Infection with Bacillus anthracis, (BA), which causes anthrax, occurs through direct exposure to active bacteria or bacterial
spores. Measures for protecting workers from exposure to BA depend on the type of work performed and knowledge of exposure risk, including potential for spore release from an accidental or intentional event. Adaptation of infection control strategies based on a thorough hazard assessment is necessary for implementing infection prevention and control measures, including
engineering and administrative controls, safe work practices, and personal protective equipment (PPE). This page provides information both for workers and employers of workers whose potential BA exposures fall into two categories: BA EXPOSURE RISK ASSOCIATED WITH WORK TASKS
Employers whose workers will be involved in emergency response operations for releases of, or substantial threats of releases of, hazardous substances (including BA) regardless of the location of the hazard must comply with OSHA's HAZWOPER standard (29 CFR 1910.120). This may include emergency response following an anthrax incident. Instruction CPL 02-02-073 describes OSHA enforcement procedures under the relevant provisions of the HAZWOPER standard. The U.S. Environmental Protection Agency (EPA) has promulgated a standard applying OSHA's HAZWOPER standard to state and local government workers in states where there is no OSHA-approved State Plan. See 40 CFR Part 311. OSHA's HAZWOPER Safety and Health Topics page explains requirements of the OSHA HAZWOPER standard, including required worker training. The OSHA Biological Agents Safety and Health Topics page also provides information for emergency response and clean-up workers. In addition to the guidance provided for general businesses, this page provides specific information for categories of workers OSHA has identified as having a higher risk of exposure to BA. General Guidance for Workers at Risk of BA Exposure Due to Specific Work Tasks
A. Standard Precautions Follow good infection control practices (e.g., standard precautions) for preventing contact with BA. Standard precautions include hand hygiene and use of appropriate PPE to avoid direct contact with BA. Standard precautions also include safe waste management and cleaning and disinfection of surfaces and equipment. Practice good hand hygiene protocols to avoid exposure resulting from touching contaminated objects or other contaminated environmental surfaces. Hand hygiene consists of washing with soap and water. Keeping cuts and abrasions covered with bandages will also help prevent BA spores from entering those wounds. The World Health Organization's (WHO) Guidelines on Hand Hygiene in Healthcare suggest that washing hands with either non-antimicrobial soap or antimicrobial soap and water reduced the amount of B. atrophaeus (a surrogate or stand-in germ used in experiments where it is unsafe to test for BA directly) on hands, while alcohol-based hand rubs do not.1 The effectiveness of washing hands with soap and water is likely due to the mechanical friction involved when rubbing the hands together. Perform hand hygiene after performing any job task with the potential for BA contamination, including contact with contaminated material that may contain BA spores, and before putting on and promptly after removal of PPE, including gloves. B. Cleaning & Disinfection BA is persistent in the environment for long periods of time, and small particles can stay suspended in the air or be re-aerosolized by agitation and air currents within buildings and other environments. This creates the potential for BA transmission from contaminated environmental surfaces or fomites (objects that can spread germs) and the need for effective cleaning and decontamination strategies. Selection of chemicals for disinfection and sterilization when BA is a contaminant of concern depend on the situation:
Regardless of the situation, effectiveness at inactivating BA may also be determined based on data associated with inactivating similar or hardier (i.e., more difficult to inactivate) spore-producing bacteria. Protect workers from exposure when tasked with cleaning surfaces and equipment potentially contaminated with BA. This may include using engineering controls, such as ventilation, along with administrative controls, safe work practices, and PPE, such as chemical-resistant or -impermeable garments and a respirator with an N95 particulate/chemical combination cartridge. See the Personal Protective Equipment section below for additional information. 2 W.A. Rutala, D.J. Weber, and the Healthcare Infection Control Practices Advisory Committee (HICPAC), "Guideline for Disinfection and Sterilization in Healthcare Facilities," Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services (HHS) (2008). C. Personal Protective Equipment PPE includes appropriate respiratory protection, protective garments (e.g., coveralls, boot covers, chemical-resistant or -impermeable suits), eye and face protection, and gloves (nitrile or vinyl). Employers should base the use of PPE on the situation and tasks involved, including to the degree of contamination, risk of exposure, exposure pathway, and anticipated level of exposure. Select PPE for workers based on the worst-case exposure scenario and in accordance with OSHA's PPE standards (29 CFR 1910 Subpart I). PPE must be sufficient for the type and level of exposure anticipated. Base the choice of glove material (e.g., nitrile, vinyl) on the chemical manufacturer's information. However, factors to consider also include safety, fit, durability, and comfort. If necessary, use vinyl or nitrile gloves under heavier gloves (e.g., leather, heavy cotton) for operations with potential for glove tearing or for protection against hand injury. Thoroughly wash hands with soap and water upon removing gloves, before eating, and when replacing torn or worn gloves. Remove gloves prior to leaving the work area and place them in areas specifically designated for storage, washing, decontamination, or disposal (depending on the glove type). Replace disposable gloves as soon as feasible when they are contaminated; immediately if they are cracked, torn, or punctured; whenever removing or changing other PPE; and upon task completion. Decontaminate non-disposable gloves if intact. Do not wash or decontaminate disposable gloves for reuse (although this recommendation does not preclude washing disposable gloves before removing them from the hands). To prevent spreading the contamination to the worker's skin, never wash torn or punctured disposable gloves prior to removal. OSHA's standards for PPE cover glove selection and use (29 CFR 1910.132) as well as hand protection (29 CFR 1910.138). Whether or not respirators are required depends on the potential for inhalation exposure to BA, including aerosolized spores. During emergency response, recovery and clean-up operations, work in a Yellow or Red Zone as defined in the OSHA Anthrax Risk Reduction Matrix may require an appropriate (i.e., properly-fitted, NIOSH-certified N95 or greater) respirator. The matrix provides additional details about respirator selection, including information about when higher levels of respiratory protection may be required. However, if workers request respirators, and employers provide only filtering facepiece respirators (FFRs) for voluntary use by workers, employers must provide workers with the information contained in Appendix D - Information for Employees Using Respirators When Not Required Under the Standard to OSHA's Respiratory Protection standard (29 CFR 1910.134). OSHA provides videos with information that explain voluntary use of respirators. In cases where employers must provide respiratory protection from BA and BA spores (e.g., where a respiratory hazard exists, such as from an ongoing release or activities that could re-aerosolize spores), use NIOSH-approved respirators that are at least as protective as an N95 FFR. (Note that OSHA recommends higher levels of respiratory protection for workers involved in response, sampling, and decontamination activities where exposure to BA spores is possible; see specific sections for those workers, below, for more details on the recommended respiratory protection.) Ensure that the selection of respiratory protection takes into account the agents used for decontamination and provides combination cartridge respirators where both particulate and chemical hazards may be present. Cartridges must be able to withstand moisture levels in the work environment, or be changed on an appropriate schedule, so that their filtration capabilities are not compromised. If organic vapor cartridges are used, implement a cartridge change schedule. Employers should ensure that workers have suitable respiratory and eye and face protection that work in conjunction with one another and that eye protection does not compromise respirator fit. Work tasks, including cleaning and decontamination activities, that involve an increase in moisture and spray may adversely affect disposable N95 respirators and certain other respirators. In such instances, combination particulate/chemical cartridges may be necessary to protect workers from exposure to the chemicals in addition to BA spores. Consider providing a supplied-air respirator (SAR) to improve worker protection. Loose-fitting powered air-purifying respirators (PAPRs) and SARs may also improve worker comfort when wearing respirators for long periods. In addition, provide workers performing tasks in areas where oil mist from machinery is present with respirators equipped with P-type filters (P95 or P100) to prevent the oil mist from degrading the filter. At worksites with mandatory use of respirators, employers must implement a comprehensive respiratory protection program that complies with the provisions of OSHA's Respiratory Protection standard (29 CFR 1910.134). This includes compliance with the standard's requirements for obtaining medical clearance for wearing the respirator and for conducting fit testing prior to actual use of respirators. These requirements of a written respiratory protection program also apply to voluntary use of any respirators other than FFRs. To achieve proper fit, workers with facial hair (beards and/or large moustaches) may require the use of alternative respirators, such as hooded PAPRs, or SARs. OSHA's Respiratory Protection e-Tool provides detailed information on establishing a respiratory protection program. Although BA and its spores are not considered a bloodborne pathogen (BBP), employers still must comply with OSHA's BBP standard (29 CFR 1910.1030) to protect workers with occupational exposure to blood or other potentially infectious materials. Occupational exposure means reasonably anticipated skin, eye, mucous membrane, or parenteral (i.e., elsewhere in/on the body) contact with human blood or other potentially infectious materials that may result from the performance of a worker's duties. OSHA's Bloodborne Pathogens and Needlestick Prevention Safety and Health Topics page provides information on the standard. D. Infectious Waste Worker protection from exposure to infectious agents, including BA, is necessary when work tasks involve handling, treatment, transport, and disposal of medical, laboratory and other potentially contaminated waste. Mishandled contaminated waste may pose a risk to workers. Follow applicable waste disposal requirements for all infectious waste, including packaging requirements found in OSHA's Bloodborne Pathogens standard (29 CFR 1910.1030) when waste includes human blood, body fluids, or other potentially infectious materials. Employers must also comply with the requirements of OSHA's PPE standards (29 CFR 1910 Subpart I), including the Respiratory Protection standard (29 CFR 1910.134), when workers need protective equipment to prevent exposures to hazards covered by those standards during waste management activities. Use an autoclave to inactivate infectious material (i.e., kill all associated infectious agents) in all waste prior to disposal, or develop and follow procedures for safely transporting waste off site for treatment and disposal if on-site autoclaving is not possible. Adhere to applicable federal, state, and local regulations when disposing of laboratory waste, including the U.S. Department of Transportation (DOT) Hazardous Materials Regulations (HMR, 49 CFR 171-180) if transporting waste off-site for treatment and disposal. Under the HMR, waste potentially contaminated with BA generally does not contain a Category A infectious substance unless it includes cultures of BA. State and local requirements may also apply. E. Reporting Illness Ensure that supervisors and all potentially exposed workers are aware of the symptoms of anthrax. Workers potentially exposed to BA or who develop symptoms of anthrax should seek medical evaluation. While symptoms of anthrax usually occur within seven days of exposure, some cases presented symptoms after only one day while others presented symptoms later than two months after exposure.
