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Control and Prevention
The Centers for Disease Control and Prevention (CDC) provides additional guidance and recommendations for preventing worker exposure to Ebola, including for healthcare workers and others at increased risk for exposure.
This guidance offers feasible methods for complying with certain OSHA requirements.
Personal Protective Equipment (PPE) for Ebola
OSHA's "PPE Selection Matrix for Occupational Exposure to Ebola Virus," provides task-based guidance to help employers select appropriate PPE for workers who may be exposed to Ebola virus. The matrix covers examples of common exposures, ranging from casual interaction with individuals with risk factors for Ebola, such as in airport screening operations; to providing medical and supportive care in hospital settings to patients with suspected or confirmed Ebola; to performing maintenance and waste handling tasks where Ebola contamination may be present.
Employers must train workers to put on, use, and take off PPE properly, including removing PPE in a way that avoids self-contamination. This may include removing outer gloves simultaneously with the gown, decontaminating PPE between removal steps, or other measures. The order of PPE removal may depend on the type of PPE a worker uses, the nature of the work tasks being performed, and which devices or garments are contaminated, among other factors.
After use, remove and place gowns, gloves, and other disposable materials in a labeled waste container, as appropriate. Wash hands with soap and water, or use an alcohol-based hand rub if soap and water are not available. Reusable goggles, face shields, respirators, and other equipment must be decontaminated before re-use.
CDC guidance states that all HCWs involved in the care of Ebola patients must receive repeated training on and must demonstrate competency in putting on and removing proper PPE before working with Ebola patients. Workers in other sectors where exposure to the Ebola virus or someone with Ebola may be anticipated should also demonstrate competency in putting on and removing proper PPE.
CDC's PPE guidance from the 2014-2015 Ebola outbreak provides additional details on the specific types of PPE to be used by healthcare workers and the processes for putting on (donning) and removing (doffing) PPE. CDC also offers a fact sheet to explain its PPE recommendations including using an observer to monitor healthcare workers putting on and taking off PPE.
Currently, most workers in the U.S. are unlikely to encounter Ebola virus or individuals with Ebola virus disease (EVD). However, exposure to the virus or someone with EVD may be more likely in certain sectors, including the healthcare, mortuary/death care, and airline servicing industries. Workers who interact with people, animals, goods, and equipment arriving in the U.S. from foreign countries with current EVD outbreaks are at the greatest risk for exposure.
Precautionary measures for preventing exposure to the Ebola virus depend on the type of work, potential for Ebola-virus contamination of the work environment, and what is known about other potential exposure hazards. Infection control strategies may have to be modified to include additional selections of personal protective equipment (PPE), administrative controls, and/or safe work practices. OSHA has developed interim guidance to help prevent worker exposure to Ebola virus and individuals with EVD.
General Guidance for Workers and Employers
Employers are responsible for ensuring their workers are protected from exposures to recognized bloodborne pathogens, including the Ebola virus, and related hazards. Employers of workers who may be exposed on the job must follow OSHA requirements to protect workers from exposure.
- Employers should follow recognized and generally accepted good infection control practices and must comply with applicable requirements in the Bloodborne Pathogens (29 CFR 1910.1030), Personal Protective Equipment (29 CFR 1910.132 and, in construction, 29 CFR 1926.95), and Respiratory Protection (29 CFR 1910.134 and, in construction, 29 CFR 1926.103) standards, among other OSHA requirements.
- Early identification and isolation of potentially infectious people is a key step in preventing the spread of EVD, including to workers who may be exposed on the job to a person with the virus.
