B09_Hantavirus_Risk_Reduction_Program_Aug2013_-_Amd1_0001.pdf

National Park Service Yosemite National Park

Yosemite National Park Directive # 9: Hantavirus Risk Reduction Program

Approved: /s/ Don L. Neubacher (original signature on file)

Effective Date: August 1, 2013

Table of Contents

1. Background and Purpose

2. Authority

3. Policy

4. Scope

5. Definitions

6. Responsibilities

7. Procedures

8. Program Requirements

1. Background and Purpose

The purpose of this Directive is to protect all Yosemite National Park (YOSE) employees, volunteers (VIP), concessioners, and visitors from all hazards associated with hantavirus exposure.

Several hantaviruses that are pathogenic to humans have been identified in the United States. Hantavirus Pulmonary Syndrome i (HPS) is a severe, sometimes fatal, respiratory disease in humans caused specifically by infection with Sin Nombre Virus, which is the primary causative agent of HPS in the U.S., including Yosemite National Park.

The best, currently available, approach for hantavirus disease control and prevention is risk reduction through environmental modification and hygiene practices that deter rodents (mice and rats) from colonizing work environments and homes, as well as safe cleanup of rodent waste and nesting materials. All persons should limit their exposure, and avoid contact with all mice and rats in Yosemite National Park. The precautions described in this directive are broadly applicable to limiting this exposure.

The universal precautions method is strongly recommended for all employees when engaged in any activity that may expose the employee to hantavirus. All persons should treat all mice and rats as potentially infected/infectious hosts of HPS causing hantaviruses.

2. Authority

a. NPS Directors Order #83, Public Health NPS Directors Order #50B, Section 1, Safety Program Management

b. OSHA, General Duty Clause Section (5)(a)(1) OSHA

c. Center for Disease Control and Prevention (CDC), http://www.cdc.gov/hantavirus/

d. CDC, MMWR July 26, 2002, Vol. 51, No. RR09

e. California Department of Public Health, Vector Borne Disease Section, http://www.cdph.ca.gov/HealthInfo/discond/Pages/HantavirusPulmonarySyndrome.aspx

f. Yosemite National Park Respiratory Protection Policy (January, 2008)

g. NPS Rodent Exclusion Manual, Mechanical Rodent Proofing Techniques (March, 2005)

h. NPS Directors Order #50B, RM 50B- Occupational Safety and Health Program

3. Policy

It is park policy to provide a safe place of employment, free from recognized hazards that may cause serious physical harm or death.

4. Scope

This is a park wide policy that applies to all YOSE employees, volunteers (VIP), and contractors potentially exposed or exposed to a hantavirus infection in the course of their duties.

5. Definitions

a. Hantavirus

Hantaviruses are a group of viruses that may be carried by some rodents. Some hantaviruses can cause a rare but deadly disease called HPS. Although there are several hantaviruses that exist in California, HPS in the western U.S. is caused by a specific hantavirus, called Sin Nombre Virus (SNV). In California, only deer mice (Peromyscus maniculatus) carry and shed SNV. Infected rodents shed hantavirus in their urine, droppings, and saliva. Any person can become infected through contact with hantavirus-infected rodents or their urine and droppings.

b. Hantavirus Pulmonary Syndrome

Infection with hantavirus can progress to HPS, which can be fatal. HPS is a febrile illness characterized by respiratory compromise usually requiring supplemental oxygen and clinically resembling Acute Respiratory Disease Syndrome (ARDS). Symptoms include fever, chills, myalgia, headache, and gastrointestinal symptoms. Most HPS patients become infected by breathing air contaminated with rodent urine, droppings, or saliva, such as when cleaning out a rodent-infested space. This most commonly occurs in small, confined spaces where there is little air circulation. To date, no cases of HPS have been reported in the United States in which the virus was transmitted from one person to another.

Although it is more accurate to call the virus Sin Nombre Virus, for purposes of standardization and uniformity, this directive will further refer to the virus as hantavirus.

http://www.cdc.gov/hantavirus/ http://www.cdph.ca.gov/HealthInfo/discond/Pages/HantavirusPulmonarySyndrome.aspx

6. Responsibilities

a. Roles and Responsibilities

i. The superintendent of YOSE is responsible for the overall implementation of this policy, and for providing necessary program funds.

ii. Division chiefs are responsible for ensuring all managers and supervisors, within their divisions, are aware of this policy, and have all of the necessary resources involved to implement and maintain the YOSE Hantavirus Program.