Where required, report an incident to OSHA by:
Physicians, employers, and/or workers may also contact their state or local health departments to notify them of any symptomatic workers or suspected exposure incidents. Some states may require these incidents to be reported. Workers may continue working after exposure if able since anthrax is not contagious, and transmission primarily occurs through contact with the BA spores. See the Medical Information page for more information on symptoms and anthrax transmission. F. Worker Training Although OSHA's HAZWOPER standard (29 CFR 1910.120) may not apply to non-emergency response workers impacted by a BA release, other OSHA standards may contain applicable training requirements. It is important for employers to:
A training program is required under the HAZWOPER standard (29 CFR 1910.120), section (q) for workers involved in emergency response and clean-up operations. Employers shall provide training to all workers performing operations on the site, such as equipment operators, general site workers, and supervisors or managers potentially exposed to hazardous substances. Workers whose jobs put them at higher risk of exposure need more training than those who do lower-risk jobs. The HAZWOPER standard (29 CFR 1910.120) provides comprehensive information on training requirements for workers involved in emergency response from a terrorist/criminal act resulting in release of BA spores. Train all emergency response workers to recognize and report early symptoms and signs of anthrax, understand the importance of immediate medical attention, know how to access emergency medical care, know about potential adverse effects and interactions with food and drugs if taking antibiotics, and understand the potential adverse effects of the anthrax vaccine and the amount of time necessary to develop an immune response if using the vaccine as a preventive measure. OSHA's HAZWOPER Safety and Health Topics page explains requirements of the OSHA HAZWOPER standard, including the required worker training. Training for workers required to use PPE includes when to use PPE; what PPE is necessary; how to properly don (put on), use, and doff (take off) PPE; how to properly dispose of or disinfect, inspect for damage and maintain PPE; and the limitations of PPE. These and other requirements are found in OSHA's PPE standards (29 CFR 1910 Subpart I), including the PPE (General Requirements) standard (29 CFR 1910.132), the Eye and Face Protection standard (29 CFR 1910.133), and the Respiratory Protection standard (29 CFR 1910.134). OSHA offers a variety of training videos on respiratory protection. When the potential exists for exposures to human blood, body fluids, or other potentially infectious materials, OSHA's BBP standard (29 CFR 1910.1030) requires employers to train workers how to recognize tasks that may involve exposure and how to reduce exposure (e.g., by using engineering and administrative controls, safer work practices, and PPE). The Bloodborne Pathogens and Needlestick Prevention Safety and Health Topics page provides information about training requirements under the BBP standard (29 CFR 1910.1030). DOT's HMR provide additional training requirements for workers preparing contaminated materials or other hazardous materials for transport. OSHA's Training and Reference Materials Library contains training and reference materials developed by the OSHA Directorate of Training and Education (DTE) as well as links to other related sites. The information about PPE and respiratory protection may provide additional material for employers to use in preparing training for their workers. OSHA's Personal Protective Equipment Safety and Health Topics page also provides information on training in the use of PPE. G. Employee Medical Program Requirements & Medical Monitoring OSHA does not have an infectious diseases standard that applies to diseases not covered by the BBP standard (29 CFR 1910.1030); however, certain medical surveillance requirements in other OSHA standards, such as the Respiratory Protection standard (29 CFR 1910.134), may apply to workers with potential exposure to BA (and other diseases spread through inhalation exposure) and for exposure to chemicals used for cleaning and disinfection. See OSHA's Medical Screening and Surveillance Safety & Health Topics page for more details on medical surveillance information, including specific hazards and surveillance guidelines requirements. In bioterrorist/criminal acts involving anthrax, employers must develop workplace medical monitoring programs to address exposure for: Short-Term Response Workers Exposures are limited to a single episode or a few episodes within a brief period (fewer than 30 days). Local emergency medical personnel, police, and firefighters who are not expected to enter and/or re-enter contaminated areas over longer periods of time fall into this category. Long-Term Response and Recovery Workers These individuals have repeated exposures over longer periods of time (30 days or more). Environmental response team members and decontamination workers fall into this category. They may work at multiple sites (such as industrial hygienists conducting environmental sampling) or at a single site (such as contractors performing decontamination work). Occupants, Workers, or Visitors at a Site Contaminated with Anthrax Mail handling workers fall into this category. The medical program for this group covers the immediate post-exposure period and the period after clearance for unrestricted entry and occupancy. Employers also must conduct initial medical screening to identify exposed persons who should avoid taking antibiotics. After clearance for unrestricted entry and occupancy, compile an initial medical history to screen for high-risk conditions (such as compromised immunity, skin conditions). Counsel high-risk persons and provide around-the-clock access to medical coverage for anthrax-like symptoms. Ensure the confidentiality of medical information. Part of the workplace medical program includes medical monitoring. Establish a medical monitoring program to monitor persons exposed to BA for signs and symptoms of anthrax. The intent is to detect adverse effects on a worker's health at an early stage when prevention is possible or treatment is most effective. An effective medical screening program for anthrax includes:
Employers need to develop a plan to inform affected workers about available options for preventing anthrax and the risk and benefits of each option. Information about when exposure monitoring is required should also be included. Inhalation exposure to a high concentration of BA spores may result in rapid death. Therefore, treat as a medical emergency any exposure to aerosolized powder potentially containing or known to contain BA spores. After receiving clearance for re-occupancy, PPE and medical measures to prevent anthrax are no longer required. However, employers may find it prudent to implement a precautionary program of medical monitoring to ensure that anthrax is no longer a threat. The Centers for Disease Control and Prevention provide further information about medical surveillance in BA Contaminated Sites. The HAZWOPER standard (29 CFR 1910.120) also details medical surveillance program requirements. H. If You Think You Have Been Exposed Any worker who thinks he or she may have been exposed to BA—including through handling a contaminated object or package, cleaning a contaminated environment, or contacting a sick animal — should take the following precautions:
See the Medical Information page of this Safety and Health Topics page and the CDC website Symptoms and Medical Care pages for more information. Specific guidance for healthcare workers, below, also describes BA exposure resulting from contact with contaminated patients (e.g., following a bioterrorism event). Specific Guidance for Workers and Employers with Elevated BA Exposure RiskHealthcare workers (HCWs) in hospitals, clinics, and other settingsmay have exposure to BA resulting from contact with spores that may contaminate a patient's skin, clothing, or personal effects, or through contact with contaminated equipment. HCWs may also be at risk of inhaling BA spores that are re-aerosolized (put back into the air) from contaminated patients or if they are in an area where a BA release has occurred. In addition to the General Guidance, applicable to all workers, provided at the beginning of this page, OSHA recommends the following controls for HCWs serving as first receivers of patients potentially exposed to BA. HCWs and their employers involved in emergency response operations outside healthcare facilities should also consult the First Responders section of this web page. Engineering Controls Because anthrax is not generally transmissible from person to person, the engineering controls typically making up the first line of defense for other infectious agents usually are not required when treating patients with possible BA exposure. The exception is when there is visible evidence of powder on the patient that requires decontamination. In such cases, isolate the patient in an airborne infection isolation room (AIIR) until decontamination is completed. Morgues often have ventilation isolation to prevent mixing of airflow with other area systems and are a good option for use as decontamination rooms.3 If AIIRs or other special isolation rooms are not available, isolate potentially contaminated patients away from other patients and staff. Use barriers, such as sheets or disposable coveralls, to prevent spread of the BA spores until completion of decontamination procedures. This is discussed further in the "Administrative controls" section, below. Use