Interim Guidance for Employers to Reduce Exposure to Novel Influenza A (Such as H5N1 Bird Flu) for People Working with or Exposed to Animals

Overview

Human infections with novel influenza A viruses (such as H5N1 Bird Flu) can happen when enough virus gets into a person's eyes, nose, or mouth, or is inhaled. This can happen when virus is in the air (in droplets, small aerosol particles, or possibly dust) and deposits on the mucus membranes of the mouth, eyes, or nose. It can also happen when a person breathes the virus in, or possibly when a person touches something contaminated by viruses and then touches their mouth, eyes, or nose.

Employers should take steps to reduce workers' exposure to novel influenza A viruses from sick animals or contaminated environments. Workers may be exposed when working with animals confirmed or potentially infected with novel influenza A viruses. They may also be exposed when working with materials, including raw milk, that are confirmed or potentially contaminated with novel influenza A viruses. Examples of related workers include:

• Poultry and dairy and other livestock farmers and workers
• Backyard bird flock owners
• Veterinarians and veterinary staff
• Animal health responders
• Public health responders
• Dairy laboratory workers
• Food processing workers handling raw milk and other confirmed or potentially contaminated materials
• Slaughterhouse workers performing certain tasks on lactating dairy cattle including:
  • Unloading or handling live lactating dairy cattle for slaughter, including working in holding pens and tasks involved with ante-mortem inspection
  • Post-mortem processes including the post-mortem inspection, handling, and transporting of viscera
  • Removing and transporting udders from dairy cattle for further processing or rendering

To protect workers who might be exposed, employers should update or develop a workplace health and safety plan. Employers are encouraged to use a health and safety committee that includes representatives from both management and workers to develop the plan. Helpful guidance and consultation on developing a workplace health and safety plan is available from the Occupational Safety and Health Administration (OSHA) and through your local agriculture extension office. Employers in a state regulated by a state OSHA plan should familiarize themselves with any additional requirements that may apply to them. Employers should conduct a site-specific hazard assessment to identify potential exposures based on work tasks and locations and use the hierarchy of controls to identify controls to reduce or eliminate hazards including exposure to novel influenza A viruses. The Hazard Assessment Worksheet for Dairy Facilities can help identify dairy workplace hazards and prioritize controls including personal protective equipment (PPE) needed for protection. Protecting Poultry Workers from Avian Influenza (Bird Flu) can help identify poultry workplace hazards and prioritize controls. CDC provides separate recommendations to prevent the spread of flu between pigs and people.

The hierarchy of controls identifies a preferred order of actions to best control hazardous workplace exposures. Engineering controls are more effective than administrative controls or PPE because they control exposures without requiring significant and ongoing efforts by workers and their supervisors. The following table identifies the type of controls that can be used based on our current understanding of the exposure risk associated with different work tasks and settings.

To help employers implement the guidance, CDC is providing the following resources:

• Engineering controls to reduce exposure to novel influenza A viruses
• Administrative controls to reduce exposure to novel influenza A viruses
• Personal protective equipment to reduce exposure to novel influenza A viruses
  • Recommended PPE to protect against novel influenza A viruses in high exposure settings
  • Recommended PPE to protect against novel influenza A viruses in medium exposure settings
• Toolbox Talk – Personal Protective Equipment for H5N1 Bird Flu (Spanish)
• Information for employers providing personal protective equipment to reduce exposure to novel influenza A viruses
  • Personal protective equipment specifications to reduce exposure to novel influenza A viruses
  • Information on working in hot environments

Engineering Controls

Engineering controls are methods to reduce or remove the hazard at the source or place a barrier between the worker and the hazard.

Proper ventilation in dairy and poultry barns depends on factors such as the size of the barn, the number of animals, and local climate, among other factors. Poor ventilation can lead to the buildup of harmful gases, excessive heat and humidity, and the accumulation of airborne pathogens (bacteria and viruses). Circulating fresh air helps dilute and disperse potential pathogens and can help control the temperature and humidity.

In high and medium exposure settings, employers can implement the following engineering controls to reduce the spread of novel influenza A viruses:

• Use a ventilation system that provides a constant supply of fresh air
• Strategically place fans and vents to generate a clean-to-less-clean flow path of fresh air through the space while removing dirty air
• Use airflow exhaust and makeup air supply strategies that do not discharge high velocity airflow upon building occupants
• Regularly clean and maintain ventilation systems to minimize the accumulation of dust, feathers, manure particles, and other debris that can obstruct airflow and provide a breeding ground for pathogens

Administrative Controls

Administrative controls are policies and work practices that reduce workers' exposure to hazards. In all exposure settings, employers can implement the following policies and work practices:

