Preventing Spread of Diseases on Airplanes: Guidance for Cabin Crew

Overview

When interacting with a sick and potentially infectious traveler (passenger or crew), follow the steps in this guidance to reduce the risk of onboard disease transmission. Be sure to follow your company's policy for managing in-flight medical emergencies.

This general guidance is NOT intended for: non-contagious illnesses or emergencies such as chest pain, possible stroke, asthma, or diabetic complications.

Key Points

• Practice routine handwashing
• Identify sick and potentially infectious travelers
• Treat all body fluids (such as respiratory secretions, diarrhea, vomit, or blood) like they are infectious
• Wear recommended personal protective equipment (PPE)
• Clean and disinfect contaminated areas
• Dispose of waste using recommended procedures

Identifying a sick and potentially infectious traveler

Suspect a contagious disease when a traveler (passenger or crew) has:

1. A fever (a measured temperature of 100.4 °F [38 °C] or greater, or feels warm to the touch, or gives a history of feeling feverish) and one or more of these signs or symptoms:

• skin rash
• difficulty breathing
• persistent cough
• decreased consciousness or confusion of recent onset
• new unexplained bruising or bleeding (without previous injury)
• persistent diarrhea
• persistent vomiting (other than air sickness)
• headache with stiff neck, or
• appears obviously unwell;

OR

2. Has a fever that has persisted for more than 48 hours.

OR

3. Has symptoms or other indications of communicable disease, as the CDC may announce through posting of a notice in the Federal Register.

General Infection Control Measures

Protecting yourself and others

• Treat all body fluids (such as respiratory secretions, diarrhea, vomit, or blood) like they are infectious.
• Handwashing is the single most important infection control measure.
  • Wash hands often with soap and water for at least 20 seconds after assisting sick travelers or touching potentially contaminated body fluids or surfaces. Also, wash hands when visibly soiled.
  • Use alcohol-based hand sanitizer (containing at least 60% alcohol) if soap and water are not available.
• Avoid touching your mouth, eyes, and nose with unwashed or gloved hands.

Personal protective equipment (PPE)

• Protect yourself by using PPE, found in the universal precaution kit (UPK), when tending to a sick traveler. After use, PPE should be removed carefully to avoid contaminating your skin or clothing. Soiled items should be placed in a biohazard bag (or plastic bag labeled "biohazard" if biohazard bag not available).
• Always wash hands or use an alcohol-based hand sanitizer after removing PPE.

Disposable gloves (Gloves don't replace proper handwashing.)

• Wear disposable gloves when:
  • tending to a sick traveler
  • touching body fluids (such as blood, vomit, or diarrhea)
  • touching potentially contaminated surfaces, such as in bathrooms
• Remove gloves carefully to avoid contaminating yourself or your clothing.
• Properly dispose of soiled gloves in a biohazard bag (or plastic bag labeled biohazard if none available); do not reuse gloves.
• After removing gloves, wash your hands with soap and water or use an alcohol-based hand rub.

Masks

• Masks should be considered:
  • for crew when you are helping sick travelers with fever or respiratory symptoms such as coughing or sneezing
  • for sick travelers (with fever or respiratory symptoms) to help reduce the spread of respiratory germs
  • for people sitting near sick travelers (with fever or respiratory symptoms) when the sick traveler cannot tolerate wearing a mask
• Masks are NOT recommended:
  • for a sick traveler complaining of nausea or vomiting. This could result in choking or a blocked airway.
  • for sick travelers who can't tolerate a face mask or refuse one. In this case, ask sick travelers to cover their coughs or sneezes.

