For managing the anthrax exposure in the workplace re-formated for circulation




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GUIDANCE FROM OSHA

FOR MANAGING THE ANTHRAX

EXPOSURE IN THE WORKPLACE

RE-FORMATED FOR CIRCULATION

BY MARSH RISK CONSULTING

NOVEMBER 16, 2001








Risk Reduction Matrix

In October 2001, four workers died from inhalation anthrax and an additional 13 developed cutaneous or inhalational disease as a result of intentional terrorist activity. In most cases seen thus far, the disease was linked to unexpected workplace exposures to anthrax spores contained in letters mailed through the United States Postal Service. Fortunately, the number of workplaces contaminated with the spores has also been quite limited. Nevertheless, employers and workers are concerned about possible exposure to Bacillus anthracis in the workplace.

This matrix was developed to offer basic advice and suggest protective measures that OSHA believes will reduce the risk of exposure in light of current concerns about the presence of anthrax spores in the workplace. This matrix is not intended to establish a legal standard of care with respect to anthrax spores in the workplace.

These recommendations do not impose and are not intended to result in the imposition of any new legal obligations or constraints on employers or the states.









Table of Contents: Page


  • OSHA's Mission and Role…………………………………2

  • Making Informed Decisions……………………………….2

  • How to Use this Guidance………………………………….3

  • Limitations of this Guidance………………………………3

  • Workplace Risk Pyramid………………………………….4

  • The Red Zone ………………………………………………………5

  • The Yellow Zone……………………………………………………7

  • The Green Zone………………………….…………………………8

  • OSHA Fact Sheet and References……………………………...9

  • OSHA Recommendations for Handling Suspicious ……...12

Letters and Packages

  • CDC interim Recommendations for Protecting …………..14

Worker Exposure to ANTHRAX

  • Information Resources…………………………………………..17


1
OSHA’s Mission and Role

OSHA believes that it can best help employers and workers protect themselves by providing information and assistance that should help reduce employee exposure to, and risk from, anthrax spores. OSHA is also working with other Federal agencies and employers -- including the Centers for Disease Control and Prevention (CDC) and, within CDC, the National Institute for Occupational Safety and Health (NIOSH); the Federal Bureau of Investigation (FBI); the Environmental Protection Agency (EPA); and the U.S. Postal Service and Postal Unions - to make sure that the guidance OSHA gives is the best and most current information available.




Making Informed Decisions

This matrix is intended to help employers understand how to assess the risk of exposure to anthrax spores in their workplaces and to make the necessary decisions to successfully protect their workers from this exposure. The level of risk in any particular workplace is based upon factors such as:



  • current patterns of workplaces contaminated with anthrax spores;

  • the likelihood of the workplace being a target for Bacillus anthracis contamination;

  • the proximity of a workplace or workstation to areas known to be contaminated with anthrax spores;

  • the likelihood of the workplace receiving mail or other items from a contaminated facility;

  • any information provided by law enforcement or public health officials about the workplace's risk of receiving contaminated items;

  • the amount of mail the workplace receives;

  • the type of workplace - for example, a post office, bulk mail center, or public or private mail room where cross-contamination might be possible;

  • the potential that workplace operations and tasks could result in exposure if contaminated mail is received;

  • the use of high speed mail handling equipment, or other processes that might aerosolize anthrax spores during processing; or any other information or analysis that would indicate the workplace might be contaminated with anthrax spores.


2
How To Use This Guidance

To help employers determine appropriate work practices and precautions, OSHA has divided workplaces and work operations into three risk zones, according to the likelihood of contamination with anthrax spores and employee exposure to them. These zones are called the green zone, the yellow zone, and the red zone.



Green Zone: workplaces where contamination with anthrax spores is unlikely.

Yellow Zone: workplaces where contamination with anthrax spores is possible.

Red Zone: workplaces where public health or law enforcement authorities have stated that contamination with anthrax spores has been confirmed or is strongly suspected.

