Appendix H: Employee Health and Safety Guidance for Avian Influenza Surveillance and Control Activities in Wild Bird Populations


Memorandum		January 2007
To:	Solicitor Inspector General Assistant Secretaries Heads of Bureaus and Offices
From:	R. Thomas Weimer Assistant Secretary
Subject:	Employee Health and Safety Guidance for Avian Influenza Surveillance And Control Activities in Wild Bird Populations
The Office of the Assistant Secretary – Policy, Management and Budget is issuing a new Occupational Health and Safety Guidance document to all Departmental Offices establishing procedures for employees involved in avian influenza surveillance activities in wild bird populations. This document provide guidelines on personal protective equipment and work practices to reduce the risk of acquiring or transmitting avian influenza or other pathogenic agents, when handling potentially infected wildlife. It is a compilation of information from numerous sources within and outside of the Department and ensures a consistent public health approach to protecting employees. If you have questions regarding these documents, please contact your Bureau Safety Manager or Tim Radtke, Office of Occupational Health and Safety, at (303) 236-7128 ext. 226. Attachment
cc:	Deputy Secretary Chief of Staff Bureau and Office Safety Managers

Department of the Interior Occupational Health and Safety Guidance

This document provides interim guidance for protecting Department of the Interior (DOI) employees involved in surveillance activities and/or in response to an outbreak of highly pathogenic avian influenza (HPAI) among wildlife in the United States.

These precautions are based on protecting individuals involved in the response to an outbreak of HPAI in wild birds and humans from illness and the risk of viral reassortment (i.e., mixing of genes from human and avian viruses). The risk and consequent recommendations are dependent on the suspected presence of the HPAI virus. Designated protective measures should be applied for at least 30 days after the date of the last detection of HPAI.

The purpose of this interim guidance is to clarify and consolidate what is currently in the various avian influenza plans concerning employee health and safety issues. The safety and health precautions, including PPE, work practices, and personal hygiene practices, depend on the circumstances and the nature of the task being performed.

General Information

Additional instruction/information needs to be provided to those who may come in contact with H5N1 through handling infected animals, being in contact with potentially infected persons, etc. Instruct employees to:

Practice frequent and thorough hand washing.
Obtain vaccination for seasonal influenza.

The Advisory Committee on Immunization Practices (ACIP) recommendations for 2006 – 2007 regarding the use of influenza vaccine and antiviral agents are available at: http://www.cdc.gov/ mmwr/preview/mmwrhtml/rr5510a1.htm.
This will reduce the possibility of dual infection with avian and human influenza viruses. There is a small possibility that dual infection could occur and result in viral reassortment.

When HPAI is detected within North America, follow the latest guidance from CDC for vaccination, prophylactic medications, and other precautionary measures for employees working with wild birds or in contact with persons who may be infected in areas where the virus has been detected, particularly during disease control operations.
Work outdoors or in well-ventilated areas.
Maintain minimum of 6 feet separation from potentially infectious person when possible (social distancing).
Take precautions even for birds appearing healthy when the HPAI virus is suspected to exist within a bird population or a specific geographic area.

Activities that could result in exposure to birds or wildlife infected with HPAI include trapping and handling live birds, euthanasia, carcass collection and disposal, and cleaning and disinfection of equipment, vehicles, and personal protective equipment (PPE).
The following guidance on determining when HPAI is suspected when handling birds has been developed by wildlife disease experts:

If the HPAI virus has not been detected in birds in North America and we have no reason to suspect that birds being handled would be infected, then normal protective measures will suffice as defined in the table below.
When handling apparently healthy live birds, or sick or dead birds, within 6.2 miles (10 km) of a site where the HPAI virus has been definitively diagnosed or is suspected in association with a bird mortality event, additional protective measures should be taken. (This 6.2 mile (10 km) radius area where additional PPE should be worn mirrors the “infected zone” that will be established by USDA as a containment measure in response to an occurrence of HPAI in birds and the “surveillance zone” applied by the European Union countries when managing HPAI outbreaks in wild birds. Either may be adjusted outward as ecological, epidemiological, or administrative circumstances warrant.)
When handling apparently healthy live birds outside of any designated “infected zone,” normal protective measures are adequate.
If the HPAI virus has been definitively diagnosed in wild birds within a migratory flyway, personnel handling sick or dead birds when responding to other mortality events within the flyway should exercise appropriate precaution and wear protective equipment outlined in the table below.