high-efficiency particulate arrestance (HEPA) vacuums to clean contaminated areas. Administrative Controls & Safe Work Practices For small-scale (i.e., isolated exposure) incidents involving anthrax, follow recognized good infection control practices. This includes changing gloves after direct patient care and before touching anything else; washing hands thoroughly with non-antibacterial or -antimicrobial soap at completion of direct patient contact and procedures; and decontamination, disinfection and proper disposal of PPE, bedding and other items potentially contaminated by a patient. See the General Guidance section for more information on standard precautions. Follow contact precautions, as well, particularly if the patient has uncontained drainage from skin lesions.4 This includes placing such patients in single-patient rooms and providing workers with additional PPE and training (see the PPE and Training sections, below). If the patient requires decontamination, restrict the number of personnel entering the room until completion of decontamination procedures. In addition to using AIIRs, first-receiver facilities may also consider implementing policies that include covering contaminated patients in an outer garment (e.g., disposable coverall) or sheet to contain spores, or misting such patients with a soap/water solution to reduce spore dissemination until the patient can be decontaminated fully (e.g., in a decontamination shower). Clean and disinfect rooms and bedside equipment of patients with anthrax infections using the same procedures used for all patients as an element of recognized good infection control practices, unless the amount of environmental contamination indicates a need for special cleaning. See the General Guidance for cleaning and disinfection for recommendations on disinfection of environmental surfaces and noncritical patient care equipment potentially contaminated with BA. When handling cases of cutaneous anthrax, sterilize surgical tools immediately after use and incinerate dressings. The CDC Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008 provides practices for disinfection and sterilization of surfaces and equipment in healthcare settings. Handle all waste as regulated medical waste and place it in red biohazard bags. Under the HMR, waste potentially contaminated with BA, including PPE and other materials associated with patient care activities, generally does not contain a Category A infectious substance unless it includes cultures of BA. Personal Protective Equipment All HCWs involved in direct patient care must wear clean, disposable gloves while taking specimens or dressing lesions, and disposable gowns to protect the skin and/or clothing. In cases requiring contact precautions, put on PPE when entering a patient care area and discard it prior to exiting. For medical and support staff not directly involved in patient contact, wear gloves even though the risk of transmission is low. OSHA's non-mandatory Best Practices for Hospital-Based First Receivers of Victims from Mass Casualty Incidents Involving the Release of Hazardous Substances offers recommendations for selecting respiratory protection to protect HCWs during the receipt of contaminated victims from mass casualty incidents occurring at locations other than the hospital. See the General Guidance section for specific recommendations on PPE selection, use, and good practices for protection against BA. Training See the General Guidance section for information on worker training. Further Information The CDC Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings provides detailed information about infection control and prevention for anthrax in healthcare settings. See the Guidance for Protecting Responders' Health During the First Week following A Wide-area Aerosol Anthrax Attack for specific information on measures to minimize responders' exposure to B. anthracis spores after a terrorist/criminal act involving BA. Diagnostic and research samples may contain viable BA bacteria and spores—including at high concentrations, in some cases. Exposure can result in severe infections. Laboratory workers who handle clinical specimens from patients with suspected/confirmed anthrax or samples of BA as part of research and development work may be exposed through direct and indirect contact with the bacteria or spores through broken skin or inhalation as a result of laboratory accidents/mishaps, laboratory activities that generate aerosols, and releases of infectious materials outside of containment equipment. While a laboratory-acquired infection with anthrax is rare, blood, drainage from skin lesions, cerebrospinal (brain and spinal cord) fluid, pleural (membranes that line the lungs) fluid, and sputum may all contain BA.5 Urine and feces rarely contain the bacteria. Follow good infection control practices to prevent or minimize transmission of anthrax as specified in the general guidance above. Follow standard laboratory practices when working with anthrax or BA samples/specimens, including in clinical and microbiological laboratories performing routine diagnostic, analytical, or other research-related tests on serum, blood, skin, and respiratory specimens. Decontaminate working surfaces, including those within biosafety cabinets, after each use and dispose of supplies and equipment in proper receptacles. The Cleaning & Disinfection section of the general guidance, above, provides information about selection of appropriate disinfectants and sterilants. Avoid touching the face, including any mucous membranes, such as the eyes, nose, or mouth, or any exposed skin with hands (gloved or ungloved). Never eat, drink, smoke, or apply cosmetics in the laboratory. Use an autoclave to inactivate infectious material (i.e., kill all associated infectious agents) in all waste prior to disposal. Adhere to applicable federal, state, and local regulations when disposing of laboratory waste. Note: Federal regulations require laboratories in healthcare facilities to retain the on-site capability of destroying discarded cultures and stocks if they isolate any microorganism or toxin identified as a Select Agent from a clinical specimen. Healthcare facilities transferring the isolated cultures to a facility registered to accept such agents, including BA, in accordance with federal regulations are exempt from the requirement. State medical waste regulations may prevent this transfer if the cultures are determined to be medical waste since most states regulate the inter-facility transfer of untreated medical wastes.6 Immediately report to management, any incidents or accidents involving potential or actual exposure to anthrax, as well as development of symptoms consistent with cutaneous or inhalation anthrax. Implement appropriate protocols for handling, storing, and shipping specimens and ensure adherence by all laboratory workers. The BBP standard (29 CFR 1910.1030) includes packaging requirements for samples of, or that are contaminated with, human blood, body fluids, or other potentially infectious materials. The U.S. Department of Transportation's Hazardous Materials Regulations, CDC and USDA permitting requirements for biological select agents and toxins, the U.S. Postal Service (USPS), the International Air Transport Association (IATA) and state and local requirements may apply when packaging, shipping, and transporting specimens suspected or known to be contaminated with anthrax. The following CDC guidelines may provide additional details on packaging and shipping procedures for anthrax samples:
Laboratories should ensure that their facilities and precautions meet the appropriate Biosafety Level (BSL) for the type of work conducted in the lab. Increasing BSLs involves more worker training, higher levels of containment of samples and other sources of pathogens, specially designed air handling systems, additional worker PPE, and other stricter controls. For example, BSL-2 practices limit access to laboratories and other controlled work areas during work operations and during use of biosafety cabinets (BSCs) or other containment equipment for certain procedures. At BSL-3, in addition to controlling access to laboratories and work areas, all work involving infectious materials is conducted in BSCs or other containment equipment. The CDC and the National Institutes of Health publication Biosafety in Microbiological and Medical Laboratories (BMBL) provides guidance on protecting workers in laboratory environments. The following sections from BMBL guidance may be particularly relevant to employers and workers if their workplaces contain BA:
Also, see the recommendations on disinfection of environmental surfaces and noncritical patient-care equipment potentially contaminated with BA contained in the General Guidance section. Train workers on proper laboratory safety and health procedures and adherence to guidelines; test competency of workers in appropriate implementation of these procedures and guidelines, including appropriate use of engineering controls and PPE; conduct refresher training on a routine basis; and verify consistent adherence to the safety and health procedures and guidelines. In addition to the recommendations outlined in the General Guidance section, engineering controls, administrative controls, work practices, and PPE needed when working with samples known to contain or suspected of containing BA vary between clinical and research laboratories. The following sections on Clinical and Research Laboratories outline controls specific for each setting. Clinical LaboratoriesOSHA's guidance for protecting workers in clinical laboratories generally follows BSL-2 controls and practices, as described in the BMBL. Engineering Controls Use Class II BSCs or other containment equipment for all
