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Avian Influenza

Avian Influenza - Photo Credit: CDC/Public Health Image Library
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Control and Prevention

Good biosecurity practices can help control the spread of AIVs. Biosecurity can include training workers to know the signs of avian influenza infection in birds, such as hemorrhaging and discoloration of the skin and legs resulting from infection with a highly pathogenic avian influenza (HPAI) virus. Photo Credit: U.S. Department of Agriculture

Photo Credit: U.S. Department of Agriculture

Good biosecurity practices can help control the spread of AIVs. Biosecurity can include training workers to know the signs of avian influenza infection in birds, such as hemorrhaging and discoloration of the skin and legs resulting from infection with a highly pathogenic avian influenza (HPAI) virus.

General Guidance for Employers and Workers

Effective strategies for controlling and preventing worker exposure to avian influenza depend on the risk of exposure and the work performed. If avian influenza viruses (AIVs) are detected in poultry populations in the United States (U.S.) or if workers travel on work assignments or work in countries with avian influenza outbreaks, appropriate precautions are critical to protect workers. This page is divided into several sections that provide:

The page features several links to Centers for Disease Control and Prevention (CDC) guidance, which describe current standards of practice for protecting workers from occupational exposure to AIVs.

General Precautions for Employers

Conduct a careful hazard analysis to identify workers potentially at risk of exposure to AIVs prior to instituting control measures to prevent such exposure. Consider work operation and tasks when performing hazard assessments.

Select appropriate controls, including engineering and administrative controls, safe work practices and personal protective equipment (PPE), based on the results of the hazard assessment. Remember to consider controls that may be required by some OSHA standards when determining the control measures to implement. See the Standards page for more information on OSHA requirements.

Ensure that facilities and supplies for performing hand hygiene are readily available to all workers.

Consider offering workers who are potentially at risk of exposure to AIVs the option for vaccination with the most recent seasonal human influenza vaccine. While the vaccine does not guard against AIVs, it does offer protection from the predominant circulating human influenza strains and may reduce the likelihood of a co-infection with both human and avian influenza viruses.

Protect workers tasked with cleaning and disinfecting areas, surfaces and equipment potentially contaminated with AIVs from chemical exposure. For airborne chemical exposures where OSHA has adopted a permissible exposure limit (PEL), feasible engineering controls, such as ventilation, and administrative controls must be used to reduce the exposure to or below the PEL. In cases where engineering and administrative controls are not implemented or do not bring the exposure below PELs, PPE (such as chemical-resistant or chemical-impermeable garments) or a National Institute for Occupational Safety and Health (NIOSH)-certified respirator (such as an air-purifying respirator fitted with a N95 particulate/chemical combination cartridge) must be used. In situations where OSHA has not adopted a PEL for harmful exposures, OSHA standards for PPE (29 CFR 1910 Subpart I) and Section 5(a)(1) of the Occupational Safety and Health (OSH) Act of 1970, 29 USC 654(a)(1) (often referred to as the "General Duty Clause") require employers to protect workers performing these tasks. See the Standards page for more detailed information.

Employers should develop specific work instructions and/or job/task hazard analyses to ensure procedures are followed consistently.

Personal Protective Equipment

Provide workers with appropriate PPE based on the results of the hazard assessment. PPE may include:

  • Disposable gloves or gloves capable of being disinfected.
  • Protective clothing (e.g., long-sleeved coveralls with a waterproof apron).
  • Disposable shoe covers or shoe covers that can be disinfected.
  • Safety goggles.
  • Respiratory protection. (If needed, use, at a minimum, a NIOSH-certified N95 or higher respirator. Respirators may also be provided for voluntary use.)

If workers need respirators, use, at a minimum, a NIOSH-certified N95 filtering facepiece respirator as part of a comprehensive respiratory protection program that includes medical exams and fit testing, and that meets the requirements of OSHA's Respiratory Protection standard (29 CFR 1910.134).

Specific PPE for high-risk jobs is described in the information for poultry workers, food handlers, animal handlers, healthcare workers, laboratory workers and business travelers, below.

As described in the "Training" section below, train workers to put on, use and take off PPE properly, as well as how to clean, maintain and dispose of PPE and any limitations of the PPE.

