Recommendations for Worker Protection and Use of Personal Protective Equipment (PPE) to Reduce Exposure to Highly Pathogenic Avian Influenza A H5 Viruses

To reduce their risk of HPAI H5 virus infection, poultry workers and responders should do all of the following:

• Avoid unprotected direct physical contact with sick birds, poultry carcasses, and poultry feces or litter.
• Wear recommended personal protective equipment (PPE) when in direct contact with birds, poultry carcasses, and poultry feces or litter, and when going into any buildings with sick or dead poultry, or carcasses, feces, or litter from potentially-infected poultry.
• Put on and take off PPE in separate clean areas;
• Recommended PPE includes: properly-fitted safety goggles, disposable gloves, boots, a NIOSH-certified respirator (e.g., N95), and disposable fluid-resistant^[1] coveralls.
• NIOSH-approved N95 (or higher) respirators are recommended for workers who have contact with HPAI H5 virus-infected birds, carcasses or potentially infected materials. Respirator use should be in the context of a comprehensive respiratory protection program in accordance with the Occupational Safety and Health Administration (OSHA) Respiratory Protection standard (29 CFR 1910.134) and other requirements. Staff that will need to wear N95 (or higher) respirators must be medically-cleared, trained, and fit-tested for respirator use. Detailed information on respiratory protection programs, including fit testing procedures, can be accessed at OSHA’s Respiratory Protection eTool: (www.osha.gov/SLTC/etools/respiratory). PPE training topics should include all of the following:
  • Proper fit-testing, wearing and use of respirators;
  • Safe removal of respirators;
  • Safe disposal of disposable respirators or cleaning and disinfection of reusable respirators;
  • Medical contraindications to respirator use.
• Reusable PPE (e.g. rubber boots, rubber apron) should be:
  • Cleaned until visible dirt is removed, and then
  • Disinfected with an EPA approved disinfectant that has label claims against influenza A viruses (http://www.epa.gov/oppad001/influenza-disinfectants.html) according to the manufacturer’s instructions.

All PPE should be used in accordance with OSHA regulations found at 29 CFR 1910 Subpart I (Personal Protective Equipment). Workers must receive training on and demonstrate an understanding of when to use PPE; what PPE is necessary; how to properly put on, use, take off, properly dispose of, and maintain PPE; and the limitations of PPE.

• Avoid touching the eyes, mouth, and nose after touching any contaminated material while wearing PPE.
• Do not eat, drink, smoke, or use the bathroom while wearing PPE.
• Safely remove PPE in sequence:
  1. Remove and dispose of the apron, if worn;
  2. Clean and disinfect boots;
  3. Remove boots;
  4. Remove and dispose of the coverall;
  5. Remove and dispose of gloves;
  6. Wash hands with soap and water;
  7. Remove goggles and respirator;
  8. Clean and disinfect reusable goggles and respirator;
  9. Wash hands with soap and water again.
• Perform good hand hygiene such as hand-washing with soap and water or using an alcohol-based hand rub after removing PPE if soap and water are not immediately available.
• Shower at the end of the work shift and leave all contaminated clothing and equipment at work. Never wear contaminated clothing or equipment outside the work area.

For more information please visit H5 Viruses in the United States.

^[1] Fluid-resistant coveralls should be made of fabric 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