CDC - Updated Interim Recommendations for Worker Protection and Use of Personal Protective Equipment (PPE) to Reduce Exposure to Novel Influenza A Viruses Associated with Disease in Humans - April 26, 2024

[sharon sanders]

Updated Interim Recommendations for Worker Protection and Use of Personal Protective Equipment (PPE) to Reduce Exposure to Novel Influenza A Viruses Associated with Disease in Humans


Español | Other Languages
Print
Updated April 26, 2024

Summary of changes

• This updated guidance identifies select occupational groups that may be at increased risk of exposure to novel influenza A viruses. Specific recommendations for these groups may be updated as CDC learns more during this evolving situation.
• Persons in these occupational groups should consult with their supervisor or their employer’s worker safety team to determine how best to apply these recommendations.

Information for workers


Take steps to reduce your risk of infection with avian influenza A viruses associated with severe disease when working with animals or materials, including raw milk, confirmed infected or potentially infected with these novel influenza A viruses. Examples of people working with or exposed to animals include:

• Poultry and livestock farmers and workers
• Backyard bird flock owners
• Veterinarians and veterinary staff
• Animal health responders
• Public health responders
• Slaughterhouse workers performing certain tasks on lactating dairy cattle including:
  • Unloading or handling live lactating dairy cattle for slaughter, including workers in holding pens and involved with antemortem inspection
  • Postmortem processes including the post-mortem inspection and handling and transporting viscera
  • Removing and transporting udders from dairy cattle for further processing or rendering

Avoid unprotected direct or close physical contact with:

• Sick birds, livestock, or other animals
• Carcasses of birds, livestock, or other animals that have died from unknown causes
• Raw milk
• Viscera and udders from lactating dairy cattle
• Feces or litter
• Surfaces and water (e.g., ponds, waterers, buckets, pans, troughs) on farms with potentially infected animals that might be contaminated with animal waste

Protect Yourself From H5N1 When Working With Farm Animals [2 MB, 1 page]
Spanish [1.7 MB, 1 page]

If you must work in or enter any not yet disinfected buildings where these materials or sick or dead cattle or other animals confirmed infected or potentially infected are or were present, wear appropriate personal protective equipment (PPE) in addition to the PPE you might be using for your normal duties (e.g., waterproof apron, hearing protection, etc.). Appropriate PPE depends on the hazards present and a site-specific risk assessment. If you have questions on the type of PPE to use or how to fit it properly, ask your supervisor.

Recommended PPE to protect against novel influenza A viruses includes:

• Disposable or non-disposable fluid-resistant[i] coveralls, and depending on task(s), add disposable or non-disposable waterproof apron
• Any NIOSH Approved^® particulate respirator (e.g., N95^®or greater filtering facepiece respirator, elastomeric half mask respirator with a minimum of N95 filters)
• Properly-fitted unvented or indirectly vented safety goggles[ii] or a faceshield if there is risk of liquid splashing onto the respirator
• Rubber boots or rubber boot covers with sealed seams that can be sanitized or disposable boot covers for tasks taking a short amount of time
• Disposable or non-disposable head cover or hair cover
• Disposable or non-disposable gloves [iii]

While wearing PPE

• Avoid touching yourself above your chest, especially your eyes, mouth, or nose, after touching any contaminated material
• Do not eat, drink, smoke, vape, chew gum, dip tobacco, or use the bathroom
• Use separate designated clean areas, one for putting on PPE and another for taking it off

Safely put on and remove PPE

• Put PPE on in this order and in a clean environment avoiding contamination:
  1. Wash hands with soap and water
  2. Fluid-resistant coveralls
  3. Waterproof apron, if needed
  4. NIOSH Approved^® respirator
  5. Properly-fitted, unvented or indirectly vented safety goggles or faceshield
  6. Head cover or hair cover
  7. Gloves
  8. Boots or boot covers

• Remove PPE in this order* making sure to dispose of all disposable PPE appropriately and to set aside all reusable PPE for cleaning after each use:
  1. Remove apron, if worn
  2. Clean and disinfect boots or boot covers
  3. Remove boots or boot covers
  4. Remove coveralls
  5. Remove gloves
  6. Wash your hands with soap and water or, if soap and water are not available, use an alcohol-based hand rub
  7. Remove goggles or faceshield
  8. Remove respirator
  9. Remove headcover or hair cover
  10. Wash your hands again with soap and water or, if soap and water are not available, use an alcohol-based hand rub

Note: Take off PPE by touching the least contaminated part of the PPE.

*Any change to the order of removing PPE should consider that the aim of the chosen sequence should be to minimize any contaminant transfer from potential contaminated protective clothing and equipment to the person’s skin or regular clothing.

