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Mail Package Handling Information

November 9, 2001

Interim Guidelines
For Minimizing Risk From Cutaneous And Inhalation Anthrax
For Mail Handlers


This document provides interim recommendations for protecting workers involved in mail sorting, distribution and handling in state, county and local public facilities.

A program to reduce skin or respiratory exposures to B. anthracis spores may decrease the risk of anthrax disease in mail handlers. These interim recommendations are based on the limited information available on ways to avoid infection and the effectiveness of various prevention strategies. These recommendations will be updated as new information becomes available.

A hierarchy of measures should be used to control potential exposures to B. anthracis. These include, in hierarchical order, engineering controls to capture B. anthracis spores at potential points of release, housekeeping measures to reduce the spread of B. anthracis spores and personal protective equipment to prevent worker exposure. The selection of these measures may be made after conducting a site-specific evaluation of the potential risk for B. anthracis exposure in each mail-handling facility.

The following recommendations are provided for workers potentially exposed to B. anthracis spores while handling or processing mail. Four types of mail handling operations are addressed below that are impacted by the recommendations. These recommendations do not address instances where a known exposure has occurred. Mail facilities should develop an emergency plan to contain the hazards; this plan should be put into effect when a known or suspected exposure to B. anthracis occurs.

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. MAIL ROOM FACILITIES WITH HIGH SPEED HANDLING MACHINES - Operators, Machine Maintenance Workers

Engineering Controls

  • Install engineering controls such as HEPA-filtered exhaust hoods or enclosures for high-speed mail handling equipment and for other areas where dust is generated by processing mail. Local exhaust (capture) ventilation at pinch roller or cutter areas should be specifically considered.

  • Install air curtains (using laminar airflow) to isolate areas where large amounts of mail are processed, if feasible.

  • Use an industrial vacuum cleaner equipped with high-efficiency particulate air (HEPA) filters as the first choice of cleaning high-speed mail-sorting equipment. Blow-down/blow-off should not be used to remove dust.

  • Install HEPA filters in the building's HVAC systems to minimize re-circulation of aerosolized spores, if feasible.

Administrative Controls

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 placed 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.

Housekeeping Controls

  • Areas should be wet cleaned and/or vacuumed with HEPA filter equipped vacuum cleaners. Do not dry sweep or dust.

Personal Protective Equipment (PPE)

Gloves

  • Protective gloves should be available to all workers handling mail (e.g., envelopes and packages). Different gloves or layers of gloves may be needed depending on the task, the dexterity required and the type of protection needed. Gloves chosen should be appropriate to the task (e.g., leather gloves may be needed for operations where gloves can easily be torn). In some cases, workers may need to wear cotton gloves under impermeable gloves for comfort and to prevent dermatitis. Skin rashes and other dermatological conditions are a potential hazard of wearing gloves.
  • Gloves should be provided in a range of sizes to ensure proper fit.
  • For workers involved in situations where a gloved hand presents a hazard (e.g., close to moving machine parts), the risk for potential injury resulting from glove use should be measured against the risk of potential exposure to B. anthracis.
  • The choice of glove material (e.g., powder-free nitrile or vinyl) should be based on safety, fit, durability and comfort. Powder-free nitrile or vinyl gloves can be worn under heavier gloves (e.g., leather and heavy cotton) if more protection against hand injury is needed.
  • Latex gloves should Not be worn because of the risk of developing skin sensitivity or allergy.
  • Sterile gloves (e.g., surgical gloves) are not necessary.
  • Care must be taken to avoid touching skin, eyes, or other mucous membranes since contaminated gloves may transfer B. anthracis spores to other body sites.
  • Gloves should be discarded if they are visibly torn or damaged.
  • Long-sleeved clothing should be worn to protect exposed skin and gloves should be pulled over the ends of the sleeves.
  • 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 my have contacted the skin. Disinfectant solutions are not needed. Do not rely on alcohol-based hand cleaners, as these cleaners will not remove spores as well as soap and water.
  • Used or torn gloves can be discarded in regular trash.

