26 March 2021
How does the coronavirus spread?
Coronavirus is typically transmitted as droplets by being in close contact with an infected person. The risk of infection is increased by coughing, sneezing and talking loud or shouting. Airborne infections are possible in indoor spaces with inadequate ventilation. The risk of airborne infection over two metres is considered to be lower compared with the risk of infection posed by close contact.
Coronavirus can also be transmitted through contact transmission, e.g. when an infected person coughs into their hands and touches another person.
Risk assessment as part of risk management
- The Finnish Institute of Occupational Health’s guidelines for preparing for the coronavirus pandemic also apply to employers in the social welfare and health care sector, including home care services.
- Employers must assess the personnel’s risk of being infected with coronavirus.
The Finnish Institute of Occupational Health’s instructions for assessing the risk of COVID-19 infections at the workplace.
- The risk assessment must also account for other workplace situations than actual work, such as breaks.
- When drawing upguidelines for social welfare and health care service providers, all employees who work at the premises (such as substitutes, students, cleaning personnel, rotating employees and property maintenance) as well as clients and visitors must be taken into account.
- It is important to use the expertise of the occupational health care service provider with considerations regarding employees that belong to a high-risk group.
- The continuation of the COVID-19 epidemic, variations in the epidemic situation and the possible risk of being infected with coronavirus increase the psychosocial workload of employees and supervisors in the social welfare and health care sector. Cf. The Finnish Institute of Occupational Health Guidelines for supporting mental well-being at workplaces.
- Ensuring that the internal communications of the workplace work is critically important. In addition, it is a good idea to establish shared practices and a designated channel of communications where employees can pose questions regarding the situations or propose practices.
- The risk assessment and the actions based on this must be processed together with the employees regularly and whenever the situation changes.
- Work-related hazards and risk factors as well as the workplace’s instructions of how to be protected against them must be taken into account in the induction training. Good induction training allows for safe and efficient working and supports well-being at work.
- It is important to use the expertise of the workplace’s occupational safety and health co-ordinators in planning the risk management measures and the related communications.
- Management measures based on the risk assessment must take the regional infection rate into consideration. THL The COVID-19 epidemic: regional situation, recommendations and restrictions
Operations in the social welfare and health care sector
- Employees must be instructed to stay home if they are not well (see THL Symptom assessment). It is a good idea to use posters in addition to verbal instructions.
cf. The Finnish Institute of Occupational Health’s instructions and posters for preventing COVID-19 infections at workplaces (in Finnish)
cf. THL instructions on what to do if you think you might have COVID-19 (available in Finnish and Swedish)
- Employers are required to consider, on the basis of a risk assessment, what measures or protective equipment to prevent COVID-19 infections should be used at the workplace, to acquire the required protective equipment and supervise and instruct the use of this equipment. Employees are required by law to follow the employer’s safety instructions and use the protective equipment according to the instructions. Employers must ensure that the occupational safety regulations issued by them are observed.
Safe distances and work arrangements
- Maintain a safe distance of more than 2 metres to others whenever possible. If close contact (less than 1 m) is necessary when working, try to keep the situation as brief as possible.
- Do not shake hands.
- Prefer working practices that do not include spending time close to each other and allow maintaining safe distances.
- Clean all pieces of equipment used by more than one person every time they have been used and handle them with clean hands only.
- Avoid job rotation whenever possible. Employees should be divided into groups, if possible. Contacts between these groups should be as minimal as possible.
- When good hand hygiene is observed, touching any objects, such as papers, is safe even if someone else has touched them.
- Ensure that the ventilation of the working premises works efficiently, seeTHL instructions.
- Ensure that safe distances are kept and face masks or surgical masks are worn also during breaks. If it is not possible to keep safe distances, breaks should be taken in turns.
- Arrange all personnel meetings and training sessions online whenever possible.
Home care visits
- The same principles of safe distances, hygiene and protection must be observed during home care visits as at the employer’s premises. See Finnish Institute of Occupational Health Guidelines for the protection of home care employees.
