Interim Guidance for Airline Cleaning Crew, Maintenance Crew, and Baggage/Package and Cargo Handlers for Airlines Returning from Areas Affected by Avian Influenza A (H5N1)
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This updated interim guidance is intended to inform personnel who clean, maintain, or remove baggage/packages from commercial and cargo airlines about appropriate precautions related to avian influenza A (H5N1). Recommendations are based on standard infection control practices used in healthcare settings and on available information about the virus that causes H5N1 avian influenza.
Avian influenza A (H5N1) viruses usually affect wild birds but can infect and cause serious disease among poultry, such as chickens. Human infections with H5N1 viruses are rare, but have also occurred in several countries since 2003. For a current list of countries reporting outbreaks of H5N1 virus infection among poultry and/or wild birds, view updates from the World Organization for Animal Health (OIE). Cumulative numbers of confirmed human cases of avian influenza A (H5N1) by country are available on the World Health Organization (WHO) Avian Influenza website. An assessment of the current situation can be found on the Centers for Disease Control and Prevention (CDC) Avian Influenza website.
Most H5N1 infections in humans are thought to have occurred from direct contact with infected poultry. Evidence to date suggests that people infected with the current form of H5N1 viruses pose a low risk for transmission to close contacts. However, it is prudent to assume that individuals infected with H5N1 viruses are potentially infectious. Transmission of H5N1 viruses from infected individuals, if it does happen, could occur through the spread of large respiratory droplets, which usually requires close contact (<3 feet) with an infected person or contact with contaminated hands or inanimate objects (e.g., armrests). Therefore, Standard and Droplet Precautions are appropriate, and hand hygiene remains the focus of infection control.
The CDC and the World Health Organization (WHO) continue to carefully monitor the situation in all H5N1-affected areas and remain in close communication about the evolving outbreak. CDC has not recommended that the general public avoid travel to any of the countries affected by H5N1 viruses.
For additional information on avian influenza, please consult the CDC web page at http://www.cdc.gov/flu/avian/.
General Infection Control Precautions
All airline personnel should always follow basic hygiene practices to prevent becoming ill.
Handwashing is an important and effective means of preventing the delivery of infectious material (e.g., nasal secretions, saliva or other body fluids that may contain viruses) from soiled hands to the mouth, nose or eyes, where it can enter the body. Cleaning one's hands with soap and water removes potentially infectious material from one's skin. Hands should be cleaned before preparing food, eating, or touching one's face and after handling soiled material (e.g., used tissues, lavatory surfaces), coughing or sneezing, and using the toilet. Waterless alcohol-based hand gels may be used when soap is not available and hands are not visibly soiled.
If airline personnel are ill, the following steps should be taken:
- Avoid traveling unless traveling locally for health care.
- Cover mouths and noses with a tissue or hands when coughing or sneezing.
- Put used tissue in a wastebasket.
- Clean hands with soap and water or an alcohol-based hand gel immediately after coughing or sneezing.
CDC does not recommend the routine use of personal protective equipment (PPE), such as respirators, gloves, or surgical masks, for protection against avian influenza exposure, except in health care-related situations. However, gloves are recommended when cleaning potentially contaminated surfaces.
When Avian Influenza A (H5N1) is Suspected in a Passenger or Crew Member:
Guidance for Airline Cleaning Crew
When cleaning commercial passenger aircraft after a flight with an ill passenger or crew member possibly infected with avian influenza, routine cleaning methods should be employed:
- Wear nonsterile disposable gloves while cleaning the cabin and lavatories.
- Wipe down lavatory surfaces and frequently touched surfaces in the cabin, such as armrests, tray tables, light and air controls, and adjacent walls and windows with a cleaning agent equivalent to household cleaner or detergent. Allow surfaces to air dry in accordance with manufacturers' instructions. Cleaning the surfaces around the seat of the passenger suspected or having avian influenza is particularly important.
- Special cleaning of upholstery, carpets, or storage compartments is not necessary unless obviously soiled with body fluids.
- Currently, there is no evidence to suggest that special vacuuming equipment or procedures are necessary.
- Remove and discard gloves after cleaning is done. Personnel should avoid touching their faces with gloved or unwashed hands.
- Clean hands with soap and water (or an alcohol-based hand gel when soap and water are not available) immediately after gloves are removed.
The International Air Transport Association also provides guidance for cleaning crews and maintenance crews in cases of suspected communicable disease (see http://www.iata.org/whatwedo/health_safety/aviation_communicable_contentDiseases.aspx).
Guidance for Airline Cargo Crew
There is no evidence that avian influenza is spread through contact with baggage, packages, or other objects, including items arriving from areas where avian influenza cases have been reported. Special handling of cargo arriving from areas where avian influenza cases have been reported is, therefore, not necessary. Cargo handlers should wash their hands frequently for the prevention of any possible infectious disease.
Management of Possible Occupational Exposures to Avian Influenza
In the unlikely event that cleaning crew, maintenance crew, or baggage/package or cargo handlers may have been exposed to a passenger suspected of having avian influenza,
- They should monitor their health for 10 days after the exposure.
- If they become ill with a fever plus a cough, sore throat, or trouble breathing, they should immediately take the following steps:
- Arrange to see the occupational health service or personal physician, and notify their employer.
- Inform the occupational health service, clinic, or emergency room before visiting about the possible exposure to avian influenza so that arrangements can be made to prevent transmission to others in the health-care setting.
- Avoid traveling, unless traveling for healthcare.
To supplement the general information provided here, the following section provides information related to specific job functions:
For avian flu-related travel information, see Avian Flu and Travel.