Common Respiratory Illnesses including Influenza, COVID-19, and RSV

Common Respiratory Illnesses Menu Workers' Rights

General Recommendations

Required Use: When respirators are required by an OSHA standard or by the employer, the employer must be in full compliance with all applicable sections of OSHA's Respiratory Protection Standard (29 C.F.R. §§ 1910.134 and 1926.103), including requirements for a written respiratory protection program, medical evaluations, fit testing, and training.

Voluntary Use: In situations where the use of a respirator is not required either by the employer or by an OSHA standard, the employer may offer to provide or permit employees to use their own respirators, as long as the employer determines that such respirator use will not in itself create a hazard. This is considered voluntary use under OSHA's Respiratory Protection Standard. If an employer allows voluntary use of respirators, the employer must provide users with Appendix D - Information for Employees Using Respirators When Not Required Under the Standard. In addition to providing Appendix D, see 29 C.F.R. § 1910.134(c)(2) for additional requirements applicable to voluntary use of respirators.

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What You Need to Know About Masks and Respirators

When used in accordance with the hierarchy of controls, properly-fitted masks and respirators have long been recognized as an effective means of controlling airborne transmissible diseases. Filtering facepiece respirators (FFRs) protect users by filtering particles out of the air the user is breathing. FFRs like the N95s are NIOSH Approved®. On the other hand, KN95s and KF94s masks are designed and tested to meet international standards and may not provide the protection and performance afforded by NIOSH Approved® respirators, which must meet rigorous quality assurance requirements. Learn how to identify counterfeit N95s and other FFRs. Note that while OSHA's respiratory protection standards set out specifications for respirators when employers are required to provide respiratory protection, OSHA does not require employers to provide the same level of verification for respirators brought into the workplace by workers for voluntary use.

General Recommendations for Employers

Employers are encouraged to engage workers to create long-term, sustainable, routine practices that protect workers on the job.

In addition to following any applicable OSHA standards as described in Standards, including recording and reporting work-related cases of respiratory illness in accordance with 29 C.F.R. Part 1904, employers can take the following steps to mitigate the impact of respiratory illnesses on workers and maintain a healthy workplace:

  • Follow all Americans with Disabilities Act and equal employment opportunity laws as they relate to respiratory illness outbreaks.
  • Conduct a hazard assessment and develop and implement a respiratory illness prevention and mitigation strategy tailored to the workplace and its employees. Where possible:
    • Encourage workers to be vaccinated to protect themselves from serious illness caused by respiratory viruses.
    • Eliminate activities that increase the risk of exposure to respiratory viruses.
    • Substitute videoconferencing and other technologies for personal interactions.
    • Allow for physical distancing of workers if space constraints allow.
  • Make and maintain improvements to indoor ventilation and air filtration systems.
  • Develop and implement policies and procedures that improve employee safety.
    • Support best practices for hand and respiratory hygiene.
    • Provide training to employees required to wear PPE, including face coverings such as respirators (OSHA training video) and masks and gloves (training video).
    • Support workers who elect to wear face coverings based on personal preference unless the work task requires a higher level of respiratory protection, or the voluntary use of a respirator itself would create a hazard.
    • Encourage employees to stay home when ill with any respiratory infection.
  • Encourage employees to get vaccinated against influenza, COVID-19, and if appropriate, RSV. This can be accomplished in several ways:
    • Work with a local clinic, public health agency, or pharmacy to make vaccinations available at the worksite.
    • Allow time off for travel to and from the vaccination site.
    • Allow employees to use sick or other paid leave to cover time off due to vaccine side-effects.
  • Perform routine cleaning and disinfection of workplace facilities to reduce the likelihood of exposure to respiratory viruses and other infectious diseases.
  • Provide support to employees who are at increased risk of hospitalization from respiratory illnesses.
  • Follow CDC guidance when employees are exposed to, or become ill with, a respiratory illness.
  • Consider implementation of workplace flexibilities (e.g., remote work, telework, and telecommuting) when respiratory virus transmission is high in the community or occurring in the workplace.
Guidance for Healthcare Employers

Note: Because some of the occupational risks are heightened or unique to healthcare, the guidance in this document may represent only baseline actions for healthcare workers and additional protections may be necessary for those workers.

