Information for Employers Providing Personal Protective Equipment to Reduce Exposure to Avian Influenza A Viruses

Training on PPE

Train workers on:

• When to use PPE
  
• What PPE is necessary
• How to maintain PPE
• How to properly put on, use and remove PPE
• How to dispose of PPE according to local and state regulations and authorities
• Limitations of PPE

Provide this training in a language that the employee understands. At the end of an effective training, workers will be able to demonstrate their understanding of these concepts.

Workers should continue to wear the PPE required for their normal duties and other hazards (for example, waterproof apron, hearing protection) and add PPE for avian influenza A virus exposure as appropriate. Appropriate PPE depends on a site-specific hazard assessment and the hazards identified. PPE may be required by the Occupational Safety and Health Administration (OSHA) standards found at 29 CFR part 1910, Subpart I (Personal Protective Equipment) and 29 CFR 1910.134 (Respiratory Protection). Even when not required, following these standards will help protect workers from novel influenza A viruses.

Using PPE safely

Putting on and removing PPE

• Employers should provide appropriate PPE at no cost.
• Putting on and removing PPE should occur during work hours.
• Dedicate areas for putting on and removing PPE:
  • Designate separate areas to put on ("clean") and remove PPE ("dirty").
  • Maintain clear separations between dirty and clean areas using physical barriers and signage.
  • Maintain flow of foot traffic in one direction, from clean to dirty when entering the worksite. Route foot traffic from dirty to clean when exiting the worksite. Use clear signage.
  • Place posters with instructions for putting on and removing PPE in the appropriate designated areas, so instructions do not need be memorized.
• In clean areas, provide a place for workers to store food, personal items, and clean personal clothing prior to putting on PPE.
• In dirty areas:
  • Have a clearly marked receptacle in the PPE removal area for disposal of PPE, and another clearly marked receptacle where reusable or washable PPE is placed for cleaning and decontamination after each use.
  • Make a plan for disposal of contaminated PPE according to local and state regulations and authorities.
• Use a trained observer to supervise each step of workers putting on and removing PPE to ensure established PPE protocols are completed correctly.
• Establish procedures and post signage reminding all workers that PPE should be removed before entering any clean areas, including restrooms, breakrooms, and administrative areas.
• During PPE removal, workers should make sure to dispose of all disposable PPE in designated receptacles following your disposal plan. Workers should set aside all reusable PPE in the designated receptacle for cleaning and disinfection after each use.

While wearing PPE

• Remind workers to avoid touching themselves above their chest, especially eyes, mouth, or nose. This is especially important after touching any contaminated material.
• Remind workers not to eat, drink, touch their phones, smoke, vape, chew gum, dip tobacco, or use the bathroom until PPE has been removed.

After removing PPE

• Provide shower facilities so workers can shower at the end of the work shift and put on clean, uncontaminated clothing.
  • If there are no shower facilities on site, instruct workers to clean up as much as possible, put on uncontaminated clothing, leave straight from work to shower, and put on clean clothing afterward.
    
• Provide a location for workers to leave all contaminated clothing and equipment at work, to be cleaned there.
  • Do not remove contaminated items from the facility until cleaned and disinfected.
  • Workers who work at multiple farms should have different equipment, PPE, and work clothing for each location.

Cleaning reusable PPE

Reusable PPE includes boot covers, boots, goggles, face shields, waterproof aprons, elastomeric half mask respirators, powered air purifying respirators, helmets or hard hats.

Generally, it is recommended that reusable respirators be cleaned and disinfected immediately after removing. Elastomeric components vary among manufacturers and react differently to cleaning and disinfection solutions and procedures. The respirator facepiece components such as facepiece, valves, and straps require maintenance including cleaning, disinfection, and inspection prior to reuse.

Provide appropriate facilities, equipment, and supplies to properly clean reusable PPE. All reusable PPE should be set aside, then cleaned and disinfected after every use. To clean and disinfect reusable PPE:

1. Select an EPA registered disinfectant with label claims for avian influenza
2. Clean reusable PPE until visible dirt is removed
3. Disinfect reusable PPE according to the disinfectant and PPE manufacturer's instructions

Employers should launder washable PPE and other garments (for example, coveralls and clothing) onsite, following these instructions:

• Wash laundry onsite with standard laundry detergent, and completely machine-dry at the highest temperature suitable for the material.
• Wear disposable gloves and protective outerwear when handling soiled laundry.
• Use separate storage and transport bins for clean and dirty laundry.
• If no laundry facilities are onsite, clothing to be laundered at home should be transported in a plastic bag. It should be kept separate from household items, washed separately, and then thoroughly machine-dried at the highest temperature suitable for the material.

OSHA provides additional information on methods for preventing and reducing contamination on personnel and PPE.

