The Federation reminds its members that vaccination is the most effective means of prevention when combined with the other means of prevention needed to prevent OHS risks.

The Federation demands that the government make an extra effort to offer vaccination in the workplace, so as to avoid encroaching on the healthcare professionals’ time off.

Healthcare professionals have a front-line role in promoting vaccination. In the field, healthcare professionals are the main ambassadors for vaccination and other public health measures among the general public.

Vaccination is a public health measure, but also a means of prevention in occupational health and safety. In this respect, vaccination is one of a series of other equally essential means of prevention. For a preventive measure to be fully effective, it must be rooted in free and conscious adherence. Vaccination campaigns must not minimize the importance of other means of prevention essential for our healthcare professionals, which means implementing the hierarchy of preventive risk methods in the workplace.

In addition to vaccination, it is essential to continue guaranteeing access to the personal protective equipment required by the CNESST or deemed necessary by the healthcare professionals in the field.

• Scientific data still show that vaccination is effective against the virus and its variants. 
• Vaccinated people who contract COVID-19 have a lower risk of transmitting the virus.
• Vaccination is therefore highly effective against serious forms of the disease. However, no vaccines provide 100% protection. COVID-19 vaccines are no exception. That is why we must continue to use all OHS preventive methods, even after getting a booster shot.

• While COVID-19 vaccines were developed rapidly, all steps were taken to ensure their safety. The massive investments in research helped to simultaneously complete several steps of vaccine development.
• In Canada, COVID-19 vaccines underwent the same analysis by Health Canada as all other vaccines. Furthermore, in Canada and Quebec, there is active monitoring of unidentified adverse side effects before vaccines are marketed.
• Like all vaccines, COVID-19 vaccines have adverse side effects, but they are monitored closely. That said, the benefits of vaccination as protection far outweigh the inconveniences.
• Overall, the side effects associated with the booster shots are similar to those of the first and second doses.

Sources: 

https://msss.gouv.qc.ca/professionnels/vaccination/piq-vaccins/covid-19-vaccin-a-arn-messager-contre-la-covid-19/#manifestations

https://publications.msss.gouv.qc.ca/msss/document-002830/https://sante-infobase.canada.ca/covid-19/securite-vaccins/ 

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety.html

• There is a higher risk of complications from COVID-19 for pregnant women. Also, contracting COVID-19 while pregnant poses higher risks for the unborn child, such as prematurity.
• There is evidence-based data that mRNA vaccines are safe for pregnant women. Moreover, the messenger RNA in the Moderna and Pfizer vaccines quickly destroys itself in cells and, consequently, does not pose any risks to an unborn child.
• Available data also indicates that there does not appear to be associated risks for breastfeeding following an mRNA vaccination.
• Given the available data, the comité d’immunisation du Québec (CIQ) and the Society of Obstetricians and Gynaecologists of Canada (SOGC) recommend vaccination for pregnant women.
• The Federations maintain that the assignment of pregnant workers, even if they are adequately vaccinated, must be done in conjunction with the principles of precaution and in compliance with the INSPQ’s recommendations

Sources: 

https://publications.msss.gouv.qc.ca/msss/document-002830/

https://www.sogc.org/common/Uploaded%20files/Latest%20News/FR_SOGC_Statement_COVID_19_Vaccination_in_Pregnancy.pdf

https://www.fiqsante.qc.ca/dossiers/pandemie/retrait-preventif/

https://www.inspq.qc.ca/sites/default/files/publications/2920_femmes_enceintes_allaitent_sommairev3.3.pdf

• There is a lot of misinformation out there and it is important to think critically and protect oneself. There is an abundance of information about COVID-19 and we naturally need to stay up to date on and understand how the situation is changing.
• To be properly informed, it is essential to question information sources and to verify if other media sources confirm the information. Furthermore, it is very important to distinguish facts from opinions. Facts can be proven, verified and do not depend on the author.

• The CNESST confirmed that it is necessary for healthcare professionals who work with patients who do not meet the criteria listed in the section “Usager à faible risque pour la COVID” (low-risk patient for COVID) from the linked table to wear an N95 mask:
• https://www.cnesst.gouv.qc.ca/sites/default/files/documents/masques-minimalement-requis-milieux-de-soins_0.pdfThe FIQ does not recommend reusing masks, using expired masks, or using disinfected disposable masks.

• N95 type RPD or better.
• Single-use eye protection (face shield or protective goggles).
• Unsterile disposable single-use long-sleeve gown.
• Unsterile single-use gloves.

