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What
are CDC’s recommendations for protecting mail handlers?
CDC and the U.S. Postal Service are collaborating to ensure that all mail
handlers and postal workers are protected against exposure to anthrax.
Detailed guidelines may be found on these Web sites:
If these
recommendations are followed does it mean workers will stop getting sick
with anthrax?
The interim recommendations that have been developed are based on the
limited information available on ways to avoid infection and the effectiveness
of various prevention strategies. As new information becomes available
the guidelines will be updated. These recommendations do not address instances
where a known or suspected exposure has occurred. Workers should be trained
in how to recognize and handle a suspicious piece of mail (www.bt.cdc.gov/documentsapp/anthrax/10312001/han51.asp).
In addition, each work site should develop an emergency plan describing
appropriate actions to be taken when a known or suspected exposure to
B. anthracis occurs.
What
kinds of anthrax worker safety guidelines are being issued?
The recommendations are divided into four categories. They are engineering
controls, administrative controls, housekeeping controls, and personal
protective equipment for workers. The guidelines describe measures that
should be implemented in mail-handling/processing sites to prevent potential
exposures to B. anthracis spores.
Is CDC
telling all mail handling operations to adopt these anthrax worker safety
guidelines immediately?
Every facility is different and should be evaluated based on the recommendations
in the guidelines, and the recommendations implemented should be selected
on the basis of an initial evaluation of the work site. This evaluation
should focus on determining which processes, operations, jobs, or tasks
would be most likely to result in an exposure should a contaminated envelope
or package enter the work site. Many of these measures (e.g., administrative
controls, use of HEPA filter-equipped vacuums, wet-cleaning, use of protective
gloves) can be implemented immediately; implementation of others will
require additional time and efforts.
What
kinds of engineering controls should mail-handling/processing operations
consider implementing for detecting anthrax spores?
B. anthracis spores can be aerosolized during the operation and
maintenance of high-speed, mail-sorting machines, potentially exposing
workers and possibly entering heating, ventilation, or air-conditioning
(HVAC) systems. Engineering controls can provide the best means of preventing
worker exposure to potential aerosolized particles, thereby reducing the
risk for inhalational anthrax, the most severe form of the disease. In
settings where such machinery is in use, the following engineering controls
should be considered:
- An industrial
vacuum cleaner equipped with a high-efficiency particulate air (HEPA)
filter for cleaning high-speed, mail-sorting machinery
- Local
exhaust ventilation at pinch roller areas
- HEPA-filtered
exhaust hoods installed in areas where dust is generated (e.g., areas
with high-speed, mail-sorting machinery)
- Air curtains
(using laminar air flow) installed in areas where large amounts of mail
are processed
- HEPA
filters installed in the building’s HVAC systems (if feasible)
to capture aerosolized spores. (Note: Machinery should not be cleaned
using compressed air [i.e., blow-down/blow-off].)
What
administrative controls should mail-handling/processing sites consider
implementing to protect workers from exposure to B. anthracis spores?
Strategies should be developed to limit the number of people working at
or near sites where aerosolized particles may be generated, such as mail-sorting
machinery and places where mailbags are unloaded or emptied. In addition,
restrictions should be in place to limit the number of people including
support staff and nonemployees entering areas where aerosolized particles
may be generated. This recommendation applies to contractors, business
visitors, and support staff.
What
housekeeping controls in mail-handling/processing sites are recommended
to protect workers from exposure to B. anthracis spores?
In the mail-handling work-site, dry sweeping and dusting should be avoided.
Instead, the area should be wet-cleaned and vacuumed with HEPA-equipped
vacuum cleaners.
What
personal protective equipment for workers in mail-handling/processing
sites is recommended to protect workers from exposure to B. anthracis
spores?
Personal protective equipment for workers in mail-handling/processing
work sites must be selected on the basis of the potential for cutaneous
or inhalational exposure to B. anthracis spores. Handling packages
or envelopes may result in skin exposure. In addition, because certain
machinery such as electronic mail sorters can generate aerosolized particles,
people who operate, maintain, or work near such machinery may be exposed
through inhalation. People who hand sort mail or work at other sites where
airborne particles may be generated such as where mailbags are unloaded
or emptied may also be exposed through inhalation.
What
are some examples of personal protective equipment and clothing that could
be used to protect workers who handle mail from exposure to B. anthracis
spores?
- Protective,
impermeable gloves should be worn by all workers who handle mail. In
some cases, workers may need to wear cotton gloves under their protective
gloves for comfort and to prevent dermatitis. Skin rashes and other
dermatological conditions are a potential hazard of wearing gloves.
