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Human Health Issues related to Avian Influenza in Canada

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9 Infection Control

The following recommendations have been developed by the Blood Safety and Surveillance, Health-Care Acquired Infections Division, PHAC and the Workplace Health and Public Safety Programme, Health Canada, for application to avian outbreak situations.

Strict adherence to infection control precautions is essential for the control of the avian influenza outbreak and prevention of possible human infection. This information should be conveyed to all workers, residents and visitors to affected sites as soon as possible when the outbreak is first identified. It is important that these messages be consistent regardless of the source, that is, whether public health or occupational health authorities are involved in developing and distributing educational materials. In this regard, P/T or local public health authorities would be responsible for conveying this information to farm families and other non-CFIA employees, and CFIA would be responsible for their employees including contracted staff and potentially visitors to the work site. Measures to monitor compliance should also be considered.

9.1 General Recommendations/Precautions

  1. i. If an avian influenza strain that is known to be of risk to human health (e.g., H5N1 Asian strain) is confirmed in the wild bird population in a specific location, individuals should avoid exposure to known or potential sources of avian influenza virus (e.g. wild birds, bird manure or potentially avian influenza-contaminated environmental surfaces)
  2. ii. Farm workers or owners who are not directly involved in culling activities should avoid exposure to known or potential sources of avian influenza virus (e.g. infected birds, bird manure or potentially avian influenza-contaminated environmental surfaces)
  3. iii. Other individuals residing on the farm (e.g. family members) should also avoid exposure to known or potential sources of avian influenza virus
  4. iv. Workers involved in environmental clean-up and/or culling activities or who are otherwise expected to be exposed to known or potential sources of avian influenza virus, should wear personal protective equipment as indicated in section 9.2 below.
  5. v. Current evidence indicates that human-to-human transmission of avian influenza virus is inefficient and occurs through exposure to large respiratory droplets or indirectly through contact with contaminated surfaces. Thus, droplet and contact infection control precautions are recommended for providing care for a patient with avian influenza. Droplet/contact precautions include the use of a good quality surgical or procedure mask, eye protection, gown and gloves.

Contacts of known or potential sources of animal sources avian influenza are advised to take the following precautions.

  • Avoid touching their faces and mucous membranes, including their eyes, with their hands (whether they have been wearing gloves or not).
  • Wash hands frequently[19] (including before putting on and after removing personal protective equipment).
  • Hand hygiene should consist of washing with soap and running water for a minimum of 15-20 seconds or the use of alcohol based hand sanitizer (containing between 60-90% alcohol) if hands are not visibly soiled.

9.2 Personal Protective Equipment for contacts of an avian/animal source of virus

The wearing of personal protective equipment (PPE) is important to minimize an individual's risk of infection and is highly recommended for persons who may be exposed to an avian/animal source of avian influenza. Workers involved in the clean-up and/or culling of infected birds and others involved in the outbreak control efforts must strictly adhere to recommended PPE.

This equipment includes:

  • Disposable fit-tested half-face N-95 or better respirator[20].
    • Safety goggles (to protect the mucous membranes of eyes)
    • Gloves that are impervious (nitrile, PVC, rubber, hospital gloves).
  • They should not be reused or washed. If heavy-duty rubber work gloves are used they should be disinfected after use or discarded.
  • Gloves should be removed immediately after use to avoid touching non-contaminated articles and surfaces.
    • Coveralls that are impervious to water.
  • If using reusable protective clothing it must be washed immediately after use. If this is not possible, disposable coveralls (as recommended by CFIA) should be used.
    • Disposable protective shoe/boot covers or rubber or polyurethane boots that are impervious to mud and water and are easily cleaned and disinfected should be worn. (Use of foot baths)
    • Disposable head or hair cover to keep hair clean

Disposable PPE must be properly discarded (sealed plastic bags) and reusable or non-disposable PPE should be cleaned and disinfected as specified by public health authorities.

Training in proper techniques of donning, removing and disposing of PPE without contaminating oneself should be provided. Hand hygiene must be performed after removing PPE. The training should be similar to that provided to health care workers by hospital occupational or infection control programs. Workers involved in environmental clean-up and/or culling activities should be trained by their employer. Others who may be exposed to infected birds (e.g. farm families) should be trained by public health.

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