• All reusable PPE (e.g., rubber boots, goggles, faceshield, waterproof apron, elastomeric half mask respirators) should be set aside, then cleaned and disinfected after every use. To clean and disinfect reusable PPE:
  1. Select an EPA-approved disinfectant that has label claims against influenza A viruses
  2. Follow manufacturer/label directions for safe use of disinfectants
  3. Clean reusable PPE until visible dirt is removed
  4. Disinfect reusable PPE according to the disinfectant and PPE manufacturer’s instructions

After removing PPE

• If possible, shower at the end of the work shift and put on clean uncontaminated clothing. If there are no shower facilities on site, clean up as much as possible, put on uncontaminated clothing, leave straight from work to a shower, and put on clean clothing immediately afterward
• Leave all contaminated clothing and equipment at work
• Never take contaminated equipment or wear contaminated clothing outside the work area
• Follow laundering instructions:

• • Wash laundry onsite with standard laundry detergent, and completely machine-dry at the highest temperature suitable for the material.
  • Wear gloves and protective outerwear when handling soiled laundry.
  • Use separate storage and transport bins for clean and dirty laundry.
  • If there is no laundry on site, clothing to be laundered at home should be transported in a plastic bag, kept separate from household items, washed separately, and then thoroughly machine-dried at the highest temperature suitable for the material.

• Self-monitor for symptoms of illness every day while you are working with sick or potentially infected animals or animals known to be infected with novel influenza A viruses for 10 days after the last day of exposure to infected or potentially infected animals or contaminated materials. If you become sick during those 10 days, isolate yourself, tell your supervisor, and get instructions for seeking medical evaluation and treatment.

Information for employers


All PPE should be used in accordance with OSHA regulations found at 29 CFR part 1910, Subpart I (Personal Protective Equipment), including identifying appropriate PPE based on a site-specific risk assessment. Workers must be trained on and demonstrate an understanding of when to use PPE; what PPE is necessary; what it looks like when PPE is properly fitted; how to properly put on, use, take off, dispose of, and maintain PPE; and understand the limitations of PPE.

Respirator use should be in the context of a comprehensive respiratory protection program in accordance with the Occupational Safety and Health Administration (OSHA) Respiratory Protection standard (29 CFR 1910.134) and other applicable requirements. Staff who will need to wear respirators must be medically-cleared, trained, and fit-tested for respirator use. Detailed information on respiratory protection programs, including fit testing procedures, can be accessed at OSHA’s Respiratory Protection eTool.

PPE training topics should include all the following:

• Proper fit-testing, wearing, and use of respirators
• Safe removal of respirators
• Safe disposal of disposable respirators
• Cleaning and disinfection of, and recommended respirator cartridge change-out schedule for, reusable respirators
• Medical contraindications to respirator use
• Use of only NIOSH Approved^® respirators

For information on NIOSH Approved^® respirators visit National Personal Protective Technology Laboratory. Important Considerations


It is important to wear the appropriate PPE for protection against dangerous hazards, including diseases, in the workplace. However, there are certain factors pertaining to the use of PPE of which employers and workers should be aware.

• Respirators: For untrained persons who work with poultry and livestock, including children, it is important to remember that respirators are designed primarily to be used in workplaces by adults who are part of their employer’s respiratory protection program. The risks and benefits of using respirators without proper training and fit testing are uncertain. For a respirator to be most effective, it must form a seal to the face to keep particles from leaking around the edges. When not fit tested, a tight seal should be achieved following manufacturer’s instructions. Additionally, most respirators will be too big to form a proper seal for younger children’s faces, and some will be too big for people with smaller faces
• Heat illness: Employers and workers should be aware that wearing PPE and certain clothing ensembles can often increase your risk for heat-related illnesses. For more on this topic visit Limiting Heat Burden While Wearing PPE
• Vision: Try to prevent fogging of goggles and face masks. Employers and workers should be aware that under certain conditions, some PPE can alter or decrease your visual acuity and peripheral vision. Under these conditions, workers should pay closer attention to their surroundings for hazards such as animal movement; clothes snagging; cuts or punctures; and slips, trips, and falls

More Information

• Avian Influenza Current Situation
• Protecting Poultry Workers from Avian Influenza (Bird Flu)
• Avian Influenza – Control and Prevention | Occupational Safety and Health Administration (osha.gov)

N95^® and NIOSH Approved^® are certification marks of the U.S. Department of Health and Human Services (HHS) registered in the United States and several international jurisdictions.

[i] Preferably, fluid-resistant coveralls should be made of material that passes:

• AATCC 42 ≤ 1 g and AATCC 127 ≥ 50 cm H2O or EN 20811 ≥ 50 cm H2O; or
• ASTM F1670 (13.8 kPa); or
• ISO 16603 ≥ 3.5 kPA

[ii] Preferably, safety goggles should conform to ANSI Z87.1 that is marked at least Z87 D3

[iii] Preferably, gloves should conform to ASTM D3578 (latex rubber examination gloves), ASTM D5250 (vinyl examination gloves), ASTM D6319 (nitrile rubber examination gloves), or ASTM D6977 (chloroprene examination gloves). If thicker gloves are required, rubber gloves should be waterproof and exclude linings. If latex allergies are present, avoid latex. These gloves could be worn underneath the exterior principal glove (e.g., gloves for cold protection, manual shoveling) for protection against direct skin exposure if the outer glove is physically compromised.

Last Reviewed: April 26, 2024

https://www.cdc.gov/flu/avianflu/h5/worker-protection-ppe.htm

[sharon sanders]

Great advice.