PPE specifications

When selecting and purchasing PPE, it is important to select items that provide the level of protection needed. This includes PPE that prevents avian influenza A virus from coming in direct contact with the eyes, nose, or mouth, or being inhaled. PPE should also protect the hair, skin, and clothing from contact with virus that could later be transferred to the eyes, nose, or mouth and cause infection. The following information will help you select PPE that provides protection against avian influenza A viruses. Consult the manufacturer or supplier to understand what specifications PPE meet. Search NIOSH PPE-Info for more information on these standards.

Respiratory protection: NIOSH Approved® particulate respirator

CDC recommends any NIOSH Approved^® particulate respirator for respiratory protection. For example:

• N95^® or greater filtering facepiece respirator
• Elastomeric half mask respirator with a minimum of N95 filters
• Powered air-purifying respirator with HE^®, PAPR100-N^®, or PAPR100-P^® filters

OSHA's Respiratory Protection eTool has detailed information on respiratory protection programs. It covers fit testing procedures and appropriate respirator selection (for example, particulate vs. combination particulate/gas or vapor cartridge). Combination cartridges may be needed when additional gas or vapor hazards are present, such as cleaning chemicals or ammonia from waste products. Even when not required, the provisions in OSHA's Respiratory Protection standard are considered best practices for worker protection.

Train workers on key respiratory protection topics. At the end of training, workers should be able to demonstrate an understanding of:

• Conducting a proper user seal check, wearing, and use of respirators
• Safe removal of respirators
• Proper respirator storage
• Safe disposal of disposable respirators
• How and when to replace a respirator that is damaged, soiled, or causing noticeably increased breathing resistance
• Cleaning and disinfection of, and recommended respirator cartridge change-out schedule for, reusable respirators
• Medical contraindications to respirator use
• Use of only NIOSH Approved® respirators

For information on NIOSH Approved® respirators see The Respiratory Protection Information Trusted Source.

Respirators are designed primarily to be used in workplaces by adults who are part of their employer's respiratory protection program. However, people working with poultry and livestock, including youth workers, may not be familiar with respirators. The risks and benefits of using respirators without proper training and fit testing are uncertain.

For a respirator to be most effective, it must form a seal on the face to keep particles from leaking around the edges. A tight seal should be achieved following the manufacturer's instructions when not fit-tested. Additionally, most respirators will be too big to form a proper seal for youth workers' faces, and some will be too big for people with smaller faces. People who cannot wear a respirator that properly seals to the face should not work near animals confirmed or potentially infected with avian influenza A viruses. They also should not work with materials, including raw milk, that are confirmed or potentially contaminated.

Outer garments: Fluid-resistant coveralls or fluid-resistant sleeved apron, waterproof apron

CDC recommends disposable or washable fluid-resistant coveralls. Depending on tasks, an optional disposable or reusable waterproof apron can be used over the top of coveralls. Fluid-resistant coveralls protect the underlying clothing and skin from contamination. Waterproof aprons protect the coveralls and allow for easy removal of gross contamination during PPE removal.

In milking parlors where cows line up on one side, a fluid-resistant coverall might be substituted with a fluid-resistant sleeved apron. However, milking parlors where cows line up on two or more sides that are relatively close together should not use this substitution because splashes could come from behind. It is important to train workers that this modification only provides partial body protection. It makes them more susceptible to transferring the virus from unprotected clothing through direct or indirect contact with their eyes, nose, or mouth, potentially causing an infection.

Preferably, fluid-resistant coveralls and sleeved aprons should be made of material that passes:

• AATCC 42 ≤ 1 g and AATCC 127 ≥ 50 cm H2O or EN 20811 ≥ 50 cm H2O; or
• ASTM F1670 (13.8 kPa); or
• ISO 16603 ≥ 3.5 kPA

The virus is less likely to penetrate coveralls and aprons made with fabrics that meet these standards compared to fabrics that do not, such as generic cotton.

Eye protection: Safety goggles, face shield

CDC recommends properly fitted unvented or indirectly vented safety goggles. Preferably, safety goggles should conform to ANSI Z87.1 that is marked at least Z87 D3 that indicates protection from droplets and splashes. If safety goggles conforming to this standard are not available, goggles conforming to any ANSI Z87.1 standard are acceptable. However, they may not provide full droplet and splash protection.

If there is a high potential for a large amount of liquid splashing onto a filtering facepiece respirator (for example, splashing raw milk or exploding eggs), consider using a face shield over goggles and respirator to protect the eyes and respirator. When selecting a face shield, make sure it does not change the way the goggles or respirator fit.

Try to prevent fogging of goggles and face shields. Using anti-fog lenses or a manufacturer's anti-fog coating may help maintain clear vision. Under certain conditions, some PPE can alter or decrease ability to see clearly and peripheral vision. If this is the case, workers should work in pairs if possible. Workers should also pay close attention to their surroundings for hazards such as animal movement, clothing snags, cuts or punctures, and slips, trips, and falls.

Foot protection: Boot covers or boots

CDC recommends reusable boot covers or boots that can be cleaned and disinfected. Only consider using disposable boot covers in areas where they will remain intact. Disposable boot covers are highly susceptible to rips and tears in many agriculture environments.