procedures with potential for infectious aerosol or splash creation. Class II BSCs use airflow into the front of the cabinet to keep potentially contaminated air and materials (i.e., BA spores) in the cabinet and high-efficiency particulate absorption (HEPA) filters to remove infectious agents from exhaust air. Administrative Controls & Safe Work Practices BSL-2 is appropriate for handling moderate-risk agents that cause human disease of varying severity by ingestion or through percutaneous or mucous membrane exposure. Conduct clinical laboratory work on samples from patients with suspected or confirmed anthrax at BSL-2, as a minimum. Use BSL-2 practices for work on samples from patients with suspected or confirmed anthrax. This includes performing all procedures to minimize the creation of splashes and/or aerosols and decontaminating work surfaces upon work completion and after spills or splashes potentially contaminated with BA. Personal Protective Equipment PPE for clinical laboratory workers handling BA specimens include gloves (vinyl or nitrile) and laboratory coats. Use eye protection (e.g., goggles, including with face shields, if appropriate) when handling BA outside the BSC or other containment device. Almost all if not all work that could generate aerosols should be done in an appropriate BSC; use appropriate respiratory protection if aerosol generation outside of a containment device is possible. When using a BSC, remove the outer pair of gloves before exiting the BSC, and don a new pair each time reentering the BSC. The general guidance above provides additional information on types of PPE protective against BA. Training As per BSL-2 precautions, train laboratory personnel in handling pathogenic agents with supervisors competent in handling infectious agents and associated procedures. Train all laboratory personnel on any additional procedures developed by the employer for safely handling clinical specimens from patients with known or suspected anthrax and research specimens. This includes training on the communication procedures in effect between the clinical and laboratory staff to ensure timely notification and proper labeling of known or suspected BA-contaminated specimens. Research Laboratories OSHA's guidance for protecting workers in non-clinical/research laboratories, where laboratory samples may contain higher concentrations of BA or its spores, follows BSL-3 controls and practices, as described in the BMBL. Engineering Controls Use Vertebrate Animal Biosafety Level Criteria (ABSL-2) practices, containment equipment, and facilities for studies involving experimentally infected laboratory rodents. Use Class III BSCs for work involving high concentrations of cultures, for screening environmental samples (especially powders) from anthrax-contaminated locations, and for activities with a high potential for aerosol production. Class III BSCs are gas-tight enclosures incorporated with gloves, non-opening windows, and mechanisms for decontaminating equipment and samples. Exhaust air from Class III BSCs passes through two HEPA filters, or a HEPA filter and an air incinerator, before releasing outdoors. Administrative Controls & Safe Work Practices Limit access to the animal facility. Authorize only workers required for program or support purposes to enter the facility and the areas where BA and/or animals are housed or handled. Use BSL-3 facilities for work involving high concentrations of cultures, for screening environmental samples (especially powders) from anthrax-contaminated locations, and for activities with a high potential for aerosol production. BSL-3 work practices build on the BSL-2 work practices and include, among other things, the requirement to place materials potentially infected with BA in durable, leak- proof containers during collection, handling, processing, storage, or transport within a facility. Some lab workers may meet the criteria for vaccination as outlined in the CDC Advisory Committee on Immunization Practices (ACIP) recommendations for Use of Anthrax Vaccine in the United States. See the Medical Information page for more details. See the Training section, below, for information about worker training. Personal Protective Equipment Wear laboratory coats, gowns, or uniforms when working in laboratories handling BA-infected rodents to prevent contamination of personal clothing. Wear nitrile or vinyl gloves to prevent skin contact with BA-contaminated materials, and when handling animals. Gloves for workers handling animals that may bite should also provide bite protection. Use eye, face, and respiratory protection in rooms containing infected rodents, based on the risk of exposure. PPE for research laboratory workers may include dedicated work clothing, such as surgical scrubs under PPE, dedicated washable footwear, double gloves, face protection, eye protection (e.g., disposable full-face shield), single-use lab coat, and shoe/boot cover. Remove all PPE in a manner that prevents transfer of infectious materials to clean areas. Use a NIOSH-approved N95 (or higher) respirator at BSL-3, including when conducting procedures that may generate aerosols. When using a BSC, remove the outer pair of gloves before exiting the BSC, and don a new pair each time reentering the BSC. If a Class III BSC is not available, or work cannot be done in a Class III BSC, a full-body, air-supplied positive-pressure suit should be worn. Training The OSHA Fact Sheet, Laboratory Safety Biosafety Cabinets (BSC) provides guidance on training and effective use of BSCs. Further Information The CDC's Biosafety in Microbiological and Biomedical Laboratories (BMBL), 5th Edition provides detailed guidance on BSLs in Section IV - Laboratory Biosafety Level Criteria. For additional information, see Recommended Specimens for Microbiology and Pathology for Diagnosis: Inhalation, Cutaneous, and Gastrointestinal Anthrax. The WHO resource, Laboratory Biosafety Manual - Third Edition, contains additional practical guidance on biosafety techniques for use in laboratories at all levels. The recommendations made by the CDC-convened Biosafety Blue Ribbon Panel, entitled Guidelines for Safe Work Practices in Human and Animal Medical Diagnostic Laboratories provides science-based guidance to address the unique operation needs of diagnostic laboratories and includes recommendations that supplement BMBL-5. OSHA's Laboratory Safety Guidance contains an entire chapter on biological hazards, including anthrax which employers and laboratory workers may find useful. Workers involved in emergency response operations to intentional or accidental releases of BA are also at risk of exposure. Potentially affected first responders include police officers and other law enforcement personnel, firefighters, emergency medical services (EMS) workers, and others who are responsible for responding to bioterrorism/criminal acts or accidental releases of anthrax. Employers whose workers will be involved in emergency response operations for releases of, or substantial threats of releases of, hazardous substances regardless of the location of the hazard must comply with OSHA's HAZWOPER standard (29 CFR 1910.120). This may include emergency response following an anthrax incident. Instruction CPL 02-02-073 describes OSHA enforcement procedures under the relevant provisions of the HAZWOPER standard. The U.S. Environmental Protection Agency (EPA) has promulgated a standard applying OSHA's HAZWOPER standard to state and local government workers in states where there is no OSHA-approved State Plan. See 40 CFR Part 311. In addition to the General Guidance, applicable to all workers, and provided at the beginning of this page, OSHA also recommends the following controls for first responders: Engineering controls Place impermeable physical barriers or use other methods to isolate contaminated areas and objects. Implement dust control measures, such as water mist, if needed to reduce the risk of re-aerosolization of settled infectious materials. For medical transport workers in ambulances or other vehicles: If there is visible evidence of powder on a patient, close the door/window between the driver/patient compartments before bringing on-board a patient with suspected anthrax or BA exposure. Minimize air flow as much as possible in the patient compartment. Vehicles that have separate driver and patient compartments and can provide separate ventilation to these areas are preferred for transport of these types of patients. If a vehicle without separate compartments and ventilation is used, the outside air vents in the driver compartment should be open, and the rear, exhaust ventilation fans turned on at the highest setting to provide a gradient of negative pressure in the patient care compartment. Administrative Controls & Safe Work Practices If possible, deploy first responders previously vaccinated against anthrax. Follow standard precautions (as well as contact and aerosol precautions, as appropriate, based on work tasks and visible evidence of powder on the patient). If possible, decontaminate patients before transporting them for medical care in order to reduce contamination of ambulances, other transport vehicles, and receiving facilities. Avoid activities that increase air movement and potentially re-disperse settled spores into the air. Sharing of information during transfer of patient care from the medical transport team to HCWs in a receiving facility is critical for effective infection prevention and control. When transporting a patient with visible evidence of powder on skin or clothing, transport workers need to convey this information to the receiving