Guidelines and Recommendations

Interim Guidance for Cargo Trucking Crews for the Prevention of Pandemic Influenza   

Cargo trucking is part of the critical infrastructure essential to maintaining the Nation’s continuity of operations in the event of an influenza (flu) pandemic (a worldwide outbreak of a novel flu virus). This draft interim guidance is meant to inform and educate cargo trucking management and crew personnel about precautions and appropriate work practices to minimize exposure and prevent workplace-related transmission of flu in the event of a pandemic. These recommendations are primarily based on standard infection control practices and information about preventing seasonal flu and specific concerns associated with the potential for an outbreak of pandemic flu.

These guidelines were developed for the three main segments of the U.S. trucking industry: government entities, private cargo carriers, and for-hire motor carriers, but are also applicable for couriers, local delivery enterprises, and other trucking operations such as refuse haulers. These guidelines and recommendations may change as more becomes known about the specifics of a particular flu pandemic, the virus believed to be responsible, and the efficacy of public health control measures.

Implementation of these Recommendations  

To achieve maximum benefit, management should begin to implement these guidelines and recommendations during the beginning stages of a pandemic; specifically, during World Health Organization (WHO) pandemic phases 4 and 5 (evidence of increased or significant human-to-human flu transmission) or the equivalent U.S. government response stage 2. Early adoption of this guidance is recommended to prevent (to the greatest degree possible) and slow the spread and infection of pandemic flu to cargo trucking personnel. Risks of exposure to cargo trucking personnel are likely to increase as a flu pandemic progresses to WHO phases 5 and 6 (significant and sustained human-to-human transmission). The WHO phases of influenza pandemics are listed at http://www.who.int/csr/disease/avian_influenza/phase/en/index.html. The most current U.S. government updates relating to pandemic flu can be found at www.flu.gov

Background  

The Department of Homeland Security (DHS) has identified the transportation sector as one of 13 critical infrastructures that are designated essential in maintaining the Nation’s continuity of operations in the event of a flu pandemic. Critical transportation sectors include cargo trucking, which is responsible for delivery of essential goods for business and is a key contributor to daily aspects of public health, safety and welfare, and national defense.

In the event of a pandemic, it is likely that employee absences in all workforces will increase, in some cases by up to 40% of a workforce. Employee work absences due to illness and/or caring for sick family members or children dismissed from school could lead to dramatic disruptions in commerce. These disruptions could have a significant impact on the U.S. economy and general public welfare if deliveries of critical supplies such as food, medicines, and other essential goods and materials get interrupted, delayed, or cancelled. Because of the importance of maintaining cargo trucking operations during a flu pandemic, managers and employees working in this sector should understand the importance of (1) planning for business continuity of operations (COOP) and (2) appropriate and recommended work practices and standard precautions to minimize the risk of employees becoming ill and spreading flu in the workplace.

Exposure Risks for Cargo Trucking Personnel   

Truck drivers in the United States work long hours (intercity drivers average 65 hours per week) and have frequent work activities that involve face-to-face or close contact with other people. While cargo trucking crews spend most of their work time driving, a recent study in Washington State reported that up to 25% of a truck driver’s time involves handling cargo and other materials.¹ Frequent and close contact with other people during pick-up and delivery and touching possibly contaminated items (such as pens, clipboards, handheld scanning devices, etc.) are likely to pose the greatest exposure risks to truck crews. Close contact with a variety of people throughout the day increases the risk of encountering someone who is infected with flu and thus increases the risk of contact, aerosol, or droplet transmission of flu viruses.

Guidance on Preparing Workplaces for a Flu Pandemic² is a document developed jointly by the Department of Labor and the Department of Health and Human Services that describes a variety of preparedness and prevention practices intended for all workers. This document presents an occupational exposure risk pyramid, scaled from low to very high exposure risks. Within that pyramid, cargo trucking workers, particularly those who travel extensively or work long hours while in contact with other workers or the public, are considered to be at medium risk for contracting the flu. Employers and employees in the transportation industry should review this document to begin pandemic and COOP planning for their workplaces. A business planning tool (checklist) has also been developed for the vessel, aircraft, and truck cargo sectors and is available at www.flu.gov.

