Avian Influenza

Control and Prevention

Effective strategies for controlling and preventing worker exposure to avian influenza depend on the risk of exposure and the work tasks performed. Appropriate precautions are critical to protect high risk workers if avian influenza is detected in wild bird and poultry populations.

General Recommendations for Employers

Conduct a hazard analysis to identify workers at risk of exposure to avian influenza viruses prior to instituting control measures. Consider work operations and tasks when performing hazard analyses. Employers should develop specific work instructions to ensure procedures are followed consistently.

Select appropriate controls, including engineering controls, administrative controls, safe work practices, and personal protective equipment (PPE), based on the results of the hazard analysis. Some controls may be required by OSHA standards.

Offer workers the option for vaccination with the most recent seasonal influenza vaccine. The seasonal influenza vaccine will not prevent avian influenza but can reduce the likelihood of getting sick with both human and avian influenza viruses at the same time.

Ensure all workers have access to hand washing facilities equipped with adequate hand-washing supplies in accordance with 29 CFR 1910.141.

Personal Protective Equipment

Provide workers with appropriate PPE based on the results of the hazard analysis. PPE might include but is not limited to:

Disposable gloves
Disposable protective shoe covers or boots,
Disposable head cover or hair cover, and if needed beard cover
Protective fluid-resistant or chemical-impermeable clothing (e.g., long-sleeved coveralls with a waterproof apron that can be cleaned and disinfected or disposed of).
Properly-fitted unvented or indirectly vented safety goggles.
If it is determined that workers need respirators, use a NIOSH-approved air-purifying respirators with a particulate filter that is rated N95 or higher. Respirators must be used as part of a comprehensive respiratory protection program that includes medical exams, fit testing, training, and meets the provisions of OSHA's Respiratory Protection Standard (29 CFR 1910.134).

See OSHA's Personal Protective Equipment Safety and Health Topics and Respiratory Protection Safety and Health Topics pages for additional information on PPE and respirator selection and use. For additional information about PPE, see also CDC's Interim Guidance for Employers to Reduce the Risk of Novel Influenza A for People Working with or Exposed to Animals.

Employers should implement programs to protect workers from the effects of heat stress when using PPE, which can be more insulating than regular work clothing. Train workers on the symptoms of heat stress and the appropriate actions to take to ensure such illnesses do not occur. Refer to OSHA's Protecting Workers from Heat Stress and the Occupational Heat Exposure Safety and Health Topics page for more information on protecting workers from heat stress while wearing PPE.

Training

Train workers who may have contact with potentially infected birds, materials, or people to understand their risk of exposure to avian influenza based on the jobs they perform. Make sure that workers understand the controls in place and protective measures available to prevent or reduce exposure to avian influenza in the workplace. Training should include housekeeping practices, when and how to sanitize surfaces, and how to minimize dust (e.g., wetting/misting prior to sweeping potentially infected materials).

Train workers to use PPE appropriately. OSHA requires training on when to use PPE; what PPE is necessary; how to properly put on, use and take off PPE; how to properly dispose of or disinfect, inspect for damage and maintain PPE; and the limitations of PPE. Applicable standards in 29 CFR 1910 Subpart I include those for personal protective equipment (29 CFR 1910.132), eye and face protection (29 CFR 1910.133), hand protection (29 CFR 1910.138) and respiratory protection (29 CFR 1910.134). OSHA offers a variety of training videos on respiratory protection.

When workers are exposed to human blood or other potentially infectious materials, workers must receive training required by the Bloodborne Pathogens (BBP) standard (29 CFR 1910.1030), including information about how to recognize tasks that may involve exposure and the methods to reduce exposure (e.g., engineering controls, administrative controls, work practices, and PPE). Such exposure may occur when evaluating or treating patients with suspected or confirmed avian influenza infection or when handling laboratory specimens from these patients. More information on OSHA's BBP training regulations and policies is available for employers and workers on the OSHA Bloodborne Pathogens and Needlestick Prevention Safety and Health Topics page.

