Interim Guidance for Employers to Reduce Exposure to Avian Influenza A Viruses for People Working with Animals

Overview

Humans can be infected with avian influenza A viruses, such as viruses that cause H5N1 bird flu, when enough virus gets into a person's eyes, nose, or mouth, or is inhaled. When virus is in the air (such as in droplets from splashes, small particles, or dust), it can deposit on the mucus membranes of the mouth, eyes, or nose. A person can also breathe the virus in from the air. Infections can also happen when a person gets virus on their skin or clothes and accidentally transfers it to their eyes, nose, or mouth. For example, when a person is splashed by a liquid that has the virus, touches their contaminated clothes, and later touches their eyes.

Employers should take steps to reduce workers' exposure to avian influenza A viruses from sick animals or contaminated environments. Reducing exposure to avian influenza A viruses helps both public health and biosecurity – protecting people and animals from illness caused by these viruses, such as H5N1 bird flu. Familiarize yourself with any Occupational Safety and Health Administration (OSHA) requirements that may apply to you. If you operate in a state regulated by a state OSHA plan, familiarize yourself with any additional requirements that may apply.

To protect workers who might be exposed, employers should update or develop a workplace health and safety plan. We encourage using a health and safety committee that includes representatives from both management and workers to develop the plan. OSHA has helpful guidance and consultation on developing a workplace health and safety plan. Your local agriculture extension office may also have resources available.

How workers are exposed

Workers may be exposed in two main ways. The first is when working with animals confirmed or potentially infected with avian influenza A viruses. The second is when working with materials, including raw milk, that are contaminated or potentially contaminated with avian influenza A viruses.

These farm workers are most likely to be exposed:

• Poultry workers
• Dairy workers

Other types of workers that may also be exposed:

• Other livestock workers
• Animal health responders including:
  • Poultry culling
  • Handling sick or dead wild animals
• Backyard bird flock owners
• Dairy laboratory workers
• Food processing workers handling raw milk and other confirmed or potentially contaminated materials
• Public health responders
• Slaughterhouse workers performing certain tasks on lactating dairy cattle including:
  • Unloading or handling live lactating dairy cattle for slaughter, including working in holding pens and tasks involved with ante-mortem inspection
  • Post-mortem processes including the post-mortem inspection, handling, and transporting of viscera
  • Removing and transporting udders from dairy cattle for further processing or rendering
• Veterinarians and veterinary staff
• Zoo, other wild animal facility, or other animal farm workers, such as:
  • Sanctuary workers
  • Aquarium workers
  • Wildlife rehabilitators
  • Fur farm workers

Conduct a site-specific hazard assessment

First, conduct a site-specific hazard assessment of your farm to identify potential exposures to avian influenza A viruses based on work tasks and settings. Employers can use the Hazard Assessment Worksheet for Dairy Facilities to identify dairy workplace hazards and prioritize controls. Protecting Poultry Workers from Avian Influenza (Bird Flu) can help identify poultry workplace hazards and prioritize controls, including PPE needed for protection.

After completing a site-specific hazard assessment, use the table below to determine the potential exposure level (low, medium, or high) for work tasks and settings. Links in the table will take you to information on the appropriate type(s) of controls that can be used to reduce exposure to avian influenza A viruses.

The recommended actions are based on the hierarchy of controls. This model identifies a preferred order of actions to best control hazardous workplace exposures.

• Engineering controls reduce or prevent hazards from coming into contact with workers. Engineering controls are more effective than other options because they don't require ongoing efforts by workers and their supervisors.
• Administrative controls establish work practices that reduce the duration, frequency, or intensity of exposure to hazards.
• Personal protective equipment (PPE) is worn to minimize exposure to hazards. To be most effective, PPE must be put on and taken off correctly and in a specific order.

Employers are encouraged to assess the feasibility of controls and PPE on their farm. Consider if the recommended controls and PPE can be used without introducing new risks. You will likely need to combine controls and PPE in order to provide the appropriate level of protection necessary to prevent infection (e.g., using a combination of engineering controls, administrative controls, and PPE). If you cannot implement a specific control or a piece of the PPE recommendations, you should ensure the combination of controls used provide the protection necessary to prevent infection.

Levels of exposure

This table identifies the type of controls and PPE that can be used depending on the exposure level of the setting or task. These recommendations are based on our current understanding of exposure risk.