Avoid eating, drinking, smoking, or engaging in any other activity (such as handling equipment, using cell phones, etc.) which puts their hands in or near their eyes, nose, or mouth while handling potentially infected animals or people until they are able to wash their hands.
After contacting infected or exposed animals or people, contacting contaminated surfaces, or after removing gloves, wash hands with soap and water for 30 seconds or use an alcohol-based gel.
Monitor health for clinical signs of influenza infection during and for one week after last exposure to potentially infected birds or people. Contact healthcare provider if fever, flu-like symptoms or conjunctivitis (eye inflammation) develops. Inform the healthcare provider prior to arrival of potential exposure to the influenza virus.

PPE

The table below describes general activities and the required protective measures to minimize exposure. It specifies the minimum personal protective equipment to be used for each activity; however, other PPE may be necessary depending on specific conditions of the worksite or the tasks. For instance, aprons, waders, face shields or other protection to prevent contact with contaminated material may be useful and more easily cleaned and disinfected. Supply sources and costs need to be identified and addressed for supplying PPE to DOI personnel who have direct/prolonged contact with known or potentially infected animals and procure such items.

PPE use and training is done in accordance with 29 CFR 1910.132 – 134.
Wear disposable gloves made of nitrile or vinyl or heavy duty rubber work gloves that can be disinfected. Gloves should be changed if torn or otherwise damaged. Remove gloves promptly after use by rolling gloves outward, before touching non-contaminated items.
If splashing or body fluids can contaminate clothing, wear disposable outer garments or coveralls with disposable shoe covers or rubber or polyurethane boots that can be cleaned and disinfected.
Wear splash goggles to protect the mucus membranes of eyes.
Wear NIOSH approved N-95 respirators. Workers must be fit-tested and medically cleared prior to wearing a respirator.
Personnel who don PPE, must be reminded to thoroughly wash face and hands with soap and water after removing the protective gear.

However, it is important to note that the table does not attempt to cover all tasks that may be assigned to DOI personnel. (High exposure tasks not anticipated in the following table should be evaluated using risk assessment methodology in consultation with safety and health professionals.)

In addition, this interim guidance on PPE will continue to be reevaluated as more information is available and as the characteristics of the pathogens are better defined.

Vaccination and Anti-Viral Medications

CDC is developing guidance on anti-viral medication and vaccine distribution and use during an influenza pandemic.

Medical Monitoring

DOI personnel who develop influenza symptoms within 10 days after working with wild birds or being in contact with people suspected to be ill with H5N1 should have prompt telephone access to a health care provider and access to medical care within 48 hours after symptom onset.

Instruct workers to be vigilant for the development of fever, respiratory symptoms, and/or conjunctivitis (i.e., eye infections) for 1 week after last exposure to avian influenza-infected or exposed birds or to potentially avian influenza-contaminated environmental surfaces.
Individuals who become ill with symptoms mentioned above should promptly seek medical care and prior to arrival notify their health care provider that they have been working on the wild bird HPAI surveillance project. In addition, employees should notify their health and safety representative. They should limit contact with others if at all possible. People who have been in close contact with the symptomatic employee should be informed.
With the exception of visiting a health care provider, individuals who become ill should be advised to stay home until 24 hours after resolution of fever, unless an alternative diagnosis is established or diagnostic test results indicate the patient is not infected with avian influenza virus. While at home, ill persons should practice good cough and hand hygiene to lower the risk of transmission of virus to others. For information on techniques to stop the spread of germs through cough and hand contact and to obtain multilingual printable versions of infection control flyers and posters visit CDC's "Cover your Cough" website.

ACTIVITY	CONDITIONS	ACTIVITY RISK	PPE	WORK PRACTICE
l) Handling apparently healthy birds.	HPAI not known or suspected within 6.2 miles¹ of the work site.	No apparent risk of HPAI infection, because virus not known or suspected within work area.	Impermeable (polyvinyl chloride (pvc), or nitrile) gloves Goggles or safety glasses. (PPE for normal bird handling operations may include coveralls or lab coats)	Follow PPE and work practices for normal operations. If working indoors, work in well-ventilated areas. When working outdoors, work upwind of animals, to the extent practical, to decrease the risk of inhaling airborne particulate matter such as dust, feathers, or dander. Do not touch any part of exposed person (especially the face) with gloved hands. Other PPE may be necessary depending on specific conditions of the worksite or the tasks. For instance, aprons, face shields or other protection to prevent contact with contaminated material may be useful and more easily cleaned and disinfected. If gloves are torn or damaged: Immediately but carefully remove them. Thoroughly wash hands with soap and water (or an alcohol-based hand gel when soap and water are not available.) Don a fresh pair of gloves after hands are dry.

