Return to Work, Recovered Employees
55
65
http://ioh.iums.ac.ir/browse.php?a_code=A-10-3407-1&slc_lang=fa&sid=1
Ehsan
Rafeemanesh
احسان
رفیعی منش
Rafeemaneshe@mums.ac.ir
13600319475328460036699
13600319475328460036699
No
MUMS
دانشگاه علوم پزشکی مشهد
Farzaneh
Rahimpour
فرزانه
رحیم پور
Rahimpourf@mums.ac.ir
13600319475328460036700
13600319475328460036700
No
MUMS
دانشگاه علوم پزشکی مشهد
Fatemeh
Ahmadi
فاطمه
احمدی
Ahmadif@mums.ac.ir
13600319475328460036701
13600319475328460036701
Yes
MUMS
دانشگاه علوم پزشکی مشهد