OSHA's Personal Protective Equipment Safety and Health Topics page also provides information on PPE selection and use.

Training

Train workers to understand their risk of exposure to AIVs based on the jobs they perform. Provide such training to workers who have contact with potentially infected birds or people or potentially contaminated materials from birds or people. Also provide training to workers who may be exposed to AIVs while traveling to counties where avian influenza is endemic in the poultry populations or places experiencing an outbreak. Make sure that workers understand the controls in place and protective measures available to prevent or reduce exposure to AIVs in the workplace.

Train workers to conduct appropriate housekeeping practices in facilities where AIV exposures may occur. For example, employers should teach workers when and how to sanitize handrails, locker areas, kitchens, and breakrooms; how to minimize dust, including through wetting/misting prior to sweeping; and about other activities that can prevent exposures to AIVs in the work environment.

Train workers to use PPE appropriately. OSHA requires training on how to use PPE for workers who are required to use such equipment for their jobs. This training includes when to use PPE; what PPE is necessary; how to properly put on, use and take off PPE; how to properly dispose of or disinfect, inspect for damage and maintain PPE; and the limitations of PPE. Applicable standards in 29 CFR 1910 Subpart I include those for personal protective equipment (29 CFR 1910.132), eye and face protection (29 CFR 1910.133), hand protection (29 CFR 1910.138) and respiratory protection (29 CFR 1910.134). OSHA offers a variety of training videos on respiratory protection.

When the potential exists for exposure to human blood or other potentially infectious materials (OPIM), workers must receive training required by the Bloodborne Pathogens (BBP) standard (29 CFR 1910.1030), including information about how to recognize tasks that may involve exposure and the methods to reduce exposure (e.g., engineering controls, administrative controls, work practices and PPE). Such exposure may occur when evaluating or treating patients with suspected or confirmed AIV infection or when handling laboratory specimens from these patients. More information on OSHA's BBP training regulations and policies is available for employers and workers on the OSHA Bloodborne Pathogens and Needlestick Prevention Safety and Health Topics page.

OSHA's Training and Reference Materials Library contains information developed by the OSHA Directorate of Training and Education as well as links to other related sites. The materials listed for BBP, PPE, and respiratory protection may provide additional material for employers to use in preparing training for their workers.

The CDC's Information on Avian Influenza webpage contains the most current information to help employers implement effective worker protections for avian influenza.

General Precautions for Workers

All workers with potential exposure to AIVs should take the following precautions:

  • Get the seasonal influenza (flu) vaccine. While the vaccine does not protect against AIVs, it does protect against the predominant circulating human influenza strains and may reduce the likelihood of a co-infection with both human and avian influenza viruses.
  • If symptoms occur, seek medical care and tell the healthcare provider prior to arrival about the possibility of exposure to AIVs.
  • Stay home if fever is present. Do not go back to work until 24 hours after the fever is gone. While the signs and symptoms of avian influenza are like those of other types of influenza that people contract, the severity may differ depending on the person's health status before infection and the ability of the AIV to cause illness.
  • Wash hands thoroughly and frequently for at least 15 seconds with soap and water or using alcohol-based hand rubs (i.e., hand sanitizer) containing at least 60 percent alcohol if soap and water are not available.1 Soap and water are best for visibly soiled hands.
    • Visit the CDC Hand Hygiene webpage for more information on effective hand hygiene practices. The CDC page focuses on hand hygiene in healthcare, but the recommendations are useful for other types of workplaces, as well.
  • Practice proper cough and sneeze etiquette:
    • Cover the mouth and nose with a tissue to reduce the spread of germs.
    • When using a tissue, dispose of it as soon as possible and properly wash hands afterwards.
    • When a tissue is not available, cough or sneeze into upper arm, not hands. See the CDC Coughing and Sneezing webpage for more information.
  • Avoid handling potentially infected poultry.
  • Use PPE as appropriate based on employer instructions for the job task(s) performed. PPE may include the following:
    • Disposable gloves or gloves capable of being disinfected.
    • Protective clothing (e.g., long-sleeved coveralls with a waterproof apron).
    • Disposable shoe covers or shoe covers that can be disinfected.
    • Safety goggles or face shields (especially if workers may be exposed to splashes or sprays to the face).
    • Respiratory protection. (If needed, at a minimum, use a NIOSH-certified N95 or higher respirator.)
  • While wearing PPE, avoid eating, drinking, and smoking.
  • Remove all PPE at work to avoid taking contaminated items home.
  • Wash hands after removing gloves and other PPE.
  • Shower at the end of the shift (or as soon as possible), if showers are available.
  • Use U.S. Environmental Protection Agency (EPA)-registered disinfectants against AIVs. Currently, there are more than 200 registered antimicrobial products with label claims to work as avian influenza disinfectants.
    • Read the label to understand the specific sites where the product is effective in killing or inactivating AIVs. Although there are no antimicrobial products registered specifically against highly pathogenic avian influenza (HPAI) viruses, available scientific information suggests the registered products on the market for AIVs will be effective against HPAI viruses.2
    • Carefully follow the disinfection directions on the label to handle and safely use the antimicrobial product and avoid harm to human health and the environment. See the Registered Antimicrobial Products with Label Claims for Avian Influenza webpage for more information on EPA antimicrobial products for AIVs.

