Interim Guidance for Employers to Reduce the Risk of Novel Influenza A for People Working with or Exposed to Animals

What to know

This updated interim guidance identifies select occupational groups that may be at increased risk of exposure to novel influenza A viruses associated with severe disease in humans and clarifies previous recommendations. Specific recommendations for these groups may be updated as CDC learns more during this evolving situation.

Overview

Information for workers‎

Workers in these occupational groups should see the Information for Workers Exposed to H5N1 Bird Flu and consult with their supervisor or their employer's health and safety committee to determine how best to apply these recommendations.

Human infections with novel influenza A viruses (such as H5N1 Bird Flu) can happen when enough virus gets into a person's eyes, nose, or mouth, or is inhaled. This can happen when virus is in the air (in droplets, small aerosol particles, or possibly dust) and deposits on the mucus membranes of the eyes or a person breathes it in, or possibly when a person touches something contaminated by viruses and then touches their mouth, eyes, or nose.

Employers should take steps to reduce workers' risk of infection with novel influenza A viruses from sick animals or contaminated environments. Workers may be at risk when working with animals confirmed or potentially infected with novel influenza A viruses or working with materials, including raw milk, that are confirmed or potentially contaminated with novel influenza A viruses. Examples of related workers include:

  • Poultry and dairy and other livestock farmers and workers
  • Backyard bird flock owners
  • Veterinarians and veterinary staff
  • Animal health responders
  • Public health responders
  • Dairy laboratory workers
  • Food processing workers handling raw milk and other confirmed or potentially contaminated materials
  • Slaughterhouse workers performing certain tasks on lactating dairy cattle including:
    • Unloading or handling live lactating dairy cattle for slaughter, including working in holding pens and tasks involved with ante-mortem inspection
    • Post-mortem processes including the post-mortem inspection, handling, and transporting of viscera
    • Removing and transporting udders from dairy cattle for further processing or rendering

To protect workers who might be exposed, employers should update or develop a workplace health and safety plan. Employers are encouraged to use a health and safety committee that includes representatives from both management and workers to develop the plan. Helpful guidance and consultation on developing a workplace health and safety plan is available from the Occupational Safety and Health Administration (OSHA) and through your local agriculture extension office. Employers should conduct a site-specific hazard assessment to identify potential exposures based on job tasks and locations and use the hierarchy of controls to identify controls to reduce or eliminate hazards including exposure to novel influenza A viruses. The Hazard Assessment Worksheet for Dairy Facilities can help identify dairy workplace hazards and prioritize controls including PPE needed for protection. Protecting Poultry Workers from Avian Influenza (Bird Flu) can help identify poultry workplace hazards and prioritize controls.

Employers should ensure workers are protected from being exposed to the virus if workers have direct or close physical contact with:

  • Any animals that are confirmed or potentially infected, including birds, dairy cows, and other livestock
    • Feces, urine, or litter from these animals
    • Raw (unpasteurized) milk from these animals
  • Any animals that have died, including birds and livestock
  • Viscera or udders from lactating dairy cattle
  • Surfaces and water (for example, ponds, waterers, buckets, pans, troughs) on farms with potentially infected animals that might be contaminated with animal waste or waste milk

CDC provides separate recommendations to prevent the spread of flu between pigs and people.

The hierarchy of controls identifies a preferred order of actions to best control hazardous workplace exposures. Engineering controls are more effective than administrative controls or PPE because they control exposures without requiring significant and ongoing efforts by workers and their supervisors.

Engineering Controls

Engineering controls are methods to reduce or remove the hazard at the source or place a barrier between the worker and the hazard.

Proper ventilation in dairy and poultry barns depends on factors such as the size of the barn, the number of animals, and local climate, among other factors. Poor ventilation can lead to the buildup of harmful gases, excessive heat and humidity, and the accumulation of airborne pathogens (bacteria and viruses). Circulating fresh air helps dilute and disperse potential pathogens and can help control the temperature and humidity.