2) Investigating, handling or disposing of multiple sick or dead birds associated with a wild bird mortality event.	HPAI not known or suspected in the flyway within the previous 30 days.	No apparent risk of HPAI infection, because virus not known or suspected within work area. Possible infection with other disease agents.	Impermeable (pvc or nitrile) gloves and protection from claw wounds Goggles NIOSH-approved particulate respirator, N-95 or better^{2 , 3} Disposable gowns or coveralls or cleanable waders/raingear. Rubber boots or boot covers	Use accepted precautions for working with any avian disease to protect employee and for disease containment to prevent or control transmission to other wildlife. Do not touch any part of exposed person (especially the face) with gloved hands. Other PPE may be necessary depending on specific conditions of the worksite or the tasks. For instance, aprons, face shields or other protection to prevent contact with contaminated material may be useful and more easily cleaned and disinfected. See torn or damaged gloves under activity 1. Remove PPE in the following order: Carefully remove coveralls and boot covers and discard as contaminated material if disposable. Disinfect rubber boots. Remove gloves and immediately wash hands thoroughly with soap and water (or an alcohol-based hand gel when soap and water are not available). Remove eye protection and place in designated receptacle for subsequent cleaning and disinfection. Remove N-95 disposable respirator and discard. Immediately after all PPE has been removed, wash hands thoroughly a second time.

3) Collecting individual dead birds, i.e., not in association with a mortality event of multiple wild birds.	Any condition.	Low risk of HPAI infection, because aerosolization of contaminated particles is unlikely.	Impermeable (pvc or nitrile) gloves. Eye protection.	Bag birds using technique to minimize contact and generation of airborne contaminated particulate material. Dispose of bag and gloves appropriately. Do not touch any part of exposed person (especially the face) with gloved hands. Other PPE may be necessary depending on specific conditions of the worksite or the tasks. For instance, aprons, face shields or other protection to prevent contact with contaminated material may be useful and more easily cleaned and disinfected. Thoroughly wash hands after removing gloves. See torn or damaged gloves under activity 1.

4) Handling apparently healthy birds.	Definitive diagnosis of HPAI, or presumptive diagnosis in association with bird mortality⁴, within 6.2¹ miles of work area.	Increased risk of HPAI infection due to aerosolization of contaminated material via dust generation or soiling of clothing with contaminated material.	Impermeable (pvc or nitrile) gloves Goggles NIOSH-approved particulate respirator, N-95 or better.² Disposable gowns or coveralls or cleanable waders/raingear. Rubber boots or boot covers	Same hygiene practices as in item 2. If working indoors, work in well-ventilated areas. When working outdoors, work upwind of animals, to the extent practical, to decrease the risk of inhaling airborne particulate matter such as dust, feathers, or dander. Do not touch any part of exposed person (especially the face) with gloved hands. Other PPE may be necessary depending on specific conditions of the worksite or the tasks. For instance, aprons, face shields or other protection to prevent contact with contaminated material may be useful and more easily cleaned and disinfected. See torn or damaged gloves under activity 1. See work practices under activity 2 for proper procedure for removal of PPE.

5) Investigating, handling, and/or disposing of multiple sick or dead birds associated with a wild bird mortality event.	Definitive diagnosis of HPAI, or presumptive diagnosis in association with bird mortality⁴ within the flyway within previous 30 days	Increased risk of HPAI infection due to aerosolization of contaminated material via dust generation or soiling of clothing with contaminated material.	Impermeable (pvc or nitrile) gloves Goggles NIOSH-approved particulate respirator, N-95 or better.² Disposable gowns or coveralls or cleanable waders/raingear. Rubber boots or boot covers	Same hygiene practices as in item 2. Use dust suppression techniques. Use work practices to minimize direct contact with birds and secretions, feathers and dander. Do not touch any part of exposed person (especially the face) with gloved hands. Other PPE may be necessary depending on specific conditions of the worksite or the tasks. For instance, aprons, face shields or other protection to prevent contact with contaminated material may be useful and more easily cleaned and disinfected. See torn or damaged gloves under activity 1. See work practices under activity 2 for proper procedure for removal of PPE. Note: If oils are used for dust suppression, use NIOSH-approved respirators that are rated for use with oils, R-95 (somewhat oil resistant) or P-95 (strongly oil resistant) respirators.