Before traveling, check the CDC's travel restrictions webpage for current information on countries experiencing outbreaks of AIVs in poultry or people.

Information (by job type):

In addition to the general information specified above, detailed recommendations follow for protecting workers at risk for potential exposure to AIVs. These recommendations and relevant OSHA standards also provide a framework for protecting state and local workers in states where OSHA or an approved State Plan do not have authority over those workers' safety and health.

Specific types of workers at risk for potential exposure to AIVs include:

On rare occasions, AIV transmission to poultry workers or others who have contact with infected poultry or contaminated surfaces occurs. Examples of workers potentially at risk include poultry processing workers; service technicians of poultry processing companies; workers caring for birds; layer barn workers and chick movers at egg production facilities; and workers involved in disease control and eradication activities, including state, federal, and contract workers.

The control measures described below are for protecting poultry workers when an avian influenza outbreak occurs. In addition to the guidelines specified in the general guidance above, adhering to the following guidelines help prevent poultry worker exposure to AIVs.

Engineering Controls
  • Keep poultry flocks isolated from wild animals and wild bird populations.

Ensure adequate ventilation to bring clean outdoor air into poultry houses, including to replace contaminated air and control any airborne contaminants.

Administrative Controls
  • Implement biosecurity practices and ensure workers follow those practices to prevent the introduction of avian influenza and other diseases into poultry flocks.
    • Biosecurity includes restricting visitors to poultry farms, prohibiting farm workers from visiting other farms or owning birds or poultry, implementing rodent and insect control, instituting disinfection and waste disposal protocols, and monitoring for AIV in poultry flocks.1
    • Biosecurity also includes training workers to know the signs of avian influenza infection in birds, the immediate steps to take to protect themselves and other workers, procedures to quarantine the farm to prevent spread of disease, and reporting requirements to ensure the notification of proper animal health authorities at the first signs of illness in flocks.
    • See the U.S. Department of Agriculture (USDA) Biosecurity for Birds webpage for guidance on the signs of avian influenza in poultry.
    • The California Department of Food and Agriculture (CDFA) Commercial Poultry Biosecurity website presents biosecurity videos in English and Spanish. The USDA and CDFA training handbook entitled Biosecurity Training Manual for Poultry Workers may be helpful in training poultry workers.
    • Guidance is also available in the free biosecurity DVD from the U.S. Poultry and Egg Association entitled Infectious Disease Risk Management: Practical Biosecurity Resources for Commercial Poultry Producers, which is designed to aid in developing more effective biosecurity practices.
  • Encourage workers involved in disease control and eradication activities to consult a healthcare provider about taking antiviral medications for influenza during an avian influenza outbreak at a poultry farm or factory.
  • Train all poultry workers on the signs and symptoms of AIV infection in humans and the importance of immediate treatment. See the Medical Information page for more details on signs and symptoms of infection, antiviral medicines, and vaccines.
  • Implement programs to protect workers from the effects of heat stress when using PPE, which can be more insulating than regular work clothing. Train workers on the symptoms of heat stress and the appropriate actions to take to ensure such illnesses do not occur. Refer to OSHA's Protecting Workers from Heat Stress QuickCard and the Occupational Heat Exposure Safety and Health Topics page for more information on protecting workers from heat stress.
Work Practices
  • Follow strict adherence to hand hygiene, especially:
  • After contact with infected or exposed poultry.
  • After contact with surfaces contaminated with bird feces or respiratory secretions.
  • After removing any PPE (e.g., gloves, goggles, respirator).
  • Prior to eating, drinking, smoking or bathroom use.