Control measures

To help employers implement the guidance following the hierarchy of controls, CDC is providing detailed recommendations. The controls described are actions that help prevent people from getting infected with avian influenza A viruses. Recommended control measures are arranged below from the most effective (engineering controls) to least effective (PPE).

Use the links below to jump to a specific section:

• Engineering controls
• Administrative controls
• Personal protective equipment
  • Recommended PPE for medium exposure settings
  • Recommended PPE for high exposure settings
• Toolbox Talk – Personal Protective Equipment for H5N1 Bird Flu (also available in Spanish)
• Information for employers providing personal protective equipment to reduce exposure to novel flu
  • Personal protective equipment specifications
  • Working in hot environments
  • Working in cold environments

Engineering controls

Engineering controls reduce or prevent hazards from coming into contact with workers. Proper ventilation in dairy and poultry barns depends on factors such as the size of the barn, the number of animals, and local climate. Poor ventilation can lead to the buildup of harmful gases, excessive heat and humidity, and bacteria and viruses. Circulating fresh air helps dilute and disperse potential pathogens and can help control the temperature and humidity.

In high and medium exposure settings, employers can implement the following engineering controls:

• Use a ventilation system that provides a constant supply of fresh air.
• Strategically place fans and vents to generate a clean-to-less-clean flow path of fresh air through the space while removing dirty air.
• Use airflow exhaust and makeup air supply strategies that do not discharge high velocity airflow upon building occupants.
• Regularly clean and maintain ventilation systems to minimize the accumulation of dust, feathers, manure particles, and other debris that can block airflow and provide a breeding ground for pathogens.
• Use milking systems with automated features, such as automatic takeoffs or robotic systems. If available, these can help reduce worker contact with lactating animals.

Administrative controls

Administrative controls are policies and work practices that reduce workers' exposure to hazards. In all exposure settings, employers can implement the following policies and work practices.

Monitoring

• Watch for sick or dead animals on your farm or workplace, and monitor animals for changes in feed consumption or production metrics.
• Test animals for avian influenza A virus if indicated (if relevant, consider joining the USDA HPAI Dairy Herd Status Program or contacting your State Animal Health Official about testing available within your state).
• Develop plans to monitor workers for illness:
  • Have monitoring plans ready to use when needed.
  • Develop a process to communicate with your workers daily to determine if they are sick or have symptoms. Ask about conjunctivitis (pink eye), mild flu-like upper respiratory symptoms, or other symptoms consistent with avian influenza A virus infection.
  • Designate management staff to maintain records for absenteeism, symptomatic workers, and testing. Review the records daily.
    

• Ask employees to monitor themselves for symptoms of illness every day while they are working with animals confirmed or potentially infected. They should continue to self-monitor for 10 days after the last day of exposure. If they become sick while working or during those 10 days:
  • Have them isolate themselves from others and tell their supervisor,
  • Help them contact your state or local health department, and
  • Give them instructions for seeking medical evaluation and treatment, if recommended.

• Encourage your employees to get a seasonal flu vaccine.
  • Seasonal flu vaccination is not designed or intended to prevent infection with avian influenza A viruses but can reduce the risk of getting sick with human seasonal influenza viruses.

Printable instructions on what to do if you feel sick are available in five languages. These documents can also be printed as 11"x17" posters and hung up in the workplace.

Testing and treatment

• Work with the state or local health department to offer flu testing, post-exposure prophylaxis, and treatment of workers, if recommended, if workers have:
  • Developed symptoms after contact with confirmed or potentially infected animals or their secretions, or
  • Had unprotected exposure to confirmed or potentially infected animals or their secretions.
• Provide employees with paid time off and develop flexible leave policies to support workers to stay home if sick.

Training

• Train workers on:
  • Relevant equipment, procedures, and hazards (for example, potential for exposure to avian influenza A virus through contact with animals, animal secretions, or contaminated objects),
  • Infection control practices,
  • Heat illness prevention,
  • Recognizing signs and symptoms of avian influenza A virus infection in themselves and others,
  • Any new procedures in the workplace, and
  • PPE including how to put on, use, and take off.