Despite our recommendations on using N95s, please note that wearing an N95 mask for an extended period of time has certain risks you should be aware of. The ASSTSAS created this document outlining the risks.

The FIQ recommends the following measures if a medical mask (ASTM level 2 and 3) is used in a cold zone and/or in the absence of any confirmed or suspected cases.

• That the mask be properly fitted.
• For optimal mask effectiveness, a healthcare professional and patient must be facing one another head on (during a procedure when a patient is to the side of a professional, droplets and aerosol particles can reach the healthcare professional on the side of their face).
• It is important to change the mask when it becomes damp because it will lose its protective properties, unless it is waterproof.

It is important to continue to be vigilant when an employer bases their positions on the recommendations of the INSPQ. 

We would like to reiterate that the CNESST maintains its decision to apply the precautionary principle, in particular with the obligation to wear an N95 respiratory protective device with patients who have confirmed or suspected cases of COVID-19 in a warm or hot zone, regardless of vaccinations and alert levels. We would also like to reiterate that a level 2 ASTM medical mask does not provide sufficient protection against the airborne transmission of COVID-19. Remember that the CNESST’s requirements must be applied and take precedence over all INSPQ and MSSS recommendations.

• RPD (respiratory protective device): must have undergone a Fit Test, be well adjusted and be used at the very least following the CNESST’s instructions in warm and/or hot zones in the presence of a confirmed or suspected case. 
• Eye protection: Prescription glasses are not considered adequate protection. Eye protection, protective goggles or a face shield that covers the face down to the chin can be used for a full work day, subject to the healthcare professional’s clinical judgement regarding possible contamination of the eye protection. 
• Gown: wear a waterproof gown if there is a risk of coming into contact with bodily fluids (e.g.: vomit, severe cases). It is recommended that you change gowns between each patient. 
• Gloves: ensure they are well fitted and cover the wrists. 
• Do not touch your eyes, nose or mouth if your hands are potentially contaminated. 
• Systematically remove the gown and gloves when leaving the examination room. 
• Practice good hand hygiene before putting on PPE and after removing it, in compliance with the IPAC. It is important to remove the protective material in a way that prevents contamination and then to properly wash and dry your hands (a damp environment can be a factor of contamination). 
• Use disposable instruments, but if that’s not possible, wash and disinfect the material between each patient. Dispose of PPE according to the IPAC procedure. 
• Whenever possible, patients who require AGMPs be given care in individual, closed negative pressure rooms or in closed properly ventilated rooms with an antechamber. 

Risk identification and reduction always starts with eliminating them at the source and then moves onto individual methods. Addressing heat-related risks is no exception.

At the source:

• In compliance with IPAC rules, whenever possible, air condition the workplace or a section of it. (Central air conditioning, portable air conditioner, fan).
• Plan ways to limit sun exposure in the workplace and leave windows closed when the outside temperature is hotter than the inside one.
• Limit the use of heat-emitting devices or equipment.

 Administrative measures:

From the union’s point of view, it is important to ensure that the employer truly plans work organization so that employees can work safely in hot weather.

• The employer should take the necessary steps to inform and train healthcare professionals on how to deal with risks related to heat, symptoms associated with heat stroke, and strategies to use to eliminate or reduce these risks.
• The employer should provide access to a cool, aired place where healthcare professionals can take breaks in a restful and temperate environment.
• The employer should review the organization of work to allow healthcare professionals to take mini breaks and extra breaks in hotter weather. According to a survey conducted by the ASSTSAS, 83% of surveyed institutions deplored the work-rest cycle measures.
• The employer should review the organization of work to reduce the pace and intensity of work. For example, by scheduling the most demanding duties for the coolest times of day or by increasing staffing on work teams (adding healthcare professionals to cover breaks, for example, or adding auxiliary staff). Once again, 83% of institutions say they lighten the workload.
• The employer must ensure that healthcare professionals have access to cold water at all times and must organize work so that they can hydrate as often as necessary. It’s a delicate issue, especially when there is a work overload (lack of time to hydrate), and staff are wearing PPE. In terms of PPE, the employer must be sure to adequately train healthcare professionals on how to hydrate themselves in a safe way so that they don’t contaminate themselves.