Other Personal Protective Equipment

The use of disposable aprons/coveralls or goggles by persons working with or near equipment or machinery known or suspected to generate aerosolized particles may provide an extra margin of protection. As with gloves, used aprons/coveralls and goggles can be discarded in regular trash.

Respiratory Protection

Where engineering controls are not yet available, NIOSH approved elastomeric half mask respirators should be made available for employees to minimize risk. P 100 filters should be made available in conditions where oil mist from machinery or high humidity is present. A Respiratory Protection Program meeting requirements of 29CFR 1910.134 Respiratory Protection Standard must be implemented. A respiratory protection program is important because it ensures that the respirator is cleaned, stored or maintained properly so that the respirator itself does not create a hazard. In addition, a medical evaluation is made to determine the ability of the individual to wear the respirator. A sample Respiratory Protection Program is available at www.state.nj.us/health/eoh/peoshweb/.

Note: The Respiratory Protection Standard 29CFR 1910.134(c)(2)(i)(ii) states: (2) Where respirator use is not required: (i) An employer may provide respirators at the request of the employees or permit employees to use their own respirators, if the employer determines that such respirator use will not in itself create a hazard. If the employer determines that any voluntary use is permissible, the employer shall provide the respirator users with the information contained in Appendix D to this section ("Information for Employees Using Respirators When Not Required Under the Standard"); and (ii) In addition, the employer must establish and implement those elements of a written respiratory protection program necessary to ensure that any employee using a respirator voluntarily is medically able to use that respirator and that the respirator is cleaned, stored and maintained so that its use does not present a health hazard to the user.

2. MAIL ROOM FACILITIES WITH HIGH SPEED HANDLING MACHINES - Non Operators

Engineering Controls - See recommendations for engineering controls under item #1.

Housekeeping Controls

  • Areas should be wet cleaned and/or vacuumed with HEPA filter equipped vacuum cleaners. Do not dry sweep or dust.

Personal Protective Equipment (PPE)

Gloves

  • Protective gloves should be available to all workers handling mail (e.g., envelopes and packages). Different gloves or layers of gloves may be needed depending on the task, the dexterity required and the type of protection needed. Gloves chosen should be appropriate to the task (e.g., leather gloves may be needed for operations where gloves can easily be torn). In some cases, workers may need to wear cotton gloves under impermeable gloves for comfort and to prevent dermatitis. Skin rashes and other dermatological conditions are a potential hazard of wearing gloves.
  • Gloves should be provided in a range of sizes to ensure proper fit.
  • For workers involved in situations where a gloved hand presents a hazard (e.g., close to moving machine parts), the risk for potential injury resulting from glove use should be measured against the risk of potential exposure to B. anthracis.
  • The choice of glove material (e.g., powder-free nitrile or vinyl) should be based on safety, fit, durability and comfort. Powder-free nitrile or vinyl gloves can be worn under heavier gloves (e.g., leather and heavy cotton) if more protection against hand injury is needed.
  • Latex gloves should Not be worn because of the risk of developing skin sensitivity or allergy.
  • Sterile gloves (e.g., surgical gloves) are not necessary.
  • Care must be taken to avoid touching skin, eyes, or other mucous membranes since contaminated gloves may transfer B. anthracis spores to other body sites.
  • Gloves should be discarded if they are visibly torn or damaged.
  • Long-sleeved clothing should be worn to protect exposed skin and gloves should be pulled over the ends of the sleeves.
  • 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 my have contacted the skin. Disinfectant solutions are not needed. Do not rely on alcohol-based hand cleaners, as these cleaners will not remove spores as well as soap and water.
  • Used or torn gloves can be discarded in regular trash.

