How Can Cleaning Workers Be Protected Against Exposure to Bacillus anthracis (Anthrax) and Other Pathogenic Microorganisms?

Frequently Asked Questions (FAQs)

October 20, 2001

INTRODUCTION

The purpose of this document is to assist facilities managers and cleaning professionals to protect themselves against disease-causing microorganisms that may be present in their work place. In preparing this information, articles and literature were reviewed from the Centers for Disease Control (CDC), Association for Practitioners in Infection Control (APIC) and Environmental Protection Agency (EPA). The information offered in this document are consistent with proven infection control and disinfecting methods for a variety of infectious microorganisms. An emphasis on anthrax is provided in this document because of recent events. The information contained in this document is believed to be accurate at the time of publication but does not purport to be medical advice.

What is Anthrax?

Anthrax is an acute infectious disease caused by the spore-forming bacterium Bacillus anthracis (B. anthracis). Anthrax most commonly occurs in hoofed mammals and rarely infects humans. The disease is caused by a bacterium, Bacillus anthracis, not a virus as reported by some news agencies. Some journalists and news agencies are woefully ignorant of microbiology and medicine, so be careful what you believe. It is sad that certain news agencies are feeding the frenzy in the name of ratings.

How can B. anthracis harm us?

There are three primary routes of entry for B. anthracis: skin contact (cutaneous anthrax), ingestion (intestinal anthrax) and inhalation (inhalation anthrax). All can be treated effectively with antibiotics with the inhalation form of the exposure being the most lethal. For anthrax to be effective as a covert agent, it must be aerosolized into very small particles. This is difficult to do, and requires a great deal of technical skill and special equipment. If these small particles are inhaled, life-threatening lung infection can occur, but prompt recognition and treatment are effective.

What are the symptoms of anthrax?

Symptoms of disease vary depending on how the disease was contracted, but usually occur within 7 days after exposure.

Cutaneous anthrax only occurs when the spores encounter broken skin creating an easily recognized boil. Even then, the illness is rarely fatal.

Initial symptoms of inhalation anthrax infection may resemble a common cold. After several days, the symptoms may progress to severe breathing problems and shock. Inhalation anthrax is often fatal.

Intestinal anthrax may follow the consumption of contaminated food and is characterized by an acute inflammation of the intestinal tract. Initial signs of nausea, loss of appetite, vomiting, and fever are followed by abdominal pain, vomiting of blood, and severe diarrhea.

How is anthrax diagnosed?
Anthrax is diagnosed by isolating B. anthracis from the blood, skin lesions, or respiratory secretions or by measuring specific antibodies in the blood of persons with suspected cases.

Is anthrax a contagious disease?

Anthrax is not contagious. The only way to get the disease is to be exposed to large numbers of spores of the microbe. Direct person-to-person spread of anthrax is extremely unlikely, if it occurs at all. Therefore, there is no need to immunize or treat contacts of persons ill with anthrax, such as household contacts, friends, or coworkers, unless they also were exposed to the same source of infection.

Can anthrax be treated?

Disease can be prevented after exposure to the anthrax spores by early treatment with the appropriate antibiotics. Anthrax is not spread from one person to another person. Early antibiotic treatment of anthrax is essential-delay lessens chances for survival. Anthrax usually is susceptible to several antibiotics including penicillin, doxycycline, and fluoroquinolones.

Are B. anthracis spores commonly found inside of buildings?

There are several pathogenic microorganisms including Staphylococcus aureus, Streptococcus faecalis and Pseudomonas aeruginos that commonly reside inside of buildings. Bacillus anthracis, the bacteria that causes anthrax is NOT one of them. The B. anthracis spores found in several buildings in Florida, New York and New Jersey were intentionally prepared and sent there presumably by terrorists. B. anthracis is NOT commonly found inside of buildings.

Should Cleaning Professionals be concerned about B. anthracis spores?

This disease-causing organism should not be ignored, but we should keep it in perspective. It is not contagious and it is highly UNLIKELY that Bacillus anthracis spores are present in your building.

A few buildings, targeted by terrorists, have been found to contain small amounts of Bacillus anthracis spores. However, we have a much higher chance of winning the lottery than of being exposed to Bacillus anthracis. Most of us are exposed everyday to potential dangers to our health and safety that are thousands of times more likely to harm us than Bacillus anthracis. Automobile accidents, slips and falls on the job, influenza and exposure to the AIDS virus all currently pose a much higher risk to our health and safety. This does not mean that we should ignore Bacillus anthracis. But we should put it in perspective and not panic.

Traditional quaternary ammonium chloride, phenolic and chlorine bleach (sodium hypochlorite) based disinfectants are NOT registered with the United States Environmental Protection Agency (USEPA) against B. anthracis. No company can make a claim that their product kills Bacillus anthracis spores or any other pathogenic microorganism unless USEPA approves it. USEPA says that no currently registered disinfectant has received approval against B. anthracis spores.

What can be used to kill the B. anthracis spores?

Electron beams, ultraviolet light, chemical sterilants, glutaraldehyde, chlorine dioxide and autoclaving are several ways that spores can be killed. All of these methods require special equipment, training and expertise to be used safely and effectively. Experts agree that the risk to untrained and unskilled workers using these methods exceed the current threat from the B. anthracis spores.

