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What is a transition program and what elements should I include in my transition program?

Anthrax CollageA transition program is recommended for facilities in which anthrax contamination has been identified and normal work operations are conducted. Three examples of this situation include the following:
  1. Normal work activities were resumed in a contaminated facility following decontamination and clearance sampling efforts.
  2. Original sampling identified low levels of surface and air contamination and therefore occupancy is permitted.
  3. Occupancy is permitted outside an established exclusion zone in which decontamination is being performed.
The duration of the program would generally be dictated by sampling results obtained during the transitional period. Site-specific transitional elements should be developed for each facility and incorporated as part of the regular site health and safety plan (HASP). It is recommended that an industrial hygienist develop these elements or at a minimum provide input during the development phase. Transitional Program elements to be included in the HASP include some or all of the following elements, as applicable:

Hazard Awareness Training
Hazard awareness training is intended to communicate information concerning hazards of anthrax and appropriate protective measures to employees. This program may include, but is not limited to:
  • Hazard Awareness TrainingElements of the transition program.

  • The health hazards of anthrax, including routes of entry, signs and symptoms of exposure, synergistic effects, and any medical conditions which would place employees at increased risk (i.e., immunocompromised individuals).

  • Operations in the work area where anthrax has been identified.
  • Dissemination of sampling results to employees, including information on how to gain access to such results.

  • Any applicable control measures, such as appropriate engineering controls, work practices, housekeeping, or personal protective equipment (PPE).

  • Implementation of interim standard operating procedures to control anthrax exposure during operations, maintenance, cleaning, etc.

  • Frequent updates regarding any on-going anthrax sampling, decontamination, control, medical surveillance, and related activities being performed at the facility, as applicable.
Additional detailed information may be found at the following site:

Medical Surveillance
Medical SurveillanceA medical surveillance program is necessary to ensure that employees receive appropriate preventive care. Medical surveillance includes, but is not limited to:
  • Identification of employee population at risk and establishment of controls for such employees (such as work reassignment, PPE, prophylactic medication, etc.).

  • Administrative follow-up on absentees (such as sick leave, etc.).

  • Selection of prophylactic medication, as appropriate.

  • Response to symptoms reported by employees.
Additional detailed information may be found at the following sites:

Transitional Sampling
Transitional sampling is conducted to confirm that the occupied areas remain safe for occupancy. Sampling during this period is continued until repeatable results demonstrate that contamination remains below an established target level. Additional information can also be found in the chapter on sampling.  Elements of transitional sampling include, but are not limited to, the following:
  • Transitional SamplingDetermination of appropriate sampling techniques. Recommended techniques include non-aggressive high-volume air sampling, aggressive HEPA vacuum surface sampling, and if appropriate bulk sampling (such as bulk samples from HEPA vacuum bags used to clean surfaces).

  • Use of high-volume air sampling as an essential tool in order to characterize levels of anthrax in the air and provide inhalational exposure information to employees.

  • Identification of specific locations and frequency of sampling.
Additional detailed information may be found at the following site:

Personal Protective Equipment
Personal Protective EquipmentThe workplace must be reassessed in order to select and use appropriate personal protective equipment (PPE) to protect employees from the anthrax hazards present. The specific types of PPE utilized would be dependant on the actual operation in question and results from the reassessment. Examples of work operations where modifications to PPE may be necessary are as follows:
  • Operating equipment or working on surfaces where anthrax was previously identified.

  • Performing maintenance tasks, such as cleaning equipment or changing HEPA vacuum filters.
Additional detailed information may be found at the following site:

Personal Hygiene
Personal HygieneA personal hygiene program should be implemented to limit exposures and control the spread of anthrax contamination. Procedures that may be required include the following:
  • Assuring that food or beverage is not present or consumed, tobacco products are not present or used, and cosmetics are not applied.

  • Regular washing of the hands and/or face, and before eating, drinking, using tobacco, or applying cosmetics.

  • Showering as necessary.

Interim Standard Operating Procedures
Interim standard operating procedures (SOPs) must be developed to address special work activities necessary under the transitional program. Affected employees should receive training on the interim SOPs. These SOPs may include, but are not limited to, the following topics:
  • Interim Standard Operating ProceduresMaintenance and housekeeping procedures developed or modified to control the spread of contamination and protect employees. Examples of procedures include:
    • Use of HEPA vacuums for cleaning surfaces instead of sweeping or other methods,
    • Cleaning, maintenance, and filter and bag removal for HEPA vacuums,
    • Maintenance and cleaning of facility equipment,
    • Cleaning of floors and other surfaces, and
    • Handling and disposal of wastes.
  • Changes to regular work operations and equipment, as applicable.
  • Modifications to facility-wide mechanical systems, particularly heating, ventilation, and air-conditioning (HVAC) systems. Examples of HVAC modifications include:
    • Increase in ventilation rates (air changes per hour)
    • Increase in percentage of outside air
    • Use of HEPA filters to collect dust in circulated air
  • Other applicable major elements being implemented as part of the transitional program, as described previously (such as training, medical surveillance, sampling, PPE, and hygiene).
Additional detailed information may be found at the following site:

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