Infection Control Guidance

• Minimize the number of people directly exposed to sick travelers. If possible, designate one crew member to interact with the sick traveler.
• Keep interactions with sick travelers as brief as possible. Provide a plastic bag for disposal of used tissues, air sickness bag(s), or other contaminated items.
• Encourage sick travelers to wash their hands or use an alcohol-based hand rub (if available).
• If possible, separate the sick traveler from others by 6 feet or move adjacent passengers without compromising flight safety or exposing additional passengers.
• Use infection control measures based on symptoms:

Infection control guidance table

Reporting illness or death

The U.S. Code of Federal Regulations [42 CFR 70.11 and 71.21] contain requirements for reporting death and illness to CDC that occur on domestic flights between U.S. states and territories, and on international flights arriving to the United States. For assistance, contact the CDC Port Health Station with jurisdiction for the airport of arrival.

Targeting clean-up in-flight

• Employees should put on PPE in the UPK before cleaning or disinfecting any area.
• Take the following actions in areas contaminated with diarrhea, vomit, blood, or other body fluids.
  • For hard (nonporous) surfaces such as tray tables, TV monitors, seat arms, windows, and walls: remove any visible contamination and clean and disinfect the area with products approved by your company.
  • For soft (porous) surfaces such as carpeted floor or seat cushions: remove as much of the contaminant as possible, cover the area with an absorbent substance, and contain the area as much as possible. Remove the absorbent substance and any remaining material, and then clean and disinfect the area with products approved by your company.

Bagging and disposal

• Carefully place all contaminated items inside a biohazard bag (or plastic bag labeled "biohazard" if none available). Tie or tape the bag shut securely to avoid spills or leaking. Keep the bag in a secure place until it can be safely collected for disposal.
• Dispose of all waste according to your company policy.

Post-flight measures

• Properly dispose contaminated items.
• Notify cleaning crew of areas contaminated with diarrhea, vomit, blood, or other body fluids, needing more than routine cleaning or possible removal. For example:
  • Soft materials (e.g., seat cushion)
  • Hard surfaces like arm rests and tray tables
  • Bathroom(s) used by sick traveler
• Remind cleaning crew this situation may require additional PPE, and they should follow company policy for such situations.
• If the sick traveler changed seats, ensure both areas are adequately cleaned.
• Follow company policy for reporting any contact with a sick passenger or potentially infectious materials such as items contaminated with diarrhea, vomit, blood, or other body fluids. Consult a healthcare provider as needed.
• CDC will coordinate with your airline's occupational medicine consultant to provide guidance for certain confirmed contagious diseases, such as measles.
• The state health department where you live may also contact you to assess your health and provide recommendations to protect you and those around you from contagious disease.
• If you develop symptoms (such as fever, rash, persistent cough, vomiting, or diarrhea) after exposure to a sick passenger or potentially contaminated body fluids, contact a healthcare provider and let them know about your possible exposure. Additionally, notify your airline according to company policy.

Sick crew members

If you have a possible contagious illness, notify your airline according to company policy and don't report to work until you have recovered to avoid exposing others. If you develop symptoms of a contagious illness during flight, discontinue your work duties as soon as it is safe to do so and follow the procedures outlined for sick passengers. Do not prepare or serve food or beverages if you have symptoms of illness that could be contagious.

Immunizations and healthy travel tips

Be prepared. Many contagious diseases can be prevented by vaccines. To protect yourself, be up to date on all routine immunizations, as well as recommended immunizations and other preventive measures, such as preventive treatment for malaria, specific to your destination(s). Check out CDC's Travelers' Health website for advice on common topics, and travel health notices for disease outbreaks.

For more information

CDC Resources

Airline-related information

• Airline Guidance
• Aircrew Safety and Health
• Air Travel, Yellow Book: Advice for Air Crews

Other Resources

International Air Transport Association (IATA)

• Communicable Disease Guideline for Cabin Crew
• Air Transport and Communicable Diseases
• Universal Precaution Kit (UPK)

International Civil Aviation Organization (ICAO)

• Managing Communicable Disease in Aviation

Occupational Safety and Health Administration (OSHA)

• OSHA's Bloodborne Pathogen Standard
• OSHA Bloodborne Pathogens Safety & Health Topics Page
• Protecting Workers Who Use Cleaning Chemicals