We show these zones within the shape of a pyramid to represent how the risk appears to be distributed. Based on information currently available, contamination with anthrax spores and exposure to the bacterium are unlikely in the vast majority of American workplaces, represented by the green zone.


Employers should consider the factors listed above and use their knowledge of their own workplace, together with current information about the anthrax threat from law enforcement organizations and public health departments, to determine the zone that best describes their workplaces. After you make that determination, click on that zone on the pyramid below to see OSHA's recommendations for work practices and precautions that may reduce the risk of and worker concern about anthrax exposure in your workplace. For each zone, we point to sources of additional online information to help you understand and implement these protective measures
Limitations on This Guidance

Terrorist activity is unpredictable, and it is possible that releases of anthrax spores and workplace exposure will occur in locations not yet anticipated. The risk criteria presented here may change as our national understanding of the threat evolves. OSHA remains committed to helping employers protect their employees from the threat of bio-terrorism in the workplace and is working closely with other Federal agencies involved in responding to that threat in order to provide employers with the most up-to-date information and guidance available.




3

Workplace Risk Pyramid

Red Zone:

Workplaces Where Authorities Have Informed You That Contamination with Anthrax Spores Has Been Confirmed or Is Strongly Suspected
Y
ellow Zone:


Workplaces Where Contamination with Anthrax Spores Is Possible

Green Zone:

Workplaces Where Contamination with Anthrax Spores Is Unlikely



4



R
ed Zone:


Workplaces Where Authorities Have Informed You That Contamination with Anthrax Spores Has Been Confirmed or Is Strongly Suspected







Red zone guidance addresses two situations:

  • The employer is notified by law enforcement or public health authorities that a facility is strongly suspected of or confirmed as having been contaminated with anthrax spores.

  • The employer is engaged in emergency response to and clean-up of bio-terrorist releases of anthrax spores.

Notification of an Exposure Incident by Authorities

Actions taken by an employer under these circumstances may vary depending on the specific facts and the nature of the incident. Employers should follow instructions given by law enforcement and public health agencies and convey appropriate information to employees.



Emergency Responders, Clean-up Personnel, and Investigators

Recommended Work Practices


  • Emergency response to, and investigation and clean-up of sites contaminated through bio-terrorist acts is specialized work that must be performed by highly trained and qualified personnel.

  • OSHA's Hazardous Waste Operations and Emergency Response Standard, also known as HAZWOPER, (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, and a bacterium like anthrax, which can cause disease and death, is covered under the definition.

  • The HAZWOPER standard provides protection through common sense requirements like emergency planning, training, exposure monitoring, and exposure control through protective measures such as work practices and personal protective equipment (PPE).

  • HAZWOPER requirements are performance-oriented and are based on the risk an employer anticipates his/her employees will face. Each employer should review the requirements and choose the best way to apply them to specific emergency or clean-up operations.


5
Personal Protective Equipment (PPE)
Like the other requirements under HAZWOPER, the PPE requirements are performance-oriented. This means that the level of protection chosen, and the PPE used should be proportional to the risk anticipated for the task workers will do. OSHA provides the following recommendations, which are based on our recent experience with workplaces contaminated with anthrax spores. In most recent instances, exposure has generally resulted from contact with or dispersal of anthrax spores from a contaminated letter or package. As a result, many workers investigating suspected releases or cleaning up these types of releases may be able to respond in Modified Level C protection, outlined in Number 1 below. Terrorist releases of anthrax spores where there is no information about the potential source or dispersal method, or where the release is still occurring, will require that workers respond in higher levels of protection, as outlined in Numbers 2-3 below.