Cleaning and Disinfecting

Protect workers from chemical exposures when cleaning and disinfecting areas, surfaces, and equipment potentially contaminated with avian influenza. For hazardous chemical exposures, train workers on the hazards of the chemicals, and provide appropriate PPE and training based on the results of the hazard analysis. Where respiratory protection is worn, respirators must be used as part of a comprehensive respiratory protection program that includes medical evaluations, fit testing, training, and meets the requirements of OSHA's Respiratory Protection standard (29 CFR 1910.134). OSHA standards for PPE (29 CFR 1910 Subpart I) and Hazard Communication (29 CFR 1910.1200) require employers to protect workers. See the Standards page for more detailed information.

General Precautions for Workers

All workers with potential exposure to avian influenza viruses should take the following precautions:

Avoid unprotected contact with birds and bird secretions or excrement. This includes inhalation of dust contaminated with bird secretions and excrement.
Select PPE that is appropriate for the job task(s) performed and use PPE properly. Use gloves appropriate for the task. Wear lightweight, disposable gloves or heavy-duty rubber work gloves that can be easily cleaned and disinfected. Avoid touching your face with gloved hands. Wear disposable outer garments, coveralls, or gowns with long, cuffed sleeves, and a waterproof apron. Wear disposable shoe covers or boots that can be easily cleaned and disinfected. Wear safety goggles and a disposable head or hair covering and if needed, beard covering.

While wearing PPE, avoid eating, drinking, and smoking. Remove gloves promptly after use and change gloves if torn, punctured, or otherwise damaged. Remove all PPE at work to avoid taking contaminated items home.
Wear respiratory protection. A NIOSH-certified N95 filtering facepiece respirator or better should be worn as part of a comprehensive respiratory protection program that includes medical exams, training, and fit testing, and that meets the requirements of OSHA's Respiratory Protection standard (29 CFR 1910.134). If unable to wear a disposable particulate respirator because of facial hair or other fit limitations, wear respirators that do not require a face seal (e.g., positive pressure respirators of the hood and helmet type, or types that can be used with a continuous-flow, supplied-air respirator). Respirators may also be provided for voluntary use.

The particulate respirators recommended above are not appropriate for protection against chemicals used in disinfection activities. The OSHA Safety and Health Information Bulletin Avian Influenza - Protecting Poultry Workers at Risk provides a table listing the advantages, disadvantages, and costs of the five types of air-purifying respirators in order of increasing levels of protection. See 2004 NIOSH Respirator Selection Logic for guidance on the protective capabilities of respirators.
Carefully clean and disinfect contaminated areas. Use U.S. Environmental Protection Agency (EPA) registered antimicrobial products with label claims for avian influenza. Carefully follow the directions on the label to handle and safely use the antimicrobial product and avoid harm to workers and the environment. Employers must also follow requirements in mandatory OSHA standards for Hazard Communication, 29 CFR 1910.1200, and PPE, 29 CFR 1910.132, .133, .134, and .138, when these chemicals are used.
Follow good hand hygiene and decontamination practices. Wash hands thoroughly and frequently for at least 15 seconds with soap and water. If soap and water are not available, use hand sanitizer containing at least 60 percent alcohol. Hand hygiene is especially important after contact with infected or exposed poultry; after contact with surfaces contaminated with bird mucus, saliva, or feces; after removing PPE; and prior to eating, drinking, smoking or bathroom use. The Centers for Disease Control and Prevention (CDC) provides additional information about effective hand hygiene practices. Shower at the end of each shift (or as soon as possible).
Get the seasonal influenza (flu) vaccine. The seasonal flu vaccine will not prevent avian influenza but can reduce the likelihood of getting sick with both human and avian influenza viruses at the same time.
If you are sick, stay at home except to get medical attention. If you believe that you may have been exposed to avian influenza, tell your employer and monitor your health for 10 days. If you become ill with a fever or develop a cough or difficulty breathing, consult with your healthcare provider and contact your state or local health department for additional guidance.