 Individual measures:

• The employer can provide healthcare professionals with cooling PPE (cooling headbands or neck wraps). These PPE should only be for personal use. They should not be shared between healthcare professionals.
• Make accommodations for healthcare professionals who are more vulnerable to heat due to a particular medical or personal situation. These personal factors could include taking certain medication, previous heat stroke incidents, working overtime or mandatory overtime, or a specific physical or medical condition, etc.
• The discomfort associated with N95 masks can be exacerbated by heat. It is possible to evaluate auxiliary strategies to make these masks more comfortable. For example, by adding adhesive lines under the mask (if they don’t compromise the airtightness) or using certain hydrating creams

To drink 250 ml of cool water every 20 minutes. Even more if you meet certain criteria listed in the charter proposed by the CNESST. Never drink more than 1.5 L per hour.

• Try to eat light, fresh meals.
• Talk with your colleagues and contact your FIQ union if the employer is not taking proper measures to mitigate the discomfort or heat stress. Help the employer and union to identify the hazards and ways to eliminate or mitigate them.
• Immediately notify an employer representative and immediately stop working if you have any symptoms of heat stroke or that warn of heat stroke. (No sweating, hot and dry skin, incoherent speech, loss of balance, drowsiness, nausea, loss of consciousness, convulsions). If you observe these symptoms in a colleague, immediately inform your immediate supervisor.

Important

• The CNESST proposes a method to measure the heat in a work environment and how to adapt the work based on the hazard. Based on the level of heat and intensity of work, the CNESST’s tool proposes a hydration and rest frequency. The level of heat and actions must take into account:
• The relative humidity: The relative humidity in a healthcare building should generally be between 30% to 60%.
• Personal protective equipment being worn: Equipment that is airtight or keeps sweat trapped inside increases heat stress (gowns, gloves, masks, face shields).
• Efforts made: In general, working sitting down or standing up while performing light tasks (e.g., taking vital signs) is considered light work. Working on your feet at a steady pace while performing more strenuous tasks (e.g., hygiene care or patient mobilization) is medium work.

 When you work in an environment that reaches a certain temperature, you must follow the CNESST’s recommendations and the employer must allow you to do so.[8] If there is a problem, consult your union immediately.

 To use the CNESST’s heat scale, the temperature must be taken:

• With a thermometer and a hygrometer.
• The union must participate in taking the temperature.
• At a frequency agreed upon with the union.
• The result must be recorded in a register.

• Centre d’aide pour les victimes d’actes criminels (CAVACS) 1 866 LE CAVAC – 1 866 532-2822
• Groupe d’aide et d’information sur le harcèlement sexuel au travail de la province de Québec – Tél. : 514 526-0789
• Regroupement québécois des CALACS (Centre d’aide et de lutte contre les agressions à caractère sexuel) – Montréal : 514 529-5252 – Extérieur de Montréal : 1 877 717-5252

• Ligne téléphonique d’écoute, d’information et de référence destiné⦁ e⦁ aux victimes d’agression sexuelle, à leurs proches, ainsi qu’aux intervenants – 1 888 933-9007
• Regroupement québécois des centres d’aide et de lutte contre les agressions à caractère sexuel (CALACS) – Contactez le regroupement de votre région
• Le réseau des centres d’aides aux victimes d’actes criminels (CAVAC) 1 866 LE CAVAC – 1 866 532-2822
• Mouvement contre le viol et l’inceste – Tél. : 514 278-9383
• Trêve pour Elles – Tél. : 514 251-0323
• Centre pour les victimes d’agression sexuelle de Montréal. Ligne-ressource sans frais provinciale 24 heures/7 jours – Partout au Québec, composez le : 1 888 933-9007 – Pour la région de Montréal, composez le : 514 933-9007
• Clinique pour victimes d’agression sexuelle. Hôpital Notre-Dame, 1560, rue Sherbrooke Est, Montréal, QC H2L 4M1 – Demandez à parler à l’intervenant(e) de garde : Tél. : 514 413-8777
• Centre de prévention des agressions de Montréal – Tél. : 514 284-1212
• Centre d’amitié autochtone de Montréal – Tél. : 514 499-1854
• Directeur des poursuites criminelles et pénales (DPCP). Ligne téléphonique destinée à renseigner les personnes victimes de violences sexuelles qui envisagent de déposer une plainte auprès des policiers – gratuit et confidentiel – 1 877 547-DPCP (3727)
• Juripop – Services juridiques gratuits et confidentiels
• Centre d’expertise Marie-Vincent – Courriel : ⦁ info@ceasmv.ca
• Centre de ressources et d’intervention pour hommes abusés sexuellement durant leur enfance (CRIPHASE) – Tél. : 514 529-5567
• Table de concertation sur les agressions à caractère sexuel de Montréal. Guide bleu d’information disponible à l’intention des victimes d’agression sexuelle
• Table de concertation en violence conjugale de Montréal. SOS VIOLENCE CONJUGALE – 1 800 363-9010
• Tel-jeunes – 1 800 263-2266
• Clinique de consultation conjugale et familiale Poitras-Wright et Côté – Tél. : 450 6700468
  Clinique universitaire de psychologie, Université de Montréal, Département de psychologie – Tél. : 514 343-7725

• Concerns related to their physical and mental capacities.
• Concerns related to the health of their loved ones and risks of contamination.
• Fears about contracting the disease or dying.