  1. Modified Level C protection should be adequate during the investigation and clean-up of a known anthrax release where the agent was dispersed from a letter or package that can be easily bagged and there is no potential for splashing potentially contaminated materials. Modified Level C cannot be used if anthrax spores were dispersed using an aerosol-generating device, like a garden duster, or there is no information about how anthrax spores were released. Modified Level C should be consistent with the description in HAZWOPER Appendix B, but employees should wear a tight-fitting, full-face Powered Air-Purifying Respirator (PAPR) and skin protection with an integral hood and booties. Note: Selection of respiratory protection should be consistent with OSHA's Respiratory Protection Standard (29 CFR 1910.134) and take into account the agents used for decontamination. If organic vapor cartridges are used, then a cartridge change schedule should be implemented




  1. Level B protection should be adequate during response to or clean-up of a release where anthrax spores may have been dispersed with an aerosol-generating device but are no longer being released, or where there is a high potential for splashing potentially contaminated materials. Level B protection is a PPE ensemble that provides the highest level of respiratory protection, but a lesser level of skin protection than Level A. Level B protection should be consistent with the description in HAZWOPER Appendix B.



  1. Level A should be adequate for response to or clean-up of a release that involves an unknown dispersal method. Level A protection should also be adequate during response to or clean-up of a release that involves an aerosol-generating device and the release is still occurring, or the release has stopped but there is no information about the duration of the release or the airborne concentrations of anthrax spores. Level A protection is a PPE ensemble that provides the greatest level of skin, respiratory, and eye protection. Level A protection should be consistent with the description in HAZWOPER Appendix B.

  2. Personnel assisting in decontamination of emergency responders or clean-up personnel should be in PPE that is equivalent to one level below that required for the responder or clean-up personnel (e.g., if responder in Level A, then decontamination personnel in Level B.


6

Y
ellow Zone:


Workplaces Where Contamination with Anthrax Spores Is Possible








This zone is where workplace contamination is possible. Risk factors that should be considered in this zone include handling bulk mail, handling mail from facilities that are known to be contaminated, working near equipment such as high-speed processors/sorters that could aerosolize anthrax spores; workplaces in close proximity to other workplaces known to be contaminated; or workplaces that may be targets of bio-terrorists.

Engineering controls are the most effective controls an employer can use to protect employees. The Centers for Disease Controls and Prevention (CDC) provide a list of suggested engineering controls in Recommendations for Protecting Workers from Exposure to Bacillus anthracis in Work Sites Where Mail Is Handled or Processed. See Page 14.


Prudent Work Practices

  • Follow OSHA's recommendations for green zone workplaces for workers who open mail or respond to suspicious envelopes or packages.

  • Develop strategies to limit the number of persons working at or near areas where airborne particles may be generated (e.g., mail-sorting machinery, places where mailbags are unloaded or emptied).

  • Restrict the number of non-essential personnel (e.g., contractors, visitors, etc.) entering areas where airborne particles may be generated.

  • Avoid practices that generate dust, such as dry sweeping, dusting, and using compressed air to clean machinery. Areas should be wet-cleaned or vacuumed with an industrial vacuum cleaner equipped with a high-efficiency particulate air (HEPA) filter. Conventional home or industrial vacuums should not be used since these vacuums may further disperse possible anthrax spores.

  • Instruct employees to wash hands regularly with soap and water. At a minimum, hands should be washed when gloves are removed, before eating, and at the end of a shift.

  • Establish procedures in the emergency plan for employees to report possible exposure and contact authorities:

  • Contact supervisor

  • Notify local police and local FBI

  • Give workers information and training on:

  • Modes of anthrax transmission;

  • Signs and symptoms of anthrax infection;

  • Emergency procedures to deal with possible contamination;

  • Protective clothing to minimize skin exposure;

  • Care for abrasions that might provide an infection route.

Personal Protective Equipment (Voluntary)

  • Impermeable gloves such as nitrile or vinyl.

