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Interim Guidance for Airline Cabin Crews, Cleaning Personnel and Cargo Personnel: How to Protect Yourself and Others from Ebola Virus Disease

Prepared by: Public Health Agency of Canada
Page last reviewed: August 25, 2014

The following guidance provides precautions to be taken by airline cabin crews (flight attendants) and cleaning and cargo personnel when someone on a commercial aircraft is ill and Ebola Virus Disease (EVD) is suspected. This guidance is based on currently available information and is subject to change as new information becomes available. It should be read in conjunction with employer-specific operating procedures.

An outbreak of EVD has affected several countries in West Africa including Guinea, Liberia, Sierra Leone and Nigeria. EVD is a rare and severe viral disease that can infect both humans and non-human primates (monkeys, gorillas, etc.).

When infected, people can become very ill, with sudden onset of fever, intense weakness, muscle pain, headache and sore throat. This is followed by vomiting, diarrhea, rash, and in some cases, internal and external bleeding. The time from exposure to the onset of symptoms can range from 2 to 21 days. There is currently no specific licensed treatment or vaccine for EVD.

EVD does not spread easily from person to person. It is spread through direct contact with infected blood and other body fluids of ill persons, not through casual contact. Persons with EVD can only spread the disease to others once symptoms begin.

According to the World Health Organization (WHO), the risk of transmission of EVD during air travel is low.  On the small chance that someone on the plane is sick with symptoms of EVD, the likelihood of other passengers and crew having contact with their body fluids is even smaller. Usually when someone is sick with EVD, they are so unwell that they cannot travel.

For further information about EVD, visit the Ebola virus disease page.

Management of an ill person

If a passenger or other cabin crew member becomes ill with symptoms that are consistent with EVD (as noted above) and they have recently been a resident in or travelled to any of the affected countries listed on the Agency’s travel site, within the last 21 days:

  • Provide the ill person with a surgical mask to cover their nose and mouth, if toleratedFootnote 1. If not tolerated, ask the person to cover their nose and mouth with a tissue.
  • If the ill person is vomiting, provide them with an air sickness bag.
  • Provide the ill person with a plastic bag for disposing of soiled tissues and used air sickness bags.
  • Encourage the ill person to clean their hands by washing with soap and waterFootnote 2 or, when hands are not visibly soiled, using alcohol-based hand rub (ABHR).
  • If possible, keep the ill person separate from others. Ideally, the ill person should be close to a washroom for their exclusive use.
  • Keep contact with the ill passenger to the minimum possible. Assign one cabin crew member (two if the person needs more assistance) to take care of the ill person, preferably those who have already been in contact with the ill person.

Infection prevention and control protocols for cabin crew when EVD is suspected

  • Clean hands after every contact with the ill person/their belongings or immediate environment. Clean hands by washing with soap and waterFootnote 2 or, when hands are not visibly soiled, using ABHR
  • In addition to cleaning hands, cabin crew members who are assisting the ill person should use appropriate Personal Protective Equipment (PPE), as per employer’s occupational health and safety protocol and as recommended in the International Civil Aviation Organization (ICAO) Universal Precaution KitFootnote 3 , such as impermeable disposable gloves.
  • Treat all body fluids (such as phlegm, diarrhoea, vomit, or blood) as potentially infectious.
  • Restrict access, where possible, to the affected area until disinfection activities are completed.

Communication/Reporting

  • As per usual protocol, notify airport authorities at the destination airport of the ill traveller as soon as possible.
  • Ensure aircraft cleaning personnel are aware of the situation and the potential for contamination of surfaces.

Upon arrival at the airport

  • Have all passengers remain seated until the ill passenger is assessed or removed from the plane.

Upon arrival, the ill passenger will be assessed either by a Quarantine Officer, Canada Border Services Agency Officer or Emergency Medical Services personnel, who will provide further instructions to the cabin crew and other passengers regarding required actions.

If there is reason to believe that others onboard the aircraft have potentially been exposed to someone suspected of having EVD, information from the cabin crew and other passengers may be collected at the time.  Cabin crew may be requested to assist in this process, if needed, by asking passengers to complete ICAO Public Health Passenger Locator forms and by making onboard announcements.

If contact tracing is required, the flight crew and other passengers may be contacted.

When to see a health care provider after exposure to someone suspected of having EVD (applicable to all cabin crew, cleaning and cargo personnel)

If you become ill within 21 days following exposure to someone with suspected EVD, telephone your health care provider and notify your employer immediately. Before visiting a doctor’s office, clinic or emergency room, alert the health care provider about the possible exposure to EVD and your symptoms, so that health care staff can make arrangements to see you safely without potentially exposing themselves or others to the virus.

Environmental cleaning

If a passenger or cabin crew member has been ill on board the aircraft with symptoms compatible with EVD:

  • Follow routine practices as found in the guidance from the Public Health Agency of Canada: General Environmental Sanitation Practices to Control the Spread of Communicable Disease in Passenger Conveyances and Terminals.
  • Cleaning crews are reminded of the importance of adequate PPE and should follow employer’s occupational health and safety protocols for such situations;
  • Wear impermeable disposable gloves while cleaning the passenger cabin and lavatories;
  • Special cleaning of upholstery, carpets, or storage compartments is not indicated unless they are obviously soiled with blood or body fluids;
  • Special vacuuming equipment or procedures are not necessary;
  • Clean hands immediately after gloves are removed with soap and waterFootnote 4 or, if hands are not visibly soiled, ABHR.
  • All waste, including soiled seat covers and carpets, used cleaning material, and disposable PPE should be disposed of in a biohazard waste disposal bag and according to company biohazard waste protocols.
    • Care should be taken when removing PPE to prevent self-contamination

Cargo Personnel

Packages should not pose a risk, as EVD is spread through direct contact with blood or body fluids from an infected person.

Preventive measures include:

  • Packages visibly soiled with blood or body fluids should not be handled.
  • Cargo handlers should wash their hands often

Footnote 1
World Health Organization http://www.who.int/ith/updates/20140421/en/
Footnote 2
In the event hands are visibly soiled and soap and water are not available , use wipes to remove visible soiling, followed by an ABHR
Footnote 3
Airplanes should be equipped with ICAO Universal Precaution Kits for management of ill onboard passengers
Footnote 4
In the event hands are visibly soiled and soap and water are not available , use wipes to remove visible soiling followed by an ABHR