healthcare facility in advance, if possible, or immediately upon arrival to ensure that the receiving facility is ready to implement appropriate isolation and decontamination procedures. Decontaminate vehicles as soon as possible after transporting a patient with suspected anthrax or BA exposure. See the General Guidance on cleaning and disinfection provided. When cleaning the interior of ambulances and other transport vehicles, do not use compressed air or water sprays, as these techniques may re-aerosolize anthrax spores. Clean non-patient-care areas of the vehicle according to standard employer protocols. Clean and disinfect patient-care compartments (including stretchers, railings, medical equipment, control panels, and flooring, walls and work surfaces in accordance with recommendations for disinfection specified in the General Guidance section. Ensure that facilities are available for decontaminating workers responding to an anthrax release. Depending on the level of contamination, this may require establishment of a decontamination line. For isolated releases, facilities for showering and changing clothes after response and clean-up activities may be sufficient. If at all possible, remove shoes prior to leaving the worksite and launder clothes on site using detergent and hot water. Avoid laundering potentially contaminated clothing at home to prevent taking BA spores home. See the Training section, below, for information about worker training. Personal Protective Equipment The type of personal protective equipment (PPE) needed for effective protection depends on different response situations, what is known or unknown about the situation, and the potential risk. As stated above, the HAZWOPER standard is performance-oriented and requires the selection and use of PPE to be proportional to the anticipated risk of exposure and appropriate to the nature of the anticipated hazard. For example, security personnel are first responders if their task involves securing the area where there is a suspected release of BA spores. These workers may be first responders at either the "awareness" or the "operations" level depending on the tasks involved. Security personnel fall under the "first responder's awareness level" if they will not take any actions other than to cordon off the affected area and/or initiate the emergency response sequence. Security personnel required to close doors, physically isolate the area, or take any other defensive action fall under the "first responders at the operations level." Full-facepiece APRs with N100 (or P100) filters or full-facepiece PAPRs with HEPA filters offer protection against inhalation exposure to BA spores during the conduct of high-risk activities, such as environmental sampling and remediation activities. When there is an ongoing release of BA spores from an aerosol-generating device or when the agent is unknown, workers need higher levels of protection, such as chemical, biological, radiological, and nuclear (CBRN)-rated self-contained breathing apparatus (SCBAs). Depending on their specific tasks, first responders may need some level of protection from dermal exposure, such as disposable hooded coveralls, gloves, and foot coverings. In some settings, however, changing the outer layer of clothing may be sufficient. EMS workers involved in direct patient care should use the same PPE recommended for healthcare workers throughout triage and transport of a patient with suspected exposure to BA. Responders riding in the patient compartment of the vehicle should wear an N-95 respirator (or higher) if there is visible evidence of powder on the patient. If the driver compartment cannot be closed off from the patient-care compartment, drivers also need to wear N-95 (or higher) respirators. Drivers assisting with direct patient care, including moving patients on stretchers, should wear all other recommended PPE for healthcare workers. Employers should monitor the driver's use of respirators to ensure that the respirator does not restrict the worker's ability to operate a vehicle safely. When patient care is completed or when items are soiled or damaged, remove and discard PPE in accord with procedures for handling infectious waste, described in the General Guidance section. Personnel who clean the patient-care compartment of emergency vehicles should wear gloves, chemical-resistant or - impermeable suits, and eye protection. Training See the General Guidance section for general information on worker training. OSHA's HAZWOPER Safety and Health Topics page explains requirements of the OSHA HAZWOPER standard, including worker training. For additional information about emergency responders and training levels, please refer to Inspection Procedures for 29 CFR 1910.120 and 1926.65, Paragraph (q): Emergency Response to Hazardous Substance Releases. Further Information See the Guidance for Protecting Responders' Health During the First Week following A Wide-area Aerosol Anthrax Attack for specific information on measures to minimize responders' exposure to B. anthracis spores after a terrorist/criminal act involving BA. NIOSH provides emergency response resources to help emergency responders prepare for critical events, including potential exposure to biological agents and infectious diseases, such as anthrax. Also see Interim Recommendations for the Selection and Use of Protective Clothing and Respirators Against Biological Agents for help in determining whether existing health and safety precautions are adequate for protection against BA exposure during emergency situations. Bioterrorism/criminal acts involving the shipment of BA spores via U.S. mail or private delivery or courier services, as well as worksite contamination where such articles are processed, delivered and opened, have increased the risk of occupational exposure for jobs involving package and mail handling. These jobs include jobs in post offices, mail and package distribution/handling centers, bulk mail centers, air mail facilities, public and private mailrooms (e.g., in office buildings), and other settings in which workers are responsible for the handling and processing of mail and packages. Cutaneous (skin) exposure may result from handling contaminated packages or envelopes. Inhalation exposure may occur from machinery that generates aerosolized particles as it handles contaminated packages or envelopes. Employers must protect workers who operate, maintain, or work near such machinery from inhalation exposure. This includes workers who hand-sort mail or work at other sites with the potential for airborne particle generation (e.g., where mailbags are unloaded or emptied). It is critically important that all such worksites develop an emergency plan describing appropriate actions to take when a known or suspected exposure to BA occurs. The scope of the emergency plan and the procedures it includes may be based on an employer's risk assessment. For example, mail handling workers in facilities that are likely to be the targets of intentionally contaminated packages or letters may need more robust emergency plans. Select the measures included in the plan based on an initial evaluation of the worksite. Focus this evaluation on determining which processes, operations, jobs, or tasks would be most vulnerable to an exposure if a contaminated envelope or package enters the worksite. Employers also should designate individuals who are trained to respond in the event that a worker receives a suspicious mailing. At a minimum, the designated responders should know how to contact facility managers, local emergency responders, and local law enforcement officials. Additionally, the designated responders should have authority to secure potentially contaminated areas or to direct other individuals to do so and limit the movement of potentially exposed/contaminated workers and visitors within the facility. Protecting trained responders may also involve the recommendations for control measures in the sub-sections below or in the other worker-specific sections of this page (e.g., guidance for first responders or clean-up workers). NOTE: While much of the guidance presented in this section directly relates to mail and package handlers, employers may also find this information useful for administrative workers who open office mail and packages. OSHA offers recommendations for assessing workplace risk and determining prudent work practices and PPE in the Anthrax in the Workplace Risk Reduction Matrix. Engineering controls Aerosolization of BA spores may occur during the operation and maintenance of high-speed, mail-sorting or other package processing machines, creating potential exposure to workers operating these machines. These operations also create the potential for spores to enter heating, ventilation, and air-conditioning (HVAC) systems, resulting in exposure to ancillary workers as well. Engineering controls are the best option for preventing worker exposure to potential aerosolized particles and reducing the risk for inhalational anthrax. When using mail-sorting machines, clean the machines using an industrial vacuum cleaner equipped with a HEPA filter. Consider installing local exhaust ventilation at pinch roller areas and HEPA-filtered exhaust hoods in areas where there is dust generation. Air curtains (using laminar air flow) also can provide isolation for areas processing large amounts of mail. HEPA filters placed in the building's HVAC systems are useful to eliminate re-circulation of aerosolized spores. Implement procedures for rapid detection (i.e., biohazard detection systems) for real-time identification of aerosolized BA spores in an air sample. Located on or near incoming mail or package processing equipment, biohazard detection systems allow timely identification of contamination, preventing inhalation anthrax through early recognition of and response to an exposure situation (e.g., immediate on-site decontamination of workers and post-exposure treatment). The U.S. Postal Service (USPS) FAQ: What is the USPS® Biohazard Detection System? offers more information on rapid detection systems. Administrative Controls & Safe Work Practices Establish handling and screening procedures for mail in all mail handling and packaging worksites. Instruct mail handlers to:
