The purpose of this interim National Institute for Occupational Safety
and Health (NIOSH) fact sheet is to provide general guidance for personal
protective equipment (PPE) for workers responding in hurricane flood zones. This guidance is based on best available information as
of September 9, 2005 and will be updated as additional information is
available. PPE selection and use is site and task specific. General guidelines
must be adapted to specific conditions.
This guidance represents professional judgment based on experience from
responses to past storms and floods. Additional
interim recommendations will be added for clean-up and restoration operations.
These interim recommendations focus on the following hazards associated
with response activities:
Hazard 1 Sharp jagged debris
Hazard 2 Floodwater exposure
Hazard 3 Electrical hazards
Hazard 4 Contact with blood/body fluids and handling animal and human
remains
Note: This guidance is not a comprehensive list of hazards and does
not include important hazards such as stress or fatigue that are not
addressed via PPE.
Background:
Disaster sites pose many occupational health and safety concerns. These
hazards and exposures are a function of the unstable nature of the site,
the potential for worker exposure to unknown hazardous substances and
the type of work performed. An accurate assessment of all hazards may
not be possible because they may not be immediately obvious or identifiable.
Where possible, NIOSH has made default recommendations for PPE that we
believe will meet the probable hazards.
General PPE Guidance:
For most work in flooded areas, or areas that have been subjected to
flooding, response personnel will need the following personal protective
equipment: hard hats, goggles or safety glasses, heavy work gloves, watertight
boots with steel toe and insole (not just steel shank), and hearing protection
where excessive noise from equipment poses a risk of hearing damage.
PPE should be provided in a range of sizes to ensure proper fit.
For additional information on what equipment you need for protection
against exposure to specific hazards, contact your local OSHA office
or consult the NIOSH Pocket Guide to Chemical Hazards (http://www.cdc.gov/niosh/npg/npg.html).
General Worker Safety Guidance:
Workers involved with hurricane or flood response should be aware of
the potential dangers involved and the proper safety precautions.
CDC has developed general guidance for what workers should bring with
them to the flood area: http://www.cdc.gov/travel/other/hurricane/hurricane_relief_workers.htm.
OSHA has worker safety guidance at the following link: http://www.osha.gov/OshDoc/hurricaneRecovery.html.
Update: NIOSH Warns of Hazards of Flood Cleanup Work
NIOSH Publication No. 94-123 identifies several hazards associated with
the aftermath of a flood. (http://www.cdc.gov/niosh/flood.html).
Because the level of experience will vary among workers, response workers
must work together and look out for one another to ensure safety.
In addition, response workers are at serious risk for developing heat
stress. Excessive exposure to hot environments can cause a variety of
heat-related problems, including heat stroke, heat exhaustion, heat cramps,
and fainting. The need to use PPE can exacerbate heat exposures. Response
workers should be familiar with heat stress symptoms.
OSHA has a pocket card on heat stress available at: http://www.osha.gov/Publications/osha3154.pdf
See http://www.cdc.gov/niosh/topics/heatstress/ for
additional NIOSH information.
NIOSH urgently requests your assistance in disseminating this interim
document to all workers involved in flood response.
HAZARD 1: Sharp, jagged debris
Risks:
Workers handling hurricane related debris may suffer wounds. Tetanus
is a potential health threat for persons who sustain wound injuries.
Also, any wound has the potential for becoming infected, and floodwater
exposures may add to this concern.
General PPE Recommendations:
Use heavy gloves to protect the hands when handling debris to minimize
the chances of cuts and scrapes. Gloves designed to protect the skin
from chemical exposure are not typically strong enough to protect from
debris. Multiple layers of gloves (double gloving) may be necessary.
Long pants, long sleeve shirts, boots, eye protection (safety glasses,
goggles, or faceshields), and headgear are also appropriate.
Additional Information:
Any wounds, cuts, or animal bites should be immediately cleansed with
soap and clean water. Familiarity with basic first aid is advised to
self-treat any injury until medical attention can be obtained. Additional
information resources include:
Interim Immunization Recommendations for Emergency Responders http://www.bt.cdc.gov/disasters/hurricanes/responderimmun.asp
Emergency Wound Care After a Natural Disaster
http://www.bt.cdc.gov/disasters/woundcare.asp
HAZARD 2: Floodwater exposure
Risks:
Floodwaters may contain
bacteria from human and animal wastes. The most likely symptoms from
an infection are stomach-ache, fever, vomiting and diarrhea. While
skin contact with flood water does not, by itself, pose a serious health
risk, emergency response personnel and the public should avoid direct
contact with standing water when possible to minimize the chance for
infection. Chemical contamination of floodwaters can also occur and
contamination levels may be higher nearer to sources such as industrial
locations.
Work in and around moving or standing water in flooded areas presents
a risk of drowning. Standing or working in water which is cooler than
75 degrees F (24 degrees C) will remove body heat more rapidly than it
can be replaced, resulting in hypothermia.
General PPE Recommendations:
Double gloving with a waterproof glove under a heavy work glove is the
best way to protect the hands from both cuts and scrapes and floodwater
exposure. Boots and rain gear can be used to prevent lower body skin
exposures.
It is important to minimize contaminating the inside of the gloves. Gloves
not disposed of should be cleaned with soap and water and dried between
uses.
