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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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