Additional Measures for Specific Industries

Some workers may require additional levels of protection because of the industry they work in or the job they do. These recommendations and relevant OSHA standards also provide a framework for protecting state and local workers in states where OSHA or an approved State Plan do not have authority over those workers' safety and health. Please note that the following recommendations are to be used in addition to the general guidance provided elsewhere in this document.

Poultry Workers

On rare occasions, poultry workers or others who have contact with infected poultry or contaminated surfaces have been infected with avian influenza. Examples of workers potentially at risk include poultry processing workers; service technicians of poultry processing companies; workers caring for birds; layer barn workers and chick movers at egg production facilities; and workers involved in disease control and eradication activities, including state, federal, and contract workers.

Plan for avian influenza. Make sure that an avian influenza response plan has been developed to complement regional, state, and industry plans prior to an avian influenza outbreak.
Implement biosecurity practices and ensure workers follow those practices to prevent the introduction of avian influenza and other diseases into poultry flocks. Keep poultry flocks isolated from wild animals and wild bird populations. Restrict visitors to poultry farms. Provide workers with clean protective clothing, equipment, and disinfection facilities, and institute cleaning and disinfection practices that include equipment and vehicles entering and leaving the farm. Implement procedures to quarantine the farm to prevent spread of disease and monitor poultry flocks for avian influenza. The U.S. Department of Agriculture (USDA) provides additional information on biosecurity in their Defend the Flock program.
Ensure adequate ventilation to bring clean outdoor air into poultry houses, including to replace contaminated air and control any airborne contaminants.
Participate in health surveillance and monitoring programs. If you had close contact with infected birds or surfaces contaminated by them because you are responding to a bird flu outbreak as part of your job, your state or local health department should contact you. Follow the USDA Public Health Monitoring Plan and CDC information for People Exposed to Birds or Other Animals Infected with Avian Influenza Viruses. Monitor your health for symptoms of avian influenza virus infection for 10 days and call your state or local health department immediately if you develop any illness signs or symptoms. Most of the signs and symptoms of avian influenza overlap with those of other respiratory illnesses. Your health department wants to hear from you, even if it turns out to not be avian influenza. If you have symptoms, stay home and limit contact with others as much as possible until the results from your avian influenza test are known. Your state or local public health department can assist in monitoring and advising when isolation is no longer required.

For more guidelines on protecting workers involved in poultry culling and depopulation see the NIOSH alert Protecting Poultry Workers from Avian Influenza, the U.S. Department of Agriculture and National Institute of Environmental Health Sciences worker training Protecting Yourself from Avian Influenza and the Occupational Safety and Health Administrations Avian Flu publications.

Animal Handlers (other than poultry workers)

While avian influenza is mostly a concern for employers and workers in domestic poultry farms, workers in pet shops, veterinary practices, and zoos must be aware of the possibility of birds infected with avian influenza. Other animals such as cats, pigs, ferrets, and dogs can also become infected with and spread avian influenza. The control measures described below should be used in addition to the measures for all workers with potential exposure described above.

Monitor animals for any unusual, flu-like symptoms. For example, symptoms in cats may include fever, listlessness, conjunctivitis, difficulty breathing, and death. Immediately notify federal or state animal health officials or local agricultural control agents when encountering sick birds or other animals exhibiting symptoms of possible avian influenza infection.
Avoid handling animals potentially infected with avian influenza as much as possible. After reporting potentially infected animals, allow the federal or state officials to handle these animals. If there is no other alternative, use appropriate PPE when isolating sick animals or removing dead animals.

Healthcare Workers

Healthcare workers and their employers who treat known or suspected persons with avian influenza should take specific precautions to prevent the spread of avian influenza.