Should custodians and cleaning professionals wear a respirator while cleaning a facility?

"A properly fitted respirator can only help reduce exposures when used immediately prior to and during the release of Bacillus anthracis spores. Unfortunately, in the case of terrorist activity it is unlikely that you would have warning or knowledge of your exposure until symptoms started to appear in infected people. Once anthrax symptoms appear, a respirator will not be effective in helping to prevent anthrax disease."

Should custodians and cleaning professionals wear gloves while cleaning a facility?

It is a good practice to always wear appropriate gloves when cleaning. The gloves will act as a barrier from direct contact of pathogenic microorganisms to your hands. Here are several important guidelines when using rubber gloves.

Wear gloves at all times when cleaning and disinfecting surfaces.

Wash gloves while still on your hands before removing them.

Remove gloves prior to leaving work area and place them in designated area for storage, washing, decontamination or disposal.

Replace single use disposable gloves as soon as feasible
when contaminated or punctured and when task is completed.

Do not wash or decontaminate disposable gloves for reuse.

Decontaminate non-disposable gloves if intact.

Immediately discard gloves when cracked, peeled, torn, punctured, or show signs of deterioration.

Continue to conduct your normal cleaning and disinfecting activities inside of your buildings.

Clean and disinfect environmental surfaces (floors, counters, toilets, urinals, walls, sinks etc.) with traditional institutional types of disinfectants that are effective against a broad spectrum of pathogenic microorganisms including Staphylococcus aureus, Streptococcus faecalis, Pseudomonas aeruginos, Hepatitis B Virus (HBV) and HIV. EPA Registered quaternary ammonium chloride based disinfectants are effective for this type of germ control activity.

On surfaces where gross contamination is located or suspected, special methods of decontamination will be required. Only qualified and specially trained experts should conduct special decontamination methods against B. anthracis. Custodians and professional cleaning staff are not expected to clean surfaces that contain gross contamination unless they have been specially trained and certified to do so.

Cleaning professionals should use universal precaution when encountering any suspicious, unknown fine-powder substance. Any suspicious, unknown fine-powder substance should not be touched, handled or removed until the substance has been determined by qualified experts to pose no threat to workers in the area. Do not agitate or stir up the fine-powdered substance. If the powder were to contain anthrax spores then it could become airborne and pose an inhalation anthrax threat.

Cleaning workers should report any suspicious and/or unknown fine-powdered substances immediately to proper managers or supervisors.

Managers or supervisors in your organization should make the proper assessment and follow your company or organization’s emergency policies. This may include but not be limited to turning off fans and/or HVAC systems in the affected area, contact with their company experts, evacuation of the building, calling 9-1-1, calling the fire department, calling local police or contacting local health officials. Managers should comply with all regulations and recommendations of health and law enforcement authorities in your area.

Protect all individuals working or visiting in the area and keep them away from the suspicious and unknown substance. Isolate and clearly mark the immediate area where the substance is located to keep people away from the area until officials arrive.

Public health officials say the single most effective way to prevent the spread of disease is frequent and proper hand washing.

The chain of custody of the suspicious substance should be controlled and maintained by properly trained and skilled experts. Under no circumstances should a suspicious or unknown powder substance be moved from an area without proper authority.

DO NOT shake or empty the contents of any suspicious envelope or package;

DO NOT try to clean up powders or fluids.

PLACE the envelope or package in a plastic bag or some other type of container to prevent leakage of contents. If you do not have any container, then COVER the envelope or package with anything (e.g., clothing, paper, trash can, etc.) and do not remove this cover.

Then LEAVE the room and CLOSE the door, or section off the area to prevent others from entering (i.e., keep others away).

WASH your hands with soap and water followed with a thorough rinsing of your hands to prevent spreading any powder to your face or skin.

If you are at WORK, then report the incident to local police, and notify your building security official or an available manager or supervisor.

If possible, LIST all people who were in the room or area when this suspicious letter or package was recognized. Give this list to both the local public health authorities and law enforcement officials for follow-up investigations and advice.

Remove heavily contaminated clothing and place in a plastic bag that can be sealed; give the bag to law enforcement personnel.

Shower with soap and water as soon as possible. Do not use bleach or disinfectant on your skin.

Contact a physician immediately and report the details of the incident and possible exposure.

Carefully follow your doctor’s treatment and advice.

What is the single most important thing that Cleaning Professionals can do to prevent the spread of disease?

Public health officials indicate that frequent and proper hand washing is the single most important way to prevent the spread of disease. Though washing our hands may not protect us against direct contact with airborne particles, it will prevent us from spreading germs through cross contamination to other surfaces and people that we touch.

Will an antimicrobial hand soap or hand sanitizer protect us from the B. anthracis?

Antimicrobial hand soaps and hand sanitizers can be effective in reducing the level of bacteria on our hands. But there is no current evidence that they will kill B. anthracis or other types of spores. CDC indicates that frequent hand washing will help prevent the spread of disease, but stops short of recommending the use of antimicrobials or hand sanitizers.

Where can I find additional information on anthrax?

The CDC has additional information on anthrax on their website at www.cdc.org <http://www.cdc.org> or you can call them at 800-311-3435.