Employers should implement the following engineering controls to reduce the spread of novel influenza A viruses:

  • Use a ventilation system that provides a constant supply of fresh air
  • Strategically place fans and vents to generate a clean-to-less-clean flow path of fresh air through the space while removing dirty air
  • Use airflow exhaust and makeup air supply strategies that do not discharge high velocity airflow upon building occupants
  • Regularly clean and maintain ventilation systems to minimize the accumulation of dust, feathers, manure particles, and other debris that can obstruct airflow and provide a breeding ground for pathogens

Administrative Controls

Administrative controls are policies and work practices that reduce workers' exposure to hazards. Employers should implement the following policies and work practices:

  • Watch for sick or dead animals on your farm or workplace, and monitor animals for changes in feed consumption or production metrics
  • Test animals for novel influenza A virus if indicated (if relevant, consider joining the USDA HPAI Dairy Herd Status Program or contacting your State Animal Health Official about testing available within your state)
  • Develop plans to monitor workers for illness
    • Have monitoring plans ready to use when needed
    • Develop a process to communicate with your workers daily to determine if they are sick or have symptoms, like conjunctivitis, mild flu-like upper respiratory symptoms, or other symptoms consistent with novel influenza A virus infection
    • Designate management staff to maintain records for absenteeism, symptomatic workers, and testing, and review the records daily
  • Ask employees to monitor themselves for symptoms of illness every day while they are working with animals confirmed or potentially infected with novel influenza A viruses and during the 10 days after the last day of exposure. If they become sick while working or during those 10 days, have them isolate themselves from others and tell their supervisor and help them contact the state/local health department, and give them instructions for seeking medical evaluation and treatment. Printable instructions are available: What to do if you feel sick.
  • Work with the state or local health department to provide influenza testing and treatment of sick workers
  • Provide employees with paid time off and develop flexible leave policies to support workers to stay home if sick
  • Train workers on relevant equipment, procedures, and hazards (for example, risk of exposure to novel influenza A virus through contact with animals, animal secretions, or contaminated objects); infection control practices; heat illness prevention; recognizing signs and symptoms of novel influenza A virus infection in themselves and others; any new procedures in the workplace; and PPE
  • Provide safe storage locations for workers' food and personal items, including clothing worn off-site, and prohibit storage of food and personal items in potentially contaminated areas, including where PPE is put on and removed
  • Provide workers access to hand washing stations with soap and clean water
    • Provide alcohol-based hand sanitizer containing at least 60% alcohol if soap and water are not immediately available
    • Place hand washing stations and alcohol-based hand sanitizer in multiple locations to encourage hand hygiene, especially in areas where workers frequently have contact with animals
    • If possible, choose hand washing stations, hand sanitizer stations, and trash receptacles that are touch-free
    • Consider other workplace programs to promote personal hygiene like building additional short breaks into staff schedules
    • Remind workers to wash their hands for 20 seconds before eating, drinking, touching their phones, smoking, vaping, chewing gum, or dipping tobacco

Personal Protective Equipment

Engineering and administrative controls are likely not sufficient for reducing exposures to confirmed or potentially infected animals and their secretions. Therefore, PPE is needed in some cases to reduce the exposures, especially for workers in direct contact with animals or their secretions. Employers should provide appropriate PPE at no cost and training on its use, and putting on and removing PPE should occur during work hours. PPE should be used in accordance with OSHA regulations found at 29 CFR part 1910, Subpart I (Personal Protective Equipment). Workers should be trained on, and demonstrate an understanding of:

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

Persons who need protection from novel influenza A viruses should wear appropriate PPE in addition to the PPE required for normal duties and other hazards (for example, waterproof apron, hearing protection). Appropriate PPE depends on a site-specific hazard assessment and the hazards identified.

Recommended PPE to protect against novel influenza A viruses:

  • NIOSH Approved® particulate respirator
  • Fluid-resistant coveralls or fluid-resistant sleeved apron
  • Optional waterproof apron over the top of coveralls
  • Safety goggles
  • Optional face shield over the top of goggles
  • Boot covers or boots
  • Head cover or hair cover
  • Disposable gloves with optional outer work gloves

PPE specifications to protect against novel influenza A viruses

When selecting and purchasing PPE, it is important to select items that provide the level of protection needed. This includes PPE that prevents novel influenza A viruses from coming in direct contact with the eyes, nose, or mouth, or being inhaled. The PPE should also protect the hair, skin, and clothing from contact with viruses 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 novel influenza A viruses. You should 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

Any NIOSH Approved® particulate respirator is recommended, for example, an N95®or greater filtering facepiece respirator, elastomeric half mask respirator with a minimum of N95 filters, or powered air-purifying respirator with HE®, PAPR100-N®, or PAPR100-P® filters.

