Loosening Lockdowns with Fever Screening
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In the wake of devastating economic costs, business and institutional leaders across the country are engaged in plans to increase activity while doing their best to protect staff and patrons during the pandemic. Local, state and federal authorities are publishing requirements and guidelines to help organizations reduce risk.
Common to most safe operating guidelines, is the requirement to measure employee temperature before entering the workplace. The FDA and CDC recommend employers pre-screen their employees. The CDC says: “Employers should measure the employee’s temperature and assess symptoms prior to them starting work. Ideally, temperature checks should happen before the individual enters the facility.”
In their Best Practices for Retail Food Businesses and Restaurants, the FDA recommends: “Employers – Pre-screen (e.g., take temperature and assess symptoms prior to starting work).”
Various localities are recommending, or requiring, that restaurants and retail establishments measure patron temperatures before they enter an establishment. Dental and medical offices are likewise measuring patient temperatures when they enter the clinic.
While pre-pandemic public attitudes might have considered a temperature scan somewhat intrusive, current public health considerations have shifted the legal stance. The Equal Employment Opportunity Commission (EEOC) issued guidance confirming specifically that the COVID-19 pandemic permits employers to measure employee’s body temperatures before allowing them to enter the worksite. Under the recommendations of governmental authorities, businesses may in fact be obligated to screen staff and patrons for fevers before they enter facilities.
If done properly, screening employees for a fever not only helps protect people but can strengthen the business against the risks of an outbreak among staff and a costly renewed closure.
What’s Involved
When staff or patrons arrive at the place of business, a trained operator measures body temperature. The CDC considers a fever to be 100.4 F or above. Some organizations set their threshold at 100.4 F, others round it lower to 100.0 F. If the subject’s temperature is above that level, they are asked to go home or denied entrance. A record may be kept to establish that the measurement was correctly made. The readings, and any records, should be considered private and should only be shared with as few members of management as necessary.
Is a Temperature Measurement Foolproof?
A temperature reading alone does not constitute an adequate screening nor does it actually detect the virus. A subject can be infected with the Coronavirus and be asymptomatic. They may not have a fever. Some will ask if a temperature reading is not 100% effective at detecting the virus, then why should we do it? The answer is simple. A fever is in fact a common symptom. If you are screening staff for fevers, you are mathematically reducing the risk of exposing healthy staff to an infected member. The goal is to reduce risk.
The temperature measurement is accompanied by a very short survey regarding symptoms. Following is a simple example but the best avenue is to check with local and state health authorities for their recommendations.
- Have you been experiencing body aches or the chills?
- Do you have a cough, shortness of breath or difficulty breathing?
- Have you been in close contact with someone who has been diagnosed with COVID-19?
- Have you taken any medications today to purposely reduce a fever?
Choosing a Thermometer
Oral thermometers are not ideal for screening numbers of people. They take longer to read and are problematic to use in a sanitary way to minimize exposure to pathogens. Timpanic membrane, or infrared ear thermometers, can measure quickly but must be inserted into the ear canal and require touching the subject and thus should be sanitized between uses. They can be uncomfortable for some people.
Some infrared forehead thermometers require that the sensor be placed against the skin of the forehead and then gently swiped across the forehead as it scans the temperature. These also require touching the subject and must be sanitized between each use.
The best choice for screening staff and visitors is a non-contact forehead thermometer. They are normally positioned an inch or more from the forehead and can read temperature in just seconds. The thermometer should be simple to operate.
Most people have seen news photos of gun-shaped IR thermometers being used to scan people for fevers. Many times these gun-shaped devices are industrial thermometers that have been adapted to measure human skin temperatures. If using a non-medical, industrial grade IR thermometer, care should be taken to analyze the measurement specifications to ensure that it will be accurate and repeatable enough for human body temperature. The type purchased in a hardware store may have an accuracy specification of several whole degrees. Meaning a reading may typically be off by several degrees. When we are trying to detect the relatively small difference between a normal reading of 98.6 F and 100.0 F, we can’t afford to use a device that can be off three to five degrees or more.
It is also important to realize that the forehead is not really at the same temperature as internal core body temperature. It is typically lower by about 5 degrees Fahrenheit. A medical grade forehead thermometer performs a compensation to the reading to yield the “oral equivalent” temperature. So, while the true surface temperature of the forehead might be 93 F under normal conditions, a medical IR thermometer will read 98 F because it has made the compensating correction. If your thermometer is not a medical forehead thermometer, it will read about 5 F below normal when reading the forehead.
When purchasing an infrared forehead thermometer, ensure that the product is indeed a medical grade device. Check to see if the thermometer holds an FDA device registration number and is ‘FDA-Cleared’ under the Class II designation ‘Thermometer, Electronic, Clinical’. If it is labeled “FDA Approved” or uses the official FDA logo on the product or packaging, it is incorrectly labeled and you should be regarded as suspicious. The FDA has provided the article, Is It Really ‘FDA-Approved’ for more information.
Other Concerns
Even core body temperature fluctuates throughout the day. And even more so, the forehead temperature can be affected by perspiration, exercise, being in the sun, wearing a hat, or standing under a heating or cooling vent. If an employee arrives at the office and the screening yields a temperature reading over 100 F, it would be wise to have the subject relax for several minutes and then take the reading again to be sure.
The staff member assigned to take measurements is acting in a high-risk role. They should use adequate personal protective gear. At a minimum they should wear a mask and use gloves. Goggles or a face screen are recommended as well as a gown. The higher the number of people they must screen, the greater their risk.
Regularly update staff training and stay current with government-sanctioned health and safety rules. Your screening policy should evolve as the recovery and the “new normal” evolves.
Summary
While a percentage of our population may be annoyed with safety measures, many more will be reassured that your organization is concerned for their health, be they staff or patrons. Fever screening is currently recommended by government authorities and in some places it is mandatory. If done correctly, it is an effective tool to help the country return to greater activity. It should form a part of larger strategies to strengthen public health and the economy. Your organization will be better protected from infection while you increase your operations.
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