Clients and visitors·
- Visiting social welfare and health care sector premises or clients’ facilities and the required safety arrangements are agreed upon and communicated separately, see THL instructions for visiting hospitals during the coronavirus epidemic (available in Finnish and Swedish) ·
- Employees must attempt to identify clients infected with coronavirus and clients with a potential infection. These persons can be separated from others by scheduling or making spatial solutions.
- Furniture should be placed and the passageways and directions should be indicated in a manner that allows for safe distances (including waiting rooms).
- Visiting hours of long-term care and nursing units and the required safety arrangements are agreed upon and communicated in advance. (see THL instructions for visiting long-term care and nursing units during the coronavirus epidemic (available in Finnish and Swedish)
Good hand hygiene
- Employers must ensure the availability and correct placement of hand sanitizer dispensers.
- Employees are instructed to use hand sanitizer
- before touching a patient
- right before using the aseptic technique
- after handling excretions or taking off protective gloves
- after touching a patient or their immediate surroundings and
- after touching an item or a piece of furniture in the immediate vicinity of a patient.
- Put about one tablespoon of hand sanitizer on the palm of your hand and rub the tips of your fingers and thumbs in it. After this, rub the sanitizer on the remaining parts of your hands. You should also use hand sanitizer after removing gloves.
cf. Hand washing and coughing instructions of the Finnish Institute for Health and Welfare
cf. Hand hygiene instructions for professionals by the Finnish Institute for Health and Welfare (available in Finnish and Swedish)
cf. THL quick tips on good hand hygiene in residential and institutional care services (in Finnish)
- Washing your hands frequently may cause skin symptoms such as dryness. The use of fragrance- and preservative-free skin creams to prevent any skin symptoms is recommended. Hand sanitizers that contain glycerol (glycerin) offer a more skin-friendly alternative to washing your hands. It reduces the alcohol’s (ethanol or propanol) effect of drying the skin.
cf. The Finnish Institute of Occupational Health’s instructions for avoiding hand rashes (in Finnish)
Using surgical masks, respirators and personal protective equipment on the basis of a risk assessment
- The employer is obligated to define the level of protection required according to the risk assessment. The risk assessment should take into account whether patients with a diagnosed or suspected coronavirus infection or other patients are examined, among other things.
- If the employer considers, on the basis of the risk assessment, that it is necessary to use surgical masks, respirators or other personal protective equipment, the employer must acquire this equipment and require that employees use it. This obligation is based on the Occupational Safety and Health Act.
- Surgical masks are not considered to be personal protective equipment as specified in personal protective equipment legislation, but, in situations where infections can be prevented from spreading efficiently with surgical masks, the employer can make it obligatory to use them. Information on surgical masks and respirators
- If the work includes being in public spaces or using public transport, where a surgical mask is required, the employer has the obligation to procure them.
- Regional State Administrative Agencies may issue instructions on the use of face masks or other protective equipment at work in more detail: https://avi.fi/en/frontpage.
- Depending on the regional and national recommendations and the epidemic situation, members of the public are recommended to wear face mask in all public spaces. Employers must assess the situation of their employees on the basis of a risk assessment and, whenever the situation changes, ensure the sufficient level of protection.
Patient treatment and THL instructions
- Employers can use the THL instructions when treating COVID-19 patients. In situations where a patient diagnosed with coronavirus infection coughs intensely and excretes mucus or potentially spreads the virus in another manner, it might be advisable to provide employees with FFP2 respirators.
cf. THL instructions on what to do if you think you might have COVID-19 (available in Finnish and Swedish)
cf. THL instructions for oral health units during the COVID-19 pandemic (available in Finnish and Swedish)
cf. THL instructions for testing for and protection against COVID-19 infections during operations and other procedures (available in Finnish and Swedish)
cf. THL instructions for the prevention of coronavirus infections in long-term care and nursing units (available in Finnish and Swedish)
cf. THL instructions for the prevention of coronavirus infections in services provided in home environments (available in Finnish and Swedish)
cf. THL recommendation on the use of face masks for citizens
see Other THL instructions for social welfare and health care professionals (available in Finnish and Swedish)
Correct use of surgical masks
- Adequate breaks from wearing surgical masks must be arranged so that employees can continue to do their work well and also eat and drink.
