The Centers for Disease Control and Prevention (C D C) is asking state and other jurisdictional health departments to make personal protective equipment (P P E) available to dairy farm, poultry farm, and slaughterhouse workers. This would consist of a one time distribution of P P E from existing stockpiles. C D C made the ask today in a call with state health officials, state epidemiologists, state public health veterinarians, state public health emergency preparedness directors, and leadership from public health partner organizations.
Increasing access to P P E is intended to help people who work with animals reduce their risk of infection with highly pathogenic avian influenza (H P A I), which is currently causing an outbreak among dairy cattle. C D C believes the current risk to the public from these viruses is low; at the same time, people who have job related exposures to infected animals, including lactating dairy cattle, may be at increased risk of infection.
Prioritizing P P E
C D C asks that states prioritize distribution of P P E in two ways. First, to farms known to have positive or presumptive herds with H P A I. After those farms have been supplied, states should offer P P E to farms that have submitted samples for pre movement P C R testing, and then to farms with no evidence of positive herds or any tests awaiting results.
The second area for prioritization is around which workers should receive P P E. C D C’s Reducing Risk for People Working with or Exposed to Animals focuses on those, “working with animals or materials, including raw milk, confirmed infected or potentially infected with these novel influenza A viruses.” Data from the current outbreak suggest that dairy cattle and select slaughterhouse workers may face an increased risk. Accordingly, workers on those farms should be prioritized for P P E.
C D C recommends that health departments work with their state agriculture colleagues to identify farmworker and related service organizations in their state. Those organizations can potentially assist health departments with identifying farms, collating orders, and coordinating distributions. It is C D C’s expectation that farms supply workers with appropriate P P E following this one time distribution.
Getting and distributing P P E
- If jurisdictions do not have sufficient P P E on hand to meet demand for this one time distribution, they can request P P E from the Strategic National Stockpile (S N S) (i.e., face shields, gloves, goggles, N 95® filtering facepiece respirators, and elastomeric half mask respirators). More information about requesting S N S assets can be found at: Requesting S N S Assets.
- Health departments can distribute P P E to employers through a range of pathways, including directly to dairy employers or through farmworker organizations, state dairy associations, university extension agents, and other community outreach.
Recommendations for worker protection and use of PPE for people working with confirmed or potentially infected animals, materials, or surfaces
- The recommended P P E to reduce the risk of exposure includes fluid resistant coveralls, any N I O S H approved® particulate respirator, safety goggles or a face shield, rubber boots or boot covers, a head or hair cover, and gloves.
- Information is still limited about ways in which the H P A I virus can spread from cows to humans, as one human illness has been identified to date. Recommendations for workers may be updated as C D C learns more during this evolving situation.
- There are considerations around heat illness, vision, and use of respirators that employers and workers should be aware of. For more information see C D C’s Limiting Heat Burden While Wearing Personal Protective Equipment (P P E).
N 95 and N I O S H Approved are certification marks of the U. S. Department of Health and Human Services (H H S) registered in the United States and several international jurisdictions.
Protect Yourself From H5N1 When Working With Farm Animals
H 5 N 1 is a bird flu virus that could make you sick. Wear recommended personal protective equipment (P P E) when working directly or closely with sick or dead animals, animal feces, litter, raw milk, and other materials that might have the virus.
Wash hands with soap and water, then put on P P E in this order:
- Fluid resistant coveralls.
- Waterproof apron, if needed for job task.
- N I O S H Approved® Respirator (e.g., N 95® filtering facepiece respirator or elastomeric half mask respirator.
- Properly fitted unvented or indirectly vented safety goggles or face shield.
- Head cover or hair cover.
- Gloves.
- Boots.
While wearing P P E
- Use separate designated clean areas, one for putting on P P E and one for taking off P P E.
- Avoid touching your eyes, mouth, and nose after touching any contaminated material.
- Do not eat, drink, smoke, vape, chew gum, dip tobacco, or use the bathroom.
Follow these steps to safely remove P P E
- Remove the apron, if worn.
- Clean and disinfect your boots.
- Remove your boots.
- Remove coveralls.
- Remove gloves.
- Wash your hands with soap and water or, if soap and water are not available, use an alcohol based hand rub.
- Remove head cover or hair cover.
- Remove goggles or face shield and then remove respirator.
- Wash your hands again with soap and water or, if soap and water are not available, use an alcohol based hand rub.
After removing P P E
- Shower at the end of the work shift.
- Leave all contaminated clothing and equipment at work.
- Watch for symptoms of illness while you are working with potentially sick animals or materials. Continue watching for symptoms for ten days after finishing working. If you get sick, tell your supervisor, and talk with a doctor.
Reusable and disposable P P E
- While removing P P E, dispose of all disposable P P E appropriately and set aside reusable P P E.