Respiratory Protection

NIOSH approved N or P 100 filtering facepiece (dust mask) respirators should be available for employees to minimize risk. Note: 29 CFR 1910.134(c)(i)(ii) states in part that - Exception: Employers are not required to include in a written respiratory protection program those employees whose only use of respirators involves the voluntary use of filtering facepieces (dust masks).

3. FACILITIES SORTING LARGE VOLUMES OF MAIL BY HAND - Mailroom Sorters

Housekeeping Controls

  • Areas should be wet cleaned and/or vacuumed with HEPA filter equipped vacuum cleaners. Do not dry sweep or dust.

Personal Protective Equipment (PPE)

Gloves

  • Protective gloves should be available to all workers handling mail (e.g., envelopes and packages). Different gloves or layers of gloves may be needed depending on the task, the dexterity required and the type of protection needed. Gloves chosen should be appropriate to the task (e.g., leather gloves may be needed for operations where gloves can easily be torn). In some cases, workers may need to wear cotton gloves under impermeable gloves for comfort and to prevent dermatitis. Skin rashes and other dermatological conditions are a potential hazard of wearing gloves.
  • Gloves should be provided in a range of sizes to ensure proper fit.
  • For workers involved in situations where a gloved hand presents a hazard (e.g., close to moving machine parts), the risk for potential injury resulting from glove use should be measured against the risk of potential exposure to B. anthracis.
  • The choice of glove material (e.g., powder-free nitrile or vinyl) should be based on safety, fit, durability and comfort. Powder-free nitrile or vinyl gloves can be worn under heavier gloves (e.g., leather and heavy cotton) if more protection against hand injury is needed.
  • Latex gloves should Not be worn because of the risk of developing skin sensitivity or allergy.
  • Sterile gloves (e.g., surgical gloves) are not necessary.
  • Care must be taken to avoid touching skin, eyes, or other mucous membranes since contaminated gloves may transfer B. anthracis spores to other body sites.
  • Gloves should be discarded if they are visibly torn or damaged.
  • Long-sleeved clothing should be worn to protect exposed skin and gloves should be pulled over the ends of the sleeves.
  • 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 my have contacted the skin. Disinfectant solutions are not needed. Do not rely on alcohol-based hand cleaners, as these cleaners will not remove spores as well as soap and water will.
  • Used or torn gloves can be discarded in regular trash.

Respiratory Protection

NIOSH approved N or P 100 filtering facepiece (dust mask) respirators should be available for employees to minimize risk. Note: 29 CFR 1910.134(c)(i)(ii) states in part that - Exception: Employers are not required to include in a written respiratory protection program those employees whose only use of respirators involves the voluntary use of filtering facepieces (dust masks).

4. OFFICE ENVIRONMENTS MAIL SORTING, OPENING AREAS AND FACILITIES SORTING SMALL VOLUMES OF MAIL - Clerical

Personal Protective Equipment

Gloves

  • Protective gloves should be available to all workers handling mail (e.g., envelopes and packages). Different gloves or layers of gloves may be needed depending on the task, the dexterity required and the type of protection needed. Gloves chosen should be appropriate to the task (e.g., leather gloves may be needed for operations where gloves can easily be torn). In some cases, workers may need to wear cotton gloves under impermeable gloves for comfort and to prevent dermatitis. Skin rashes and other dermatological conditions are a potential hazard of wearing gloves.
  • Gloves should be provided in a range of sizes to ensure proper fit.
  • For workers involved in situations where a gloved hand presents a hazard (e.g., close to moving machine parts), the risk for potential injury resulting from glove use should be measured against the risk of potential exposure to B. anthracis.
  • The choice of glove material (e.g., powder-free nitrile, vinyl) should be based on safety, fit, durability and comfort. Nitrile or vinyl gloves can be worn under heavier gloves (e.g., leather and heavy cotton) if more protection against hand injury is needed.
  • Latex gloves should Not be worn because of the risk of developing skin sensitivity or allergy.
  • Sterile gloves (e.g., surgical gloves) are not necessary.
  • Care must be taken to avoid touching skin, eyes, or other mucous membranes since contaminated gloves may transfer B. anthracis spores to other body sites.
  • Gloves should be discarded if they are visibly torn or damaged.
  • Long-sleeved clothing should be worn to protect exposed skin and gloves should be pulled over the ends of the sleeves.
  • 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 my have contacted the skin. Disinfectant solutions are not needed. Do not rely on alcohol-based hand cleaners, as these cleaners will not remove spores as well as soap and water.
  • Used or torn gloves can be discarded in regular trash. Areas should be wet cleaned and/or vacuumed with HEPA filter equipped vacuum cleaners. Do not dry sweep or dust.