When encountering a suspicious piece of mail, adhere to the following procedures:
See the Homeland Security Response Checklist for steps to take when encountering a suspicious package. Restrict entry into and limit the number of persons working at or near sites with potential for aerosolized particle generation (such as mail-sorting machinery or areas where emptying and unloading of mailbags occurs). Follow proper procedures and work practices during maintenance of machinery to protect workers from other injuries. Do not use compressed air to clean machinery. Avoid dry sweeping and dusting of all areas with potential for aerosolized particle generation. Use wet-cleaning methods and vacuum with HEPA-equipped vacuum cleaners. After a release of anthrax, such as BA being used as a biological weapon, ensure that adequate facilities are available to workers for washing and changing clothes prior to leaving the worksite. Also, remove shoes prior to leaving the worksite and launder clothes on site using detergent and hot water. See the Training section, below, for information about worker training. Personal Protective Equipment Base PPE selection (e.g., gloves, smocks, eye protection, respiratory protection) for workers in mail and package handling/processing worksites on the potential for cutaneous or inhalation exposure to BA spores (e.g., the amount of mail a worker handles, how he or she handles the mail, and where he or she works). Factors to consider when determining PPE selection include the nature of the workplace and amount of mail received; whether the facility receives mail directly from a USPS facility with a higher risk of receiving contaminated mail; and whether the facility uses equipment that might disperse dust or anthrax spores into the air. Employers may rely on information from local, state, and federal authorities (e.g., the U.S. Department of Homeland Security National Terrorism Advisory System), their own biohazard detection systems, and other information in order to characterize threat levels upon which to base risk assessment and PPE decisions. Thorough risk assessment, biohazard detection systems, and other controls (e.g., those discussed in the engineering and administrative controls and work practices subsections, above) can reduce the risk of anthrax exposure and the need for certain types of PPE. However, depending on threat levels for a release, workers working with or near machinery that is capable of generating aerosolized particles (e.g., electronic mail sorters) or at other worksites potentially generating such particles, may require NIOSH-approved respirators that are at least as protective as an N95 respirator. In these cases, respirators must be used in the context of a comprehensive respiratory protection program that includes medical exams, training, and fit-testing. For day-to-day operations when there is no reason to suspect BA contamination of the workplace or packages and mail; remove PPE prior to leaving the work area and discard single-use PPE as regular trash. When an incident occurs involving a suspicious piece of mail, dispose of the worker's protective gear as a potentially contaminated material, and place the PPE in an appropriately labeled and/or color-coded container that is closable and leak-proof. Dispose of the container as infectious/regulated waste. See the General Guidance section for more information on PPE selection, respiratory protection, and establishing a respiratory protection program that complies with the provisions of OSHA's Respiratory Protection standard (29 CFR 1910.134). Training Training is essential to ensure worker protection and safety from potentially contaminated mail. Train mail and package handlers in basic security procedures, suspicious package recognition, and reporting, proper use of PPE, safe work practices, and procedures relating to their specific job tasks. The USPS Mail Security Center page contains links to FAQs, posters, and best practices that can be useful in developing training programs for package and mail workers. The characteristics of suspicious packages and letters include:
Further Information Designated responders or other appropriate authority will determine the need for further action, which may include:
The U.S. Postal Service poster Suspicious Letters or Packages graphically illustrates some of the characteristics of a suspicious letter or package. The U.S. Postal Service guidance U.S. Postal Inspection Service Guide to Mail Service Security provides general advice and recommends protective measures to help mail and package workers assess, prevent, and respond to several types of mail-related threats including biological threats. The Guidance on Initial Responses to a Suspicious Letter / Container With a Potential Biological Threat is a coordinated effort by various agencies to provide recommendations for local responders on the initial response to a suspicious letter/container, while other follow-on response plans, such as portions of the National Response Plan (NRP), may be used if a threat is deemed credible. Workers whose jobs involve wild and domestic (e.g., cattle, sheep, goats, antelope, and deer) animals, animal hides, or animal fibers (e.g., workers who process hides, hair, bone and bone products and wool) are at increased risk for occupational exposure. These workers include veterinarians; animal breeders; hunters and trappers; slaughterhouse workers; fur industry workers; tanning and leather industry workers; and wildlife, agricultural, and laboratory workers who handle infected animals or specimens. Inhalation anthrax has also been associated with making drums from animal hides.7 While exposure risk for animal and agricultural workers is much higher in developing countries or countries without veterinary public health programs, workers in the U.S. in these jobs are at risk. BA spores can remain viable (i.e., able to cause diseases) in soil for many years. Infection in livestock occurs when an animal ingests (i.e., swallows) sufficient quantities of spores from the soil. For the most part, spores in soil do not pose a direct risk of infection for animal and agricultural workers. Disease in workers usually follows contact with contaminated carcasses or animal products. Animal and agricultural workers are at increased risk of exposure to BA when handling dead carcasses and bedding or other contaminated material, and when cleaning and disinfecting stables, pens, milking barns, and equipment used on livestock. Engineering Controls Ensure that the workspace is well-ventilated. OSHA recommends that workers processing products from animals have adequate ventilation systems, including local exhaust systems, to reduce dust levels. Administrative Controls & Safe Work Practices Arrange for veterinary supervision of animal production and slaughter to ensure animals are healthy and to minimize the risk of widespread anthrax infection among grazing animals. Implement a program of routine pre-exposure vaccination for veterinarians, veterinarian workers, and workers who come into contact with imported animal hides, furs, bone meal, wool, animal hair, or bristles when standards and restrictions (e.g., disinfection of hides prior to shipment to tanneries) are insufficient to prevent exposure to anthrax spores. Observe recognized good infection control practices to prevent exposure and spread of the disease as specified in the General Guidance section. As appropriate, maintain a clean workspace. Use a high-efficiency particulate arrestance (HEPA) filter-equipped vacuum to clean workspaces, avoiding use of compressed air, dry sweeping, and shaking or beating of animal hides. Do not remove objects from the workspace to prevent contamination of clean areas. Employ procedures for rapid detection and reporting of animals suspected or confirmed to have anthrax, quarantine, treatment of asymptomatic animals (post-exposure prophylaxis) and burning/burial of deceased animals suspected or confirmed to have anthrax. Dispose of potentially infected animal carcasses by burning or deep burial. Disinfect the premises and appliances with an EPA-registered disinfectant specific against BA. Never conduct a post mortem (after death) examination on an animal suspected of having anthrax. The CDC Treatment of Products web page discusses different methods for processing hides that can reduce the BA exposure risk. The CDC Advisory Committee on Immunization Practices advises against routinely vaccinating veterinarians in the U.S., due to the low incidence of animal cases in the U.S. See the Training section, below, for information about worker training. Personal Protective Equipment Cover all exposed skin with clothing (pants, long sleeves). Keeping cuts and abrasions covered with bandages will also help prevent BA spores from entering those wounds. Also see the CDC anthrax Web page Protection from Exposure for detailed information on worker protection from exposure to BA spores specific to working with animal hides. Use appropriate personal protective equipment (PPE) as specified in the General Guidance section based upon the potential risk for exposure to BA spores. Ensure that adequate facilities are available to workers for washing and changing clothes after work. Remove shoes prior to leaving the worksite and launder clothes on site using detergent and hot water. Training Inform workers who handle live animals and raw animal materials about modes of transmission for BA. Train workers to report any suspicious symptoms immediately. See the General Guidance section for more information on training workers. Further Information The CDC's People Who Handle Animal Products page contains information for animal workers on exposure to hides/drums, treatment of products, protection from exposure, importation of animal products and worker safety. The World Health Organization (WHO) Guidelines for the Surveillance and Control of Anthrax in Humans and Animals provides useful information on the pathogenesis, pathology, treatment, control, and surveillance of anthrax. This section provides control and prevention information for two categories of clean-up workers:
Clean-up Workers (small scale)Engineering Controls When feasible, use engineering controls, such as HEPA vacuums and local exhaust ventilation, to protect clean-up workers from exposure to BA during clean-up procedures. Administrative Controls & Safe Work Practices Immediately report to management any suspicious and/or unknown fine-powdered substances. Isolate and clearly mark the immediate area where a spill or suspicious substance is located to keep other workers away from the area until first responders arrive. Clean and disinfect environmental surfaces adhering to the General Guidance, Cleaning and Disinfection described. Use recognized good infection control practices when cleaning small areas not grossly contaminated with BA and when encountering any suspicious, unknown, fine-powder substance. Avoid touching, handling or removing, any suspicious, unknown, fine-powder substance until the substance has been determined by qualified experts to pose no threat to workers in the area. Stirring up a fine-powered substance containing anthrax spores increases the potential for airborne, inhalation exposure. When cleaning a small area potentially contaminated with BA, do not dry sweep or dust the areas. Use wet-cleaning methods and vacuum with high-efficiency particulate arrestance (HEPA)-equipped vacuum cleaners. Follow proper hand washing procedures after cleaning areas contaminated or potentially contaminated with BA. See the Training section, below, for information about worker training. Personal Protective Equipment Select PPE based on the potential for exposure during clean-up. At a minimum, wear vinyl or nitrile gloves at all times when cleaning and disinfecting surfaces. During cleaning operations, when the potential exists for exposure to BA spores through inhalation, use appropriate respiratory protection as specified in the General Guidance, Personal Protective Section above. See the General Guidance section, Personal Protective Equipment for detailed information on PPE selection, use, handling, and disposal. Training Refer to the General Guidance section for detailed information on worker training. Clean-up Workers (large scale)OSHA's HAZWOPER standard (29 CFR 1910.120) applies to these operations. The HAZWOPER standard protects workers who respond to uncontrolled or emergency releases of hazardous substances and clean-up of sites contaminated with these substances. Under the standard, the definition of hazardous substances includes both chemicals and biological agents such as BA. Employers of clean-up workers responding to an uncontrolled or emergency release of BA must follow the HAZWOPER requirements for emergency planning, training, exposure monitoring, and exposure control through protective measures such as work practices and personal protective equipment (PPE). Engineering Controls, Administrative Controls, and Work Practices HAZWOPER requirements are performance-oriented and based on the risk anticipated in the clean-up task. Review HAZWOPER requirements and choose how to best apply the recommended controls for the specific BA clean-up operation. Employ appropriate engineering and administrative controls and work practices as necessary and feasible. See the Training section, below, for information about worker training. Personal Protective Equipment Like the other requirements under HAZWOPER, the PPE requirements are performance-oriented. This means that the level of protection chosen, and the PPE used is proportional to the risk anticipated for the task. OSHA provides the following recommendations on PPE for clean-up workers: Workers investigating suspected releases or cleaning up these types of releases may be able to respond in modified Level C protection. Level C PPE generally includes a full-face or half-mask, NIOSH-approved air-purifying respirator (APR); hooded chemical-resistant clothing (e.g., overalls; two-piece chemical-splash suit; disposable chemical-resistant overalls); and inner and outer chemical-resistant gloves. Depending on the hazard, modified Level C protection may include coveralls, outer chemical-resistant steel toe and shank boots with chemical-resistant boot covers, a hard hat, an escape mask, and/or a face shield. Employers also may need to provide enhanced respiratory protection, such as a full-face powered air-purifying respirator (PAPR) or self-contained breathing apparatus (SCBA). (Note: Adding a SCBA increases the PPE to Level B and additional training, fit-testing, and medical clearance requirements may apply.) Use modified Level C protection during the investigation and clean-up of a known anthrax release where the agent dispersal occurred from a letter or package and is easily bagged. Under these conditions, no potential exists for splashing possibly contaminated materials. Do not use modified Level C if the BA spores dispersal was from an aerosol-generating device (e.g., a garden duster), or no information exists about the BA spores' mechanism of release. Modified Level C should be consistent with the description in HAZWOPER Appendix B, but employees should wear a tight-fitting, full-face PAPR and skin protection with an integral hood and booties. Releases of anthrax spores where there is no information about the potential source or dispersal method, or where the release is still occurring, require higher levels of protection as recommended in Modified A and B protection described below. Use Level B protection during response to or clean-up of a release of BA spores dispersed with an aerosol-generating device that has stopped, or where there is a high potential for splashing possibly contaminated materials. Level B protection should be consistent with the description in HAZWOPER Appendix B. It requires the highest level of respiratory protection, but a lesser level of skin protection than Level A. Use Level A PPE for response to or clean-up of a release involving an unknown dispersal method, a release involving an aerosol-generating device and the release is still occurring, or involving an aerosol-generating device where the release has stopped but no information exists about the duration of the release or the airborne concentrations of anthrax spores. Level A protection provides the greatest level of skin, respiratory, and eye protection. Level A protection should be consistent with the description in HAZWOPER Appendix B. Use PPE that is equivalent to one level below what is required for the responder or clean-up personnel for those assisting in decontamination of emergency responders or clean-up personnel (e.g., if responder is in Level A, then decontamination personnel will be in Level B). Training Use only highly trained and qualified clean-up workers to clean sites contaminated with BA through accidental or intentional releases. In accordance with OSHA's HAZWOPER standard (29 CFR 1910.120), all responders who enter a hazardous area, including an area where BA spores are present, must receive certain training. Federal OSHA does not cover state and local government workers. Emergency responders employed by state or local governments are covered either by OSHA-approved State Plans (which must have standards that are at least as effective as the Federal OSHA standards) or by the EPA's HAZWOPER standard (40 CFR Part 311). (The EPA standard adopts OSHA's HAZWOPER standard by reference.) OSHA's HAZWOPER Safety and Health Topics page explains requirements of the OSHA HAZWOPER standard, including required worker training. Further Information OSHA's Workplace Risk Pyramid – Anthrax for additional information on BA response and clean-up operations. OSHA's Model Health & Safety Plan (HASP) for Clean-up of Facilities Contaminated with Anthrax Spores provides model language acceptable to OSHA in meeting the requirements of the HAZWOPER standard (29 CFR 1910.120). See the Guidance for Protecting Responders' Health During the First Week following A Wide-area Aerosol Anthrax Attack for specific information on measures to minimize responders' exposure to B. anthracis spores after a terrorist/criminal act involving BA. Guidance for Other Workers Exposed during Releases or Other Emergency ScenariosAny worker or employer may be affected by a variety of emergency situations. Even though workers may not conduct emergency response or recovery operations—like rescue workers, law enforcement officers, or cleanup technicians—all employers and their workers should be prepared for emergency situations. This page includes information for general businesses on how to protect workers and others at the worksite or facility during an anthrax incident. Please visit the Getting Started – General Business Preparedness page for additional information on planning, preparing, equipping, and training for emergencies.