  • Avoid direct and indirect contact with bird secretions and inhalation of dust contaminated with these secretions.
  • After an avian influenza outbreak, properly decontaminate areas following employer guidelines and the disinfection practices described in the general guidelines.
Personal Protective Equipment
  • Wear lightweight, disposable gloves or heavy-duty rubber work gloves that can be easily cleaned and disinfected. Avoid touching the face with gloved hands.
    • Select gloves appropriate for the task (e.g., using thick rather than lightweight gloves may be more appropriate for some tasks).
  • Remove gloves promptly after use and change gloves if torn, punctured, or otherwise damaged.
  • Wear disposable outer garments, coveralls, or gowns with long, cuffed sleeves, and a waterproof apron.
  • Wear disposable shoe covers or boots that can be easily cleaned and disinfected.
  • Wear safety goggles and a disposable head or hair covering.
  • Wear respiratory protection (i.e., a NIOSH-certified disposable N95 filtering facepiece respirator) as part of a comprehensive respiratory protection program that includes medical exams, training, and fit testing, and that meets the requirements of OSHA's Respiratory Protection standard (29 CFR 1910.134). If unable to wear a disposable particulate respirator because of facial hair or other fit limitations, wear respirators that do not require a face seal (e.g., positive pressure respirators of the hood and helmet type, and types that can be used with a continuous-flow, supplied-air respirator).

The particulate respirators recommended above are not appropriate for protection against chemicals used in disinfection activities. The OSHA Safety and Health Information Bulletin Avian Influenza - Protecting Poultry Workers at Risk provides a table listing the advantages, disadvantages, and costs of the five types of air-purifying respirators in order of increasing levels of protection. Also, for guidance on the protective capabilities of respirators, see 2004 NIOSH Respirator Selection Logic.

While avian influenza is mostly a concern for employers and workers in domestic poultry stocks on farms, workers in pet shops, veterinary practices, and zoos must be aware of the possibility of other birds infected with AIVs. This is important since other animals such as cats, pigs, ferrets, and dogs can also become infected with and spread AIVs.

In addition to the guidelines specified in the general guidance above, animal handlers (other than poultry workers) working in locations where poultry or wild birds could be infected with AIVs should take the following precautions.

Administrative Controls
  • Monitor animals for any unusual, flu-like symptoms. For example, symptoms in cats may include fever, listlessness, conjunctivitis, difficulty breathing, and death.4
  • Immediately notify federal or state animal health officials or local agricultural control agents when encountering sick birds or other animals exhibiting symptoms of possible AIV infection. For a current listing of state animal health officials, please see the U.S. Animal Health Association's link to the 50 state animal health officials roster located on their State and Federal Official Agency Members website.
Work Practices
  • Wash hands thoroughly and frequently using proper hand hygiene as outlined in the general guidance.
  • Clean and disinfect any areas with possible contamination, following the disinfection recommendations specified in the general guidance.
  • Avoid handling potentially infected animals as much as possible. After reporting infected animals, allow the federal or state officials to handle these animals. If there is no other alternative, use appropriate PPE when isolating sick animals or removing dead animals.
Personal Protective Equipment
  • When working with potentially infected animals, wear appropriate disposable PPE or reusable equipment easily cleaned and disinfected. Such PPE may include:
    • Gloves.
    • Shoe covers.
    • Safety goggles.
    • Outer garments with a waterproof apron.

Respiratory protection. (If needed, use, at a minimum, a NIOSH-certified disposable N95 filtering facepiece respirator as part of a comprehensive respiratory protection program that includes medical exams and fit testing, and that meets the requirements of OSHA's Respiratory Protection standard (29 CFR 1910.134).)