- Under the Bloodborne Pathogens standard, employers must follow a hierarchy of controls, implementing engineering controls first, followed by administrative and work practice controls. See 29 CFR 1910.1030(d)(2)(i). Using PPE, while often essential to protecting workers from occupational exposure to Ebola virus (especially for healthcare workers providing patient care), should be the final step in protecting workers. Some examples of controls for protecting employees from Ebola are presented in the chart below. When there is a significant risk of exposure, all of these types of controls may be needed to protect workers. Apply the hierarchy of controls to other hazards that do not fall under BBP (e.g., chemical and physical hazards).
|Hierarchy of Controls|
|Engineering Controls||Administrative Controls and Safer Work Practices||Personal Protective Equipment (PPE)|
|Requires a physical change to the workplace to prevent or minimize exposure||Requires the employer or worker to do something to prevent or minimize exposure||Requires the worker to use or wear something to prevent or minimize exposure|
|Most effective 🡪||🡪||🡪 Least effective|
General guidance on Personal Protective Equipment (PPE)
- When engineering or administrative and work practice controls are insufficient to prevent employee exposure to the Ebola virus, or before engineering controls can be implemented, employers must provide appropriate PPE for workers. See 29 CFR 1910.134(a)(1) and, in construction, 29 CFR 1926.103.
- The general requirements of the PPE standards (29 CFR 1910.132 and, in construction, 29 CFR 1926.95) describe the basis for effective selection and use of adequate PPE including protective garments.
- Typically, the level of PPE workers must wear corresponds to their risk of exposure, as identified in required hazard assessments and exposure determinations. Consider the work tasks being performed and their relationship to potential sources of worker exposure.
- Ensure that workers wear PPE as required to prevent exposure to the virus via mucous membranes or non-intact skin, or through inhalation of bioaerosols.
- OSHA's "PPE Selection Matrix for Occupational Exposure to Ebola Virus," provides task-based guidance to help employers select appropriate PPE for workers who may be exposed to Ebola virus in a number of higher-risk work settings.
- Workers who may be splashed, sprayed, or spattered with blood or body fluids from environmental surfaces where Ebola virus contamination is possible must wear face and eye protection, such as a full-face shield or surgical masks with goggles. Aprons or other fluid-resistant protective clothing must also be worn in these situations to prevent the worker's clothes from being soiled with infectious material.
- Some workers may need respirators to protect them from exposure to aerosols containing the Ebola virus or hazardous chemicals. The Respiratory Protection standard (29 CFR 1910.134 and, in construction, 29 CFR 1926.103) requires employers to identify and evaluate respiratory hazards in the workplace. If respiratory hazards exist, employers must implement a comprehensive, written respiratory protection program that includes training, fit testing, medical exams, and use of National Institute for Occupational Safety and Health (NIOSH)-certified respirators.
- Employers must ensure PPE is cleaned, repaired, and replaced, as needed. Provision, maintenance, repair, and replacement must be provided at no cost to the worker. See 29 CFR 1910.1030(d)(3).
Employers should ensure workers follow effective hand hygiene practices:
- Wash or sanitize hands frequently to avoid exposure to infected blood and body fluids, contaminated objects, or other contaminated environmental surfaces.
- Wash hands with soap and water for at least 15 seconds, including after removing PPE.
- Always wash hands with soap and water for at least 15 seconds whenever hands are visibly soiled.
- If soap and water are not available for hand washing, use an alcohol-based hand rub that contains at least 60% alcohol.
- Train workers on good hand hygiene practices.
Other worker protection considerations
- Employers must train workers about the sources of Ebola exposure and appropriate precautions. Employers must train workers required to use PPE on what equipment is necessary, when and how they must use it, and how to dispose of the equipment. In addition where workers are exposed to blood or other potentially infectious materials, employers must provide the training required by the Bloodborne Pathogens standard (29 CFR 1910.1030), including information about how to recognize tasks that may involve exposure and the methods to reduce exposure, including engineering controls, work practices, and PPE.
- Healthcare workers and responders involved with cases related to Ebola in the United States may be required to work extended, rotating, consecutive, or otherwise unusual shifts. They also need enhanced PPE when working with Ebola patients or in Ebola-contaminated areas. These conditions increase the risk of injuries and accidents and can contribute to poor health and worker fatigue. The NIOSH/OSHA "Preventing Worker Fatigue Among Ebola Healthcare Workers and Responders" document provides guidance for protecting workers responding in the United States, but the same concepts apply to those working in other countries.
