Should solid waste workers be concerned about anthrax?

Ann Daniels
Professional Development Program Manager
APWA Kansas City Office

Dr. John Skinner
Executive Director
Solid Waste Association of North America

The events following the attacks on September 11 are beginning to fade from our recent memories. While the devastation and destruction will long be with us, our daily lives are beginning to return to normal, as they should be.

One group of public works employees often overlooked during times of emergencies is those who work in the solid waste department. While police, fire, and emergency management departments continue to conduct tests of their plans and systems, the solid waste department is likely to be caught off guard when it comes to emergency procedures. APWA is committed to providing information and assistance to our members as we all prepare for any newfound challenges that may come our way.

The news media has fully covered the cases of anthrax spores transmitted to the postal service and government office buildings in Washington, D.C. But the health threat doesn't stop there. Postal employees distribute the mail; government workers open and respond to the infected mail. But what about the solid waste collectors who have the ultimate responsibility of destroying the infected pieces?

With this question in mind, members of the APWA Solid Waste Management Committee began the search for appropriate guidelines for handling solid waste which may have been contaminated. Utilizing the Partnership Agreement between APWA and SWANA (Solid Waste Association of North America), the Committee has endorsed the "Guidance on Precautions for Solid Waste Workers Handling Wastes Potentially Contaminated with Anthrax." You will find SWANA's Guidelines printed below. While the threat of anthrax may not be one many of us will face, we should continue to be aware that other forms of bio-terrorism could be used which will require us to continue making plans for caring for our workers.

The following Guidelines are reprinted by permission from Dr. John Skinner, Executive Director, Solid Waste Association of North America.

"Guidance on Precautions for Solid Waste Workers Handling Wastes Potentially Contaminated with Anthrax"
Disease-causing anthrax spores have been released intentionally through the U.S. postal system or other sources. To date, this is directly affecting parts of Florida, Indiana, New Jersey, New York, and the Washington, D.C. region. SWANA has received numerous questions regarding the precautions necessary to protect solid waste workers while carrying out the collection, disposal and recycling of discarded mail and associated waste materials that may be contaminated with anthrax spores.

Federal and environmental authorities have not yet issued guidance to the solid waste industry for steps that should be taken to avoid exposure to our workers. Therefore, after consultation with federal officials, industry representatives, and SWANA members, this document was developed to provide SWANA's initial responses to these questions.

Potential for Exposure
Employees coming in contact with anthrax spores have the potential to contract anthrax through inhalation, direct skin contact (exposure to open wounds) or ingestion. It is not yet clear how many people have been affected by the anthrax releases. Federal and state agencies are working diligently to locate the source and distribution path of the anthrax spores.

Meanwhile, investigations continue and concerns about businesses and residents throwing suspicious letters or packages in the trash are emerging. Solid waste managers are concerned about the potential risk of exposure to solid waste management employees that may occur from discarded items that may contain anthrax spores.

The primary concern about exposure is in solid waste facilities receiving wastes from anthrax-targeted areas, i.e., areas that have identified anthrax in mail deliveries. In those facilities exposures would be highest in high dust areas such as those found in material recycling facilities (tipping floor, sorting belts, baling stations), and waste tipping floors (transfer station and waste-to-energy facilities) and at the discharge locations at landfills. Employees that have direct contact with potentially exposed materials (such as mixed-paper sorters at recycling facilities and residential waste haulers) also may have some increased risk of exposure.

The purpose of this guidance is to provide information on how to reduce the potential for such exposures. In implementing this guidance the Environmental Health and Safety Officer at solid waste management facilities should coordinate activities with local law enforcement and health officials.

Keeping Anthrax Out of the Waste Stream — Don't Throw it in the Trash!
Solid waste managers and their agencies and companies should work with local, state and federal authorities to spread the message that suspicious letters and packages should NOT be placed in trash bins or other solid waste collection containers. These materials should be separated and contained in accordance with instruction for handling such items by the CDC and FBI (see the CDC and FBI websites on page 31 for details), and local law enforcement agencies should be contacted for further instructions.

If a suspicious package is identified within your service area and the presence of anthrax is suspected by local health and enforcement authorities, solid waste managers should:

  • Suspend solid waste and recycling collection from the buildings under investigation until authorities make a final determination.

  • Depending on that determination, take either of the precautions described below.
1. Solid Waste from Buildings and Residences Where Anthrax Has Been Found
For solid waste managers who are operating systems that may receive wastes from buildings (either postal facilities or others) where anthrax has been identified, the risk of anthrax exposure may occur during collection, processing or disposal of the wastes. The following are some measures that managers can take to reduce exposures:
  • Determine whether any buildings in your service area have been identified as contaminated with anthrax. Coordinate with local haulers and government authorities to ensure that materials from any quarantined buildings are not removed until after the responsible government agency has cleared the facility and its waste streams for disposition and a clear plan of action has been developed with local solid waste officials for its disposal in the safety manner. Measures may include arranging for materials to be delivered during hours that minimize exposure of employees and will allow optimal use of dust suppression measures.

  • Suspend collection of potentially contaminated recyclables and wastes from those buildings.