Install and properly maintain appropriate air-handling systems in healthcare facilities. Acute care facilities should already have appropriate heating, ventilation, and air conditioning (HVAC) systems (including appropriate exhaust and filtration) to help control exposure to avian influenza viruses. See the CDC's Guidelines for Environmental Infection Control in Health-Care Facilities for detailed information on air-handling systems and other infection controls in healthcare facilities.
Place patients with suspected avian influenza infection in an Airborne Infection Isolation Room (AIIR). If an AIIR is not available, place a facemask on the patient (if the patient can tolerate wearing one) and isolate the patient in an examination room with the door closed. Transfer the patient as soon as possible to a facility where an AIIR is available. The CDC's 2007 Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings provides additional information on isolation rooms.
Implement policies and practices to minimize potential exposures to avian influenza before arrival, upon arrival, and throughout an affected patient's presence in the healthcare setting. Avoid transporting patients outside the isolation room unless necessary and limit the numbers of healthcare workers caring for patients and visitors allowed to see the patients.
Track all healthcare workers and support staff who care for or enter the rooms of confirmed or suspected avian influenza patients. Implement a policy for healthcare workers who develop respiratory symptoms after an exposure to avian influenza. Workers should notify their supervisor, receive prompt medical evaluation, and comply with work exclusion (i.e., stay home) until they are no longer contagious. Implement sick leave policies for healthcare workers that are non-punitive (e.g., that do not reduce a worker's pay, benefits or standing), flexible and consistent with public health guidance.

Laboratory Workers

Exposure to avian influenza viruses in clinical, research, and production laboratory workers can occur through inhalation and direct contact. Inhalation may occur from aerosols generated by manipulating viral cultures, handling avian influenza virus-infected samples, or inoculating research animals. Direct contact of the eyes, nose, and mouth with bare hands or gloves contaminated with avian influenza may occur after handling viral cultures or infected human and animal samples including nasopharyngeal and oral secretions, blood, tissues, and excrement.

Refer to the U.S. Department of Health and Human Services' Biosafety in Microbiological and Biomedical Laboratories (BMBL), 6th edition for detailed guidance on biosafety controls when working with avian influenza.

Use Biosafety Level 2 (BLS-2) practices for diagnostic, research and production activities involving low pathogenic avian influenza (LPAI) viruses and Animal Biosafety Level 2 (ABSL-2) practices for work with these viruses in animal models.
Use BSL-3 and ABSL-3 practices, procedures, and facilities for work involving highly pathogenic avian influenza (HPAI) viruses, with rigorous adherence to additional respiratory protection, showering and clothing change protocols.

Laboratories Working with LPAI viruses

Use engineering controls including the use of a biosafety cabinet (BSC). Ensure that laboratory entrances and exits have self-closing doors. Conduct aerosol-generating procedures in a properly installed, maintained, and certified Class II BSC. If possible, conduct all work with infectious samples in the BSC. The OSHA Fact Sheet, Laboratory Safety Biosafety Cabinets, provides guidance on training and effective use of BSCs.
Restrict access to the laboratory during work operations and post appropriate biohazard warning signs at the entrance.
Enroll laboratory workers in a medical surveillance program.
Minimize work tasks that contribute to the generation of bioaerosols or droplet sprays. These may include using syringes, pipetting, vortexing, centrifuging, and opening/closing sample tubes.
Dispose of contaminated material in appropriate biohazard containers and autoclave, incinerate, or inactivate it using an alternative method of decontamination.
Use respiratory protection and PPE appropriate for the work tasks performed. In laboratories, the BMBL guidance can help employers select appropriate respiratory protection and PPE. All PPE worn in the laboratory should be considered contaminated.

Laboratories Working with HPAI Viruses

HPAI virus is a Select Agent regulated by the US Federal Select Agent Program (FSAP; 7 U.S.C. 8401; 7 CFR 2.22, 2.80, and 371.4.) The FSAP regulates the possession, use, and transfer of biological select agents. A facility must be registered with FSAP before propagation or culture of live, wild-type, HPAI. All work with HPAI virus must be conducted in a USDA-approved Biosafety Level 3 or 4 enhanced containment facility. Refer to USDA Guidelines for Avian Influenza Viruses for more information.

Follow appropriate BSL precautions. Work must be conducted under BSL-4 and ABSL-4 or BSL-3 conditions. Laboratory work with HPAI conducted in BSL-4 and ABSL-4 laboratories do not require additional provisions. All FSAP requirements must be met for BSL-3 conditions