  • Properly fitted, NIOSH-certified filtering facepiece (N95 or greater). See Appendix D of OSHA's Respiratory Protection standard for information about the use of respirators when such use is voluntary. 29 CFR 1910.134 Appendix D

  • Respirators equipped with P-type filters in areas where oil mist from machinery is present should be considered to ensure filter effectiveness.

7


Green Zone:
Workplaces Where Contamination with Anthrax Spores Is Unlikely







This zone covers the vast majority of workplaces in the United States. Since October 2001, anthrax spores have only been discovered in a very limited number of workplaces.



Prudent Work Practices

  • Establish procedures for safe handling of mail and packages. Employees should:

  • Be on the lookout for suspicious envelopes or packages.

  • NOT open suspicious mail!

  • Open mail with a letter opener or another method that minimizes skin contact with the mail and is least likely to disturb contents.

  • Open mail with a minimum amount of movement.

  • Not blow into envelopes.

  • Keep hands away from nose and mouth while opening mail.

  • Turn off fans, portable heaters, and other equipment that may create air currents while opening mail.

  • Wash hands after handling mail.

  • Train workers on characteristics of suspicious mail and how to respond. For guidance on identifying suspicious mail, see the Information Resources section below.

  • Establish procedures for handling mail that appears to contain a suspicious powder or other unusual substance. Employees should:

  • Put the letter or package down on a stable surface and do not open or handle it further.

  • Alert others nearby.

  • Not try to clean up the substance.

  • Not remove any items from the area.

  • Leave the area and close the door gently.

  • Contact their supervisor, designated responder, or other appropriate authority after evacuating.

  • Wash hands with soap and water.

Designated responders or other appropriate authority will determine the need for further action.

Personal Protective Equipment (Voluntary)

Employers may wish to consider providing nitrile or vinyl gloves to employees who request them.



8


OSHA Fact Sheet and References

On Worker Health and Safety for ANTHRAX Exposure

What is Anthrax?
Anthrax is an acute infectious disease caused by a spore-forming bacterium called Bacillus anthracis. It is generally acquired following contact with anthrax-infected animals or anthrax-contaminated animal products. Anthrax is receiving heightened attention recently because of its use as a biological warfare agent. In humans, three types of anthrax infections can occur, based on the route of exposure: cutaneous (skin exposure), inhalational (inhalation exposure), and gastrointestinal (ingestion exposure). Symptoms are dependent on the route of exposure. Those most often associated with skin infections are itching, boils, and formation of a black scab. Symptoms most often associated with inhalation infections are fever, chest pain, and difficulty breathing. Symptoms most often associated with ingestion infections are nausea, vomiting and diarrhea. More general information about anthrax can be found in the following resource:

C
DC Public Health Emergency Preparedness & Response


Who Can be Exposed to Anthrax?

Animal Handling Occupations
Anthrax is most common in occupations involving animals, animal hides or fibers. Grazing animals such as cattle, sheet, goats and horses are chief animal hosts of anthrax. Occupations susceptible to exposure may include shepherds, farmers, butchers, handlers of imported hides or fibers, weavers, veterinarians, and veterinary pathologists.

S
elected Illnesses Which May Result From Exposure in the Work Environment

OSHA Recordkeeping Guidelines, App. C

Workers Exposed Through Criminal/Terrorist Acts
Workers whose jobs would not ordinarily involve anthrax exposure could be exposed through acts of terrorism. Conventional thinking is that terrorists are likely to target places where large populations can be found such as large buildings, sporting events, or mass transit systems. Recent events have shown that there is a wider range of physical locations that could be targeted and this expands the range of employees who could be exposed.

Health Care Workers
Health care workers in occupational settings such as hospitals, clinics, and medial laboratories may be exposed to anthrax as a result of contact with patients whose skin, clothing, or personal effects are contaminated with anthrax spores, or through contact with contaminated equipment. Anthrax is not a contagious disease, so exposure will not result from contact with an infected patient.

Emergency Response Workers
Emergency responders, including police, firefighters, emergency medical services workers, and others who are responsible for responding to acts of terrorism may be exposed to anthrax.