Close contact with infected persons is the greatest risk factor for trucking personnel to become infected with pandemic flu. Flu viruses are spread from person to person, primarily through large-particle respiratory droplet transmission (e.g., when an infected person coughs or sneezes on or near a susceptible person). Transmission via large-particle droplets requires close contact between persons, because droplets do not remain suspended in the air and generally travel only a short distance (about 3 to 6 feet) through the air. Contact with surfaces contaminated with respiratory droplets is another possible source of flu transmission. Localized airborne transmission may occur via droplet nuclei or particles that are small enough to be inhaled, but direct contact with infected persons and contact transmission are believed to be the more common routes of transmission.

Limiting Risks of Flu Exposures through Avoidance of Contacts with Other People and General Infection Control Measures 

Because completely eliminating face-to-face and close contact with other persons is unlikely to be feasible, strong adherence to (and understanding of) general infection control practices will be an important risk reduction strategy.

Limiting close face-to-face contacts with other people is known as social distancing; it is an important protective behavior to limit the risks of exposures from droplet, aerosol, or contact transmission in the event of a flu pandemic. Social distancing generally means maintaining a distance of 3 feet or more between persons.

Practice social distancing in the cargo transport workplace:

• Limit the frequency of face-to-face contacts during pickups and deliveries
• Limit casual (social) interactions that normally occur at work
• Do not report to work if you are sick
• Schedule staggered break times
• Establish flexible work hours or an alternative delivery schedules
• Use text messaging and personal mobile phones to communicate instead of face-to-face contact
• Avoid conferences and group gatherings during a pandemic

For long-haul drivers, avoiding places where other people congregate (such as truck stops) is one example of using social distancing. Another is maintaining separation (again, roughly 3 feet) when in dispatch areas, locker rooms, while refueling, during pickup and deliveries, and when working in an area where there is likely to be a group of people.

In the event of a pandemic, anticipating the need and necessary steps for social distancing will be the key to effective implementation while minimizing business disruptions.

Cough etiquette is a behavior that can limit the transmission of droplet nuclei and aerosols when you cough or sneeze. Practice cough etiquette by always covering your mouth with a tissue or coughing or sneezing into your shirt sleeve (holding the inside your elbow to your face) to help contain and prevent flu viruses from being released into the air and contaminating other surfaces (including your hands) that other people might touch or come into contact with.

Hand washing will be a very important practice in the event of a pandemic. Cleaning your hands many times each day is one of the best ways to protect yourself. Potentially infectious virus particles can be present on the skin but can be effectively removed by soap and water or inactivated by using waterless alcohol-based sanitizing gels (at least 60% alcohol).

As a general rule, wash hands any time after sneezing or coughing, touching someone else’s hands, or touching potentially virus-contaminated surfaces (commonly touched surfaces). Avoid handshaking or other unnecessary physical contact during a pandemic. Examples of potentially contaminated surfaces can include the following:

• Cab and cargo door handles, seat belts, steering wheels, mirrors, gear shifts, control knobs and buttons, latches, and handles
• Shared objects including clipboards, pens and pencils, bar code scanning devices, dollies, and hand carts
• Surfaces in public places such door and faucet handles, phones, ATM machines, keyboards, or touch screens

Antibacterial soaps and hand washes (i.e., those containing Triclosan or advertised as “antibacterial”) are not better than soap and water for hand disinfection.³ CDC hand washing guidance is available at http://www.cdc.gov/flu/protect/habits/. The following guidance is recommended:

Hand washing using soap and water

• Wet both hands with clean running water and apply soap. Use warm water if possible.
• Rub your hands together, make a lather, and rub all surfaces on your hands and fingers.
• Continue lathering and rubbing your hands together for about 20 seconds; this is about the time it takes to hum the song “Happy Birthday” twice.
• Rinse hands well under running water to remove the lather.
• Dry your hands using a paper towel or an air dryer. If using a paper towel, use the paper towel to turn off the faucet and open the bathroom door. You might also use your foot to open the door if it swings outward.