Food handlers most at risk for exposure to AIVs include workers who butcher, handle, and package raw poultry in retail establishments and workers in restaurants who handle or work with raw poultry (e.g., chefs/cooks).

No evidence exists to indicate any elevated risk of AIV exposure when eating properly handled and cooked poultry and eggs.

An addition to the guidelines specified in the general guidance above, food handlers and their employers should take the following precautions when confirmed or suspected avian influenza exists in local poultry or wild birds to ensure protection from potential exposure.

Administrative Controls
  • Ensure worker awareness of the indefinite AIV survival in frozen poultry, making it infectious when later thawed and prepared.5
Work Practices
  • Always handle raw poultry hygienically to control germs that cause foodborne diseases, as well as AIVs.
  • Follow good hand hygiene as described in the general guidance above.
  • Properly clean all utensils and surfaces in contact with raw poultry or eggs with soap and water.
  • Follow proper food preparation and handling practices, including the CDC and USDA food safety guidelines. These include recommendations for separating raw and cooked foods, using different chopping boards and utensils for each, and cooking to appropriate temperatures to destroy germs, including AIVs.
  • To avoid potential AIV transmission, avoid touching the mouth, nose, or eyes while handling raw poultry products.
Personal Protective Equipment
  • Generally, food handling workers do not need PPE specifically to protect them from exposure to AIVs. PPE, such as gloves, usually worn during food handling operations should be sufficient. If workers are conducting defeathering, butchering, or other poultry-processing activities, especially in large quantities, follow the guidance for poultry processing.

In addition to the general guidance applicable to all workers with potential exposure to AIVs provided above, healthcare workers and their employers should take specific precautions to prevent the spread of AIVs.

Engineering Controls
  • Install and properly maintain appropriate air-handling systems in healthcare facilities. Acute care facilities should already have appropriate heating, ventilation, and air conditioning (HVAC) systems (including appropriate exhaust and filtration) to reduce the potential for exposure to airborne infectious diseases, which are appropriate for controlling AIVs. See the CDC's Guidelines for Environmental Infection Control in Health-Care Facilities for detailed information on air-handling systems and other infection controls in healthcare facilities.
  • Consider installing engineering controls to reduce or eliminate exposures by shielding healthcare workers and other patients from suspected avian influenza cases. Examples of engineering controls include installing physical barriers such as floor-to-ceiling partitions in triage areas.
  • Place patients with suspected avian influenza infection in an Airborne Infection Isolation Room (AIIR) constructed in accordance with current guidelines. If an AIIR is not available, place a facemask on the patient (if the patient can tolerate wearing one) and isolate him/her in an examination room with the door closed. Transfer the patient as soon as possible to a facility where an AIIR is available. The CDC's 2007 Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings provides additional information on isolation rooms.
  • Use engineering controls to reduce exposures related to specific procedures generating aerosols, such as using closed suctioning systems for airway suction in intubated patients.
Administrative Controls
  • Implement policies and practices to minimize potential exposures to AIVs before arrival, upon arrival, and throughout an affected patient's presence in the healthcare setting. This includes promptly screening and triaging symptomatic patients, implementing respiratory hygiene and cough etiquette, placing a facemask on symptomatic patients upon entry to the facility, and rapidly implementing airborne isolation precautions, in addition to following standard and contact precautions.
  • Avoid transporting patients outside the isolation room unless necessary and limit the numbers of healthcare workers caring for patients and visitors allowed to see the patients.
  • Track all healthcare workers and support staff (e.g., workers performing environmental or food services tasks) who care for or enter the rooms of confirmed or suspected avian influenza patients.
  • Implement a policy to ensure that healthcare workers developing respiratory symptoms after an unprotected exposure to AIV infections:
    • Notify their supervisor;
    • Receive prompt medical evaluation;
    • Start treatment with antiviral medication, if appropriate; and
    • Comply with work exclusion (i.e., stay home) until they are no longer infectious.
  • Consider excluding asymptomatic healthcare workers with an unprotected exposure (i.e., those who have been exposed but who do not have signs/symptoms of disease) for 10 days after the last known contact with a sick patient to monitor for signs and symptoms of respiratory illness.6
  • Implement sick leave policies for healthcare workers that are non-punitive (e.g., that do not reduce a worker's pay, benefits or standing), flexible and consistent with public health guidance.

