Recommendations for Worker Protection and Use of Personal Protective Equipment (PPE) to Reduce Exposure to Novel Influenza A Viruses Associated with Severe Disease in Humans

To reduce their risk of infection with avian influenza A viruses associated with severe disease, poultry workers and responders should do all of the following:

  • Avoid unprotected direct physical contact with sick birds.
  • Avoid unprotected direct physical contact with any of the following that are associated with sick birds: poultry carcasses, poultry feces or litter, surfaces and water that might be contaminated with poultry excretions (e.g., ponds, waterers, buckets, pans, troughs).
  • Wear recommended personal protective equipment (PPE) when in direct contact with birds that are potentially infected with avian influenza A viruses, including poultry carcasses, poultry feces or litter, or when going into any buildings with sick or dead poultry, or carcasses, feces, or litter from poultry.
  • Put on and take off PPE in separate clean areas;
  • Recommended PPE includes: properly-fitted unvented or indirectly vented safety goggles, disposable gloves, boots or boot covers, a NIOSH-approved respirator (e.g., N95), and disposable fluid-resistant[1]coveralls, and disposable head cover or hair cover.
  • NIOSH-approved air-purifying respirators with a particulate filter that is rated N95 or higher are recommended for workers who have contact with highly pathogenic avian influenza (HPAI) A(H5) or A(H7) virus-infected birds, carcasses or potentially virus-contaminated materials. Respirator use should be in the context of a comprehensive respiratory protection program in accordance with the Occupational Safety and Health Administration (OSHA) Respiratory Protection standard (29 CFR 1910.134) and other requirements. Staff that will need to wear respirators must be medically-cleared, trained, and fit-tested for respirator use. Detailed information on respiratory protection programs, including fit testing procedures, can be accessed at OSHA’s Respiratory Protection eToolexternal icon. PPE training topics should include all of the following:
    • Proper fit-testing, wearing and use of respirators;
    • Safe removal of respirators;
    • Safe disposal of disposable respirators or cleaning and disinfection of reusable respirators;
    • Medical contraindications to respirator use.
  • Reusable PPE (e.g., rubber boots, rubber apron) should be:
    • Cleaned until visible dirt is removed, and then
    • Disinfected with an EPA-approved disinfectant that has label claims against influenza A viruses according to the manufacturer’s instructions.

All PPE should be used in accordance with OSHA regulations found at 29 CFR 1910 Subpart I (Personal Protective Equipment). Workers must receive training on and demonstrate an understanding of when to use PPE; what PPE is necessary; how to properly put on, use, take off, properly dispose of, and maintain PPE; and the limitations of PPE.

  • Avoid touching the eyes, mouth, and nose after touching any contaminated material while wearing PPE.
  • Do not eat, drink, smoke, or use the bathroom while wearing PPE.
  • Safely remove PPE in sequence:
    1. Remove and dispose of the apron, if worn;
    2. Clean and disinfect boots;
    3. Remove boots;
    4. Remove and dispose of the coveralls;
    5. Remove and dispose of gloves;
    6. Wash hands with soap and water;
    7. Remove goggles and respirator;
    8. Clean and disinfect reusable goggles and respirator;
    9. Wash hands with soap and water again.
  • Perform good hand hygiene such as handwashing with soap and water or using an alcohol-based hand rub after removing PPE if soap and water are not immediately available.
  • Shower at the end of the work shift and leave all contaminated clothing and equipment at work. Never wear contaminated clothing or equipment outside the work area.
  • Self-monitor for symptoms of illness for 10 days after the last day of exposure to potentially infected poultry or contaminated materials.

For more information: Avian Influenza Current Situation and Protecting Poultry Workers from Avian Influenza (Bird Flu).

[1] Fluid-resistant coveralls should be made of fabric that passes:

  • AATCC 42 ≤ 1 g and AATCC 127 ≥ 50 cm H2O or EN 20811 ≥ 50 cm H2O; or
  • ASTM F1670 (13.8 kPa); or
  • ISO 16603 ≥ 3.5 kPA