• Fatigue and stress.
• Aggravation of pre-existing physical or mental health problems.
• Increase in alcohol consumption and other mood-altering substances.
• Moral suffering and psychological distress related to clinical decisions to prioritize access to care.
• Sleep, concentration and appetite disorders.
• Anxiety and depression.
• Post-traumatic stress disorder.

Some of you are possibly at higher risk to experience psychological distress or mental health problems, due to personal or family characteristics:

• If you feel pressure from loved ones to leave the profession.
• If you have difficulty balancing professional and family requirements.
• If there are members of your family with COVID-19, suspected to have it or seriously ill.
• If you experienced grief recently.
• If you have a chronic disease or a history of mental disorders.

Moreover, health care personnel would be more likely to experience psychological distress or mental health problems, because of certain characteristics specific to this sector of activity:

• The personnel with direst exposure to the suffering of infected people and must deal with the users’ anxiety or concerns.
• The one working in a high-risk setting.
• The one working in a geographic epicentre.

In its document on psychosocial risk factors, the Institut national de recherche et de sécurité pour la prévention des accidents du travail et des maladies professionnelles (INRS), a French scientific body, explained that:

(…) according to work situations, the psychosocial risk factors may compensate (for example higher requirements, but good quality social support) or, on the other hand, strengthen itself (for example higher requirements and lack of recognition of efforts made). Different studies show the more “toxic” they are on health when :

• They are part of the long term
  The sustained psychological risk factors may in fact create a stage of chronic stress that that represents a health risk.
• They are sudden
  Sudden psychosocial risk factors are more difficult to deal with.
• They are numerous
  An accumulation of risk factors is a compounding factor.
• They are incompatible
  The coexistence of certain “aggravating” factors particularly affects health, for example a high demand for productivity and little room for manoeuver.

With respect to workload, are healthcare professionals, for example, subject to:

• A heavier workload, pressure to pick up the work not done.
• Long work hours (e.g. no breaks, mandatory overtime).
• A staff shortage.
• Poorly defined work mandates, tasks or instructions or subject to many interpretations or changes.
• A lack of tools necessary to do a good job (e.g. personal protective equipment).
• A lack of training for the tasks she is asked to do when resources are shuffled.
• Greater complexity of work related to respecting the instructions for protection (e.g. distancing, use of personal protective equipment).
• A feeling of not being able to do quality work.
• Ways of doing things that clash with their personal or professional values.
• Emotional traumas (e.g. agonizing care decisions, patients’ deaths).
• Inappropriate behaviour by patients or their loved ones.
• Fear of being contaminated by COVID-19 and contaminating their loved ones
• Difficulty in balancing work, family, and personal responsibilities (e.g. telework, daycare).

Is social support from superiors currently marked by:

• A lack of availability to provide the useful or essential information for carrying out the work.
• Less time for discussion and sharing (e.g. lack of team meetings).
• Greater difficulty in clarifying everyone’s mandates and roles.
• Little listening or empathy for the staff’s concerns (e.g. request for time off, needs in organization of work).
• Tensions, conflicts or rudeness not managed on the work teams.

Social support from colleagues currently marked by:

• Greater instability on the work teams.
• Fewer or lack of team meetings.
• Greater distance between a healthcare professional and the members of her team.
• Lack of informal opportunities to meet, exchange, share and help each other.

With regard to recognition, is the current work situation characterized by:

• Lack of respect and esteem for staff.
• Difficulty in adequately recognizing staff efforts.
• Lack of recognition of the risks incurred by staff.
• Existence of iniquities or favoritism between sectors or individuals.
• Tensions related to remuneration in a context of a pandemic (e.g. premiums, salary improvements).
• The staff’s sense of job security in keeping their jobs and working conditions.

For decision-making autonomy, can we, for example, see in the healthcare professionals:

• A lack of opportunities to participate in decisions that affect them.
• A lack of opportunities to use their skills and develop new ones.
• Little possibility to show creativity and take initiatives.