iii. Managers are responsible for ensuring that potentially exposed employees have received hantavirus awareness training as required in this program. Employees should also receive any other pertinent program, such as Respiratory Protection and Hazard Communication, before beginning clean-up activities, and these employees should be provided the required personal protective equipment.

iv. Supervisors and work leaders will also ensure that employees are properly equipped and trained to safely perform rodent activity assessments when entering a seasonally-closed building which has not been previously cleaned. Supervisors and work leaders will also ensure that employees, engaged in cleaning activities, use proper personal protective equipment as directed by this policy.

v. The Safety and Occupational Health Manager is responsible for developing and maintaining the

YOSE Hantavirus Program, for prescribing adequate personal protective measures and equipment for all employees having potential exposure, and for providing hantavirus awareness training to employees.

vi. The Environmental Health Officer is responsible for coordinating and implementing the park-wide Hantavirus Directive with park concessionaires and other park partners. The Environmental Health Officer ensures that YOSE employees, park concessioners, and partners utilize adequate personal protective measures and equipment. The Environmental Health Officer also ensures that hantavirus training is completed.

vii. Park employees working at YOSE facilities are responsible for following the procedures of this policy in accordance with instructions and the training they have received. Upon training completion, all YOSE employees will be responsible for assessing rodent activity in park facilities and performing light infestation cleanup in accordance with the protocol in this policy.

viii. Building and Grounds supervisors are also responsible for identifying and assigning employees who will perform heavy rodent infestation clean up.

7. Procedures

a. Exposure Assessment: General

i. All employees should assess the situation to determine if an infestation is light or heavy. A risk assessment for a specific hazard can be completed by using the Severity, Probability, Exposure (SPE) model. Appendix A provides an overview of the SPE model, appendix B provides two hantavirus case scenarios using the SPE model, and appendix C provides an SPE model risk assessment for hantavirus.

ii. An infestation is considered light if there are few droppings in one area, a few nests, and one to two live or dead rodents. All employees should be able to follow the light infestation procedure in 7(c) in order to properly remove the light infestation.

iii. An infestation is considered heavy if piles of feces or numerous nests or live or dead rodents are observed. All heavy infestations will be removed by trained personnel.

b. Exposure Assessment: Seasonally Closed Unoccupied Building or Structures

i. An assessment by a trained YOSE employee shall be made during the entry of seasonally closed unoccupied buildings and/or confined spaces in order to determine the level of rodent activity. All affected employees are responsible for performing these assessments, and are required to follow the YOSE Hantavirus Assessment protocol below for hantavirus exposure.

ii. WARNING: Inhalation of airborne particles is the primary exposure route. When an employee begins assessing or cleaning, it is important that employees do not stir up dust by sweeping or vacuuming up droppings, urine, or nesting materials.

iii. If only minimal intrusion into the structure is necessary at the time the building is opened, (i.e., an employee needs to pick up a tool, and this activity will not stir up any dust), it is under these circumstances likely safe to enter the building briefly to conduct this type of activity. If more involved activities are necessary that may stir up dust or debris, or if the building will be occupied for a period of time by one or more individuals, then cleaning of rodent materials will be necessary.

iv. Open all doors and allow for natural ventilation for 30 minutes, using cross ventilation whenever possible. Ventilation will aid in the removal of any aerosolized virus inside the structure.

v. In order to assess the seasonally closed building for rodent infestation, put on a P-100 respirator, and enter the structure/building. All employees using a P-100 or other Respirator Protection Program required respirator shall be medically cleared and respirator fit tested in accordance with the YOSE Respirator Protection Program.

vi. Assess the rodent activity. Look for rodent droppings, urine stains, dead rodents, and nesting material. Do not perform any activity creating dusty conditions during the assessment. Determine whether it is a light of heavy infestation and treat accordingly. If structure shows signs of light infestation (as in most cases), follow the light infestation clean up procedures in section 7(c). If the structure shows signs of heavy infestation, follow the heavy infestation clean up procedures in section 7(d).

vii. Upon completion of assessment, wash hands and face with warm soap and water to prevent potential dermal exposure.

c. Light Infestation Cleanup Procedures: All YOSE Employees, volunteers (VIP), and contractors should follow the following guidelines for cleanup procedures for a light infestation

i. Put on rubber, latex, nitrile or vinyl gloves. A respirator and goggles can be used, but is not required. The use of a respirator requires medical clearance and annual fit testing. Respirators are not considered protective if facial hair interferes with the face seal or fit testing has not been performed in the previous year, since proper fit cannot be assured. Respirator use practices should be in accordance with Yosemite National Park’s Respirator Fit Program, and should be supervised by a knowledgeable person. See section 7d (ii) for further details.