Work practices

• Provide safe storage locations for workers' food and personal items, including clothing worn off-site.
• Prohibit storage of food and personal items in potentially contaminated areas, including where PPE is put on and removed.
• Provide workers access to hand washing stations with soap and clean water.
  • Provide alcohol-based hand sanitizer containing at least 60% alcohol if soap and water are not immediately available.
  • Place hand washing stations and alcohol-based hand sanitizer in multiple locations to encourage hand hygiene, especially in areas where workers frequently have contact with animals.
  • If possible, choose hand washing stations, hand sanitizer stations, and trash receptacles that are touch-free.
  • Consider other workplace practices to promote personal hygiene like building additional short breaks into staff schedules.
  • Remind workers to wash their hands for 20 seconds before eating, drinking, touching their phones, smoking, vaping, chewing gum, or dipping tobacco.
• Provide workers access to shower facilities at the end of the work shift and a clean area to put on clean, uncontaminated clothing.

Personal protective equipment

Engineering and administrative controls are not always sufficient for reducing exposures to confirmed or potentially infected animals and their secretions. PPE is needed in some cases to reduce the risk of exposures, especially for workers in direct contact with animals or their secretions.

Employers should provide appropriate PPE at no cost as well as training on its proper use. Putting on and removing PPE should occur during work hours.

Respirators

• Protect workers from breathing in small droplets and biological material from animal secretions (such as raw milk, saliva or urine)
• Prevent workers from touching their mouth and nose during work

Goggles

• Protect workers from getting small droplets and splashes in their eyes
• Prevent workers from touching their eyes during work

Face Shields

• Protect the worker's face and respirator from splashes
• However, face shields should not be used alone as they do not provide as much protection against droplets and smaller particles as goggles and a respirator

Gloves, fluid-resistant protective clothing, boot covers or boots, and head or hair coverings

• Protect workers from getting animal secretions, droplets, and splashes on their skin, hair, or clothing
• Reduce the likelihood that later, after the worker has removed their PPE, they will touch contamination on their skin, hair, or clothing and then accidentally transfer it to their eyes, nose, or mouth

CDC has additional information on specifications for PPE items. This information is helpful when making PPE purchasing decisions.

Recommended PPE for high exposure settings

• NIOSH Approved^® particulate respirator
• Fluid-resistant coveralls
• Safety goggles
• Boot covers or boots
• Head cover or hair cover
• Disposable gloves
• Optional items:
  • Waterproof apron over the top of coveralls to prevent cross contamination during PPE removal
  • Face shield over the top of goggles and respirator to protect against large amount of liquid splashing onto the filtering facepiece respirator
  • Outer work gloves to protect the disposable gloves

Posters on wearing PPE, how to put on PPE, and how to remove PPE are available in five languages. Employers can print these as 11"x17" posters and post them in the workplace. You can also print them in smaller sizes to hand out to workers.

In milking parlors where contamination from cows can only reach the worker from one side, a fluid-resistant coverall may be substituted with a fluid-resistant sleeved apron. This modification should not be used in milking parlors where cows line up on two or more sides that are relatively close together because splashes could come from behind.

Posters on wearing PPE, how to put on PPE, and how to remove PPE in milking parlors are available in five languages. Employers can print these as 11"x17" posters and post them in the workplace. You can also print them in smaller sizes to hand out to workers.

Recommended PPE to for medium exposure settings

• NIOSH Approved^® particulate respirator
• Safety goggles
• Disposable gloves with optional outer work gloves

A poster on how to put on and remove PPE in medium exposure settings is available in English and Spanish. Employers can print this as a 11"x17" poster and post it in the workplace. You can also print it in smaller sizes to hand out to workers.

More Information

CDC

• Avian Influenza Current Situation
• Protecting Poultry Workers from Avian Influenza (Bird Flu)

Occupational Safety and Health Administration

• Avian Influenza – Control and Prevention
• Avian Influenza (Bird Flu)
• H5N1 (Avian Influenza) in Dairy Cattle

USDA

• APHIS Requirements and Recommendations for Highly Pathogenic Avian Influenza (HPAI) H5N1 Virus in Livestock For State Animal Health Officials, Accredited Veterinarians and Producers

Others

• Interim Highly Pathogenic Avian Influenza (HPAI) Virus Biosafety Guidance and Resources for Industry Laboratories and State Dairy & Dairy Product Laboratories
• Biosecurity – Secure Milk Supply Plan

NIOSH Approved is a certification mark of the U.S. Department of Health and Human Services (HHS) registered in the United States and several international jurisdictions.