Exposure to AIVs in clinical, research, and production laboratory workers can occur through inhalation and direct contact. Inhalation may occur from aerosols generated by manipulating and handling AIV-infected samples or inoculating research animals. Direct contact of the eyes, nose, and mouth with AIV-contaminated gloves may occur after handling infected samples or feces, tissues and secretions of laboratory animals.

As detailed in the U.S. Department of Health and Human Services' Biosafety in Microbiological and Biomedical Laboratories (BMBL), 5th edition:

  • Use Biosafety Level 2 (BLS-2) practices for diagnostic, research and production activities involving low pathogenic avian influenza (LPAI) and Animal Biosafety Level 2 (ABSL-2) practices for work with these viruses in animal models.
  • Use BSL-3 and ABSL-3 practices for work involving highly pathogenic avian influenza (HPAI), with rigorous adherence to additional respiratory protection, showering and clothing change protocols.

See Section VIII-E: Viral Agents of the BMBL guidance for detailed guidance on biosafety when working with AIVs.

Below is specific information on control of AIVs in laboratories, broken down into guidelines for work with LPAI versus HPAI strains. Use these in addition to the guidelines specified in the general guidance above to prevent laboratory worker exposure to AIVs.

Laboratories Working with LPAI viruses
Engineering Controls
  • Ensure the laboratory entrance has self-closing doors.
  • Ensure a sink and eyewash are readily available.
  • Conduct as much work with infectious samples as possible in a properly installed and maintained Class II biosafety cabinet (BSC). All work that could generate infectious aerosols should be done in the BSC. The OSHA Fact Sheet, Laboratory Safety Biosafety Cabinets, provides guidance on training and effective use of BSCs.
Administrative Controls
  • Restrict access to the laboratory during work operations and post appropriate biohazard warning signs at the entrance.
  • Enroll laboratory workers in a medical surveillance program and offer and provide seasonal influenza vaccinations.
Work Practices
  • Follow universal precautions required by OSHA's BBP Standard (29 CFR 1910.1030) whenever working with human blood, body fluids or other potentially infectious material. In laboratories, standard precautions are used to expand the universal precautions required by the BBP standard (29 CFR 1910.1030). CDC-recommended standard precautions include, hand hygiene; injection safety and the use of PPE to avoid direct contact with blood and other potentially infectious materials, including laboratory specimens/samples; and added respiratory hygiene/cough etiquette. Standard precautions include appropriate use of PPE; in laboratories, the BMBL guidance can help employers select appropriate PPE for their workers. Also see the PPE section for more information.
  • Perform hand hygiene as specified above in the general guidance before and after any contact with potentially infectious material and before putting on and upon removing PPE, including gloves.
  • Handle human specimens containing blood or body fluids that contain blood accordance with the BBP standard (29 CFR 1910.1030) when examining or testing them for the presence of the AIVs.
  • Consistently and correctly clean and disinfect laboratory work surfaces and equipment. The general guidance above describes using EPA-registered disinfectants to inactivate AIVs on environmental surfaces.
Personal Protective Equipment
  • Use PPE appropriate for the work operations performed, including gloves, gowns, laboratory coats, face shields or masks, and eye protection. In laboratories, the BMBL guidance can help employers select appropriate PPE for their workers
  • Use respiratory protection as determined by risk assessment.
  • Minimize work tasks that contribute to the generation of bioaerosols or droplet sprays.
  • Dispose of contaminated material using an autoclave or an alternative method of decontamination.
  • Properly clean, sanitize, and dispose of all PPE potentially contaminated with AIVs or other infectious material.
Laboratories Working with HPAI Viruses

Note: Consider implementing these controls in addition to LPAI controls above.