Respirator use should be in the context of a comprehensive written respiratory protection program administered by a trained program administrator in accordance with the OSHA Respiratory Protection standard (29 CFR 1910.134) and other applicable requirements. Before using a respirator, staff must be medically cleared, fit tested, and trained on proper use of respirators, and cleaning of reusable respirators or disposal of disposable respirators as applicable. Detailed information on respiratory protection programs, including fit testing procedures, and appropriate respirator selection (for example, particulate vs. combination particulate/gas or vapor cartridge) can be accessed at OSHA's Respiratory Protection eTool. Combination cartridges may be needed when additional gas or vapor hazards such as cleaning chemicals or ammonia from waste products are present.

Workers should be trained on, and demonstrate an understanding of the following respiratory protection topics:

  • 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.

For persons not trained or fit tested in respirator use who work with poultry and livestock, including youth workers, it is important to remember that respirators are designed primarily to be used in workplaces by adults who are part of their employer's respiratory protection program. 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. Individuals who cannot wear a respirator that properly seals to the face should not work near animals confirmed or potentially infected with novel influenza A viruses or work with materials, including raw milk, that are confirmed or potentially contaminated with novel influenza A viruses.

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

Disposable or washable fluid-resistant coveralls are recommended, and 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 with novel influenza A viruses. Waterproof aprons protect the coveralls and allow for easy removal of gross contamination during PPE removal.

In limited settings, where the source of contamination is only from one side, a fluid-resistant coverall might be substituted with a fluid-resistant sleeved apron. This modification should be limited to milking parlors where contamination from cows can only reach the worker from one side, excluding milking parlors where cows line up on two sides that are relatively close together and splashes could come from behind. It is important to train workers that this modification only provides partial body protection and makes them more susceptible to transferring the virus from unprotected clothing through direct or indirect contact with their eyes, nose, or mouth, causing 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

Eye protection: Safety goggles, face shield

Properly fitted unvented or indirectly vented safety goggles are recommended. 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, but may not provide full droplet and splash protection.

If there is a high risk of a large amount of liquid splashing onto a filtering facepiece respirator (for example, splashing raw milk or exploding eggs), consider the use of 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. A manufacturer's anti-fog coating may help maintain clear vision. Employers and workers should be aware that under certain conditions, some PPE can alter or decrease your visual acuity and peripheral vision. Under these conditions, workers should work in pairs if possible and pay closer 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

Reusable boot covers or boots that can be cleaned and disinfected are recommended. Use of disposable boot covers should only be considered 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

Disposable head cover or hair cover are recommended. 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 goggles or respirator fit.

Hand protection: Gloves, outer work gloves

Disposable gloves with optional outer work gloves are recommended. Disposable gloves protect the hands from contamination with novel influenza A viruses. 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. When outer work gloves are used, they 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 exclude linings and 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.

Enable the safe use of PPE

While wearing PPE

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

Safely put on and remove PPE

  • 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.
    • Provide a location in clean areas for workers to store food, personal items, and clean personal clothing prior to putting on PPE.
    • The location for putting on PPE should be a separate location from where PPE is removed.
    • Maintain flow of foot traffic in one direction, from clean to dirty when entering the worksite and from dirty to clean when exiting the worksite.
    • Post markings for personnel flow and clear signage for procedures to put on and remove PPE. The instructions for putting on and removing PPE must be posted using a poster in the appropriate designated areas, so the instructions need not be memorized. Printable instructions are available: Put on personal protective equipment safely for recommended PPE, Put on personal protective equipment safely for milking parlor modified PPE, Remove personal protective equipment safely for recommended PPE, and Remove personal protective equipment safely for milking parlor modified PPE.
    • 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.
  • Training, signage, and observer should instruct workers to put PPE on in this order* and in a clean area, avoiding contamination:

Put on PPE safely: Recommended PPE

  1. Wash hands for 20 seconds with soap and water or, if soap and water are not available, using an alcohol-based hand sanitizer
  2. Fluid-resistant coveralls
  3. Boot covers or boots
  4. Waterproof apron, if needed
  5. NIOSH Approved® particulate respirator
  6. Safety goggles
  7. Head cover or hair cover
  8. Face shield, if needed
  9. Hard hat, if needed
  10. Disposable gloves
  11. Outer work gloves, if needed

Put on PPE safely: Optional milking parlors PPE modification

  1. Wash hands for 20 seconds with soap and water or, if soap and water are not available, using an alcohol-based hand sanitizer
  2. Disposable gloves
  3. Boot covers or boots
  4. Fluid-resistant sleeved apron
  5. NIOSH Approved® particulate respirator
  6. Safety goggles
  7. Head cover or hair cover
  8. Face shield, if needed
  9. Hard hat, if needed
  10. Outer work gloves, if needed
  • Establish procedures and post signage reminding all workers that PPE should be removed before entering any clean areas, including restrooms, breakrooms, and administrative areas.
  • Training, signage, and observer should instruct workers to remove PPE in this order*, only touching the least contaminated part of the PPE. During the process workers should make sure to dispose of all disposable PPE in designated receptacles following your disposal plan, and to set aside all reusable PPE in the designated receptacle for cleaning and disinfection after each use:

Remove PPE safely: Recommended PPE

  1. Remove outer work gloves, if worn
  2. Lightly rinse outer clothing (boot covers or boots and apron)
  3. Remove hard hat, if worn
  4. Remove waterproof apron, if worn
  5. Remove boot covers or boots
  6. Remove coveralls
  7. Remove face shield, if worn
  8. Remove head cover or hair cover
  9. Remove goggles
  10. Remove respirator
  11. Remove disposable gloves
  12. Wash your hands again for 20 seconds with soap and water or, if soap and water are not available, use an alcohol-based hand sanitizer

Remove PPE safely: Optional milking parlor PPE modification

  1. Remove outer work gloves, if worn
  2. Lightly rinse outer clothing (boot covers or boots and apron)
  3. Remove hard hat, if worn
  4. Remove boot covers or boots
  5. Remove sleeved apron
  6. Remove face shield, if worn
  7. Remove head cover or hair cover
  8. Remove goggles
  9. Remove respirator
  10. Remove disposable gloves
  11. Wash your hands again for 20 seconds with soap and water or, if soap and water are not available, use an alcohol-based hand sanitizer

*Any change to the order of putting on or removing PPE should prioritize minimizing contaminant transfer from potentially contaminated protective clothing and equipment to the person's skin or regular clothing.

After removing PPE

  • If possible, 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 and not removed from the facility where it is used until cleaned and disinfected. Workers who work at multiple farms should have different equipment and work clothing for each location.

Cleaning reusable PPE

Provide appropriate facilities, equipment, and supplies to properly clean reusable PPE. All reusable PPE (for example, boot covers, boots, goggles, face shield, waterproof apron, elastomeric half mask respirators, powered air purifying respirators, hard hats) should be set aside, then cleaned and disinfected after every use. Generally, it is recommended that 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. OSHA only requires replacing filters "where necessary," for example, when soiled, contaminated, or clogged. 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, when possible, 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, 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.

Hot Working Environments

Agricultural work is often carried out in hot and sometimes humid environments. Employers and workers should be aware that certain circumstances can increase the risk of heat-related illnesses and injuries, including:

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

For example, PPE can reduce the wearer's exposure to fresh, cooling air; limit evaporation from skin; and 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, and consider implementing additional controls to protect workers, such as:

  • Provide training that covers both PPE and heat stress and explains to employees 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, and 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), and suspend work when temperatures are too hot.
  • Modify work/rest schedules to increase frequency and duration of rest periods that 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 and 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 (both 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.
  • Acclimatize new and returning employees by gradually increasing time working in hot conditions over 1 to 2 weeks.
  • Increase ventilation with cooler, drier outside air when possible. This can reduce the amount of novel influenza A viruses in the air and reduce the temperature and humidity. However, realize that 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 the 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.

More Information

CDC

Occupational Safety and Health Administration

USDA

Others

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.