Head and hair protection: Head cover or hair cover

CDC recommends a disposable head cover or hair cover. If hard hats are required for impact protection, they should be able to be cleaned and disinfected after each use. When selecting a hard hat, make sure it does not change the way the face shield, goggles, or respirator fit.

Hand protection: Gloves, outer work gloves

CDC recommends disposable gloves with optional outer work gloves. Disposable gloves protect the hands from contamination. Outer work gloves (for example, gloves for cold protection, manual shoveling, handling live poultry) can be worn over the inner disposable gloves to protect the inner glove and the hands. Outer work gloves should be considered contaminated unless they are able to be cleaned and disinfected according to manufacturer's instruction and disinfectant product label.

Preferably, disposable gloves should conform to ASTM D5250 (vinyl examination gloves), ASTM D6319 (nitrile rubber examination gloves), or ASTM D6977 (chloroprene examination gloves). If thicker reusable gloves are required, rubber gloves should be waterproof and not have linings. Thicker gloves should be able to be cleaned and disinfected after each use. Use gloves conforming to ASTM D3578 (latex rubber examination gloves) as a last resort, as an employee may not know they have a latex allergy until a reaction occurs. If latex allergies are present, avoid latex.

Information on hot working environments

Agricultural work is often carried out in hot and sometimes humid environments. Certain circumstances can increase the risk of heat-related illnesses and injuries:

• Wearing PPE and certain clothing ensembles
• Increased temperature and humidity
• Increased physical activity

PPE can reduce the wearer's exposure to fresh, cooling air and limit evaporation from skin. It can also decrease a worker's ability to drink and rehydrate. When work must be carried out in hot and/or humid environments, it is important to educate workers about symptoms of heat-related illnesses. Also consider implementing additional controls to protect workers. These might include:

• Provide training that covers both PPE and heat stress. Explain why the prescribed PPE is necessary while also discussing the risks of heat-related injury associated with wearing PPE.
• Provide training on the symptoms, risk factors, first aid, and prevention of heat-related illnesses. Provide frequent reminders and messaging to reinforce the training.
• Adjust shifts so that work can be completed in the coolest part of the day (for example, night shift). Suspend work when temperatures are too hot.
• Modify work/rest schedules to increase frequency and duration of rest periods. Provide workers enough time to safely remove PPE, cool down, and fully hydrate.
• Provide a cool, shaded location for rest breaks with sufficient supply of potable <15°C (59°F) water. Also provide electrolyte packets or sports drinks if workers have been sweating for several hours.
• Make cool, wet towels, cold packs, or wearable personal cooling systems (for example, ice vests) that can be applied to the skin available during rest breaks to aid in quicker, more efficient cooling.
• Work with a healthcare provider to conduct screening of all workers for medical conditions and medications (including over the counter, herbal, and prescription) that would place them at increased risk of heat-related illness.
• Ensure workers do not work alone and use the buddy system to observe one another for symptoms of heat-related illness. Workers with symptoms of heat-related illness should not be left alone.
• Acclimatize new and returning employees by gradually increasing time working in hot conditions over 1 to 2 weeks. These workers will need more frequent rest breaks.
• Increase ventilation with cooler, drier outside air when possible. This can reduce the amount of virus in the air and reduce the temperature and humidity. However, its value for evaporative cooling likely would be limited due to fluid-resistant PPE.

For more on this topic visit:

• Protecting Workers from Heat Illness,
• Limiting Heat Burden While Wearing PPE,
• Heat Stress—Recommendations, and
• NIOSH Criteria for a Recommended Standard: Occupational Exposure to Heat and Hot Environment.

The OSHA-NIOSH Heat Safety Tool and AIHA Heat Stress App (Apple App Store and Google Play Store) are useful resources for planning outdoor work activities based on how hot it feels throughout the day.

Information on cold working environments

Using PPE in cold environments presents unique challenges. Often, wearers experience moisture build-up, stiffer PPE, and reduced lifespan for reusable PPE.

• Moisture build up may:
  • Cause respirator outlet valves to stick
  • Cause goggles and face shields to fog
  • Reduce comfort
• Stiffer PPE may cause:
  • Gaps in the respirator seal to the face
  • Difficulty putting on gloves
  • Reduced hand dexterity
  • Restricted body movements
  • Reduced comfort
• May reduce lifespan for reusable PPE

To address these challenges, employers can:

• Select fog-proof lenses or use a fog-proofing solution recommended by the manufacturer
• Store PPE in warm areas
• Consider shortening change-out schedules for reusable PPE

Refer to the manufacturer's instructions for the range of temperatures where the PPE may be used and stored. For more information about other potential hazards of working in cold environments, refer to The Physiological Response of Working in Cold Environments and how your PPE can Help.

N95 and NIOSH Approved are certification marks of the U.S. Department of Health and Human Services (HHS) registered in the United States and several international jurisdictions. HE, PAPR100-N, and PAPR100-P are certification marks of the U.S. Department of Health and Human Services (HHS) registered in the United States.