Engineering Controls
  • Use dedicated, single pass, directional, and pressure gradient ventilation systems.
  • Ensure that air supply and exhaust systems are independent and use high efficiency particulate arrestance (HEPA) filtration. Ensure that interlocking of each system to prevent positive excursion (leakage).
  • Ensure that the exhaust system has a sealed ductwork system extending from the containment barrier to the filter.
  • Locally collect and chemically disinfect or heat treat run-off water, or collect and process in a central effluent decontamination system before releasing into local sanitary systems.
  • Install a hands-free sink and eyewash near the exit.
  • Ensure that the laboratory entrance has two sets of self-closing and locking doors.
  • Conduct all work with infectious samples in a properly installed and maintained Class II or Class III BSC. The OSHA Fact Sheet, Laboratory Safety Biosafety Cabinets, provides guidance on training and effective use of BSCs.
Administrative Controls
  • Continuously control, restrict, and monitor access to the laboratory.
  • Prohibit virus culture studies on respiratory specimens from patients suspected of having AIVs except under stringent BSL-3 conditions with enhancements.
  • If a clinical laboratory does not have appropriate facilities (BSL-3 laboratories with enhancements), prohibit the ordering of virus isolations for patients suspected of having AIVs unless the specimen can be safely sent to a laboratory with proper controls. The CDC provides guidance on shipping specimens on its Interim Guidance for Specimen Collection, Processing, and Testing for Patients with Suspected Infection with Novel Influenza A Viruses Associated with Severe Disease in Humans webpage.
  • Ensure proper storage of baseline serum samples from workers working with HPAI viruses.
  • Train workers to recognize disease symptoms (See Medical Information page for detailed explanation of symptoms) and monitor workers for these symptoms.
  • Develop a medical protocol for addressing suspected laboratory-acquired HPAI virus infections and ensure that antiviral drugs are available for treatment and prophylaxis, as appropriate.
Work Practices
  • Use a gown-in, shower-out procedure to enforce a change of street clothing and reduce the risk of transmission of HPAI viruses outside the laboratory.
  • Monitor health for symptoms of avian influenza infection for at least one week after the last exposure to material infected with HPAI viruses.
  • Use an EPA-registered disinfectant effective against HPAI AIVs for the following situations:
  • At the beginning and end of diagnostic or research activities with HPAI viruses.
  • When non-laboratory workers must enter the lab to perform tasks such as maintenance of equipment.
  • For spills outside primary containments.
  • Inside biosafety cabinets (all interior surfaces) and containment centrifuges after diagnostic or research activities.
  • The general guidance above describes using EPA-registered disinfectants to inactivate AIVs on environmental surfaces.
Personal Protective Equipment
  • Wear appropriate PPE including solid-front wrap around gowns, scrub suits, or coveralls, eye protection and respirators, as determined by risk assessment. Negative pressure, HEPA filtered respirators or positive air-purifying respirators (PAPRs) may provide the best protection and comfort for laboratory workers who may encounter AIVs with potential to infect humans. In laboratories, the BMBL guidance can help employers select appropriate PPE for their workers.
  • Perform all work with HPAI viruses within an appropriate biosafety cabinet. The OSHA Fact Sheet Laboratory Safety Biosafety Cabinets provides guidance on training and effective use of BSCs.

While the CDC's Interim Risk Assessment and Biosafety Level Recommendations for Working with Influenza A (H7N9) Viruses detailed information related to the H7N9 AIV, employers may find the information useful for work with other HPAI viruses, as well.

In addition to the guidelines specified in the general guidance above, the following controls are recommended for workers traveling to regions affected by AIV outbreaks among poultry or in humans to minimize risk of infection and illness.