ii. Do not sweep or vacuum droppings, urine or nesting materials, as contaminated dust will become airborne.

iii. Saturate dead rodents, rodent droppings, and urine stained area with a disinfectant filled spray bottle. A general purpose commercial disinfectant can be used if it is prepared according to the label, and it is not pre-diluted. Almost any agent commercially available in the U.S. is sufficient, as long as the label states that it is a disinfectant certified by the Environmental Protection Agency, as indicated on the product label. A chlorine solution freshly prepared by mixing 1 ½ cups of household bleach in 1 gallon of water (1:10 solution) can be used in place of a general purpose commercial disinfectant. Chlorine is corrosive. When using chlorine solution, avoid spilling the mixture. Chlorine solutions should be prepared fresh daily in order to be effective. Wait 10-15 minutes after saturating the area before cleanup.

iv. Use a paper towel to pick up the urine and droppings, and dispose of the waste in the garbage.

Place a disinfected dead rodent or rodent nest in a plastic bag, seal, place in a second plastic bag, and discard. Avoid cleaning activities that create airborne dust particles.

v. After the rodent droppings and urine have been removed, disinfect items that might have been contaminated by rodents or their urine and droppings.

vi. Disinfect carpets with an approved disinfectant (see 7c (iii) for guidance on disfectants).

vii. Disinfect reusable gloves before removing or discard disposable gloves appropriately. Dispose of respirator if made for single-use or clean and disinfect if multi-use.

viii. Wash hands immediately with warm soap and water upon leaving work area.

d. Heavy Infestation Cleanup Procedures: Employees must be properly trained to perform a heavy infestation cleanup

i. If the building has been closed and unoccupied, ventilate by opening doors and windows for a minimum of 30 minutes before beginning any work. Use cross ventilation whenever possible.

Leave area during this period.

ii. Persons performing the cleanup should wear machine washable coveralls or disposable suits

(e.g.Tyvek suits), disposable shoe covers (e.g. Tyvek Booties), rubber, latex, vinyl, or nitrile gloves, protective goggles, and a tight-fitting negative pressure respirator equipped with N-100 or P-100 rated filters. As an alternative to wearing disposable shoe covers, persons can wear gumboots or workboots that can be washed and disinfected. A Power Air Respirator (PAPR) could be used if the user has been properly trained and approved by the YOSE Safety, Health, and Environmental Office. (Important: Federal law requires employees be medically evaluated, trained and fit-tested annually for the use of this type of respiratory protection.)

iii. Spray dead rodents, droppings, and urine with a disinfectant (see above for disinfectants in section

7c [iii]) until completely saturated. Remember to avoid creating dusts or aerosols and do not vacuum or dry sweep up any materials until they have been completely saturated with the disinfectant solution for at least 10 minutes.

iv. Using paper towel or dispensable rags, wipe up and remove the material. Unless burned, all waste material shall be double-bagged and sealed. Discard as normal solid waste.

v. All PPE shall be decontaminated using a disinfectant at the end of the work shift before it is removed. However use soap and water rather than disinfectant to clean the face and any other exposed skin. If necessary, disinfect goggles and respirators after they have been removed. If disposable Tyvek suits or coveralls are not used, immediately remove and launder work clothing with regular clothing detergent. UV or sunlight is also key to breaking down or destroying the virus;

leaving equipment exposed to sunlight is helpful.

vi. Wash hands, face, and any other exposed skin with warm soap and water upon completion of job.

vii. WARNING: Persons developing a high fever or respiratory illness within 45 days of last potential exposure should notify their supervisor immediately and seek medical attention. Inform the physician of the potential occupational risk of hantavirus infection.

8. Program Requirements

a. Hantavirus Exposure

i. Although hantavirus in California is found only in deer mice and is excreted in the deer mouse’s urine, feces, and saliva, YOSE employees must take a universal precautions approach, and assume all rodent (rat and mice) excreta, urine, and saliva may contain hantavirus or other rodent borne pathogens. YOSE employees must recognize that these fluids are potentially harmful, and take precautions against contact and/or exposure.

ii. Occupational exposure to hantavirus is most often through inhalation of infectious airborne particles. However, other potential exposure routes include dermal/direct contact with the virus through breaks in the skin, membranes, and the eyes. All employees should treat all mice and rats as potential hosts of HPS causing hantaviruses, and each mouse or rat as though it were infected and infectious.

iii. WARNING: Symptoms of hantavirus infection occur from 1 to 6 weeks after exposure. Early symptoms include fatigue, fever, muscle aches, headaches, chills, dizziness, and abdominal pain.

