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These interim recommendations are intended to assist personnel responsible for occupational health and safety in developing a comprehensive program to reduce potential cutaneous or inhalational exposures to Bacillus anthracis spores among workers, including maintenance and custodial workers, in work sites where mail is handled or processed. Such work sites include post offices, mail distribution/handling centers, bulk mail centers, air mail facilities, priority mail processing centers, public and private mailrooms, and other settings in which workers are responsible for the handling and processing of mail. These interim recommendations are based on the limited information available on ways to avoid infection and the effectiveness of various prevention strategies and will be updated as new information becomes available. These recommendations do not address instances where a known or suspected exposure has occurred. Workers should be trained in how to recognize and handle a suspicious piece of mail http://www.phppo.cdc.gov>). In addition, each work site should develop an emergency plan describing appropriate actions to be taken when a known or suspected exposure to B. anthracis occurs.
These recommendations are divided into the following hierarchical categories describing measures that should be implemented in mail-handling/processing sites to prevent potential exposures to B. anthracis spores:
These measures should be selected on the basis of an initial evaluation of the work site. This evaluation should focus on determining which processes, operations, jobs, or tasks would be most likely to result in an exposure should a contaminated envelope or package enter the work site. Many of these measures (e.g., administrative controls, use of HEPA filter-equipped vacuums, wet-cleaning, use of protective gloves) can be implemented immediately; implementation of others will require additional time and efforts.
B. anthracis spores can be aerosolized during the operation and maintenance of high-speed, mail-sorting machines, potentially exposing workers and possibly entering heating, ventilation, or air-conditioning (HVAC) systems. Engineering controls can provide the best means of preventing worker exposure to potential aerosolized particles, thereby reducing the risk for inhalational anthrax, the most severe form of the disease. In settings where such machinery is in use, the following engineering controls should be considered:
Strategies should be developed to limit the number of persons working at or near sites where aerosolized particles may be generated (e.g., mail-sorting machinery, places where mailbags are unloaded or emptied). In addition, restrictions should be in place to limit the number of persons (including support staff and non-employees, e.g., contractors, business visitors) entering areas where aerosolized particles may be generated. This includes contractors, business visitors, and support staff.
Dry sweeping and dusting should be avoided. Instead, areas should be wet-cleaned and vacuumed with HEPA-equipped vacuum cleaners.
Personal protective equipment for workers in mail-handling/processing work sites must be selected on the basis of the potential for cutaneous or inhalational exposure to B. anthracis spores. Handling packages or envelopes may result in cutaneous exposure. In addition, because certain machinery (e.g., electronic mail sorters) can generate aerosolized particles, persons who operate, maintain, or work near such machinery may be exposed through inhalation. Persons who hand sort mail or work at other sites where airborne particles may be generated (e.g., where mailbags are unloaded or emptied) may also be exposed through inhalation.
Recommendations for Workers Who Handle Mail
Additional Recommendations for Workers Who May Be Exposed through Inhalation
In work sites where respirators are worn, a respiratory-protection program that complies with the provisions of OSHA [29 CFR 1910.134] should be in place. Such a program includes provisions for obtaining medical clearance for wearing a respirator and conducting a respirator fit-test to ensure that the respirator fits properly. Without fit testing, persons unknowingly may have poor face seals, allowing aerosols to leak around the mask and be inhaled. (See December 11, 1998, MMWR, available at http://www.cdc.gov/mmwr/preview/mmwrhtml/00055954.asp
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