- Workers tasked with cleaning surfaces that may be contaminated with Ebola virus must be protected from exposure. Employers are responsible for ensuring that workers are protected from exposure to Ebola and that workers are not exposed to harmful levels of chemicals used for cleaning and disinfection. OSHA's Cleaning and Decontamination of Ebola on Surfaces (Spanish) Fact Sheet provides guidance on protecting workers in non-healthcare/non-laboratory settings from exposure to Ebola and cleaning and disinfection chemicals. CDC also offers specific guidance for workers cleaning and disinfecting surfaces that have been in contact with blood or body fluids from a traveler known to have or suspected of having EVD.
- Workers involved in handling, treatment, transport, and disposal of medical, laboratory and other waste must be protected from exposure to infectious agents, including Ebola virus, which causes Ebola virus disease. Contaminated waste may pose a greater risk to workers if it is not handled safely or packaged, treated, and disposed of properly. The federal government provides consolidated guidance for managing waste contaminated with Ebola or another Category A substance. A summary of key points and significant changes may be useful to readers, including those familiar with the 2017 interim version of this document.
- OSHA's "Protecting Workers during a Pandemic" Fact Sheet provides general guidance about principles of worker protection that may be useful during a wide-spread disease outbreak.
Specific information for workers (by job type)
- Healthcare workers
- Airline and other travel industry personnel
- Mortuary and death care workers
- Laboratory workers
- Border, customs and quarantine workers
- Emergency responders
- Workers in critical sectors
The CDC is the authoritative source for information for healthcare workers (HCWs) who care for, treat, and otherwise interact with patients who are known to or are suspected of having EVD. CDC provides guidance and recommendations, including the following publication:
- Infection Prevention and Control Recommendations for Hospitalized Patients Under Investigation (PUIs) for Ebola Virus Disease (EVD) in U.S. Hospitals
CDC also provides information for workers who may be exposed to Ebola virus through environmental contamination in healthcare settings:
- Interim Guidance for Environmental Infection Control in Hospitals for Ebola (Applicable to housekeeping staff in healthcare workplaces)
Employers of healthcare workers are responsible for following applicable OSHA requirements, including OSHA's Bloodborne Pathogens (29 CFR 1910.1030), Personal Protective Equipment (29 CFR 1910.132), and Respiratory Protection (29 CFR 1910.134) standards. For additional information on OSHA requirements, visit the Standards section of this web page.
Use transmission-based precautions appropriate for Ebola virus (i.e., based on each worker’s job tasks and exposure risk, typically a combination of contact and droplet precautions with airborne precautions for aerosol-generating procedures).
Generally, healthcare workers must use proper personal protective equipment (PPE) and other infection control measures to avoid exposure to infected blood and body fluids, contaminated objects, or other contaminated environmental surfaces. CDC recommendations for U.S. healthcare workers caring for patients with EVD include wearing:
- surgical scrubs or disposable garments under PPE
- dedicated washable footwear
- double gloves
- boot covers that are waterproof and extend to at least mid-calf or leg covers
- single use fluid-resistant or impermeable gown that extends to at least mid-calf or coverall without integrated hood
- disposable N95 or powered air-purifying respirator (PAPR)
- disposable full-face shield
- surgical hoods to ensure complete coverage of the head and neck
- a waterproof apron that covers the torso to the level of the mid-calf should be used if EVD patients have vomiting or diarrhea
OSHA's new "PPE Selection Matrix for Occupational Exposure to Ebola Virus", provides task-based guidance to help employers select appropriate PPE for workers who may be exposed to Ebola virus, including HCWs evaluating individuals with suspected Ebola, caring for hospitalized patients, transporting individuals with suspected or confirmed Ebola, and performing cleaning and waste handling tasks where Ebola contamination may be present.