[sharon sanders]

bump this

[Michael Coston]

CDC Recommendations On Making PPE Available To Workers on Dairy Farms, Poultry Farms, and in Slaughterhouses





#18,048



It is frustrating that six weeks since we first learned that HPAI H5 had been detected in American dairy cows and 5 weeks since the first human infection was reported, the size and scope of this spillover event remains murky.

• Just 1 case has been identified, but there are credible anecdotal reports of `many' symptomatic farm workers who have refused to be tested.
• We've seen reports - both in the media and in statements made by APHIS/USDA officials - that they've met `resistance' from farmers who don't want their herds tested.
• And recent media reports (see here, and here) suggest that some state agencies are not cooperating with the CDC or USDA (Note: The CDC has no authority at the state level unless they are invited in, and apparently some states have elected not to do so).

As a result, despite strong evidence suggesting the HPAI H5N1 virus is widespread in dairy cattle, only 36 herds across 9 states have been identified. And only one herd has been added to the list over the past 18 days.

There may also be community cases of human H5N1 infection which have gone undetected. But without testing, we simply can't know.

Turf wars between local and federal officials are nothing new, although until fairly recently the CDC appeared immune. The deep political divide over the agency's COVID response appears to have changed that dynamic.

I try not to ascribe motivations and intent to people I don't know, who are working under constraints I can only imagine. But this is a very dangerous game, and if H5N1 gains transmissibility in humans, everyone loses.

Three weeks ago the CDC came out with strong recommendations for protective gear to be worn by people working with potentially infected animals. It is unclear however - whether, or how much - they are being used.

Given the difficulties in trying to do farm work in protective gear, the costs (in lost time and materials), and the public's general distaste for wearing face masks after COVID, I suspect adherence is low.



As noted above, properly donning and doffing PPEs requires both training, and separate `designated clean areas'. But when cattle are visibly sick, or when they have tested positive for HPAI, wearing PPEs becomes crucial.

Yesterday the CDC held a conference call (see readout below) with `state health officials, public health emergency preparedness directors, state epidemiologists, and state public health veterinarians, and leadership from public health partner organizations' discuss farm worker protection using PPEs.

Quite telling is the following sentence in the last paragraph (emphasis mine).

CDC offers real-time support for state and local public health officials, as well as staff who are ready to deploy within 24 hours, if requested.

First the CDC's statement, after which I'll have brief postscript.

Readout of CDC Call with State Public Health Partners Regarding Avian Influenza and Farmworker Protection

Media Alert

For Immediate Release: Monday, May 6, 2024
Contact: Media Relations
(404) 639-3286
media@cdc.gov


May 6, 2024 – Today, CDC Principal Deputy Director Nirav D. Shah met with state health officials, public health emergency preparedness directors, state epidemiologists, and state public health veterinarians, and leadership from public health partner organizations to discuss farmworker protection and personal protective equipment (PPE) for avian influenza.

CDC asked that jurisdictions make PPE available to workers on dairy farms, poultry farms, and in slaughterhouses. Specifically, CDC asked state health departments to work with their state agriculture department counterparts and partners in communities, such as farmworker organizations, that can help coordinate and facilitate PPE distributions.

Shah recommended that states prioritize distribution of PPE to farms with herds in which a cow was confirmed to be infected with avian flu, noting that some states have already distributed PPE to dairy farms. Jurisdictions were asked to use existing PPE stockpiles for this effort. Shah also briefed state officials on how to request additional PPE from HHS/ASPR’s strategic national stockpile, if needed.

Although CDC’s assessment of the immediate risk to the U.S. public from avian influenza remains low, Shah highlighted the importance of states acting now to protect people with work exposures, who may be at higher risk of infection. CDC has actively engaged with state and local health departments, farmworker organizations and public health veterinarians since first learning about the outbreak of HPAI in dairy cattle herds. CDC is also sharing information with staff at Federally Qualified Health Centers, who may care for farmworkers to help ensure that these staff are aware of the importance of PPE and the options to obtain it.

Shah reiterated the agency’s commitment to support state health officials, who are conducting the on-the-ground public health response to this outbreak. CDC offers real-time support for state and local public health officials, as well as staff who are ready to deploy within 24 hours, if requested. CDC will continue to provide states with the latest situational information and advice to help support their public health response efforts.

I suspect that a lot of people are banking on the idea that H5N1 will eventually burn itself out in cattle, and that since it hasn't sparked a pandemic after 20 years, it never will. While I hope both assumptions are correct, the downsides to getting this wrong are enormous.

It is possible, of course, that even if we manage to contain it here, HPAI could spillover to humans in some other country next week or next month.

But a robust, and transparent, investigation might yield valuable data to help us deal with that contingency. Meanwhile, the virus is indifferent to our political divides, economic concerns, or logistical constraints.

HPAI has time on its side, and will do whatever it is going to do, regardless of our plans or assumptions.

Our only realistic option is to face the problem directly, prepare for whatever comes, and hope it is enough.

https://afludiary.blogspot.com/2024/05/cdc-recommendations-on-making-ppe.html