Latex gloves should be avoided because of the risk of developing skin
sensitivity or allergy.
- Gloves
should be provided in a range of sizes to ensure proper fit.
- The choice
of glove material such as nitrile or vinyl should be based on safety,
fit, durability, and comfort. Sterile gloves such as surgical gloves
are not necessary.
- Different
gloves or layers of gloves may be needed depending on the task, the
dexterity required, and the type of protection needed. Protective gloves
can be worn under heavier gloves such as leather, heavy cotton for operations
where gloves can easily be torn or if more protection against hand injury
is needed.
- For workers
involved in situations where a gloved hand presents a hazard such as
those who work close to moving machine parts, the risk for potential
injury resulting from glove use should be measured against the risk
for potential exposure to B. anthracis.
- Workers
should avoid touching their skin, eyes, or other mucous membranes since
contaminated gloves may transfer B. anthracis spores to other
body sites.
- Workers
should consider wearing long-sleeved clothing and long pants to protect
exposed skin.
- Gloves
and other personal protective clothing and equipment can be discarded
in regular trash once they are removed or if they are visibly torn,
unless a suspicious piece of mail is recognized and handled. If a suspicious
piece of mail is recognized and handled for anthrax, the worker’s
protective gear should be handled as potentially contaminated material
(See “Guideline For Handwashing And Hospital Environmental Control,”
1985, available at www.cdc.gov/ncidod/hip/guide/handwash.htm)
- Workers
should wash their hands thoroughly with soap and water when gloves are
removed, before eating, and when replacing torn or worn gloves. Soap
and water will wash away most spores that may have contacted the skin;
disinfectant solutions are not needed.
Are there
some areas in the postal setting that present a greater risk to some workers
than others for anthrax exposure?
- People
working with or near machinery capable of generating aerosolized particles,
such as electronic mail sorters, or at other work sites where such particles
may be generated should be fitted with NIOSH-approved respirators that
are at least as protective as an N95 respirator.
- People
working in areas where oil mist from machinery is present should be
fitted with respirators equipped with P-type filters.
- Because
facial hair interferes with the fit of protective respirators, workers
with facial hair like beards or large moustaches may require alternative
respirators such as powered air-purifying respirators [PAPRs] with loose-fitting
hoods.
- Workers
who cannot be fitted properly with a half-mask respirator based on a
fit test may require the use of alternative respirators, such as full
facepiece, negative-pressure respirators, PAPRs equipped with HEPA filters,
or supplied-air respirators.
- If a
worker is medically unable to wear a respirator, the employer should
consider reassigning that worker to a job that does not require respiratory
protection.
- In addition,
the use of disposable aprons or goggles by persons working with or near
machinery capable of generating aerosolized particles may provide an
extra margin of protection.
How can
I recognize suspicious packages that have anthrax?
Only specially trained personnel can distinguish between a real bioterrorism
attack and a false one. If you suspect that a package, letter, or anything
else contains a harmful biological agent, call 911 to activate the local
emergency response system; in communities without 911 systems, notify
local law enforcement authorities. Guidance on identifying suspicious
packages and letters and what to do until the authorities arrive are available
on CDC’s Web site at www.bt.cdc.gov/agent/anthrax/mail/suspiciouspackages.asp.
What
can the consumer buy to protect against germ or chemical warfare such
as anthrax?
Currently, the CDC does not recommend consumers buy any particular product
to protect against biological or chemical attacks.
What
should be done with clothing contaminated with anthrax? Is washing in
a regular home washer and dryer ok? Does CDC recommend adding bleach to
the wash?
Contact your state or local public health department for advice. Clothing
can be decontaminated using soap and water, and 0.5% hypochlorite solution
(one part household bleach to 9 parts water).
Are other
solutions used at hospitals for cleaning blood spills also effective against
anthrax?
(Source: Interim Recommendation for Firefighters and other First Responders)
The recommendation for decontaminating equipment is a 0.5% hypochlorite
solution (1 part household bleach to ten parts water). www.bt.cdc.gov/documentsapp/anthrax/protective/10242001protect.asp.
What
actions need to be taken if a facility is found to have an environmental
sample positive for anthrax?
The number and location of positive environmental samples will be used
to guide clean-up efforts. Positive environmental samples alone do not
indicate the need for antibiotics or the need to close a facility. Employees,
visitors, and family members of employees at these facilities are advised
to monitor their own health carefully and report any unusual symptoms
to a physician.
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