Headlines warning of a possible pandemic flu outbreak have started to wane, but the threat is far from over. According to the Centers for Disease Control and Prevention (CDC), a global outbreak of easily transmissible influenza – such as the H5N1 avian flu virus – will happen, and likely within a few years.

Influenza pandemics have occurred for centuries, with three recorded during the last 100 years – in 1918, 1957 and 1968. The pandemic of 1918, referred to as the Spanish flu, resulted in more than 50 million deaths worldwide, with nearly 700,000 deaths occurring in the United States. After experts warned that a modern flu pandemic could result in just as many fatalities, the World Health Organization (WHO) urged all countries to develop or update their “influenza preparedness plans.”

At least 15 different strains of avian influenza are presently in existence. The current outbreak, which was discovered in China in 1996, is caused by H5 N1, which is highly contagious among fowl and has killed millions of birds in Europe, Africa, Asia and the Middle East. Fortunately, no case of H5N1 infection has been reported in poultry or humans in the United States.

The H5N1 stain, unlike many other strains of avian influenza, can be transmitted to humans and causes severe illness and even death. Most humans who have become infected with avian flu have come into close contact with infected poultry (domestic geese, chickens and turkeys) or surfaces contaminated with secretions or excretion from infected birds.

Early studies indicated the avian flu virus does not pass easily between humans, although this opinion began to change after health officials confirmed that avian flu cases in Indonesia involved person-to-person transmission of the flu virus, even though infected individuals had not come into close contact.

Concern continued to grow after researchers discovered that bird flu virus H5N1 has mutated into a form that makes it more infectious to humans, increasing the risk of a human pandemic. At this point, more than 300 avian influenza cases have been reported in humans, with the virus proving fatal to nearly two-thirds of its victims.

Preventing the Spread of Avian Flu

According to OSHA, poultry, health care and laboratory workers; veterinarians; and animal and food handlers face the greatest risk of infection if an avian flu outbreak occurs. Poultry farmers who move infected live birds, dead birds, chicken feces, contaminated crates or even feathers and farm equipment also can become infected and spread the disease.

Other individuals – including workers at public facilities such as restaurants, parks, factories, shopping malls and waste management facilities – also should be protected since they may clean or dispose of items handled by individuals who were exposed to the virus or who already are infected. Protecting these individuals especially is important since the incubation period for the avian flu virus typically ranges from 1 to 4 days.

Individuals can help protect themselves in a number of ways, such as frequently washing their hands with soap and water. They also should avoid contact with sick poultry or surfaces soiled with discharge from the mouths or beaks of infected birds or their feces.

Workers who may be at risk should recognize the symptoms of avian flu so they can seek medical attention and isolate themselves from others. Avian flu symptoms are similar to other types of influenza and include cough, fever, sore throat and muscle aches. Victims can develop life-threatening complications such as viral pneumonia and acute respiratory distress within a few days.

Individuals who have flu or cold-like symptoms should make sure they cough or sneeze into tissues or the crook of their arm instead of into their hands. The CDC recommends that workers who are ill stay home from work and keep sick children home from school. To prevent the flu, individuals should avoid touching their eyes, mouth or nose and stay away from people who are ill.

PPE to Protect Workers

OSHA recommends that employers provide at-risk workers with the appropriate PPE, including gloves, apparel (aprons and sleeves), goggles and boots or protective shoe covers that can be disposed of or disinfected.
Workers should wear impermeable, disposable gloves or heavy-duty rubber gloves that can be disinfected. Gloves must be liquid-proof and protect the hands throughout the period of exposure. They also should be comfortable enough for long-term wear and have the mechanical strength to prevent exposure from cuts, snags, punctures or tears.

Disposable outer garments or coveralls, impermeable aprons or surgical gowns with long cuffed sleeves also are recommended. Workers should be protected with headwear that fully covers the hair and disposable protective shoe covers or rubber or polyurethane boots than can be cleaned or disinfected. All disposable PPE should be properly discarded after use and non-disposable items cleaned and disinfected using standard disinfection procedures.

Preparing for Pandemic Flu

With pandemic flu a looming threat, many businesses and organizations are preparing pandemic flu plans and developing a crisis management team structure. Companies are identifying methods for maintaining a healthy work environment, educating employees and developing channels for strategic communication.

Businesses that offer critical products and services – such as health care and foodservice providers, financial institutions and utilities – are determining how they can maintain critical operations during a pandemic. They are identifying leadership and decision-making authorities, designating employees who will work from home or remote locations and developing plans for restricting travel. They also are coordinating with key organizations in the community – including health care providers – and forming ongoing partnerships with key suppliers, including PPE manufacturers.

Some businesses already have expressed concern about their ability to secure the PPE supplies they will need during a pandemic. It is important to form a partnership with an established PPE manufacturer/supplier that has stockpiled product in anticipation of a pandemic and has the manufacturing capacity to meet product demand over a period of time. With experts predicting that Asia could be the epicenter for influenza pandemic, companies should consider working with suppliers that have multiple manufacturing facilities in a number of different countries to help assure product availability.