Interim PPE/Respirator Recommendations for First Responders, CDC 9

How Can Employers Prevent and Control Exposure and Infection?
The methods for preventing and controlling anthrax exposure and infection vary by workplace. Employers in animal handling occupations who may anticipate exposure may find the following useful.
Anthrax, Veterinary Service, USDA, 10/2001.

Anthrax exposures that result from a criminal or terrorist act are more difficult for unsuspecting employers to prevent and control. Nevertheless, OSHA, the CDC, USPS and FBI have developed recommendations to address the recent exposures resulting from contaminated mail and packages:


Recommendation for Handling Suspicious Packages or Letters, OSHA
How to Handle Anthrax and Other Biological Agent Threats, CDC Health Advisory.
We Are Taking Every Possible Measure To Assure Safety Of Customers And The Mail , U.S. Postal Service, 10/17/01, Message to Customers.
What to do if you receive a suspicious letter or package [PDF], FBI, 10/12/01
For health care employers and emergency responders, there is a larger body of response planning information. The Department of Health and Human Services (DHHS), CDC, the American Hospital Association (AHA), Department of Defense, and OSHA have several resources about how hospitals can plan and prepare for terrorist events:

Counter Terrorism Program, DHHS.
Readiness for Potential Attack Using Chemical or Biological Agents, AHA 10/20/01.
Hospital Preparedness for Mass Casualties [PDF], AHA & DHHS 8/2000.
Hospitals and Community Emergency Response, OSHA.
Local emergency responders also have an important role in recognizing and responding to terrorist events. The National Domestic Preparedness Office (NDPO), Federal Emergency Management Administration (FEMA), CDC, and OSHA provide several resources that address readiness and response by emergency responders:

National Domestic Preparedness Office, (NDPO)
Terrorist Incident Planning Guide, FEMA
Planning Resources, CDC
Emergency Response Technical Links, OSHA
In the event that anthrax is released, controls such as personal protective equipment (e.g., respirators) and decontamination will be needed to limit exposure and prevent secondary infection. You can find additional technical information in the following resources:

I
nterim PPE/Respirator Recommendations for First Responders
, CDC
E
mergency First Responder Equipment Guide
, U.S. Department of Justice.
F
irst Responder References
, USDOJ, Office of Justice Programs
L
aboratory Safety, Anthrax MSDS
, Health Canada Online
B
iosafety in Microbiological and Biomedical Labs, 4th Edition, 5/99 [PDF]
, CDC
G
uidelines for the Surveillance and Control of Anthrax in Humans and Animals
, WHO
B
ioterrorism Alleging Use of Anthrax, Interim Guidelines for Managment 1998
, CDC
State and Local Approaches, Mass Casualty Decontamination, USDOJ
Standard Precautions for Anthrax - Pulmonary, Yale-New Haven Hospital
Medical Management of Biological Casualties Handbook, U.S. Army Medical Research Institute of Infectious Diseases, 2/2001 10

Need More Information?
For additional assistance about specific aspects of worker health and safety associated with potential anthrax exposure, contact the following hotlines or helplines.

To report suspicious letter or package:

Call 911 (police) then


contact your local FBI Field Office

For vaccination information:

Centers for Disease Control and Prevention Vaccine Information


National Immunization Hotline (English): 1-800-232-2522
National Immunization Hotline (Spanish): 1-800-232-0233

U.S. Department of Defense


Anthrax Vaccine Immunization Program Information Line: (877) 438-8222 (877-GET-VAC).

