H5N1: Preparing For A Pandemic
Avian influenza is already responsible for the deaths of millions of birds, but if the virus should change into an easily transmissible human disease, it threatens to cripple the world economy and kill a significant percentage of the population.
The World Health Organization (WHO) defines phases for pandemic alert on a scale of one to six. One signals a low risk of human cases, while six portends efficient and sustained human-to-human transmission. Currently, the avian flu is only in phase three, meaning there is no — or very limited — human-to-human transmission. It’s impossible to predict if and when a pandemic could occur and many experts still believe a pandemic to be unlikely.
But since September 11, there has been a new urgency for disaster preparedness, says Brian Sansoni, vice president of communication and membership, Soap and Detergent Association (SDA), Washington D.C. The potential for an influenza pandemic is certainly a reason to create emergency preparedness plans, he says.
However, for jan/san distributors, what makes the pandemic different from other crises such as terrorist attacks or natural disasters is that the supplies they provide to their customers can limit the damage. By instituting proper infection-control measures, distributors can help restrict the spread of the virus should the avian flu become easily transmissible from human to human.
What Is Avian Flu?
Avian influenza, also known as bird flu, is an infection caused by viruses that occur naturally in birds. There are different subtypes of bird flu, but scientists are most concerned with the H5N1 subtype because it is the deadliest of all avian influenza viruses that have crossed the species barrier to infect humans, according to the Centers for Disease Control and Prevention (CDC).
H5N1 is a Type A influenza virus. It first infected humans in 1997 in Hong Kong, killing six people. Since then, more than 200 human cases have been reported in at least 10 countries, including China, Egypt, Iraq, Thailand, Turkey and Vietnam. More than half of those infected have died.
But avian flu is not a problem limited to Asia and Africa. While no human cases have been reported in Europe, wild birds infected with H5N1 were found there last year. The United States is not immune, either: a mild form of bird flu — but not the H5N1 strain — was found in a live bird market in New Jersey in May.
Human infection is a result of direct contact with infected birds or contact with surfaces contaminated with secretions or excretions from infected birds. The H5N1 virus has spread from human to human, but these cases have been extremely rare and infection has not been observed to spread beyond one person, says CDC.
However, all influenza viruses have the ability to mutate. Scientists are concerned that H5N1 could one day change to a form that could spread easily from human to human. If this happens, the H5N1 virus will no longer be a bird virus, but a human influenza virus. Since bird viruses rarely affect humans, there is no human immune protection against them, the CDC reports.
WHO states: “once a contagious virus emerges, its global spread is considered inevitable.” Also, given the speed and volume of international travel, the virus could reach all continents in less than three months, the report continues.
Based on calculations using past pandemics, a modern pandemic could lead to the deaths of 200,000 to 2 million people in the United States alone, according to the U.S. Government’s “Implementation Plan for the National Strategy for Pandemic Influenza.” WHO estimates 2 million to 7.4 million deaths worldwide.
Efforts to produce a vaccine effective against the H5N1 virus are in progress, but it will probably be months before vaccines will be ready and made widely available. As a result, “the ability to limit transmission and delay the spread of the pandemic will therefore rely primarily on the appropriate and thorough application of infection control measures,” states the “Implementation Plan.”
Without a vaccine readily available in time for a pandemic, the cleaning industry will be partly responsible for preventing the further spread of the virus. Preventing pandemic influenza requires the same techniques as those used to prevent seasonal influenza, according to reports by U.S. Department of Health and Human Services (HHS). According to many industry manufacturers, preventing infection includes disinfecting commonly touched surfaces, preventing cross-contamination and promoting proper hand washing. However, this type of cleaning program would mean distributors will have a bigger role in informing customers on the differences between “clean” and “disinfected.”
“Our industry cleans at a sanitary level or less,” says Dave Frank, president, American Institute for Cleaning Sciences, Highlands Ranch, Colo. “Cleaning for emergency preparedness would move it up a level to disinfecting.”
In his book Protecting the Built Environment, Dr. Michael Berry explains that sanitary is cleaning to the point of protecting health in general, but surfaces will still have some contamination. In order for environments to be disinfected, 95 percent of harmful substances must be removed.
Wiping contaminated surfaces with a disinfectant effective against Type A influenza viruses should kill the H5N1 virus, according to WHO. Currently, more than 90 disinfectant products are registered by the U.S. Environmental Protection Agency (EPA) and are intended for use against avian influenza A viruses on hard, non-porous surfaces.
There are several aspects of the disinfecting process that distributors can review with end users. Janitors applying disinfectant need to pay close attention to the instructions and allow the product enough dwell time, says Dick Anderson, safety director for Mitch Murch’s Maintenance Management Co. (4M), St. Louis. Anderson is also a member of InfraGARD and the MidAmerica Contingency Planning Forum; both organizations are dedicated to contingency planning.