6) Small scale cleaning and disinfecting, through wipe down of equipment known or suspected to be contaminated with avian influenza virus when aerosolizing particles is unlikely.	Definitive diagnosis of HPAI, or presumptive diagnosis in association with bird mortality⁴ within 6.2 miles¹ of the work site.	Low risk of HPAI infection via inhalation, because aerosolization of contaminated particles or soiling of clothing from contact with contaminated material is unlikely.	Impermeable (pvc or nitrile) gloves Goggles	Surfaces of equipment and reusable PPE should be cleaned with detergent and water and then disinfected using an antimicrobial pesticide registered by EPA and bearing a claim to inactivate avian influenza A (see www.epa.gov/pesticides/factsheets/avian.htm for list of registered products). All safety precaution and use directions on the pesticide label must be followed. If registered product is not available, then use 6 oz. (3/4 cup) of household bleach (5.25-6.00% sodium hypochlorite) per gallon of water for hard, non-porous surfaces. Do not touch any part of exposed person (especially the face) with gloved hands. Other PPE may be necessary depending on specific conditions of the worksite or the tasks. For instance, aprons, face shields or other protection to prevent contact with contaminated material may be useful and more easily cleaned and disinfected. See torn or damaged gloves under activity 1. Remove eye protection after hands have been washed and place in designated receptacle for subsequent cleaning and disinfection. Clean hands with soap and water a second time (or an alcohol-based hand gel when soap and water are not available) immediately after PPE is removed.

7) Large scale decontamination (decon) or cleaning operations involving dusty conditions or risk of aerosolizing contaminants.	Definitive diagnosis of HPAI, or presumptive diagnosis in association with bird mortality⁴ within 6.2¹ miles of the work area	Increased risk of HPAI infection due to aerosolization of contaminated material or soiling of clothing with contaminated material.	Impermeable (pvc or nitrile) gloves Goggles NIOSH approved particulate respirator, N-95 or better.² Disposable gowns or coveralls or cleanable waders/raingear. Rubber boots or disposable boot covers	Avoid generating mists with water sprayers during equipment decon procedures (i.e., hosing out the bed of a contaminated truck, hosing off contaminated equipment, etc.) Use general cleaning procedures listed above. Do not touch any part of exposed person (especially the face) with gloved hands. Other PPE may be necessary depending on specific conditions of the worksite or the tasks. For instance, aprons, face shields or other protection to prevent contact with contaminated material may be useful and more easily cleaned and disinfected. See torn or damaged gloves under activity 1. See work practices under activity 2 for proper procedure for removal of PPE.

8) Wildlife inspectors at Port of Entry points into U.S.	Handling import shipments of wild birds (i.e. port of entry operations) Presence of avian influenza - unknown.	Possibility of dust generation and direct contact with bird secretions, feathers and dander.	Impermeable (pvc or nitrile) gloves Goggles NIOSH approved particulate respirator, N-95 or better.² Disposable gowns or coveralls or cleanable waders/raingear. Shoe covers	Follow established practices including decon procedures as described in wildlife inspector training manual. Do not touch any part of exposed person (especially the face) with gloved hands. Other PPE may be necessary depending on specific conditions of the worksite or the tasks. For instance, aprons, face shields or other protection to prevent contact with contaminated material may be useful and more easily cleaned and disinfected. See torn or damaged gloves under activity 1. See work practices under activity 2 for proper procedure for removal of PPE.

9) High exposure tasks (not otherwise identified above)	Definitive diagnosis of HPAI, or presumptive diagnosis in association with bird mortality⁴ within 6.2¹ miles of the work area	Increased risk of HPAI infection due to aerosolization of contaminated material or soiling of clothing with contaminated material.	Consultation with safety and health professionals.²	Consultation with safety and health professionals.