Using an alcohol-based hand sanitizer

• Apply a thumbnail sized amount of the product into the palm of one hand.
• Rub the product over all surfaces of hands and fingers until hands are dry.
• Note: when hands are visibly soiled or “dirty,” hand sanitizers may be less effective, and hand washing with soap and water is recommended.

When to wash or sanitize your hands

• After any hand contact with surfaces that get frequently touched by other people
• After shaking hands (which is discouraged during a pandemic)
• After blowing your nose, coughing, or sneezing (but don’t cough or sneeze into your hand, use your shirtsleeve or a tissue)
• Before preparing or eating food
• After going to the bathroom
• After handling an animal or animal waste
• After handling garbage
• Before and after treating a wound, cut, or abrasion

Personal protective equipment (PPE) can also play a role in reducing the risks from inhalation exposures and surface contact with infectious flu containing droplets and aerosols. Please note that any mandatory (i.e., required in the workplace) use of respiratory protection requires a respiratory protection program that includes the following:

• A written program
• Medical evaluation
• Training
• Fit testing
• Proper storage
• Recordkeeping.

Proper planning and stockpiling before the onset of a pandemic will make it much easier to achieve these goals for protection. Examples of PPE include the following:

• Using NIOSH-approved N, P, or R95 (or greater efficiency, 99 or 100) filtering face piece respirators if you cannot avoid close contact with a person with influenza symptoms
• Using utility gloves when handling cargo

Risk of Infection from Handling Truck Cargo  

In studies, influenza A (and B) viruses can persist on porous and nonporous surfaces for hours to days. If a surface is contaminated with a flu virus, crew members might become infected by touching that surface and then touching the mucous membranes of their eyes, nose, and mouth. Routine cleaning and disinfection of frequently touched hard environmental surfaces is a reasonable precaution. But the effectiveness of disinfection may vary depending on the surface, the cleaning method, and the cleaning and disinfecting agent that is used.

Recommended Practices for Cleaning and Disinfecting Cabs and Trailers  

To disinfect hard surfaces (plastic and metal), clean them with soap or detergent in water to remove dirt and use disinfectants to inactivate flu viruses. Inactivating or reducing the amount of flu viruses on a surface can reduce the chances of hand contamination, transfer of the virus, and possible infections in workers. Flu viruses may be inactivated by chemical disinfectants such as these:

• Chlorine or sodium hypochlorite (diluted household bleach)
• Aldehydes (formaldehyde and glutaraldehyde are effective but quite toxic!)
• Quaternary ammonium compounds (such as Lysol® spray disinfectant)
• Phenolics (pine oil products, some mouthwashes)
• Alcohols and peroxygen compounds (hydrogen peroxide)

Numerous commercial disinfectants registered by the U.S. Environmental Protection Agency (EPA) claim to inactivate avian flu viruses and are effective when used according to manufacturers’ instructions. For more information about EPA-registered disinfectants, visit www.epa.gov/oppad001/chemregindex.htm or http://www.epa.gov/oppad001/. Use EPA-registered disinfectants when cleaning hard surfaces.

To clean or disinfect hard surfaces in truck cabs or truck cargo trailers, general cleaning techniques and practices can be used along with a variety of common commercial products that have a detergent (to clean) and a disinfectant (to inactivate) the flu virus:

• Follow the manufacturers’ instructions (for usage and amounts) when using a standard household cleaner (a soap or detergent)
• Then rinse with clear water.
• Next, use a disinfectant.