  • Make masks available to employees that work in high dust areas in the processing and disposal facilities and implement a respirator protection program. These masks should remove dust particles to .3 microns to employees (National Institute of Occupational Safety and Health [NIOSH], approved N95, N100 or P100 series).

  • Provide training on the proper use of respiratory equipment (OSHA 29 CFR 1910.134).

  • Make surgical gloves (or equivalent) available to collection and processing personnel that may have direct contact with materials.

  • For potentially exposed equipment, consider cleaning with wet methods and HEPA vacuums to avoid blowing.

  • Encourage employees to wash hands, face and exposed skin thoroughly.

  • Arrange for employees to change out of work clothes when leaving the facility.

  • Distribute information that describes the symptoms of possible anthrax exposure (see the CDC resources on page 31) and instruct employees that if they suspect they have these symptoms they should report them to their employer and be checked by a health professional right away.
2. Solid Waste from Buildings and Residences Where Anthrax Has Not Been Found
For the majority of the country, anthrax has not been a threat. Every day as solid waste employees handle waste products and equipment, they can come in contact with a variety of potentially harmful materials. Today, it is more important than in the past to take reasonable precautions. The following are some measures that managers should consider.
  • Remind employees to use personal protective equipment that prevents exposure to biohazards (OSHA 29 CFR Parts 1900-1999, Operation and Maintenance Manuals, Employee Manuals, etc.).

  • Have employees wear gloves and wash hands before rubbing face or eyes, or before eating or drinking.

  • Have employees notify their supervisor if they come across suspicious materials.

  • Provide refresher training on preventive measures.

  • Enforce the use of these preventive measures.

  • Evaluate opportunities for dust reduction and control.

  • Encourage staff to consider getting a flu shot. While the shots do not protect against anthrax, they may lessen the stress associated with having the flu and thinking it might be anthrax.

  • Recognize that individuals have different tolerances for risks and be prepared to provide NIOSH N100 masks and surgical gloves to employees, if they request them.
The following additional resources may be helpful in developing your plan for dealing with this issue:
  • Identifying symptoms of anthrax - Center for Disease Control frequently asked questions: http://www.bt.cdc.gov/DocumentsApp/faqanthrax.asp.

  • CDC health advisory notice "HOW TO HANDLE ANTHRAX AND OTHER BIOLOGICAL AGENT THREATS": http://www.cdc.gov/nip/diseases/anthrax/anthrax-handling.htm.

  • Federal Bureau of Investigation (FBI) advisory procedures for suspicious mail at: http://www.fbi.gov/pressrel/pressrel01/mail3.pdf.

  • Department of Labor, Occupational Safety and Health Administration (OSHA), 29 CFR Parts 1910, 1915, and 1926 at: http://www.dol.gov.

  • U.S. Office of Personnel Management, Anthrax and Other Bioterrorism issues: http://www.opm.gov/ehs/terrorism.htm.
A Letter of Concern

Dr. John Skinner, SWANA Executive Director, received the following correspondence from a SWANA member in Ohio, Charles Ramer. It is reprinted to offer insight into the thoughts and responses associated with a "suspicious" substance.

"Test results are back. It's not anthrax. Official word from the Ohio Department of Health is that the mysterious white powder found inside the brown envelope with the Arabic writing is an "unknown biological agent"???

"Although we are all relieved to know it's not anthrax, more questions remain:

Who was responsible?
Why us?
What actually was the stuff?

"Harmless or not...I'm not excited about receiving ANY biological agent but since it's not anthrax, case is dropped and we go about our business.

"What did we learn?

"Lesson #1. These biohazard scares are disruptive, expensive, and almost impossible to prevent. It's going to happen eventually in most facilities. Pat Holland and SWANA have done an excellent job assembling the reference material. Ironically, I received a draft of the SWANA document the night before our incident and it proved an invaluable tool in our response strategy.

"Lesson #2. When an incident occurs, expect major conflicts between Agencies. Our goal now will be to establish some clear authority to coordinate efforts of the police, fire, health department, EMA, prosecutor, commissioners, etc.

"Lesson #3. Cipro is nasty. Ugh. I recommend preparation and planning so that you can avoid or minimize the damage.

"What happens next? I'm going to try to get the envelope and remaining powder back from the ODH so that we can run independent tests. ODH has stated that they are not set up to determine the specific variety of biological agent...and to my knowledge no one has even tried to translate the Arabic writing. It looks like the investigation is now our responsibility.

"I'll attempt to keep everyone informed as the mystery unfolds. As an aside, I don't think anthrax is a real threat for most of us. However, I think the threat of bio-hazards IS real. That's why I'm still worried. And until we can determine why someone delivered ANY biological agent to us, we'll stay alert for more. It's a wacky world."

The National Solid Waste Management Association (NSWMA) also has extensive guidance on anthrax and bioterrorism on the website at: http://www.nswma.org/.

One word of caution: Don't overlook the potential hazard to solid waste employees. While you don't think it will happen to you, the possibility does exist at anytime and anywhere. Being prepared is your best defense.

Ann Daniels can be reached at 816-472-6100 or at adaniels@apwa.net; John Skinner can be reached at 301-585-2898 or at jskinner@swana.org.