Bill Bennett is marketing manager, chemical and disposable products, for Ansell. For more information about pandemic flu preparedness and specific PPE products, visit http://www.ansellpro.com or call (800) 800-0444.

Sidebar: Recommendations for PPE

Recommendations for hand protection and apparel products are provided below and follow WHO recommendations for selecting PPE for specific applications. Products listed are available in a range of sizes to ensure proper fit and the highest level of protection.

Removing Animal Corpses and Disinfecting

Gloves:

Premium quality, unsupported nitrile – Unsupported nitrile gloves are manufactured by dipping hand forms directly into the glove compound with no supporting liner or fabric. Gloves made with this process protect against chemicals and promote a high level of dexterity and tactile sensitivity. Nitrile gloves are appropriate for removing animal corpses and disinfecting an area because they will not swell, weaken or degrade and they protect against snags, punctures, abrasions and cuts. Nitrile gloves are available with a raised pattern that ensure a superior grip for handling wet or slippery materials. Some styles include form-fitting fingers and a tapered wrist for a more comfortable, ergonomic fit.

Aprons:

Vinyl, medium- to heavy-duty coat aprons with splash protection – Aprons should be high-quality virgin vinyl with at least a 6 mil thickness. Coat aprons are available with dielectrically welded seams (no sewn seams) to eliminate contaminate traps and permit cleaning to Class 100 standards.

Dissection and Disinfection

Gloves:

  • Unsupported, un-lined, light-duty natural rubber latex – Natural rubber latex gloves combine dexterity and superior tactile sensitivity with an acceptable level of chemical, snag, puncture, abrasion and cut resistance. Styles are available with a patterned grip surface.
  • Unsupported, medium-duty natural rubber latex with cotton flock lining – Natural latex gloves provide a high degree of tensile strength and excellent sensitivity. Gloves with an embossed design improve grip on wet or dry objects.
  • Unsupported, premium quality nitrile – High-performance nitrile gloves provide strength and chemical resistance. Embossed styles are available to enhance grip on wet, slippery objects.
  • Unsupported, extra-heavy-duty natural rubber latex with cotton flock lining – These heavyweight gloves provide added protection against physical and chemical hazards and offer increased cut and puncture resistance. The flock lining increases user comfort.
  • Unsupported, heavy-duty neoprene over natural rubber latex, with cotton flock lining – A combination of neoprene over natural rubber latex increases worker protection against a wide range of chemicals. These gloves are extra rugged and durable, and they are more economical than higher priced, heavy gauge nitrile and neoprene products. Styles are available with an embossed pattern for added grip on wet or dry surfaces.
  • Unsupported neoprene gloves with flock lining – Neoprene gloves provide broad-spectrum protection and excellent resistance to a wide range of chemicals. The flock lining absorbs moisture and promotes user comfort. Gloves with an embossed surface texture improve grip, especially when handling wet, slippery objects.

Sleeves:

18-inch vinyl – Vinyl sleeves protect against chemicals, snags, punctures and abrasion. The longer length will help protect the entire lower arm.

Lab Applications and Administering Preventive Vaccinations

Gloves:

  • Disposable natural rubber latex – Natural rubber latex is highly resistant to cuts and protects against acids, bases, alcohols and the diluted aqueous solutions of most types of chemicals. Styles are available with a textured grip surface. Latex, however, may cause an allergic reaction in some individuals.
  • Non-sterile, disposable poly-chloroprene (neoprene) – Poly-chloroprene gloves are durable and provide chemical splash protection. They also prevent latex allergies.
  • Sterile poly-chloroprene blend – This synthetic alternative prevents both Type I and Type IV allergies. The fabric is soft, flexible and resists punctures while protecting against a broad range of chemicals.
  • Single-use, powder-free neoprene – Neoprene gloves are comfortable and prevent Type I allergies. They also provide excellent protection against acids, bases and alcohols.

Polyvinyl chloride (PVC) gloves are not recommended for the above applications because they do not provide the level of protection required. Powdered gloves also should be avoided because of increased risk of airborne propagation of the flu virus. Double gloving may be an option to achieve desired levels of protection. Workers also should strictly adhere to procedures for donning and removing PPE to ensure maximum protection.

The CDC and WHO recommend that all persons who have been in close contact with infected birds or contaminated surfaces should, after removing their gloves, wash their hands frequently. Hand hygiene guidelines include washing the hands with soap and water under running water for 15 to 20 seconds. Individuals also should follow standard hand-disinfection procedures as specified by state government, industry or USDA outbreak-response guidelines.

PPE Storage Guidelines

Since no one knows when the avian flu may strike, companies and organizations purchasing PPE should consider the shelf life of PPE products. Natural latex gloves usually can be stored for about 3 years, with nitrile and neoprene products having a nominal 5-year shelf life. To maximize their useful life, PPE products should be kept in a cool, dark environment and stored away from steam pipes, radiators and other heat sources.

In general, when gloves look normal and can be stretched without surface cracks and pulled onto the hands without breaking or tearing, they probably will provide the level of protection they were designed to provide. Gloves that have deteriorated during storage will show definite signs of deterioration and should be discarded.