Approximately 10 days following initial symptoms, additional symptoms appear, including cough, shortness of breath, and respiratory distress. If a person exhibits these symptoms and has been in contact with rodents or their body fluids (feces, urine, etc.), they should contact a physician immediately and inform them of potential rodent exposure.

b. Prevention of Rodent Infestation

i. The most significant and effective method to prevent exposure to hantavirus is to eliminate or minimize contact with rodents. Making homes and workplaces unattractive to mice will lessen employee risk of exposure to the virus.

ii. Eliminate rodents by reducing the availability of food sources and nesting sites used by rodents inside homes, cabins, and other buildings. Store garbage inside homes in rodent proof metal or plastic containers with tight fitting lids. If storing garbage outside, ensure that proper rodent and bear proof containers are used within YOSE.

iii. Wash dishes and cooking utensils immediately after use, and immediately store them in an area not accessible to rodents. Keep area as clean as possible to prevent rodent harborage.

iv. Do not leave pet food in feeding dishes. Dispose of trash and clutter.

v. Continuously use spring-loaded rodent traps in buildings. Keep all food (including pet food) and water covered and stored in rodent proof containers with tight fitting lids.

c. Reduce Rodent Shelter and Food Sources Within 100 Feet of Homes

i. When possible, place woodpiles 100 feet or more from buildings, and elevate wood at least 12 inches off of the ground.

ii. Store grains and animal feed in rodent-proof containers.

iii. Near buildings, remove food sources which might attract rodents or store food and water in rodent-proof containers.

iv. Store hay on pallets to keep hay free of rodents. Elevate 12 inches if possible, and use traps continuously.

v. Dispose of garbage and trash in rodent-proof containers that are elevated at least 12 inches off of the ground.

vi. Haul away trash and other items that may serve as rodent nesting sites.

vii. Cut grass, brush, and dense shrubbery within at least 30 feet of buildings. Do not use dense ground covers in landscaping.

viii. Place spring-loaded rodent traps in likely areas of rodent shelter within 100 feet around buildings, and use continuously.

ix. Eliminate water sources: standing water (barrels, buckets) and/or leaky faucets or pipes.

d. Engineering Controls Utilized at the Job Site

i. The use of tools, such as a dust pan and wet brush, to collect all wet materials and disinfected materials suspected of being contaminated, is suggested. Place these waste materials into a properly doubled waste bag, this will reduce the possibility of infection. A properly functioning HepaVac may be utilized after potentially infected materials have been properly disinfected and removed by properly trained personnel.

ii. Provide an approved disinfectant for the immediate decontamination of suspect materials.

iii. Provide hand washing facilities, with potable water, which should be readily accessible to potentially exposed employees.

iv. Provide soap, antiseptic hand cleanser, and disposable towels or antiseptic towelettes.

v. Require employees to wash their hands immediately after removing contaminated gloves or other personal protective equipment.

vi. Employees should wash hands, face, and any other exposed skin with warm soap and water upon completion of job. Employees should wash any area of the body, and flush mucous membranes with water, as soon as possible after contact with potentially infectious materials.

vii. Utilize procedures listed above involving clean-up of rodent infestations or other potentially infectious materials to ensure that splashing, spraying, splattering, and the generation of dust and droplets are minimized.

viii. All items and equipment found to be contaminated will either be decontaminated or it will be appropriately labeled and disposed of properly.

ix. Mammalogists/wildlife biologists handling wild rodents for research and management must follow

NPS Reference, RM 50B: Safe work practices for employees handling wildlife.

e. Training and Education

i. All YOSE employees are authorized to perform hantavirus assessments, light infestation and general housekeeping clean-up of rodent excreta, and nesting material. Employees shall be knowledgeable and trained in the protocols listed in this program and have the ability to take the appropriate precautions against hantavirus. Employees will receive training in the following areas:

a. The epidemiology and symptoms of hantavirus infection and hantavirus pulmonary syndrome.

b. YOSE’s hantavirus assessment and clean up protocol and how to recognize tasks that may involve exposure.

c. A review of the engineering controls, work practices, and personal protective equipment required to reduce or eliminate exposure.

ii. Supervisors are responsible for ensuring that employees engaged in exposure assessments, cleanup of unoccupied buildings and cleanup of heavy infestations receive annual training in the following areas:

a. Hantavirus awareness

b. Personal protective equipment

c. Respiratory protection and fit-testing i While the CDC still uses the term HPS, CDPH prefers the term, Hanta Cardio Pulmonary Syndrome (HCPS) because of the cardio aspect of the disease has a significant clinical influence on the outcome of the case and patient.