Select PPE based on its ability to protect the worker from splashes of blood, body fluids, or other sources of infectious material. Train workers on when and how to use PPE, including how to put it on (donning), remove it (doffing), and dispose of it. Employers must also comply with provisions of OSHA standards that apply to PPE (e.g., Personal Protective Equipment, 29 CFR 1910.132) and respirator use (e.g., Respiratory Protection, 29 CFR 1910.134), such as medical exams and fit testing for workers who wear respirators.
Workers who may be exposed to aerosolized Ebola virus particles, including during aerosol-generating procedures (AGPs) in healthcare or laboratory worksites, must use an N95 or higher filtering facepiece respirator (FFR), half- or full-face air-purifying respirator (APR) or powered air-purifying respirator (PAPR) in the context of a comprehensive respiratory protection program. A full-face APR or PAPR offers higher levels of protection (i.e., greater assigned protection factor) than a half-mask APR or disposable N95 FFR. Loose-fitting PAPRs may improve worker comfort and provide options for workers who cannot wear other types of respirators. Wearing respirators in patient care, laboratory, and certain other settings can help prevent worker exposures in the event of an unexpected AGP. Aerosol-generating procedures may include:
- aerosolized or nebulized medication administration
- diagnostic sputum induction
- airway suctioning
- endotracheal intubation
- positive pressure ventilation via face mask (e.g., biphasic intermittent positive airway pressure ventilation or continuous positive airway pressure ventilation)
- high-frequency oscillatory ventilation
Following good hand hygiene protocols, safe injection practices, and other infection control techniques may further reduce healthcare worker exposure to Ebola virus and other infectious agents.
Healthcare workers deploying to and/or working in Ebola-impacted areas (e.g., countries in Africa where the virus is currently spreading) may require additional protections. Under austere conditions, facilities for routine hand hygiene, cleaning and decontamination of environmental surfaces, adequate air exchange and ventilation, and other factors that reduce exposure to and transmission of Ebola virus may not exist. Frequent contact with high densities of Ebola patients may also require higher levels of respiratory protection (including encapsulating suits with powered air-purifying respirators) and other PPE. CDC offers guidance for workers in healthcare settings outside of the U.S.
Workers involved in airline and airport service operations—including flight attendants, cleaning and provisioning staff, and cargo personnel—may be exposed to Ebola virus in a number of scenarios, including exposure to infectious body fluids in lavatories and direct exposure to individuals sick with EVD. Currently, airline service worker exposure to Ebola virus is unlikely. Passengers originating from locations affected by the ongoing EVD outbreak pose the greatest hazard to workers in the airline service industry.
The CDC has prepared guidance for airline flight crews, cleaning personnel, and cargo operations workers.
Employers must provide protective clothing and equipment for workers who may perform tasks that could result in exposure to Ebola virus. This would include employees whose work tasks include cleaning up blood, vomit, or other body fluids from a sick passenger.
Disinfection and clean up should include wiping down lavatory surfaces and frequently touched surfaces in the passenger cabin, such as armrests, seat backs, tray tables, light and air controls, and adjacent walls and windows with a registered cleaner/disinfectant with label claims for use against non-enveloped viruses (e.g., norovirus, rotavirus, adenovirus, poliovirus) and that has been tested and approved for use by the airplane manufacturers.
CDC recommends that airline and other travel industry workers consider providing sick travelers with surgical masks (if the sick person can tolerate wearing one) to reduce the number of droplets expelled into the air by talking, sneezing, or coughing.
Note on Flight Crews: The safety and health of flight crews are under the jurisdiction of the Federal Aviation Administration (FAA) and such workers are generally not subject to OSHA requirements. However, under a policy adopted by memorandum of understanding between the FAA and OSHA, they are subject to OSHA's Bloodborne Pathogens, Noise, and Hazard Communication standards. The Personal Protective Equipment standard and the General Duty Clause was not included in this memorandum of understanding.