For state and local response planning:

Department of Justice


State & Local Domestic Preparedness Helpline: 800-368-6498, 9-6 EST (non-emergency technical assistance)

Centers for Disease Control


Emergency Preparedness & Response Branch Hotline for State Health Officials: 770-488-7100 (24-hour line)

Health and Human Services, Office of Emergency Preparedness


National Disaster Medical System: (301) 443-1167 or 800-USA-NDMS

11

OSHA Recommendations for

Handling Suspicious Letters or Packages


Anthrax organisms can cause infection in the skin, gastrointestinal system, or the lungs. To do so, the organism must be rubbed into abraded skin, swallowed, or inhaled as a fine, aerosolized mist. It is important to note that the attached guidance emphasizes minimum disruption of suspect packages and their contents.



General Mail Handling

  • Be observant for suspicious envelopes or packages.

  • Open all mail with a letter opener or method that is least likely to disturb contents. Do not use hands.

  • Open packages/envelopes with a minimum amount of movement.

  • Do not blow into envelopes.

  • Do not shake, pour out contents.

  • Keep hands away from nose and mouth while opening mail.

  • Wash hands after handling mail.

Some items that can trigger suspicion

  • Discoloration, crystallization, strange odors or oily stains

  • Envelope with powder or powder-like residue

  • Protruding wires or aluminum foil

  • Excessive tape or string

  • Unusual size or weight given size

  • Lopsided or oddly shaped envelope

  • Postmark that does not match return address

  • Restrictive endorsements such as "Personal" or "Confidential"

  • Excessive postage

  • Handwritten, block-printed or poorly typed addresses

  • Incorrect titles

  • Title but no name

  • Misspellings of common words

  • No return address

  • Addressed to individual no longer with organization

How to handle a suspect package or letter

  • Stay calm.

  • Do not shake or empty the contents of any suspicious package or letter.

  • Keep hands away from mouth, nose and eyes.

  • Isolate the package or letter.

  • Gently cover the envelope or package with anything available nearby (e.g. clothing, paper, inverted trash can, etc.) and do not remove cover.

  • If an unknown substance spills from the package/envelope, do not try to clean up substance.

  • Avoid creating air currents.

  • Do not handle package/envelope any further.

  • If material spills on floor avoid stepping near it. Avoid tracking any spilled materials to other locations. 12

  • Wash hands with soap and water.

  • Do not remove any potentially contaminated items from area.

  • If contaminated, keep movements within the building to a minimum. This will keep contamination of building to a minimum. Remove heavily contaminated clothing as soon as possible and gently to minimize dispersal.

  • If shower facilities are available, remove clothing in shower under water stream. Place clothing into a plastic bag or other container that can be sealed. This bag should be given to responders for proper handling.

  • Contact supervisor/designated responder.

  • Supervisors/ designated responders will determine if further action is necessary such as:

  • Notify others in the room, turn off any fans/portable heaters, evacuate the room and close the door.

  • Ensure no one enters the room until proper authorities arrive.

  • Report incident to security and to the Federal Protective Service so they may notify appropriate authorities.

  • Report incident to facility management so they can shut down the room's ventilation system.

  • List all people who were in the room or area when the package or letter was recognized. Give this list to the health and law enforcement officials.

Disease can be prevented after exposure to the anthrax spores by early treatment with the appropriate antibiotics. Anthrax is not spread from one person to another person.

13
CDC Interim* Recommendations for Protecting Workers from Exposure to Bacillus anthracis in Work Sites Where Mail Is Handled or Processed
(updated from the CDC Health Advisory 45 issued 10/24/2001)

These interim recommendations are intended to assist personnel responsible for occupational health and safety in developing a comprehensive program to reduce potential cutaneous or inhalational exposures to Bacillus anthracis spores among workers, including maintenance and custodial workers, in work sites where mail is handled or processed. Such work sites include post offices, mail distribution/handling centers, bulk mail centers, air mail facilities, priority mail processing centers, public and private mailrooms, and other settings in which workers are responsible for the handling and processing of mail. These interim recommendations are based on the limited information available on ways to avoid infection and the effectiveness of various prevention strategies and will be updated as new information becomes available. 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 http://www.phppo.cdc.gov>). 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.