Accidental and intentional releases of BA increase the potential risk of exposure to BA for workers whose jobs would not ordinarily involve anthrax exposure. Use the OSHA Anthrax in the Workplace Risk Reduction Matrix to help identify workers' exposure risk levels and select appropriate controls to protect against BA exposure. Employers whose workers will be involved in emergency response operations for releases of, or substantial threats of releases of, hazardous substances regardless of the location of the hazard must comply with OSHA's HAZWOPER standard (29 CFR 1910.120). This may include emergency response following an anthrax incident. Instruction CPL 02-02-073 describes OSHA enforcement procedures under the relevant provisions of the HAZWOPER standard. Information for these types of workers and employers is provided in the general guidance for workers and employers with elevated BA exposure risk and specific guidance for workers and employers with elevated BA exposure risk sections above; not in this section for other workers exposed during releases or other emergency scenarios. OSHA's Biological Agent Emergency Preparedness and Response (EPR) page contains general information for addressing controls and emergency response relating to terrorist/criminal acts involving biological agents. The information presented here pertains specifically to BA. A. Administrative Controls & Safe Work PracticesSome OSHA standards require employers to develop an Emergency Action Plan (EAP) or an Emergency Response Plan (ERP) depending on whether workers evacuate during an emergency or participate in an emergency response. Paragraph (a) of the Emergency Action Plans standard (29 CFR 1910.38) requires a written plan to facilitate and organize employer and employee actions during workplace emergencies. Employers may be required to comply with OSHA's HAZWOPER standard (29 CFR 1910.120) when workers are expected to perform certain types of shut-down processes. Add BA-specific information to the EAP or ERP if a facility falls into the Yellow/Red Zone on the Anthrax in the Workplace Risk Reduction Matrix and include the following information as applicable to the specific facility:
Emergency procedures, such as an EAP or ERP, should also include provisions to prevent further spread of the BA spores during an incident, including:
OSHA and the Environmental Protection Agency (EPA) developed a Model Health & Safety Plan (HASP) for Clean-up of Facilities Contaminated with Anthrax Spores, which provides model language to help employers prepare an EAP. The OSHA Evacuation Plans and Procedures Tool also provides information on how to write and implement an EAP (including OSHA's Expert System to help formulate an EAP). See the Training section for information about worker training. C. Personal Protective Equipment (PPE)The Workplace Risk Pyramid – Anthrax provides detailed information on appropriate selection of PPE based on workplaces where contamination is unlikely (green zone), possible (yellow zone), or confirmed/strongly suspected (red zone). Most types of operations and workers not covered in the general guidance for workers and employers with elevated BA exposure risk or specific guidance for workers and employers with elevated BA exposure risk sections above are likely to fit in the green or yellow zones of the risk pyramid. No PPE is required for workplaces in the green or yellow zones. For workplaces and workers that fall into the red zone—workplaces where authorities have informed the employer that contamination with anthrax spores has been confirmed or is strongly suspected—protective actions, such as sheltering in place or evacuation, may be more appropriate than using PPE so workers can remain on the job. If workers in operations not covered in the general guidance for workers and employers with elevated BA exposure risk or specific guidance for workers and employers with elevated BA exposure risk sections above must continue working in red-zone workplaces, decisions about when to use PPE and what level of protective equipment is needed should be based on the risk anticipated for the task workers will do. Employers and workers who must work in red-zone workplaces, instead of sheltering in place or evacuating, should follow guidance for PPE as described in the general guidance for workers and employers with elevated BA exposure risk and specific guidance for workers and employers with elevated BA exposure risk sections. In general, PPE may include impermeable gloves and properly fitted NIOSH-certified filtering facepiece respirators. PPE required for the red zone must adhere to the requirements under the HAZWOPER standard (29 CFR 1910.120). Also see the OSHA Respiratory Protection e-Tool, the OSHA Respiratory Protection standard (29 CFR 1910.134), and the Getting Started - PPE for Emergency Response and Recovery Workers page for more information on PPE selection, use, care, and maintenance. Employers who provide or allow workers to wear other PPE should be familiar and must comply with applicable requirements of OSHA's PPE standards (29 CFR 1910 Subpart I). D. Medical Monitoring ProgramIn bioterrorist/criminal acts involving anthrax, employers must develop workplace medical monitoring programs to address exposure of: Occupants, Workers, or Visitors at a Site Contaminated with Anthrax Generally, workers in operations not covered by the General guidance for workers and employers with elevated BA exposure risk or Specific guidance for workers and employers with elevated BA exposure risk sections above fall into this category. The medical program for this group covers the immediate post-exposure period and the period after clearance for unrestricted entry and occupancy. Employers also must conduct initial medical screening to identify exposed persons who should avoid taking antibiotics. After clearance for unrestricted entry and occupancy, compile an initial medical history to screen for high-risk conditions (such as compromised immunity, skin conditions). Counsel high-risk persons and provide around-the-clock access to medical coverage for anthrax-like symptoms. Ensure the confidentiality of medical information. Part of the workplace medical program includes medical monitoring. Establish a medical monitoring program to watch persons exposed to BA for signs and symptoms of anthrax. The intent is to detect adverse effects on a worker's health at an early stage when prevention is possible or treatment is most effective. An effective medical screening program for anthrax includes:
Employers must develop a plan to inform affected workers about available options for preventing anthrax and the risk and benefits of each option. Information about when exposure monitoring is required should also be included. Inhalation exposure to a high concentration of BA spores may result in rapid death. Therefore, treat as a medical emergency any exposure to aerosolized powder potentially containing or known to contain BA spores. After receiving clearance for re-occupancy, PPE and medical measures to prevent anthrax are no longer required. However, employers may find it prudent to implement a precautionary program of medical monitoring to ensure that anthrax is no longer a threat. The Centers for Disease Control and Prevention provide further information about medical surveillance in BA Contaminated Sites. The HAZWOPER standard (29 CFR 1910.120) also details medical surveillance program requirements. E. TrainingHazard awareness training is also an important component of the workplace medical program. In addition to HAZWOPER training (29 CFR 1910.120), response workers will also need particular knowledge and information about anthrax and protective medical measures. The validity and reliability of symptom reports are only as good as the exposed worker's knowledge and understanding of the characteristics of anthrax and the risks of developing the disease. Successful treatment of anthrax will depend on the worker's understanding of the need for immediate medical attention if symptoms occur and their knowledge of how to access emergency medical care. OSHA recommends that employers offer anthrax-specific hazard awareness training to help workers understand the health hazards of anthrax and the measures needed to prevent exposure to spores. Specific topics may include:
F. Cleaning and DisinfectionMost types of workers not covered in the general guidance for workers and employers with elevated BA exposure risk or specific guidance for workers and employers with elevated BA exposure risk should not undertake cleaning and disinfection operations after a release of BA that affects the worksite. While ensuring that a worksite is safely cleaned up after such an event is the employer's responsibility, employers should consult their state and local health authorities in addition to considering the exposure risk to workers, special expertise and equipment needed, and other issues related safely cleaning up contaminated worksites when deciding how whether to seek professional assistance with remediation operations. In instances where workers in businesses impacted by a BA release are involved in clean-up operations, follow the general guidance for workers and employers with elevated BA exposure risk and specific guidance for clean-up workers, above. Those sections of this Web page provide more detailed information about selection of chemicals for disinfection and sterilization when BA is a contaminant of concern, and recommendations for protecting workers from exposure to BA and any chemical hazards associated with clean-up work. BA is persistent in the environment for long periods of time, and small particles can stay suspended in the air or be re-aerosolized by agitation and air currents within buildings and other environments. This creates the potential for BA transmission from contaminated environmental surfaces or fomites (objects that can spread germs) and the need for effective cleaning and decontamination strategies. G. Reporting IllnessEnsure that supervisors and all potentially exposed workers are aware of the symptoms of anthrax. Workers potentially exposed to BA or who develop symptoms of anthrax should seek medical evaluation. While symptoms of anthrax usually occur within seven days of exposure, some cases presented symptoms after only one day while others presented symptoms later than two months after exposure.
Where required, report an incident to OSHA by:
Physicians, employers, and/or workers may also contact their state or local health departments to notify them of any symptomatic workers or suspected exposure incidents. Some states may require these incidents to be reported. Workers may continue working after exposure if able since anthrax generally is not transmissible from person to person (transmission primarily occurs through contact with the BA spores). See the Medical Information page for more information on symptoms and anthrax transmission. H. If You Think You Have Been ExposedAny worker who thinks he or she may have been exposed to BA—including as a result of a BA release impacting his/her workplace—should take the following precautions:
See the Medical Information page of this Safety and Health Topics page and the CDC website Symptoms and Medical Care pages for more information. Which of the following is the first priority in preventing infections when providing care for client?Hand washing is regarded as the most important measure among the various protective measures applied against infection.
Which of the following is the first priority in preventing infections when providing care for a client quizlet?4. Which of the following is the FIRST priority in preventing infections when providing care for a client? Option A: Handwashing remains the most effective way to avoid spreading infection.
What are recommended as a precaution for anthrax exposure?Use appropriate personal protective equipment (PPE), including: Properly-fitted face mask or respirator (N-954) Eye protection. Protective gloves.
What should the nurse do first to prevent patient infections?Under the universal precautions rule, nurses must wear personal protective equipment when coming into contact with the specified body fluids. Hand washing is another potent weapon in the nurse's arsenal against infection, and is the single most important nursing intervention to prevent infection.
|
Which of the following is the first priority in preventing infections when providing care for a client diagnosed with anthrax?
zusammenhängende Posts
Urheberrechte © © 2024 paraquee Inc.