Mortuary and death care workers who must have contact with the remains of individuals known or suspected to be contaminated with Ebola virus must use proper PPE and other infection control measures to avoid exposure to infected blood and body fluids, contaminated objects, or other contaminated environmental surfaces. These workers must wear face protection (a face shield or a medical mask and goggles); a clean, non-sterile long-sleeved gown; and gloves (sterile gloves for some procedures) where required to protect the worker against contact with contaminated materials. These items must be selected based on their ability to protect the worker from splashes of blood, body fluids, and other sources of infectious material. Following good hand hygiene protocols and other infection control techniques may further reduce mortuary and death care worker exposure to Ebola and other infectious agents.
Laboratory workers who handle samples containing Ebola virus, including for diagnostic testing of patients with suspected or confirmed Ebola and as part of research and development work, must be protected from exposure to the virus on the job. Workers in clinical and research laboratories can safely handle such samples by strict adherence to precautions and practices specifically designed for contact- and droplet-transmissible diseases, including more common bloodborne pathogens. When followed appropriately, these precautions and practices are effective in protecting workers from exposure to Ebola virus. However, Ebola has low infectious dose, diagnostic and research samples may contain high numbers of viral particles, and exposure can result in severe disease. Therefore, it is essential that employers review laboratory safety and health procedures and guidelines with lab workers; train and test competency of workers in appropriate implementation of these procedures and guidelines, including appropriate use of engineering controls and PPE; and ensure consistent adherence to them.
Employers of laboratory workers are responsible for following applicable OSHA requirements, including OSHA's Bloodborne Pathogens (29 CFR 1910.1030), Personal Protective Equipment (29 CFR 1910.132), and Respiratory Protection (29 CFR 1910.134) standards. In addition to OSHA requirements that are broadly applicable to occupational exposure to Ebola virus and related hazards, such as chemicals used for cleaning and disinfection, laboratory employers must also follow specific requirements that apply to labs. For additional information on OSHA requirements, visit the Standards section of this web page.
CDC's "Biosafety in Microbiological and Biomedical Laboratories (BMBL), 5th Edition" provides guidance on protecting workers in laboratory environments. The following sections may be of particular relevance to employers and workers whose workplaces may contain Ebola virus:
- Section IV - Laboratory Biosafety Level Criteria
- Section VII - Occupational Health and Immunoprophylaxis
- Section VIII - E – Viral Agents Agent Summary
The CDC Morbidity and Mortality Weekly Report (MMWR) also featured biosafety laboratory competency guidelines. A useful matrix describes staff competencies across a number of skill domains, including identifying and describing hazards, controlling potential exposures, implementing administrative controls, and preparing for and responding to emergencies.
Importantly, handling of samples from individuals with suspected or confirmed Ebola, or research samples of Ebola virus, should always be done in containment (e.g., biosafety cabinets, BSCs) to protect workers and to prevent contamination of surfaces outside the BSC.
Employers must also be prepared to safely and effectively decontaminate laboratory work environments, and handle waste generated from both the laboratory work and cleaning and decontamination activities. CDC's "Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus" provides information on cleaning and decontamination applicable to laboratory settings. When selecting disinfectants, employers should consult EPA List L of selected registered antimicrobial products that meet the CDC criteria for use against the Ebola virus. OSHA's "Safe Handling, Treatment, Transport, and Disposal of Ebola-Contaminated Waste" fact sheet details best practices throughout the waste cycle, from the point of waste generation through final disposition of treated waste products.
Note: Different or additional engineering controls, PPE, and other measures may be needed to protect workers from exposure to hazardous chemicals used for cleaning and disinfection.
Specific recommendations for engineering controls and PPE needed when working with samples known to or suspected of containing Ebola virus vary between clinical and research laboratories. Each setting is discussed below.
Conduct clinical laboratory work on samples from patients with suspected or confirmed Ebola at, a minimum, Biosafety Level (BSL) 2 with BSL 3 precautions. CDC BMBL guidelines, including Section IV, describe the standard microbiological practices, special practices, and safety equipment and laboratory facilities (including engineering controls and PPE), for working at this level.