“If you do not obey the dwell time requirements, you will not kill all the bacteria and viruses,” Anderson adds.
Flu viruses can live on hard surfaces for up to 48 hours, so janitors should focus on surfaces that are frequently touched by hands such as doorknobs, countertops, desks and elevator buttons and panels.
Utilizing proper cross-contamination techniques will also help prevent further spread of the virus. Mop heads should be changed after cleaning each room, vacuum bags should be replaced each day and tools should be color-coded for use in specific areas such as restrooms and kitchen areas, recommends Frank.
The best way to kill flu viruses on one’s person is by cleaning hands several times a day for at least 20 seconds with either soap or hand sanitizers. It will be up to building occupants to ensure their hands are washed often and long enough, but cleaning crews can still encourage proper techniques. Signs posted in restrooms and kitchens serve as good reminders, says Sansoni.
4M is supplying hand sanitizing stations to be put in hallways or cafeterias — places where it would be a little too much trouble for building occupants to go to the restroom to wash hands, says Anderson.
Installing the latest restroom technology such as touch-free dispensers and foaming soaps can encourage hand washing, as well, says Sansoni.
Protecting tenants from a pandemic flu is a major responsibility for cleaning crews, but they must also take precautions to protect themselves from infection. Distributors can initiate conversations with customers about products that can help them do this.
When cleaning potentially contaminated areas, CDC recommends wearing gloves and masks. In healthcare facilities, when cleaning rooms with infected patients, additional personal protective equipment (PPE) includes long-sleeve, cuffed gowns and protective eyewear.
Besides proper PPE, there are other safety precautions distributors can educate end users about. Following HHS guidelines, end users should reduce the size of crews working in a building, limit the amount of interaction between workers and keep workers at least three feet apart.
The U.S. government’s “Implementation Plan” warns that in the event of a pandemic, 40 percent of employees may be absent from work for three to four months due to personal illness, illness in family members or fear of contagion.
Even though experts are uncertain if and when a pandemic will occur, distributors can at least prepare for a crisis now by establishing emergency preparedness planning programs with their customers. Customers need and want to know what steps should be taken to plan for avian flu.
“Planning is worthwhile,” says John Walker, president of Managemen, Salt Lake City. “Most cleaning organizations won’t be ready for such a scenario.” Being prepared for a worst-case scenario such as pandemic influenza is an opportunity for distributors to show their customers they are partners in the fight against disease.
“Cleaners are usually near the bottom of the totem pole of importance, but here is an opportunity when our routine job is no longer routine,” adds Anderson.
But facility mangers typically don’t view their cleaning providers as a resource in emergency planning, says Frank. End users will need to decide if emergency preparedness is important to them and if they have a plan or committee in place. If they do, ask if cleaning is a part of it, continues Frank. If cleaning isn’t currently included, find out how to get involved.
“Most customers aren’t as well informed about cleaning issues as their contractor,” says Steve Spencer, facilities specialist, State Farm Insurance, Bloomington, Ill. “I think customers would be interested in having BSCs on their committee or at least welcome input from them.”
4M has received a lot of interest from customers — and even from some institutions that aren’t customers — who want information about a possible pandemic. Anderson has developed a PowerPoint presentation and booklet that answers frequently asked questions about avian flu and explains how cleaning can help during a pandemic.
“By educating customers, we’ve piqued their curiosity,” he says.
Besides literature, periodically providing customers with hand sanitizers or disinfecting wipes with the name of the cleaning company on it is another way distributors can show customers they are prepared and educated about a pandemic, says Sansoni.
Distributors should also be sure that their customers understand that cleaning frequency could increase by two or three times the norm during a pandemic, says Frank. Customers will need to have funding to cover that type of cleaning.
In return, end users need to ensure they are educated enough to provide such intensive cleaning without making any guarantees, advises Spencer. If an outbreak still occurs despite the new cleaning measures, there is the possibility the cleaning crew — especially a contractor — could be held liable for damages, he adds.
If distributors have enough accounts interested in emergency preparedness planning, they should stock up now on PPE, disposable tools, disinfectants, soaps and sanitizers, says Frank. If a pandemic occurs, there will be a shortage of supplies.
“Don’t forget there will be 40 percent [fewer] people manufacturing products and 40 percent [fewer] people delivering them,” says Walker.
Whether or not the H5N1 virus mutates to a human transmissible disease, this is still an opportune time for distributors to talk with customers about emergency planning. Preparing for the H5N1 virus will help ensure that distributors are ready for other emergencies that may arise, and end users will be reassured that if the worst ever happens, their distributor is an educated resource for their business.
Dan Weltin is editor of SM’s sister magazine for the building service contractor market, Contracting Profits.