- Clean and disinfect reusable P P E after every use.
[Q R code: Scan to find more P P E and worker safety information.]
[Logo: Department of Health and Human Services, U S A, N I O S H.]
Frequently Asked Questions
General
- What, specifically, is C D C asking states to do?
- C D C is asking states to help make P P E from their jurisdictional stockpiles available to dairy farm, poultry farm, and slaughterhouse workers to protect them against H P A I.
- How much P P E should jurisdictions provide?
- There is no set amount. It depends on the needs of workers in your jurisdiction and available supplies.
- Who should train workers in P P E use?
- Ultimately, employers should train workers on proper P P E use. If jurisdictions are able to provide trainings for farm owners or workers, however, they should do so, as feasible.
Rationale and Approach
- On which workers are we focused?
- Consistent with our guidance for Reducing Risk for People Working with or Exposed to Animals, C D C recommends focusing on those individuals who “work with animals or materials, including raw milk, confirmed infected or potentially infected with these novel influenza A viruses.”
- Initially, C D C recommends focusing P P E distribution on dairy farm and select slaughterhouse workers.
- Additional categories of agriculture workers can be added at the state’s judgement and discretion.
- What epi data are these recommendations based on, given that there has only been
one confirmed human case this year?- Data from the current outbreak suggest that dairy cattle and select slaughterhouse workers are at increased risk of H P A I. These data include likely asymptomatic transmission among cattle as well as findings of H P A I virus in a dairy cow at a slaughterhouse.
- In general, the wide geographic spread of H P A I viruses in wild birds, poultry, and some other mammals, including the current outbreak in cows, could create additional opportunities for people to be exposed to these viruses.
- C D C believes the current risk to the general public from bird flu viruses is low. People who have job related exposures to infected birds or animals, including cows, are at greater risk of contracting H P A I.
- Why all states and not just those with affected cattle herds? And why all farms and not just those with affected cattle herds?
- Data around potential asymptomatic transmission of H P A I among cattle could mean that there are affected herds beyond those that are currently recorded.
- C D C is recommending that health departments help make P P E available to people who work with dairy cattle, not indicating that it must be used in all areas and at all times.
- Having P P E more readily available can help protect workers and reduce the risk of further spread of H P A I for higher risk exposures, which can include exposure to raw milk and udders from lactating dairy cattle.
- Greater use of P P E during these exposures may reduce the risk when cattle are infected with H P A I but have not yet tested positive.
- For how long will this recommendation last?
- This is not a new recommendation but rather an ask to health departments to help make P P E more available on a one time basis to dairy workers with higher risk exposures. This ask is being made because the full scope of dairy cattle infections with H P A I is not known; recommendations may change as we learn more.
Worker Safety and Health
- What are employer responsibilities?
- All P P E should be used in accordance with OSHA regulations, including identifying appropriate P P E based on a site specific risk assessment.
- Workers must be trained on and demonstrate an understanding of when to use P P E, what P P E is necessary, what it looks like when P P E is properly fitted, how to properly put on, use, take off, dispose of, and maintain P P E, and the limitations of P P E.
- Respirator use should be in the context of a comprehensive respiratory protection program in accordance with the OSHA Respiratory Protection standard and other applicable requirements. Detailed information on respiratory protection programs, including fit testing procedures, can be accessed at OSHA’s Respiratory Protection e Tool.
- What P P E is recommended?
- C D C provides steps to reduce worker risk of infection with avian influenza A viruses associated with severe disease when working with animals or materials, including raw milk, confirmed infected or potentially infected with these novel influenza A viruses.
Recommended PPE to protect against novel influenza A viruses includes:- Disposable or non-disposable fluid-resistant coveralls, and depending on task(s), add disposable or non-disposable waterproof apron.
- Any N IO S H Approved® particulate respirator (e.g., N 95®or greater filtering facepiece respirator, elastomeric half mask respirator with a minimum of N 95 filters).
- Properly fitted unvented or indirectly vented safety goggles or a face shield if there is risk of liquid splashing onto the respirator.
- Rubber boots or rubber boot covers with sealed seams that can be sanitized or disposable boot covers for tasks taking a short amount of time.
- Disposable or non disposable head cover or hair cover.
- Disposable or non disposable gloves
- C D C provides steps to reduce worker risk of infection with avian influenza A viruses associated with severe disease when working with animals or materials, including raw milk, confirmed infected or potentially infected with these novel influenza A viruses.
Caches
- Can expired product be used?
- If there is an expiration date designated by the N I O S H approval holder (i.e., respirator manufacturer) and it has been exceeded, it should not be used within an occupational respiratory protection program. Respiratory protective devices that have passed their expiration date are no longer considered N I O S H approved for use in occupational settings.