BSL-3 precautions require that all procedures involving the manipulation of infectious materials must be conducted within a BSC, or other appropriate physical containment devices. Do not conduct work with open vessels on the laboratory bench or perform tasks that result in the generation of bio-aerosols—this may include vortexing, pipetting, aspirating, or other similar procedures—outside of the BSC. When a procedure absolutely cannot be performed within a BSC, a combination of appropriate enhanced PPE (e.g., additional skin coverage, respiratory protection, etc. ) and other containment devices, such as a centrifuge safety cup or sealed rotor, must be used.1
Use a Class II BSC to protect both the laboratory worker and the laboratory environment from infectious agents. Class II BSCs use airflow into the front of the cabinet to keep potentially contaminated air and materials (e.g., Ebola virus particles) in the cabinet and high-efficiency particulate absorption (HEPA) filters to remove infectious agents from exhaust air.
When working in a Class II BSC, PPE for clinical laboratory workers may include:
- dedicated work clothing, such as surgical scrubs under PPE
- dedicated washable footwear
- double gloves
- face and eye protection (e.g., disposable full-face shield)
- single-use fluid-resistant gown that extends to at least mid-calf
In instances where a high(er)-risk exposure(s) is present, such as if a BSC cannot be used or when work tasks are anticipated to result in bio-aerosol generation, workers may need fluid-resistant coveralls (without integrated hood) instead of gowns, fluid-resistant head and neck covers, shoe/boot covers high enough to cover the lower leg, and respiratory protection (e.g., N95 or better disposable respirator, elastomeric respirator with appropriate cartridge, or PAPR).
OSHA's new "PPE Selection Matrix for Occupational Exposure to Ebola Virus", provides task-based guidance to help employers select appropriate PPE for workers who may be exposed to Ebola virus, including workers conducting clinical laboratory work on samples from patients with suspected or confirmed Ebola. Workers must receive repeated training on and must demonstrate competency in putting on and removing proper PPE before working with clinical samples from Ebola patients.
Some types of laboratory tests may be done in the same room or area where an Ebola patient receives treatment. For such practices, known as "point of care testing," healthcare workers wearing PPE suitable for the care of a hospitalized Ebola patient should perform laboratory tests on dedicated equipment. This may help reduce risk for infection of clinical laboratory personnel and contamination of laboratory equipment in a hospital's core laboratory.2
Following a risk assessment and development of a comprehensive strategy for mitigating lab worker exposures, some types of specimens from individuals with suspected or confirmed Ebola may be safely handled and tested in the core clinical laboratory (i.e., at levels lower than BSL-2 with 3 precautions) using an integrated approach. Such an approach may involve decontaminating and packaging samples in containment within an Ebola patient care area; use of specialized equipment that does not require opening/uncapping tubes, centrifugation, or other aerosol-generating procedures; training on and use of appropriate PPE; and proper waste handling and disposal techniques.3
CDC provides updated guidance for collecting, transporting, and testing specimens from persons suspected or confirmed to have EVD.
Ebola viruses are considered BSL-4 agents in research settings. BSL-4 agents pose a high individual and community risk of life-threatening disease that can be readily transmitted from person-to-person, directly or indirectly and for which there are no effective vaccines or treatments available. Accordingly, conduct research work on samples of suspected or confirmed Ebola virus at BSL-4, including taking appropriate precautions in properly equipped laboratories when performing tests on specimens obtained from humans and animals suspected or confirmed to be infected with Ebola virus or during necropsy and other laboratory procedures involving the remains of humans and animals infected with the virus. CDC BMBL guidelines, including Section IV, describe the standard microbiological practices, special practices, and safety equipment and laboratory facilities (including engineering controls and PPE), for working at this level.