For visibly dirty surfaces such as the insides of a cargo trailer, do the following:

• Clean surfaces that are touched often or are suspected to be contaminated
  • Clean the soil away first
  • Rinse
  • Then use a disinfectant. If disinfectants are not available, use a diluted chlorine bleach solution. Carefully add 2 teaspoons of household bleach (5.25%–6%) into a quart (4 cups) of clear water. Wear rubber gloves and use a cloth to apply this to surfaces and let stand for 3–5 minutes before rinsing with clean water. For a larger supply of disinfectant, use ¼ cup of bleach in a gallon (16 cups) of water.
• Use a disinfecting wipe or spray to clean commonly touched items such as pens, bar-code scanning devices, steering wheels, shift knobs, door handles, etc. Always read the manufacturer’s directions first when using cleaning products; pay attention to hazard warnings on the labels and instructions for proper disposal.
• Never mix disinfectants and cleaning chemicals unless the labels say it is safe to do so. Combining certain products, such as chlorine bleach and ammonia cleaners, could result in toxic chemical vapors if inhaled can cause serious injury or even death.

Some disinfectant products (sanitizer cloths and liquid disinfectants) available from grocery and hardware stores and commercial cleaning products have been registered with the EPA. Use EPA-registered products when available. Always follow label instructions carefully when using these products. For more information about cleaning and disinfecting surfaces for pandemic flu virus, consult the Interim Guidance on Environmental Management of Pandemic Influenza Virus at http://flu.gov/planning-preparedness/hospital/influenzaguidance.html. CDC will be issuing further guidance on cleaning truck cabs which will be posted on the internet at http://www.flu.gov/professional/transport/cleaning_trucking.html.

Crew Awareness of Health Symptoms of Possible Pandemic Flu  

Cargo trucking crews should be vigilant and aware of flu symptoms in themselves and other workers during a pandemic. The most common symptoms include the following:

• Fever (often high)
• Runny or stuffy nose
• Sore throat
• Headache
• Muscle aches
• Fatigue
• Dry cough.

Other symptoms can include nausea, vomiting, and diarrhea, which are often more common in children than adults. Types and severity of symptoms could be different with a novel (or pandemic strain) of flu.

Management of Ill Crew  

Cargo crew members who become ill with the flu should take the following precautions:

• If you have flu-like symptoms (or have household members who become ill), do not come to work or travel. The exception is local travel in a private vehicle to visit a health care facility for treatment.
• Crew members in the same cab should wear a NIOSH approved N95 (or greater efficiency, such as N99 or N100) filtering face piece respirator while transporting the ill person for health care.

Employers should take the following steps:

• If a crew member becomes ill while working, send him or her home as soon as possible. Until then, the ill person should wear a surgical mask to decrease the possibility of transmitting the illness to others.
• If crew members need to visit a doctor's office, clinic, or emergency room, tell the health care provider before the visit that the ill person is seeking treatment for suspected pandemic flu.

Prevention of Illness in Well Crew  

Employers should take the following steps:

• Encourage employees to get annual flu vaccines and a pandemic flu vaccine if one is available.
• Ensure trucking crews understand exposure risks for pandemic flu and the precautions to prevent transmission.
• Take measures to encourage infection control practices in the workplace such as displaying posters that address and remind workers on correct hand and respiratory hygiene and cough etiquette.
• Provide alcohol-based hand sanitizers (or wipes) in areas such as loading docks and dispatch areas
• Provide tissues and appropriate disposal receptacles for use by crews.
• As appropriate, provide crews with PPE such as protective gloves and NIOSH-approved filtering face piece respirators, such as an N95, for workers who may need to use such equipment in the course of their work.
• Plan for the impact of a pandemic on their business. Use the Workplace Planning Business Checklist as a guide: www.flu.gov/professional/business/businesschecklist.html
• In the event of a pandemic, consider leave policies that encourage and allow employees who are sick to stay at home to care for themselves, ill family members, or children dismissed from school.
• Encourage crew members with household members with confirmed or probable flu to stay home for 7 days.

¹ http://www.lni.wa.gov/Safety/Research/Trucking/
² www.osha.gov/Publications/OSHA3327pandemic.pdf
³ Nonpharmaceutical Interventions for Pandemic Influenza, National and Community Measures http://www.cdc.gov/ncidod/eid/vol12no01/pdfs/05-1371.pdf