Floodwaters are associated with strong odors, but preliminary estimates
and disease outbreak tracking do not suggest the need for a general recommendation
for default respirator use by all personnel at this time. As with all
emergency operations, site specific information should be used to tailor
recommendations to the hazards and exposures at hand. For example, use
of N95 respirators might be advisable adjacent to aerated floodwater
where mists are created- such as potential tasks associated with repair
of pumping facilities or discharge pipes. CDC will provide additional
updates as more information becomes available.
Avoid working alone and wear a Coast Guard-approved life jacket or buoyant
work vest when entering flood waters or working over or near flood waters.
Refer to OSHA guidance:
http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10669
For additional information on what equipment you need for protection
against chemical exposures, contact your local OSHA office or consult
the NIOSH Pocket Guide to Chemical Hazards.
(http://www.cdc.gov/niosh/npg/npg.html).
Additional Information:
Wearing wet gloves or PPE can cause dermal irritation. Long exposures
to wet conditions can compromise the function of the skin barrier. Repeated
use of impermeable gloves, especially in hot and humid conditions, can
aggravate skin rashes. Cotton liners are sometimes used under protective
gloves to improve comfort and to prevent dermatitis. Latex gloves should
be avoided because of the risk of developing skin sensitivity or allergy.
Open wounds and skin conditions such as eczema and psoriasis may increase
your risk of infection. Contamination of wounds with water (fresh or
sea water) can lead to infections caused by waterborne organisms. See:
http://www.bt.cdc.gov/disasters/emergwoundhcp.asp
If skin contact with floodwaters does occur, CDC strongly advises the
use of soap and water to clean exposed areas. Waterless alcohol-based
hand rubs can be used when soap or clean water is not available. Hands
should be washed after removal of gloves.
There is a wide range of damage, work scenarios, and tasks associated
with hurricane response, and exposure assessments are not yet available.
Local information should be used to tailor recommendations to the hazards
and exposures at hand.
Firefighters and others involved with responding to fires should use
appropriate respiratory protection. Post fire clean-up operations occurring
at industrial or chemical facilities may warrant use of protective equipment.
As conditions dry out, there is some likelihood that demolition operations
may generate dust exposures for construction and restoration workers.
It is likely that other special tasks (e.g. welding and cutting) may
generate airborne hazards and that respiratory protection will be needed.
CDC will provide additional updates as more information becomes available.
HAZARD 3: Electrical Hazards
Risks:
Electrical, overhead power lines, power junctions, and downed electrical
wires and cables can cause electrocution and burns. Fallen lines can
also energize other objects such as fences, ladders, or metal building
parts. Use of improperly sized or operated portable generators can during
electrical outages can also cause “backfeed” injuries to
workers performing repair work in neighboring buildings. Only trained
electricians and utility workers should approach or handle electrical
lines. All other response workers should avoid going near all downed
lines and should treat them as if energized.
General PPE Recommendations:
Special electrically resistant PPE including headgear, gloves, boots,
and appropriate eye protection are used by electricians and utility
workers.
Additional information:
Special electrical PPE is only one aspect of electrical safety practice.
Special training and practices to test, de-energize, isolate, and/or
lockout hazardous energy sources are important. See the NIOSH electrical
safety page at: http://www.cdc.gov/niosh/injury/traumaelec.html
OSHA has electrical safety factsheets at: http://www.osha.gov/OshDoc/data_General_Facts/downed_electrical_wires.pdf http://www.osha.gov/OshDoc/data_Hurricane_Facts/elect_safety.pdf
CDC has a factsheet on “backfeed” and power outage safety
at: http://www.bt.cdc.gov/poweroutage/workersafety.asp
Hazard 4: Contact with blood/body fluids and handling animal and human
remains
Risk:
There is no direct risk of contagion or infectious disease from being
near human remains for people who are not directly involved in recovery
or other efforts that require handling dead bodies. However, workers
who must have direct contact with human remains can have exposure to
blood borne pathogens. Blood, bloody fluids, body fluids, and tissues
are potential sources of blood-borne infections from pathogens including
Hepatitis B, Hepatitis C, and HIV. Exposures to medical providers and
responders may occur via a cut or puncture wound; through mucous membranes
(eye, nose, mouth); and through non-intact skin (dermatitis/rashes, injuries,
abrasions).
General PPE Recommendations:
Workers who will have direct contact with the victims, or surfaces contaminated
with blood or body fluids should use universal precautions. These require
use of protective barriers such as gloves, face-shields, or protective
eyewear.
See: http://www.cdc.gov/ncidod/hip/blood/UNIVERSA.HTM
The CDC has developed interim health recommendations for workers who
handle human remains.
http://www.bt.cdc.gov/disasters/handleremains.asp.
Additional information is available from the Pan American Health Organization
at: http://www.paho.org/english/dd/ped/ManejoCadaveres.htm
Workers who have direct contact with the victims, bodies, or surfaces
contaminated with blood or body fluids should use universal precautions
identified in the interim CDC recommendations: http://www.bt.cdc.gov/disasters/handleremains.asp
CDC recommends surgical masks for handling human remains. http://www.bt.cdc.gov/disasters/handleremains.asp.
Organic vapor respirators can be used for nuisance odor control where
needed. One option that provides odor control and universal precaution
splash and eye protection is to use a full facepiece respirator with
N95 and organic vapor cartridges.
Additional information:
See the NIOSH bloodborne pathogens page at: http://www.cdc.gov/niosh/topics/bbp/
CDC recommends N95 particulate respirators for handling swine and poultry
animal carcasses. http://www.bt.cdc.gov/disasters/animaldisposal.asp
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