Use a Class III BSC to protect both the laboratory worker and the laboratory environment whenever working with the highly infectious microbiological agents. Class III BSCs are typically gas-tight enclosures with integrated gloves and non-opening viewing windows. Class III BSCs typically have double-pass-through mechanisms that integrate decontamination capabilities for equipment and samples (e.g., built-in autoclave or disinfectant dunk-tank). Exhaust air from Class III BSCs must pass through two HEPA filters, or a HEPA filter and an air incinerator, before being discharged directly to the outdoors. Class III BSCs are not exhausted through the general laboratory exhaust system or back into the laboratory environment.1 If a Class III BSC is not available, or work cannot be done in a Class III BSC, wear a full-body, air supplied positive-pressure suit.4
When working in a Class III BSC, PPE for research laboratory workers may include:
- dedicated work clothing, such as surgical scrubs under PPE
- dedicated washable footwear
- double gloves
- face and eye protection (e.g., disposable full-face shield)
- single-use impermeable gown that extends to at least mid-calf
- impermeable head and neck cover (e.g., surgical hoods to ensure complete coverage of the head and neck)
- impermeable shoe/boot covers high enough to cover the lower leg
- respiratory protection (e.g., an N95 respirator)
In instances where a high(er)-risk exposure(s) is present, workers may need impermeable coveralls (without integrated hood) instead of gowns or higher levels of respiratory protection (e.g., elastomeric respirator with appropriate cartridge or PAPR).
OSHA's new "PPE Selection Matrix for Occupational Exposure to Ebola Virus", provides task-based guidance to help employers select appropriate PPE for workers who may be exposed to Ebola virus, including workers conducting clinical laboratory work on samples from patients with suspected or confirmed Ebola. Workers must receive repeated training on and must demonstrate competency in putting on and removing proper PPE before working with research samples of Ebola virus.
Workers involved in border patrol and security, immigration and customs enforcement, and public health investigation and quarantine work may encounter individuals with EHD arriving at U.S. borders from foreign countries impacted by the ongoing epidemic. These types of workers may also be exposed to infected blood and body fluids or other potentially infectious materials, contaminated objects, or other contaminated environmental surfaces as they perform tasks such as inspection of cargo, baggage, and arriving aircraft or vessels.
The U.S. Centers for Disease Control and Prevention (CDC) has prepared guidance for airline flight crews, cleaning personnel, and cargo operations workers. Some of these guidelines may be applicable to border, customs and quarantine workers.
Generally, employers must provide protective clothing and equipment for workers who may perform tasks that could result in exposure to Ebola virus, including, for example, employees who would be expected to clean up vomit or other body fluids from a sick passenger.
CDC recommends providing sick travelers with surgical masks (if the sick person can tolerate wearing one) to reduce the number of droplets expelled into the air by talking, sneezing, or coughing. Sick individuals may be requested to wear surgical masks when interacting with border, customs, or quarantine workers.
Most border, customs, and quarantine workers at international ports of entry are likely to be employees of the U.S. Government. The Occupational Safety and Health (OSH) Act of 1970, Section 19, Executive Order 12196, and 29 CFR 1960 require the head of each Federal agency to establish and maintain an effective and comprehensive occupational safety and health program. Federal employers must protect their workers from known occupational safety and health hazards. OSHA's Federal Agency Programs page provides additional information for federal employers and workers.
In the event that the ongoing EVD outbreak reaches the U.S., emergency responders, including emergency medical service (EMS) workers, may encounter patients known to have or suspected of having EVD. The job duties of emergency responders may also put them in situations where exposure to Ebola-contaminated environments is possible. In these scenarios, CDC and OSHA guidance for healthcare workers can help prevent exposure.
Healthcare workers and others who must have contact with individuals with EVD must follow appropriate requirements, including OSHA's Bloodborne Pathogens standard (29 CFR 1910.1030). CDC also provides guidance and recommendations for protecting these workers.
In other scenarios where Ebola or Ebola-containing body fluids contaminate environmental surfaces, food (e.g., meat), or human or animal remains, emergency responders may be at no greater risk of exposure than healthcare workers. An incident commander should assess the hazard to workers and require appropriate PPE and other controls based on the specific details of an emergency response.