These recommendations are divided into the following hierarchical categories describing measures that should be implemented in mail-handling/processing sites to prevent potential exposures to B. anthracis spores:

1. Engineering controls


2. Administrative controls
3. Housekeeping controls
4. Personal protective equipment for workers

These measures 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.



1. Engineering Controls in Mail-handling/processing Sites
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

14

(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., “blowdown/blowoff”).

2. Administrative Controls in Mail-handling/processing Sites
Strategies should be developed to limit the number of persons working at or near sites where aerosolized particles may be generated (e.g., mail-sorting machinery, places where mailbags are unloaded or emptied). In addition, restrictions should be in place to limit the number of persons (including support staff and non-employees, e.g., contractors, business visitors) entering areas where aerosolized particles may be generated. This includes contractors, business visitors, and support staff.

3. Housekeeping Controls in Mail-handling/processing Sites
Dry sweeping and dusting should be avoided. Instead, areas should be wet-cleaned and vacuumed with HEPA-equipped vacuum cleaners.

4. Personal Protective Equipment for Workers in Mail-handling/processing Sites
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 cutaneous exposure. In addition, because certain machinery (e.g., electronic mail sorters) can generate aerosolized particles, persons who operate, maintain, or work near such machinery may be exposed through inhalation. Persons who hand sort mail or work at other sites where airborne particles may be generated (e.g., where mailbags are unloaded or emptied) may also be exposed through inhalation.

Recommendations for Workers Who Handle Mail


  • 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 (e.g., nitrile, vinyl) should be based on safety, fit, durability, and comfort. Sterile gloves (e.g., 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 (e.g., 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 (e.g.,

15

use should be measured against the risk for potential exposure to B. anthracis.



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, the worker’s protective gear should be handled as potentially contaminated material (See “Guideline For Hand washing And Hospital Environmental Control,” 1985, available at http://www.cdc.gov/ncidod/hip/guide/handwash.htm

  • Hands should be thoroughly washed 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.

Additional Recommendations for Workers Who May Be Exposed through Inhalation

  • Persons working with or near machinery capable of generating aerosolized particles (e.g., 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.

  • Persons 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 (beards and 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.

In work sites where respirators are worn, a respiratory-protection program that complies with the provisions of OSHA [29 CFR 1910.134] should be in place. Such a program includes provisions for obtaining medical clearance for wearing a respirator and conducting a respirator fit-test to ensure that the respirator fits properly. Without fit testing, persons unknowingly may have poor face seals, allowing aerosols to leak around the mask and be inhaled. (See December 11, 1998, MMWR, available at http://www.cdc.gov/mmwr/preview/mmwrhtml/00055954.htm
16

INFORMATION RESOURCES

Appendix D of OSHA's Respiratory Protection standard for information about the use of respirators when such use is voluntary

  • OSHA Standard for Respiratory Protection, 1910.134

  • OSHA Standard for Hand Protection, 1910.138

  • Technical Links Webpages for Emergency Response, Respiratory Protection and PPE

  • OSHA Instruction CPL 2-2.59A Inspection Procedures for the Hazardous Waste Operations and Emergency Response Standard, 29 CFR 1910.120 and 1926.65, Paragraph (q): Emergency Response to Hazardous Substance Releases.

  • Inspection Procedures for the Respiratory Protection Standard.

  • Recommendations for Protecting Workers from Exposure to Bacillus anthracis in Work Sites Where Mail Is Handled or Processed.

  • OSHA Fact Sheet and References on Worker Health and Safety

  • Inspection Procedures for the Respiratory Protection Standard.

(See discussions on voluntary use throughout this document)

  • OSHA Recommendations for Handling Suspicious Letters or Packages

  • OSHA Anthrax Fact Sheet

  • United States Postal Service, Service Updates, Security of the Mail

  • Federal Bureau of Investigations, Mail Advisory Poster



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