Nurses’ Union Weighs in on ILO's Newest Biohazards Guidelines

Ensuring that the outcome document addresses workers’ realities, promotes workers’ rights and upholds accountability from employers was no mean feat for unions during the tripartite deliberation of the guidelines. In this email interview, Veronica Black, lead of the Work, Health and Safety (WHS) team at NSW Nurses and Midwives Association, shares with PSI Asia Pacific what the new guidelines is all about, what workers fought to be included in the guidelines and how workers and unions can make use of the guidelines to protect workers’ health and safety.

Q: Please introduce yourself and your union

Veronica Black (VB): I’m Veronica Black and I lead the WHS team at the NSW Nurses and Midwives Association.  We represent nurses and midwives working in NSW. The majority of our members work in public hospitals, but we have members working in lots of other settings including private hospitals, residential aged care, disability support services, community health, GP practices, prisons and more.

Q: We are here to talk about the new guidelines released by the ILO on biological hazards. Before we discuss the guidelines itself, please give us an idea of what a biological hazard is?

 VB: Often when people think of biological hazards, they think of infectious diseases.  Infectious diseases are of course, biological hazards, but the term encompasses much more than this.  A biological hazard refers to any micro-organism, cell, or other organic material that may be of plant, animal or human origin, including any which have been genetically modified and which can cause harm to human health. This may include but is not limited to bacteria, viruses, parasites, fungi, moulds, prions, DNA materials, bodily fluids, and any other microorganisms and their associated allergens and toxins.

A biological hazard refers to any micro-organism, cell, or other organic material that may be of plant, animal or human origin, including any which have been genetically modified and which can cause harm to human health.

Q:  According to the ILO, in 2021, there were around 310,000 worker deaths due to exposures to biological hazards. Could you share with us specific sectors or groups of workers who are most susceptible to falling ill from biological hazards? How about workers in public services?

VB: Workers in all kinds of industries are exposed to biological hazards at work and one of the things that we worked hard on as a workers group was to have a (non-exhaustive) list of industries and examples of biological hazards included within the body of the document.

Some examples of biological hazards in each of the sectors are the following:

• Healthcare – viral and bacterial infections through contact, droplet and airborne transmission, needlestick injuries etc.

• Agriculture – bacteria, fungi, mites and viruses transmitted from animals, parasites and ticks; microorganisms and mites in organic dusts of grain, milk powder, flour and spices which can lead to respiratory diseases and allergic diseases

• Construction – moulds (allergenic, pathogenic, toxigenic) bacteria and fungi due to deterioration of building materials; and animal waste which may lead to leptospirosis and Weil’s disease

• Archives/museums/libraries – moulds/yeasts and bacteria causing allergies and respiratory disorders

Workers in public services cover such an incredibly broad range of industries, there are a very broad range of biological hazards!

Q: What is your opinion on these new ILO guidelines on biological hazards issued by the ILO? 

VB: The lack of guidance on the management of biological hazards has been a major gap in occupational health and safety knowledge, and this gap has become even more obvious during the COVID-19 pandemic.  The new ILO guidelines are the first for this type of risk. They provide specific advice, aligned with international labour standards, on preventing and controlling work-related injuries, diseases, and deaths related to exposure to biological hazards in the working environment. It includes advice on the responsibilities and rights of competent authorities, employers, occupational health services and workers, workplace risk management, workers’ health surveillance, and preparedness and response to emergencies. Of course, there is always more to do, but the new guidelines make a good start.

Q: Please share with us some important provisions of the guidelines.

VB: For the workers’ group, the following are the major outcomes:  

•  A very broad definition of biological hazard which I have cited earlier
   Inclusion of workers’ rights, repeat references to workers’ rights and their representatives, as well as references to social dialogue, collective agreements and to all the fundamental conventions, the key conventions, protocols, recommendations and guides as well as an explicit reference to the MNE declaration. 

• A markedly improved section on provision of personal protective equipment (PPE) such as fit testing of P2/N95 respirators and the need to ensure that gender is considered in PPE supply

• A broader group of occupations and examples of associated hazards were included within the body of the document. 

• Explicit references are made throughout the document for the need to consider gender including in relation to risk assessments, PPE provision, and emergency preparedness.

•  A limited but still important reference to precautionary principle, which requires that the competent authority “establish requirements for the protection of workers against occupational exposure to biological hazards. Such requirements should be based on sound scientific criteria and accepted international practice. Where sufficient information is not available, the competent authority should elaborate guidelines, procedures and precautionary measures”

The precautionary principle was hotly debated and strongly resisted by the employers’ group, but eventually it was acknowledged that particularly with new and emerging biological hazards, it may take some time for the scientific evidence to catch up.

Q: How does this new guidelines protect workers' health and safety? Can you give us some examples in the nurses/ health sector?

VB: Supporting members during the COVID-19 pandemic; hearing about their experiences at work; providing education, advocating for additional protections and supporting collective action on these issues really focused my attention on practical things that needed to be in this new guidance.

The WHO estimates that up to around 180,000 healthcare workers died from COVID-19 in the first 16 months of the pandemic, with hundreds of thousands more contracting the disease in the course of their work.  Initially as COVID-19 was a new disease, there was insufficient scientific evidence about how the disease spread which led to inadequate PPE being provided.  Once it was finally acknowledged that COVID-19 was airborne there were significant issues in accessing properly fitting PPE, with much of the global supply of P2/N95 masks being too big for many women and with fit testing of P2/N95 masks not being routine procedure in healthcare in many countries (including Australia).

 The new guidelines address these types of issues.  They require that the competent authority issues guidelines using precautionary measures where there is insufficient information available about how to manage the risk (e.g. for emerging diseases like COVID-19).  The guidelines also clearly state that gender must be taken into account in risk assessment, PPE provision and emergency preparedness and that workers requiring P2/N95 masks must be fit tested.

Q: Are there any areas of concern? 

VB: As with any tripartite consultation process, there was a need to reach agreement between the groups representing workers, employers and government.  While there was broad consensus on most issues between the ILO office, the government representatives, and the workers’ representatives, the employer group was particularly hostile. The key objectives of the employers appeared to be to narrow the definition of biological hazard as much as possible, to limit explicit reference to the rights of workers and their representatives and to limit obligations of employers.

Three areas that could have been better:

• Despite well-established evidence of psychosocial risks to workers arising from exposure to biological hazards (e.g. anxiety arising from working with COVID-19 positive patients without properly fitting PPE), the employers blocked any explicit inclusion of psychosocial risk or psychological harm. 

• Employers blocked consideration of precautionary principles throughout the document (other than the one section referenced above)

• The workers group wanted reference to “the risks of biological hazards, transmission, infectious diseases and vector-borne diseases caused by temperature rise” but the employers blocked attempts to reference the impact of climate change.

Q: We understand that this technical guideline is not a convention, and therefore it is not binding. How do you think workers can make use of these guidelines? How can unions, at different levels-local, national, regional/global, make the most of these guidelines to protect workers' health? 

VB: While the technical guidelines are not binding, the ILO is an extremely credible source of information and as such, ILO guidelines will be highly persuasive in discussions/negotiations, whether this is at a single employer level or in discussions with governments.  The guidelines increase the existing “body of knowledge” in relation to the management of risks arising from biological hazards in the work environment. Additionally, the guidelines will form the basis for future ILO work in this area, including as a foundation for a future convention.

* Takala et. al. (2021). "Work-related injuries and diseases, and COVID-19" in International Journal of Labour Research 10(1-2) pp. 428-49