OSHA's Emergency Preparedness and Response page provides additional information for emergency response and recovery workers and their employers.
Employers in critical infrastructure / key resource (CIKR) sectors may wish to review their personnel and evaluate whether they are at particularly high risk for exposure. For example, in the transportation industry, some vehicle conductors, such as bus drivers, may have frequent direct contact with ill individuals while others who have similar job classifications, such as subway drivers sitting in separate cabs, may not. Pharmacists dispensing medication to ill individuals may need higher levels of protection as they are likely to have frequent contact with ill individuals. Such workers may require higher levels of protection than the average worker, who is unlikely to be in an environment known or suspected to be contaminated with the Ebola virus.
Employers in such industries may need to explore strategies for:
- Obtaining, selecting, and stockpiling protective clothing and equipment.
- Providing medical evaluations, fit-testing, and training for workers who may be required to wear respirators.
- Incorporation of engineering controls into work settings to prevent worker exposure to infectious agents (e.g., pressurization across glass windows in pharmacies, banks, or other areas where workers perform customer service tasks).
- Cleaning and decontamination of environmental surfaces.
If you think you have been exposed…
Any worker who thinks he or she may have been exposed to Ebola virus, including through travel, assisting an ill traveler or other person, handling a contaminated object, or cleaning a contaminated environment (such as an aircraft) should take the following precautions:
- Notify your employer immediately.
- Monitor your health for 21 days. Watch for fever (temperature of 101°F/38.3°C or higher), muscle pain, headache, sore throat, diarrhea, vomiting, rash, and other symptoms consistent with Ebola.
- Seek medical attention if you develop any of these symptoms.
- Before visiting a health care provider, alert the clinic or emergency room in advance about your possible exposure to Ebola virus so that arrangements can be made to prevent spreading it to others.
- When traveling to a health care provider, limit contact with other people. Avoid all other travel.
If you are located abroad, contact your employer for help with locating a health care provider. The U.S. embassy or consulate in the country where you are located can also provide names and addresses of local physicians.
Any worker who may reasonably be expected to come into contact with the Ebola virus, either from the work environment or from direct contact with individuals infected, has the right to know the hazards associated with this potential exposure and how to protect themselves during work activities. Any occupational exposure to blood or other potentially infectious materials fall under the requirements in the Bloodborne Pathogens Standard (29 CFR 1910.1030). Other occupational exposures may require protection of workers under the PPE Standard (29 CFR 1910.132), Respiratory Protection Standard (29 CFR 1910.134), or the General Duty Clause of the OSH Act (29 USC 654(a)).
Employers should educate workers about the hazards to which they are exposed and to provide reasonable means by which to abate those hazards. Additional information about communicating job hazards to workers is available on OSHA’s Hazard Communication page. While OSHA’s Hazard Communication Standard (29 CFR 1910.1200) does not apply to the Ebola virus itself, employers may be required to comply with the standard when chemicals are used for cleaning and disinfection of the work environment.
1 "Biosafety in Microbiological and Biomedical Laboratories (BMBL) 5th Edition," U.S. Centers for Disease Control and Prevention.
2 Kortepeter, M. G., Martin, J. W., Rusnak, J. M., Cieslak, T. J., Warfield, K. L., Anderson, E. L., & Ranadive, M. V. (2008). Managing Potential Laboratory Exposure to Ebola Virus by Using a Patient Biocontainment Care Unit." Emerging Infectious Diseases, 14(6), 881.
3 Iwen, P. C., Garrett, J. L., Gibbs, S. G., Lowe, J. J., Herrera, V. L., Sambol, A. R., ... & Hinrichs, S. H. (2014). An Integrated Approach to Laboratory Testing for Patients with Ebola Virus Disease. Lab Medicine, 45(4), e146-e151.
4 "Recognizing the Biosafety Levels," U.S. Centers for Disease Control and Prevention.