Administrative Controls
  • Train workers about any avian influenza disease risks in the required work location. See the CDC's Avian Influenza (Bird Flu) webpage for recommendations on what travelers can do to protect themselves from avian influenza as well as travel warnings and other traveler resources. For the monthly updates on human cases with avian influenza infection, consult the World Health Organization (WHO) Influenza at the human-animal interface - Monthly Risk Assessment Summary webpage.
  • Train workers about vaccination policies and encourage workers to ensure their vaccinations are up-to-date. Ideally, travelers should visit a healthcare provider four to six weeks prior to travel to get any additional vaccinations needed for the specific location visited and any medications or other information workers may need. The CDC's Travelers' Health website provides the most current recommendations for international travel to countries affected by AIVs.
  • Consider assembling and distributing travel health kits to workers on foreign travel. Include such things as a thermometer and alcohol-based hand rubs (i.e., hand sanitizer) for hand hygiene. If this is not possible, provide information to workers about what to include in a travel health kit. Tailor the contents of a travel health kit to the traveler's needs, length of travel, and destination. See the CDC's Travel Health Kits webpage for detailed information useful to both employers and workers.
  • Advise workers to check health insurance plans or get additional insurance that covers medical evacuation in case of illness while on travel. Visit the State Department's Your Health Abroad webpage for medical evaluation and other information related to medical emergencies when traveling abroad.
  • Consider implementing a health monitoring policy applicable for 10 days after returning from travel for workers visiting regions impacted by avian influenza. Include instructions on information to give a healthcare provider prior to the appointment if illness develops during this period (i.e., symptoms, travel destination returned from and any direct poultry contact or contact with a known or suspected human case of avian influenza in a country impacted by AIVs).
Work Practices
  • Avoid consuming uncooked or undercooked poultry or poultry products.
  • Cook all foods from poultry, including eggs and poultry blood, to kill potential AIVs in these foods. For more information, see the U.S. Department of Agriculture (USDA) Questions and Answers: Food Safety and Avian Influenza webpage. Also, consult the WHO's Avian Influenza: Food Safety Issues website for information on food safety and drinking water sanitation.
  • Avoid places with live birds (e.g., poultry farms and bird markets).
  • Avoid all direct and indirect contact with wild birds or poultry, even if appearing healthy and especially if dead or appearing sick.
  • Avoid handling surfaces contaminated with bird feces, saliva, or respiratory secretions—the major source for human infections  associated with contact with these substances.
  • Frequently clean hands, following proper hand hygiene as specified in the general guidance. Hand washing is especially important when preparing raw poultry for cooking.
  • Practice proper cough and sneeze etiquette as described in the general guidance.
  • Consult a healthcare provider if illness develops within 10 days of returning home from travel to regions affected by avian influenza. When scheduling the appointment, provide information on symptoms, destination returned from, and any direct poultry contact.

The CDC has a free, downloadable TravWell app that provides destination-specific vaccine recommendations, a travel preparation checklist, a customizable healthy travel packing list, and emergency services phone numbers for every destination.

If you have a fever and respiratory symptoms (cough or shortness of breath) or if you have any illness that requires prompt medical attention, a U.S. consular officer can help find medical services and inform family or friends. The USEmbassy.gov website provides emergency contact information for U.S. citizens by country.

In addition to the guidelines specified in the general guidance above, the following guidelines are applicable to construction workers during the performance of construction activities, such as renovation, demolition, and remodeling, in an active healthcare setting.

  • Conduct pre-design construction meetings with a multi-disciplinary team regarding plans for interior construction areas, in accordance with OSHA and other required federal, state, and local requirements.
  • Educate construction workers in infection control practices (standard precautions, contact, and airborne precautions) to prevent contamination throughout the worksite, patient care areas, corridors, and travel routes during construction activities.
  • Identify and implement environmental infection control measures required for patient care areas and areas with patients at high risk during construction activities.
  • Ensure the use of engineering controls (negative/positive pressure), monitoring of air filtration and use of personal protective equipment.
  • Install appropriate isolation and containment barriers for dust control during construction activities.
  • Appropriately cover and dispose of construction materials.

Prepare worksites to handle emergencies, such as water-system disruptions, water leaks, fires and natural disasters.

For detailed information relating to groups of workers at risk for potential exposure to AIVs, see OSHA's Guidance Update on Protecting Employees from Avian Flu (Avian Influenza) Viruses.


1 Centers for Disease Control and Prevention (CDC), Show Me the Science – When to Use Hand Sanitizer.

3 MacMahon, KL, Delaney, LJ, Kullman, G, Gibbins, JD, Decker, J, and Kiefer, M., Protecting Poultry Workers from Exposure to Avian Influenza Viruses, Public Health Rep, 123(3), 316-322 (2008).

4 American Veterinary Medical Association (AVMA), Avian Influenza in Companion Animals.

5 Jacob, J.P., Butcher, G.D., Mather, F.B, and Miles, R.D., "Avian Influenza in Poultry," The Institute of Food and Agricultural Sciences, online article, University of Florida IFAS Extension (2014).

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