Healthcare workers who perform tasks for, or in the presence of, patients who may have respiratory illnesses should take additional precautions to prevent exposure to, and illness from respiratory viruses. Workers who are typically at more risk include those who:

  • Perform direct patient care (nurses, doctors, etc.).
  • Perform aerosol-generating procedures (laboratory and clinical staff, respiratory therapists, etc.).
  • Handle and/or test specimens from patients (phlebotomists, laboratory staff, etc.).
  • Handle or come into contact with contaminated materials (clinical staff, medical equipment processors, housekeeping and laundry workers, cafeteria workers, etc.).
  • Work in congregate settings (long-term care facilities, hospices, residential rehabilitation centers, etc.).

In addition to general recommendations for employers, employers of healthcare workers should take additional transmission-based precautions, using a combination of controls, or a layered approach, to reduce the likelihood of worker exposure and illness. In addition to administrative controls (patient management, hand hygiene, and sick leave policies, etc.), additional worker protection can be achieved by:

General Precautions for All Workers

Although healthcare workers are at a heightened risk of exposure to respiratory viruses and their transmission, respiratory viruses can be transmitted in any workplace. All workers can take the following steps to better protect themselves against the transmission of respiratory illness:

  • Learn about respiratory virus exposure and ways to reduce the risk of infection.
  • Get vaccinated and stay up to date with annual (flu) and booster (COVID-19) vaccines as they are offered and RSV vaccine if you are aged ≥ 60.
    • Utilize workplace vaccination programs if offered.
    • Request time off to get vaccinated and for vaccine side effects as needed.
  • Follow workplace policies and procedures in place to reduce transmission of respiratory illnesses at work.
  • Practice hand and respiratory hygiene at work.
  • Keep your work area clean and regularly decontaminate high touch fixtures and equipment (door handles, phones, keyboards, light switches, etc.).
  • Follow CDC guidance when you are exposed to, or become ill with, a respiratory virus.
  • Stay at home and notify your supervisor if you have symptoms of influenza, COVID-19 or RSV.
    • If you have symptoms of COVID-19 or were exposed to someone who has COVID-19, take an at-home COVID-19 test. Call your healthcare provider if you test positive; you may be prescribed medications to reduce your risk of hospitalization.
    • If you are symptomatic, and were exposed to someone who has influenza, call your healthcare provider if you are at risk of complications. You may be prescribed medications to reduce your risk of serious illness and hospitalization.
  • Call your healthcare provider or go to the emergency room if your symptoms are severe (difficulty breathing, extreme weakness, high fever (102.4° to ≥104°)).
Precautions for Healthcare Workers

Healthcare workers can be exposed to many circulating respiratory illnesses during the course of their duties and should utilize hazard controls available to them and follow their employers' infection control programs to reduce the likelihood of infection.

In situations where potential exposure to respiratory viruses causing illness are identified, healthcare workers should rank the safeguards and controls as described in the Hierarchy of Controls pyramid. When possible, use the most effective controls at the top of the pyramid to reduce risk, or use a combination of controls, called a layered approach, to achieve the most effective protection against exposure and infection.

In the Hierarchy of Controls, elimination, or eliminating contact with the source of contamination of infection is the most effective control, while PPE is the least effective since it is the last line of defense when close contact with infected people or materials cannot be avoided.

Following a layered approach to infection control, employees should use:

  • Elimination of contact with the source of infection by scheduling telehealth to prevent exposure to or contact with patients who may be infected with respiratory viruses.
  • Administrative controls to prevent or reduce contact between patients with respiratory illness and others by:
    • Screening incoming patients and separating those with flu-like symptoms.
    • Isolating patients with respiratory illnesses and grouping/housing them according to facility procedures.
    • Limiting entry to patient isolation rooms to only those staff necessary for patient care.
    • Restricting visits for patients in isolation.
    • Limit patient transport and perform procedures at bedside when possible.
  • Engineering Controls to prevent or reduce exposure to bioaerosols by
    • Using closed, rather than open, suctioning systems for airway clearance of patients using ventilators.
    • Using AIIRs when performing aerosol-generating procedures (AGP) on patients with respiratory illnesses.
    • Using biosafety cabinets, glove boxes, closed-bucket centrifuges and other appropriate equipment in the laboratory to prevent exposure to bioaerosols while performing AGP.
  • Wearing PPE as appropriate for patient care, laboratory work, and other tasks as determined by a workplace hazard assessment.

It is also important to follow industry-standard cleaning and decontamination methods using registered disinfectants listed by the Environmental Protection Agency (EPA).