• Watch for sick or dead animals on your farm or workplace, and monitor animals for changes in feed consumption or production metrics
• Test animals for novel influenza A virus if indicated (if relevant, consider joining the USDA HPAI Dairy Herd Status Program or contacting your State Animal Health Official about testing available within your state)
• Develop plans to monitor workers for illness
  • Have monitoring plans ready to use when needed
  • Develop a process to communicate with your workers daily to determine if they are sick or have symptoms, like conjunctivitis, mild flu-like upper respiratory symptoms, or other symptoms consistent with novel influenza A virus infection
  • Designate management staff to maintain records for absenteeism, symptomatic workers, and testing, and review the records daily
• Ask employees to monitor themselves for symptoms of illness every day while they are working with animals confirmed or potentially infected with novel influenza A viruses. They should continue to self-monitor for 10 days after the last day of exposure. If they become sick while working or during those 10 days, have them isolate themselves from others and tell their supervisor, help them contact the state/local health department, and give them instructions for seeking medical evaluation and treatment. Printable instructions are available: What to do if you feel sick.
• Work with the state or local health department to offer influenza testing, post-exposure prophylaxis, and treatment of workers, if recommended, if workers have:
  • Developed symptoms after contact with animals confirmed or potentially infected with novel influenza A viruses or their secretions, or
  • Had unprotected exposure to animals confirmed or potentially infected with novel influenza A viruses or their secretions
• Provide employees with paid time off and develop flexible leave policies to support workers to stay home if sick
• Train workers on
  • Relevant equipment, procedures, and hazards (for example, potential for exposure to novel influenza A virus through contact with animals, animal secretions, or contaminated objects);
  • Infection control practices;
  • Heat illness prevention;
  • Recognizing signs and symptoms of novel influenza A virus infection in themselves and others;
  • Any new procedures in the workplace; and
  • PPE including how to put on, use, and take off

• Provide safe storage locations for workers' food and personal items, including clothing worn off-site. Prohibit storage of food and personal items in potentially contaminated areas, including where PPE is put on and removed
• Provide workers access to hand washing stations with soap and clean water
  • Provide alcohol-based hand sanitizer containing at least 60% alcohol if soap and water are not immediately available
  • Place hand washing stations and alcohol-based hand sanitizer in multiple locations to encourage hand hygiene, especially in areas where workers frequently have contact with animals
  • If possible, choose hand washing stations, hand sanitizer stations, and trash receptacles that are touch-free
  • Consider other workplace practices to promote personal hygiene like building additional short breaks into staff schedules
  • Remind workers to wash their hands for 20 seconds before eating, drinking, touching their phones, smoking, vaping, chewing gum, or dipping tobacco
• Provide workers access to shower facilities at the end of the work shift and a clean area to put on clean, uncontaminated clothing

Personal Protective Equipment

Engineering and administrative controls are not always sufficient for reducing exposures to confirmed or potentially infected animals and their secretions. Therefore, PPE is needed in some cases to reduce the risk of exposures, especially for workers in direct contact with animals or their secretions. Employers should provide appropriate PPE at no cost as well as training on its proper use. Putting on and removing PPE should occur during work hours.

Recommended PPE to protect against novel influenza A viruses in high exposure settings

• NIOSH Approved® particulate respirator
• Fluid-resistant coveralls
• Safety goggles
• Boot covers or boots
• Head cover or hair cover
• Disposable gloves
• Optional items:
  • Waterproof apron over the top of coveralls to prevent cross contamination during PPE removal
  • Face shield over the top of goggles and respirator to protect against large amount of liquid splashing onto the filtering facepiece respirator
  • Outer work gloves to protect the disposable gloves

Keep Reading: Wear Personal Protect Equipment – High Exposure

Keep Reading: Wear Personal Protect Equipment – High Exposure - Spanish

Keep Reading: Put On Personal Protective Equipment Safely – High Exposure

Keep Reading: Put On Personal Protective Equipment Safely – High Exposure - Spanish

Keep Reading: Remove Personal Protective Equipment Safely – High Exposure

Keep Reading: Remove Personal Protective Equipment Safely – High Exposure - Spanish

In milking parlors where contamination from cows can only reach the worker from one side, a fluid-resistant coverall may be substituted with a fluid-resistant sleeved apron. This modification should not be used in milking parlors where cows line up on two or more sides that are relatively close together because splashes could come from behind.

Keep Reading: Wear Personal Protect Equipment – High Exposure for Milking Parlor

Keep Reading: Wear Personal Protect Equipment – High Exposure for Milking Parlor - Spanish

Keep Reading: Put On Personal Protective Equipment Safely – High Exposure for Milking Parlor

Keep Reading: Put On Personal Protective Equipment Safely – High Exposure for Milking Parlor - Spanish

Keep Reading: Remove Personal Protective Equipment Safely – High Exposure for Milking Parlor

Keep Reading: Remove Personal Protective Equipment Safely – High Exposure for Milking Parlor - Spanish

Recommended PPE to protect against novel influenza A viruses in medium exposure settings

• NIOSH Approved® particulate respirator
• Safety goggles
• Disposable gloves with optional outer work gloves

Keep Reading: Put On and Remove Personal Protective Equipment Safely – Medium Exposure

More Information

CDC

• Avian Influenza Current Situation
• Protecting Poultry Workers from Avian Influenza (Bird Flu)

Occupational Safety and Health Administration

• Avian Influenza – Control and Prevention
• Avian Influenza (Bird Flu)
• H5N1 (Avian Influenza) in Dairy Cattle

USDA

• APHIS Requirements and Recommendations for Highly Pathogenic Avian Influenza (HPAI) H5N1 Virus in Livestock For State Animal Health Officials, Accredited Veterinarians and Producers

Others

• Interim Highly Pathogenic Avian Influenza (HPAI) Virus Biosafety Guidance and Resources for Industry Laboratories and State Dairy & Dairy Product Laboratories
• Biosecurity – Secure Milk Supply Plan