Appropriate Personal Protective Equipment: Respirators And Gloves

1. What types of gloves are recommended as a precaution for anthrax exposure?

   Nitrile or vinyl gloves will protect workers from cutaneous anthrax exposure. Latex gloves offer protection similar to nitrile or vinyl gloves, but can result in sensitization or elicit allergic reactions in a small percentage of people. Since mail handling includes a range of tasks and is conducted in various occupational settings, gloves should be provided in a range of sizes and types to fit a variety of workers and job tasks. Employers whose employees work in situations where a gloved hand presents a hazard (e.g., work close to moving machine parts), can minimize risk by ensuring employee training on work practices, proper machine guarding, and correct fit of workers' gloves.
   
   OSHA's recommendations for assessing workplace risk and determining prudent work practices and personal protective equipment (PPE) are addressed in OSHA's Anthrax in the Workplace Risk Reduction Matrix. Please be aware that OSHA's standards for general PPE cover glove selection and use (1910_0132) as well as hand protection (1910_0138).
   
   Note: The U.S. Postal Service (USPS), which continues to work closely with the Centers for Disease Control and Prevention (CDC) regarding the control of anthrax in its facilities (Morbidity and Mortality Weekly Report - MMWR - October 26, 2001), has purchased vinyl and nitrile gloves for postal employee protection (USPS News Release Oct 25, 2001).

    

2. What personal protective equipment would provide effective protection while handling mail if exposure to anthrax spores is a concern? Would this include respirators?

   OSHA's recommendations for assessing workplace risk, prudent work practices, and personal protective equipment (PPE) are addressed in the Anthrax in the Workplace Risk Reduction Matrix.
   
   Because the majority of recent cases of confirmed occupational anthrax contamination and infection have been related to mail delivered through the USPS, selecting appropriate personal protective equipment (PPE) depends on the amount of mail a worker handles, how he or she handles the mail, and where he or she works. Some factors to consider include: the current patterns of anthrax spore contamination; the nature of the workplace and amount of mail received; whether the facility receives mail directly from a USPS facility that is known to be contaminated with anthrax; and whether the facility uses equipment that might disperse dust or anthrax spores into the air. Employers also should consider factors such as information from law enforcement agencies in assessing employee risk.
   

   For the most part, employers whose workers handle small volumes of mail will not need to do more than to establish handling and screening procedures for mail. These employers may consider providing their employees with vinyl or nitrile gloves.
   
   Workers in USPS facilities often handle an extremely high volume of mail and may work around mail sorting equipment that could disperse anthrax spores contained in processed mail. As a result, the workers in these facilities may be at a higher risk of exposure than workers who handle smaller volumes of mail, and higher levels of PPE may be appropriate.
   
   As explained, OSHA does not recommend respirators for the vast majority of workers. If workers request respirators, however, and employers provide filtering facepiece respirators for voluntary use by employees, the employers must make sure that employees are provided with the information contained in Appendix D to OSHA's Standard for Respiratory Protection, 29 CFR 1910.134 ("Information for Employees Using Respirators When Not Required Under the Standard").
   
   To provide effective protection from anthrax spores, the CDC recommends the use of NIOSH-approved respirators that are at least as protective as an N95 respirator. In addition, persons working in areas where oil mist from machinery is present should use respirators equipped with P-type filters (P95 or P100) to prevent the oil mist from degrading the filter.
   
   At worksites where employers require workers to wear respirators, a respiratory-protection program that complies with the provisions of 29 CFR 1910.134 must be implemented. This includes compliance with the standard's requirements for obtaining medical clearance for wearing the respirator and for conducting fit testing before requiring their employees to use respirators. These latter requirements also apply to voluntary use of respirators that are not filtering facepiece respirators.

    

3. What precautions should healthcare workers (HCWs) take when treating patients who may be infected and/or contaminated with anthrax (Bacillus anthracis)?

   Healthcare workers should use Universal Precautions for all patient care activities. "Universal Precautions" are standard approaches to infection control designed to reduce the risk of transmitting microorganisms from both known and unknown sources of infection. Universal Precautions can include, but are not limited to, appropriate use of gloves, masks, protective clothing, work practices, and housekeeping.
   
   Clinical anthrax illness occurs days or weeks after exposure to the anthrax spores and person-to-person spread of this disease has not been documented. Therefore, after the onset of clinical illness, no precautions specific to anthrax have been recommended.
   
   However, if healthcare workers are providing initial care to a patient with suspected recent exposure to anthrax, they should take precautions against the potential for reaerosolizing any anthrax spores remaining on the exposed individual or clothing. Further direction for appropriate personal protective equipment is available on OSHA's Anthrax in the Workplace Risk Reduction Matrix.

    

4. How should contaminated PPE used to handle mail (e.g. gloves) be disposed of? Can it go in regular trash?

   Unless the PPE has been used to handle a suspicious piece of mail, gloves and other personal protective clothing and equipment can be discarded in regular trash once removed. If a worker recognizes and handles a suspicious piece of mail, the worker's protective gear should be treated as potentially contaminated; it should be placed in an appropriately labeled and/or color-coded container that is closable and leak-proof. This container should then be disposed of as infectious/regulated waste.
   

    

5. What are the health and safety precautions for laboratory workers handling anthrax samples?