- There must be a sufficient number of surgical masks available for employees to change the mask whenever they are removed, such as when eating or drinking, or if the mask becomes damp.
- It is recommended that disposable face masks or surgical masks are put into mixed waste always when taking a break.
- Visor-like face shields protect the face from direct exposure to spatter and droplets. Their effect in preventing coronavirus infections may be significant only in close contact situations. If it is not possible to wear a surgical mask, protective visors can also be used according to the employer’s risk assessment. Their use may be necessary in situations that require seeing the user’s face. If disposable protective visors are not used, their outer surface and contact points must be disinfected whenever taking a break and the visor must be washed with water and soap, rinsed and dried at least once per day.
cf. THL instructions on how to clean and disinfect visors (available in Finnish and Swedish)
- All employees must be instructed on the use of protective equipment and surgical masks. This also includes those employees who do not enter the premises regularly (e.g. substitutes and property and equipment maintenance personnel).
- In the risk assessment, any potential risk factors caused to the employees by the use of protective equipment must be considered. If an employee experiences any symptoms that make it difficult for them to use protective equipment, they should be instructed to consult the occupational health services. In occupational health care, the causes of symptoms can be studied, the symptoms can be alleviated or the employer can be advised to arrange other tasks for the employee.
- Official information about protective equipment, the coronavirus and occupational safety and health is available on the website of the Occupational Safety and Health Administration of Finland.
- THL instructions for visiting long-term care and nursing units during the coronavirus epidemic (available in Finnish and Swedish)
Enhanced cleaning in workplaces of the social welfare and health care sector
- The possible need for enhanced cleaning is determined according to the risk assessment performed by the employer.
- In the cleaning of premises and surfaces, specifications regarding the cleaning of equipment provided by the manufacturer, for example, must also be taken into consideration.
- Contact surfaces (e.g. table tops, door handles, railings, furniture, touch screens and keyboards and toilet facilities) must be cleaned carefully and as often as possible.
- A mildly alkaline all-purpose detergent should be used for basic cleaning purposes. Cleaning can be enhanced by using a disinfectant in sanitary facilities and other spaces, if necessary (such as when removing vomit or other excrement).
cf. Cleaning guidelines by the Finnish Institute of Occupational Health
cf. THL instructions regarding common precautions and categories of precautions and general instructions regarding disinfection of excrement (available in Finnish and Swedish)
- It is advisable to use disposable cleaning cloths for wiping down surfaces. If washable cloths are used, they must be collected in a separate container after use. Cloths and other cleaning equipment must be cleaned and fully dried daily. Either a temperature of 60 °C or a disinfecting detergent must be used when washing laundry.
- It advisable to use leakproof and easily removable bags in waste bins. Waste bins should be checked frequently, and they should not be allowed to get more than three-quarters full. There must be a sufficient number of waste bins available and they must emptied daily.
- In addition to meals eaten by employees, the principles concerning meals apply to meals served to clients and patients.
- Everyone having a meal should be offered the opportunity to wash their hands or use alcohol-based hand sanitizer upon arriving in the cafeteria.
- It is advisable to have instructions regarding hand and coughing hygiene and safe distances displayed in the cafeteria.
- The instructions on safe distances must be taken into consideration when planning the locations of seats and the number of people admitted to the premises.
- Employees and clients must be reminded of instructions related to hygiene whenever necessary.
- Hands must be washed often with soap and water. To prevent skin problems caused by constantly washing hands with water, alcohol-based hand sanitizer may be used when the hands are not stained.
- It is advisable to have enough tight-fitting disposable gloves available for any task in which they are required according to guidelines. Washing hands and using an alcohol-based hand sanitizer provide better protection against coronavirus infections than wearing gloves.
Disposable gloves should be worn on clean hands only.