Certain organizational conditions also affect the work climate and staff’s mental health, including the lack of:

• Team cohesion.
• Planning and organization of work.
• Confidence in colleagues.
• Preparation of the institution.
• Training and equipment for avoiding contamination.
• Psychological support.

• Communicate regularly and transparently as to what needs to be done and how to do it.
• Being attentive to staff concerns and suggestions and follow up on them as soon as possible.
• Pay attention to the staff’s issues of work-family balance (e.g. childcare, telework).

• Lead by example.
• Encourage empathy and compassion on the work teams.
• While respecting the physical distancing measures and using technological tools, provide opportunities for workers to be together, express themselves, help each other and reflect on the solutions for the challenges encountered.
• Pay attention to the conditions conducive to the emergence of psychological harassment at work (e.g. unresolved conflicts, rudeness) and implement, as soon as possible, the necessary measures to prevent it and, if applicable, stop it (see the documentation de la CNESST) (CNESST documents on this subject).
• Equip/give the staff the appropriate means so they can do their work, safely and satisfactorily (e.g. telework tools, personal protective equipment, clear procedures in the event of the presence of symptoms).
• As needed, provide one-off training to acquire the minimum critical knowledge to carry out the work required.
• Encourage the staff to take the full scheduled break.
• Foster daily recognition, reward everyone’s efforts and make a positive assessment of the work.
• Consult the employees about the decisions affecting their work.
• Invest in the participation of people and groups and stimulate initiatives.

Healthcare professionals are accustomed to thinking that they have to be available for others and their own needs are secondary, without taking into account the fact that failing to eat or rest causes exhaustion. Be sure to eat, drink and sleep regularly. Not doing so jeopardizes mental and physical health and in the end, it compromises the capacity to care for patients.

Try to maintain some of your habits despite the new restrictions imposed by the current context. Explore creative ways for other options at home: daily exercise routines, personal care, reading, communicate with loved ones, etc.

Some people need to talk while others need to be alone. Recognize and respect these differences for your patients, work colleagues and yourself.

Talk with loved ones, if possible. They are your support outside the health network. They may be able to give you more support if you share with them. Feeling useful to each other is a protection factor.

Explicit images and disturbing messages will increase your stress and may lower your efficiency and general well-being. Protect yourself psychologically setting limits on the demands that can come from WhatsApp groups or other digital means asking for personal information or advice. Hence, you can preserve your rest time and capacity to get through this endurance race.

Professional competence and strength are consistent with feelings of confusion, concern, feeling of a loss of control, fear, guilt, exhaustion, sadness, irritability, desensitization, instability, etc. These feelings are precisely those that make us human. Sharing one’s feelings with someone who inspires safety and trust helps us tolerate these feelings better and resolve them.

Breathing, awareness techniques, physical exercise, among other things, may be useful in defusing negative thoughts, emotions and physical symptoms.

When possible, take part in activities that are comforting, fun or relaxing for you. Listening to music, reading a book or talking to a friend may help. Some people may feel guilty not working all the time or if they take the time to relax when so many are suffering. However, taking a break will also help in giving better care to patients.

Talk with your work colleagues and support each other. Isolation due to the pandemic may produce fear and anxiety. Talk about your experience and listen to that of others.

Talk to your colleagues clearly and encourage them. Identify errors and failures constructively in order to be able to correct them. They all complement each other: praise can be a powerful motivator and stress reducing. Share your frustrations and solutions. Problem solving is a professional aptitude that provides a feeling of accomplishment even for little incidents.

Rely on trusted sources of knowledge. Participate in meetings to keep informed of the situation and find out what is planned.

.

Recognizing our signs of stress, asking for help and learning to stop to take care of oneself is an internal regulation mechanism that fosters stability in a situation of enduring stress.

Feeling unpleasant emotions is not a threat: it is our mind’s normal defence mechanism when faced with danger. However, be watchful that symptoms of depression and anxiety do not develop: lingering sadness, difficulty sleeping, invasive memories, despair. Talk with your colleagues, superiors, or seek professional help if necessary.

Healthcare professionals are constantly exposed to the darker side of this dramatic pandemic: suffering and death in terrible conditions. Obviously, it can create an emotional charge that makes you think of the worst. However, it is important not to lose hope and remember that many of the infected people develop milder forms of the disease.

Remember that, despite the obstacles and frustrations, you are on a great mission: providing care to those in need. Recognize your colleagues, formally and informally. Remember that all those currently working in care settings are doing their best and are the real heroes for the population.