Anthrax Mailroom Sampling Frequently Asked Questions

1
Anthrax Mailroom SamplingFrequently Asked
Questions
2
Who is designated to do the sampling?

• Basically its a local decision. We are not
  dictating who does the sampling. However,
  properly trained and equipped personnel should do
  the sampling. This will require a
  multidisciplinary team effort.

3
What means are currently available for rapid ID
of Anthrax?

• CDC has a four-hour rapid return test. The Mayo
  Clinic claims to have a test that determines the
  presence of Anthrax in an hour. That information
  cannot be considered valid as it comes from the
  media. Be careful when using spore strips (not
  sensitive enough). Check a lab before using
  tools you have questions about.

4
Are we coordinating efforts? Homeland Defense has
different protocols

• USAMRIID and CDC protocols
• Do not use test strips alone must have
  confirmation by lab culture
• Spore strips are not sensitive enough. The level
  of detection is higher than the infective dose so
  people could be at risk of inhalational anthrax
  without knowing it.
• Get the list of approved federal labs and know
  where to send samples. We need to make sure the
  specimens we send meet the requirements of the
  receiving lab.

5
FBI takes our samples.Define credible exposure

• Its a combination of things
• The FBI decides whether package is high or low
  risk.
• Results of epi investigation look at the cases
  of anthrax and how exposed.
• Results of environmental sampling- ( positive)
  single wipe positive out of hundreds taken vs.
  dozens of wipes positive out of a hundred.

6
Are there plans to develop a training kit (field
training kit)?

• Input is being considered will post an answer
  to the CHPPM web site.

7
Is there a purchasing list for PPE, equipment,
etc for Anthrax sampling?

• Depends on where you check. There is no
  centralized list. You would purchase items
  locally. Check with your preventive medicine
  office, industrial hygiene office, or with your
  engineers.
• Also, you can call us for support.

8
Should we do nasal swabs if there is a credible
threat?When should we stop prophylaxis?

• Nasal swabs are unreliable so dont discontinue
  prophylaxis wait for results of environmental
  assessments.

9
Should we continue to do nasal swabs?

• CDC recommends nasal swabs to determine the
  extent of airborne exposure when Anthrax spores
  are airborne. If there are processes occurring
  that generate airborne spores, then do nasal
  swabs. CDC indicated that the risk of airborne
  spores diminishes over time so that 2 weeks after
  opening a letter, there would be no airborne
  spores present because they clump and settle out.

10
Should we sample our distribution or wait for
other sampling to indicate a threat?

• It is a local decision. Look at the probability
  of a potentially contaminated letter. Use a
  cautious approach.
• Use risk communication to ensure sampling actions
  are perceived in a positive manner.

11
Our facilitys policy is each activity has one
mail opener with the option of wearing PPE your
opinion?

• That is fairly common. We have PPE for our
  people too.

12
Anticipating environmental sampling, how do we
get supplies? Who do we send samples to?

• Supplies can be obtained commercially. Do not
  use culturettes they inhibit PCR and cotton
  inhibits PCR analysis. First contact your state
  health department labs, then contact AFIP or
  USAMRIID.

13
What if we get back a positive test?Do we shut
down and sample?

• Yes, that is reasonable for the mailroom.
• Close the post office, conduct sampling and
  decontaminate immediately.
• Have finished by the next day to minimize amount
  of time facility is closed and employees are out
  of work.
• Practice good risk communication techniques to
  increase public awareness

14
What about the employees that wont be working?
Should we treat them?

• CDC is not recommending treatment.

15
Should we get a contractor to decontaminate?
Conduct follow-up sampling after decon?

• Yes there are a number of contractors out there
  and the decontamination process is the same
  throughout.
• Yes day after results.

16
Will there be funds available for training or EPR
money?

• MEDCOM put out a data call asking what budget
  requirements existed to support homeland
  security. Support of the response to
  bio-terrorism may well fall into the definition
  of covered activities. Let your RMD folks know
  your training, equipment and transportation
  needs.

17
Assuming youre sampling in an area of suspect
should you shut off HVAC and remove the filters?
Sample filters?

• Yes, you are correct. Brentwood sampled their
  filters. Replacing all filters would be prudent.
  Remove HVAC HEPA filters and dispose as regulated
  medical waste.
• At the Capitol, a small HEPA vacuum was used to
  obtain the samples off the HVAC filters. A
  specially designed sock was attached to the HEPA
  vacuum then sent to the laboratory for extraction
  then lab analysis. Stick with non-porous
  surfaces in mailroom. Contact us for more
  guidance, when a positive sample has been
  identified.

18
Should mailroom employees bring a change of
clothes?

• A change of clothes may be prudent to have nearby
  but not in the mailroom. If there is a credible
  threat, the current recommendation is to take off
  clothes and treat as contaminated, shower right
  away.

19
Should the people doing the sampling and
decontamination be treated with prophylaxis?

• Yes until the environmental samples that the
  sampling team collects come back and all are
  negative.

20
In small community mailrooms is it practical for
them to be changing gloves and clothing after
each shift?

• Gloves yes. If theres no indication of
  contamination, dont worry about changing
  clothes.

21
If mailroom handlers are wearing respirators and
gloves, should more PPE be worn?

• Not necessary

22
What is the respirator policy for postal workers?
Fit testing unclear.

• The CHPPMs Recommendations for worker
  protection from B. Anthracis when engineering
  controls are not in place indicates that for low
  risk postal workers that ½ face N95 HEPA
  respirator should be offered, then also goes on
  to recommend that these workers that accept the
  use of respirators be fit tested and get a
  medical option that they can wear a respirator.
• We recommend that they be placed on the
  respiratory protection program and that the
  respirators are fit tested.

23
Should dusts masks be routinely made available?

• As a minimum N-95 filter respirators should be
  made available we again recommend that the
  mailroom people who wear respirators should be
  included in the Respiratory Protection Program.
• It is difficult to fit test a disposable N-95
  filter mask

24
For voluntary use of respirators the OSHA
Respirator standard does not require that these
workers be placed on the Respiratory Protection
Program

• This maybe true, however, the OSHA standards are
  minimum requirements and because anthrax is a
  serious hazards (we dont want to give these
  workers a false sense of security), we are
  recommending that all people who wear respiratory
  protection to protect themselves from anthrax be
  placed on the respiratory protection program we
  can be more stringent than OSHA.

25
If we have a contaminated facility, what do we
define as decontaminated?

• Some areas have indigenous Anthrax, thus for
  positive decontaminate. Then resample. A
  negative result means its clear and a positive
  results means its dirty. Positive results
  decontaminate again and test again.

26
Is there a decontamination procedure for mail as
its received?

• There are several different options being used by
  the U.S. Postal service radiation, chlorine
  dioxide, but they are not readily available and
  are expensive. If you have a hot room
  decontaminate first. Options are somewhat
  limited and being researched.

27
Chlorine and Lysol are not effective?

• No. irradiation is best, but it remains to be
  seen that radiation is validated as a proven
  effective method to eliminate Anthrax spores.
  Right now, only sodium hypochlorite has been
  shown to be effective.