Cf. The Finnish Institute of Occupational Health’s model solution Instructions for taking off disposable gloves (in Finnish). Instructions regarding the use of hand sanitizer must be provided in addition to the instructions related to the use of gloves.
- If there are any foods served on a self-service basis, utensils for this purpose must be made available.
- The serving utensils should be changed several times per day. Any buttons and handles that people touch when taking food and drinks should be cleaned often.
- It is important to arrange meal breaks in turns in common areas.
In the event of exposure to coronavirus or a diagnosed coronavirus infection at a social welfare and health care sector workplace
Exposure to coronavirus can be due to close contact with an infected person (patient/client/employee) or handling a source that contains the virus (virus samples, waste, laundry) without appropriate protective equipment. The physician responsible for infectious disease control in the municipality or hospital district is responsible for tracing the chains of transmission in co-operation with infection trackers and placing those exposed to coronavirus in quarantine according to the Communicable Diseases Act. Cf. THL instructions regarding contacts and quarantine in social welfare and health care units
It is advisable to prepare instructions for initiating the tracking of those exposed to coronavirus at the workplace. If there are any suspicions of an exposure at a social welfare or health care sector workplace, they should be addressed to local or regional infectious disease authorities.
Employers must include the employees exposed to biological factors that pose the risk of a serious hazard or disease in their work (including, for example, the SARS-CoV-2 virus) in the list of biological factors. The occupational safety and health authorities have collected in the Tyosuojelu.fi online service.
- Please also see the Data Protection Ombudsman’s Guidelines, which, among other things, explain how employee health data is processed in the event of illness.
The work of social welfare and health care sector employees during quarantine
Whenever an employee is officially placed in quarantine by a communicable disease authority, the employee is entitled to sickness allowance on account of an infectious disease. A social welfare and health care sector employee cannot be obligated to work if they have been placed in quarantine. A quarantine mandated by an infectious disease authority is carried out in the person’s apartment or another location approved or appointed by the authority.
In certain situations, such as when waiting for the result of a coronavirus test, the authorities recommend a self-imposed quarantine (see THL instructions regarding quarantine and isolation) to prevent infections. A person in self-imposed quarantine is not entitled to sickness allowance on account of an infectious disease. The employer must consider whether they will pay the employee a salary during a self-imposed quarantine. The employer and employee can agree for the employee to work during a self-imposed quarantine.
Official instructions regarding employees who have recovered from COVID-19 and been exposed again and vaccinated employees must be followed.
COVID-19 as an occupational disease
If an employee is exposed to coronavirus while working or in the workplace, the disease caused by coronavirus can be considered an occupational disease. In order for an employee to be entitled to allowance on account of an occupational disease, the criteria of the Workers’ Compensation Act must be fulfilled.
If an employee falls ill with a disease caused by coronavirus, they must contact a physician. If the physician determines that the employee has a coronavirus infection, the employee can turn to occupational health services, who will participate in resolving the matter of whether the disease is an occupational disease or not. If the physician suspects an occupational disease or other work-related disease as specified in the Workers’ Compensation Act, notwithstanding any confidentiality regulations, they must report the matter to the Regional State Administrative Agency’s Occupational Safety and Health Division without undue delay. The employer submits a report to the insurance company.
See additional information on the Finnish Workers’ Compensation Center website (in Finnish)
Instructions prepared together with social welfare and health care sector organizations
Experts at the Finnish Institute of Occupational Health have prepared these instructions together with social welfare and health care sector organizations the Finnish Union of Practical Nurses, the Union of Health and Social Care Professionals in Finland, the Finnish Association of Private Care Providers, the Finnish Medical Association, Local Government Employers and the Ministry of Social Affairs and Health. The Finnish Institute for Health and Welfare (THL) has also commented on these instructions. The THL website contains the instructions related to the treatment of patients and the protection of social welfare and health care sector employees.
Further information please contact firstname.lastname@example.org
The guidelines of the Finnish Institute of Occupational Health (FIOH) are drawn up together with the Ministry of Social Affairs and Health (SMAH) and the Finnish Institute for Health and Welfare. We also follow the publications of the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO).