Control and Prevention

Most workers in the U.S. are very unlikely to encounter ebolavirus or individuals with EVD. However, exposure to the virus or someone with EVD may be more likely in certain sectors, including the healthcare, mortuary/death care, and airline servicing industries. Workers who interact with people, animals, goods, and equipment arriving in the U.S. from foreign countries with current EVD outbreaks are at the greatest risk for exposure.

Precautionary measures for preventing exposure to ebolavirus depend on the type of work, potential for ebolavirus contamination of the work environment, and what is known about other potential exposure hazards. Infection control strategies may have to be modified to include additional selections of personal protective equipment (PPE), administrative controls, and/or safe work practices.

General Recommendations for Employers

Employers are responsible for ensuring their workers are protected from exposures to recognized bloodborne pathogens, including ebolaviruses, and related hazards. Employers of workers who may be exposed on the job must follow OSHA requirements to protect workers from exposure.

Conduct hazard assessments for workers whose jobs may increase the likelihood of exposure to ebolavirus, with consideration given to potential sources of infection, including risks and routes of exposure associated with work procedures and job tasks.

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 the option for vaccination to eligible workers whose jobs put them at risk for exposure to EVD.

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

Bloodborne Pathogens

The Bloodborne Pathogens standard (BBP) requires employers to develop a written Exposure Control Plan that details the job classifications in which workers have occupational exposure to human blood and body fluids containing blood along with the tasks performed by such workers that result in exposure. Under the BBP standard

• "Occupational exposure" means reasonably anticipated skin, eye, mucous membrane, or parenteral (i.e., routes other than the gastrointestinal tract, such as through injection) contact with blood or other potentially infectious materials (OPIM) that may result from the performance of an employee's duties. See 29 CFR 1910.1030(b).
• OPIM includes semen, vaginal secretions, saliva in dental procedures, specific bodily fluids (cerebrospinal, synovial, pleural, pericardial, peritoneal, and amniotic), anybody fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids. In addition, OPIM includes any unfixed tissue or organs (other than intact skin) from a human (living or dead). Human immunodeficiency virus (HIV)-containing cell or tissue cultures, organ cultures, and HIV- or hepatitis-B virus (HBV)-containing culture medium or other solutions are also OPIM, as are blood, organs, or other tissues from experimental animals infected with HIV or HBV.S Although the BBP standard does not include them in the definition of OPIM, the provisions of the standard offer a framework that may help control other sources of the virus, such as sweat, breast milk, vomit, urine, and feces from an individual with suspected or confirmed EVD.

Early identification and isolation of potentially infectious people is a key step in preventing the spread of EVD, particularly for workers who may be exposed on the job to a person with the virus. Employers should follow recognized and generally accepted good infection control practices and must comply with applicable requirements in the Bloodborne Pathogens standard (29 CFR 1910.1030).

Personal Protective Equipment (PPE)

When engineering or administrative and work practice controls are insufficient to prevent employee exposure to the ebolavirus, or before engineering controls can be implemented, employers must provide appropriate PPE for workers.

OSHA's PPE Selection Matrix for Occupational Exposure to Ebola Virus provides task-based guidance to help employers select appropriate PPE for workers who may be exposed to ebolavirus. The matrix covers examples of common exposures, ranging from casual interaction with individuals with risk factors for EVD, such as in airport screening operations; medical and supportive care to patients with suspected or confirmed EVD in hospital settings; and maintenance and waste handling tasks where ebolavirus contamination may be present. In addition, employers should ensure workers follow effective hand hygiene practices.

Typically, the level of PPE that workers must wear corresponds to the risk identified in required hazard assessments and exposure determinations. Consider the work tasks being performed and their relationship to potential sources of worker exposure. Ensure that at risk workers wear PPE as required to prevent exposure to the virus via mucous membranes, non-intact skin, or through inhalation of aerosolized droplets of infectious material.

The general requirements of the PPE standards (29 CFR 1910.132) describe the basis for the effective selection and use of adequate PPE including protective garments. Employers must ensure that respiratory, head, face, and hand protection is provided for workers who may be splashed, sprayed, or spattered with blood or body fluids and from environmental surfaces where ebolavirus contamination is possible. Types of PPE suited for protection against ebolavirus include powered air-purifying respirators (PAPRs) or an N-95 respirator used with goggles and a full-face plastic shield. Aprons or other fluid-resistant protective clothing must also be worn in these situations to prevent the worker's clothes from being soiled with infectious material. Employers must:

• Provide respirators to protect employees from potential exposure to aerosols containing the ebolavirus or hazardous chemicals. The Respiratory Protection standard, 29 CFR 1910.134, requires employers to identify and evaluate respiratory hazards in the workplace. If respiratory hazards exist, employers must implement a comprehensive, written respiratory protection program that includes training, fit testing, medical evaluation, and use of National Institute for Occupational Safety and Health (NIOSH)-certified respirators.
• Ensure PPE is cleaned, repaired, and replaced, as needed. Provision, maintenance, repair, and replacement must be provided at no cost to the worker in accordance with 29 CFR 1910.132(h)(1).
• Train workers at risk for exposure to don (put on), use, and doff (take off) PPE in a way that avoids self-contamination. This may include removing outer gloves simultaneously with the gown, decontaminating PPE between removal steps, and / or other measures. The order of PPE removal may depend on the type of PPE a worker uses, the nature of the work tasks being performed, and which devices or garments are contaminated, among other factors.

Cleaning and Disinfection

Ebolavirus in body fluid remains viable outside of the body for several days. An evaluation of the persistence of ebolavirus on common materials found in hospital rooms and airline cabins showed that the virus remains viable for 7 days or longer in dried whole blood at 90% relative humidity but cannot be recovered and cultured from vomit or feces.

Workers must be protected from exposure to harmful chemicals when cleaning and disinfecting areas contaminated with blood and/or body fluids suspected or confirmed to be infected with ebolavirus. Disinfectants proven effective against ebolavirus are described on the U.S. Environmental Protection Agency's (EPA) List L: Disinfectants for Use Against Ebola Virus and List Q: Disinfectants for Emerging Viral Pathogens (EVP).

OSHA provides guidance for workers and employers in non-healthcare/non-laboratory settings for Cleaning and Decontamination of Ebola on Surfaces.

Note: In all settings, avoid using compressed air or pressurized water when cleaning surfaces, as it may cause droplets containing infectious material to become aerosolized (i.e., create a bioaerosol).

Waste Management

All waste suspected to be contaminated with blood, body fluids, or any materials that may be infected with ebolavirus is considered Category A waste, which is defined as waste that is contaminated with an infectious substance "capable of causing permanent disability or life-threatening or fatal disease in otherwise healthy humans or animals when exposure to it occurs".

Category A waste is subject to the U.S. Department of Transportation's Hazardous Materials Regulation (HMR), 49 C.F.R. Parts 171-180, as well as any additional State and Local regulations governing waste management and transportation.

The U.S. Department of Transportation (DOT)/Pipeline and Hazardous Materials Safety Administration regulates movement and certain other aspects related to the management of known or suspected Category A waste, including waste through its HMR. DOT provides Guidance for Preparing Packages of Ebola Contaminated Waste for Transportation and Disposal.

Prevention

Prevention of the most commonly occurring ebolavirus, Zaire ebolavirus (EBOV), is possible with the Food and Drug Administration (FDA)-approved vaccine, rVSV-ZEBOV (Ervebo®). Ervebo® is a live-attenuated, single-dose vaccine for preventative use in workers who are responding to or planning to respond to an EVD outbreak.

In addition, the Advisory Committee on Immunization Practices recommends pre-exposure prophylaxis vaccination with Ervebo® for adults 18 years of age or older in the U.S. population who are at potential occupational risk of exposure to EBOV. This recommendation includes the following workers:

• Laboratory and/or other staff working with live ebolavirus at high containment facilities in the United States; and
• Healthcare workers at federally designated Ebola Treatment Centers in the United States.

Visit CDC's Ebola Disease: Prevention and Vaccine for more information.

Medical Management and Follow-Up.

Individuals who may have come in contact with ebolavirus may be quarantined at the discretion of public health officials. It is important for employers to ensure that workers who may be infected receive prompt and appropriate medical evaluation and follow-up, which may include post-exposure prophylaxis similar to the elements described in the BBP standard 29 CFR 1910.1030(f)(3), and to separate and isolate potentially infected workers from others to prevent transmission. In addition, most states require that procedures for reporting ebolavirus-related exposure incidents are in place. CDC's Ebola Disease page provides the most up-to-date information on medical aspects of ebolavirus infection and EVD.

Two biologic drug treatments have been approved by the FDA for use in Individuals who become infected with EBOV. These are Inmazeb (atoltivimab, maftivimab, and odesivimab-ebgn) and Ebanga (ansuvimab-zykl). Please visit CDC's Ebola Disease Treatment website for more information.

General Precautions for Workers

All workers with potential exposure to ebolaviruses should take the following precautions:

1. Avoid direct unprotected contact with persons (or animals) suspected or known to have EVD and with blood, body fluids and objects and materials that have been used by persons (or animals) suspected or known to have EVD, since these may harbor ebolavirus.
2. Select PPE that is appropriate for both the amount of contamination (area or volume of infected materials) and the job or task being performed. If ebolavirus contamination is known or suspected, at minimum, a long-sleeved, closed-front gown, disposable nitrile or powder-free latex gloves, eye protection (goggles or face shield), and a NIOSH-certified N-95, fit-tested respirator should be worn. Workers performing tasks in or cleaning large areas of contamination or areas with a large concentration or volume of potentially infectious material need to wear PPE that provides greater protection. Outerwear should include shoe/boot covers, a waterproof gown or apron, head covering, and a PAPR as described in the Healthcare Workers and Employers section.
3. Thoroughly inspect all PPE before use to ensure it is intact and functioning properly. Wearing many types of PPE requires training to don and doff it properly to avoid contaminating yourself and the objects around you prior to disposal. For your protection, you will be required to have a medical evaluation and be fit-tested before being assigned to use a respirator. If it is determined that you are unable to wear a filtering facepiece respirator (mask-type) you may be provided with a loose-fitting PAPR device.
4. Carefully clean and disinfect contaminated areas using products registered and approved for use against ebolaviruses (List L). Follow OSHA instructions for Cleaning and Decontamination of Ebola on Surfaces. Note: particulate respirators do not provide protection against chemicals used in disinfection activities, so work in a well-ventilated area or refer to the NIOSH Respirator Selection Guide for more information.
5. Dispose of all contaminated materials in a labeled biohazardous waste container upon completion of the work task. Carefully remove PPE (video), set aside reusable items for decontamination and discard disposable items in biohazardous waste. Wash hands thoroughly with soap and water or use an alcohol-based hand rub if soap and water are not available.
6. 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 removing PPE and prior to eating, drinking, smoking, or bathroom use. The CDC provides additional information about effective hand hygiene practices. It is recommended that workers potentially exposed to ebolavirus take a shower at the end of each shift (or as soon as possible) to avoid self-contamination.
7. If you are sick, stay at home and call your healthcare provider. If you believe that you may have been exposed to ebolavirus, tell your employer, and monitor your health for 21 days. If you become ill with a fever, sore throat, weakness, stomach pains, loss of appetite, vomiting and/or diarrhea, or have unexplained bruising or bleeding, consult with your healthcare provider, and contact your state or local health department for additional guidance.

For more information, see CDC's Guidance on Personal Protective Equipment (PPE) for Healthcare Workers.