If there is a suspected piece of mail in any one of the four types of mail handling operations, follow the latest CDC recommendations:

Steps for handling a suspicious unopened letter or package:

  • Do not shake or empty the contents of the envelope or package.
  • Put the envelope or package in a plastic bag or other container to prevent leakage of the contents. If a bag or container is not available, cover the envelope or packages with anything (clothing, paper, trash can, etc.). Do not remove the covering.
  • Leave the room and close the door or section off the area.
  • Ask co-workers and others to leave and keep others from entering.
  • Wash your hands with soap and water.
  • Do not bring the envelope or package to an emergency department or doctor's office.
  • Report the incident to local police or other law enforcement officials. If the incident occurs in the workplace, also notify building security or a supervisor.
  • Make a list of all people in the room or area when the letter or package was recognized. Provide the list to law enforcement and public health officials.
  • For incidents involving a possibly contaminated letter, the environment in direct contact with the letter or its contents should be decontaminated with a solution of one part household bleach to 10 parts water, following a crime scene investigation. Personal affects may be decontaminated similarly.

Steps to follow if powder from a suspicious envelope or package has spilled out:

  • Do not try to clean up the powder.
    Cover the spilled contents immediately with anything (clothing, paper, trashcan, etc.). Do not remove the covering.
  • Leave the room and close the door or section off the area. Ask co-workers and others to leave and keep others from entering.
  • Wash your hands with soap and water.
  • Do not bring the envelope or package to an emergency department or doctor's office.
  • Report the incident to local police or other law enforcement officials. If the incident occurs in the workplace, also notify building security or a supervisor.
  • Remove heavily contaminated clothing and other personal items as soon as possible. Place it in a plastic bag or other container that can be sealed. Give the bag of clothing to emergency responders.
  • The bag should be labeled clearly with the owner's name, contact telephone number and inventory of the bag's contents.
  • Shower with lots of soap and water as soon as possible. Do not use bleach or other disinfectant on your skin.
  • Make a list of all people in the room or area, especially those who had actual contact with the powder. Provide the list to law enforcement and public health officials.
  • For incidents involving a possibly contaminated letter, the environment in direct contact with the letter or its contents should be decontaminated with a solution of one part household bleach to 10 parts water following a crime scene investigation. Personal affects may be decontaminated similarly.


In incidents where a biological agent is suspected in the air:

  • Turn off local fans or ventilation units in the area.
  • Leave the room and close the door or section off the area. Ask co-workers and others to leave and keep others from entering.
  • Dial 911 to report the incident to local police and the local FBI field office. If the incident occurs in the workplace, also notify building security or a supervisor.
  • Shut down the air handling system.
  • Make a list of all people in the room or area. Provide the list to law enforcement and public health officials.
  • For incidents involving a possibly contaminated letter, the environment in direct contact with the letter or its contents should be decontaminated with a solution of one part household bleach to 10 parts water following a crime scene investigation. Personal affects may be decontaminated similarly.

Complete CDC guidelines, including tips for identifying suspicious letters or packages, are available on the Internet at www.bt.cdc.gov.


These recommendations will be updated as new information becomes available.

 
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