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Guidance for Airline Crews

 

1. The current outbreak

Influenza A (H1N1) currently spreading in many parts of the world is due to a new influenza A virus that has not previously caused illness to spread from people to people. This flu is likely to spread very fast once the virus gets introduced into any population groups as we will not have immunity against this new virus. At present there are several uncertainties regarding the spread of the disease as the behavior of the virus is unpredictable. However, countries around the world are taking several actions to ensure the protection of their population and especially port-based staff and airline crew who may be the first group of people encountering a case of influenza A (H1N1)

2. The symptoms

Symptoms of influenza A (H1N1) are no different from that of the regular human flu and include:

         Fever

         Cough

         Sore throat

         Runny nose

         Nose block/stuffy nose

         Body aches

         Headache

         Chills and fatigue

It is important to note that these symptoms and general flu are very common among most of the population groups. Special precaution need only be taken if a passenger meets the criteria of a suspected case of influenza A (H1N1).

A suspected case of influenza A (H1N1) virus infection is defined as a person who develops acute febrile respiratory illness:

         within 7 days of close contact with a person who is a confirmed case of influenza A (H1N1) virus infection, or

         within 7 days of travel to a community where there are one or more confirmed cases of influenza A (H1N1) cases, or

         resides in a community where there are one or more confirmed influenza cases.

For the purpose of case definition a Close contact is defined as a person within one meter of an ill person who is a probable or confirmed case of influenza A (H1N1) virus infection during the case’s infectious period.

Acute respiratory illness is defined as recent onset of at least two of the following: rhinorrhea or nasal congestion, sore throat, cough (with or without fever or feverishness).

 

 

 

3. Spread of Influenza A (H1N1)

Influenza A (H1N1) is believed to spread the same way as any other respiratory flu virus. The two main way of spread are:

         Through coughing or sneezing of people infected with the influenza virus

         Through hands contaminated when touching something with influenza viruses on it. The virus enters the body when people with contaminated hands touch their mouth, nose or eyes.

 

 

 

4. Recommendations

All airline personnel are advised to follow this guidance to prevent getting infected and spreading the disease. These recommendations are based on the current available knowledge and standard infection control and industrial hygiene practices. If properly implemented these practices will help protecting workers and delaying the spread of this newly emerged influenza virus via airline travel.

Airlines should ensure the availability of appropriate first-aid equipment and PPE supplies, cabin crew training in its use and general sanitary precautions in accordance with IATA standards and recommendations.

 

 

 

4.1 Hand Washing

Hand washing is an important and effective means of preventing the delivery of infectious material (e.g., nasal secretions, saliva or other body fluids that may contain viruses) from infected hands to the mouth, nose or eyes, where it can enter the body.

Wash your hands often with soap and water, especially after you cough or sneeze. Appropriate antiseptic hand rub solutions and gel are also equally effective. However, antiseptic solution alone should not be used when hands are visibly soiled. If hands are visibly soiled, soap and water should be used to clean the hands.

Avoid touching your nose, mouth or eyes with unclean hands.

 

 

 

Hands should be cleaned:

         After handling soiled material (e.g., used tissues, lavatory surfaces)

         After coughing or sneezing

         After using the toilet

         Before preparing food

         Before eating

         Before touching any part of your face

 

 

 

4.2 Cough Etiquette

Cover your nose and mouth with a tissue when you cough or sneeze. Use the sleeve of your shirt if tissue is not available. Throw the tissue in the trash after you use it. Wash your hands with  soap and water or use a hand disinfectant after you cough or sneeze.

 

 

 

4.3 Stay home if you are sick

If you get sick, or have flu symptoms described above, you are recommended to stay home from work and not to travel by air and limit contact with others to keep from infecting them.

 

 

 

4.4 Gloves

Crew members should wear disposable surgical gloves onboard aircraft if they need to have direct contact with potentially contaminated surfaces such as airplane seats, tray tables, and lavatories used by ill passengers. They should not touch their face with gloved or unwashed hands. Hands should be washed with soap and water immediately after removing the gloves.

Improper use of gloves may actually increase transmission. Gloves are not intended to replace proper hand hygiene. Gloves should not be washed or reused.

 

 

 

4.5 Surgical masks and High filtration masks

People with symptoms of influenza A (H1N1) should not fly. If symptoms of influenza A (H1N1) develop during the flight, the cabin crew should ensure that the ill person wear a surgical mask to reduce the number of droplets coughed or sneezed into the air. The crew assisting that person should also wear a surgical mask at a minimum, but ideally use a high filtration mask rated N-95 or higher. The optimal use of high filtration masks requires training and fit testing. It is important to note that a proper and effective seal of the high filtration mask could not be achieved in children and people with facial hair like beard. Proper use is recommended to maximize effectiveness. The use of surgical masks may be considered as an alternative to high filtration masks, although they might not be as effective as high filtration masks. While surgical masks provide barrier protection against droplet and contact transmission of the virus, they do notprotect against inhalation of very small airborne particles.

Disposable surgical mask and high filtration masks are not intended to be used more than once. They should also never be shared. It may be difficult for some workers in certain situations, such as cabin crew members on lengthy flights, to wear high filtration mask for extended periods of time and during physically heavy workloads.

 

If a cabin crew member or passenger is displaying signs and symptoms of influenza A (H1N1) prior to flight they should not board the aircraft, especially if they have been to an area with confirmed cases of influenza A (H1N1) or have history of close contact (within one metre) of an infected person.

If passengers or crew develop symptoms en route, they should cover their nose and mouth when coughing or sneezing, use tissues to contain respiratory secretions, dispose of used tissues in the nearest waste receptacle after use, and wear a surgical mask.

If a cabin crew develops symptoms of influenza A (H1N1) reallocation of cabin crew duties should be arranged if possible and measure should be taken to minimize.

Hands should be washed after contact with respiratory secretions or contaminated objects or materials. If a pilot becomes ill with the symptoms of influenza A (H1N1), all persons in the cockpit should wear masks.

 

 

 

4.6.1 Management of passengers or crew members with symptoms of influenza

         Cabin and flight deck crew should be aware of the possible symptoms of influenza A (H1N1) described above in section 2. To avoid possible transmission of the virus in the flight, crews should:

         Minimize the number of crews directly exposed to the ill person.

         Separate the ill person from others as much as possible. If possible keep a distance of one metre.

         It is recommended to establish and maintain an effective passenger tracing system in case any passenger is being relocated. This information is required by the Port Health officials on arrival.

         Have the ill person wear a surgical mask, to reduce the number of droplets coughed or sneezed into the air.

         If a surgical mask cannot be tolerated, provide tissues and ask the ill person to cover his or her mouth and nose when coughing or sneezing along with a plastic bag for proper disposal of contaminated tissues.

 

 

Surgical masks and high filtration masks do not provide complete protection from airborne germs and other contaminants. They are one part of an infection-control strategy that should also include frequent hand washing, social distancing, and staying home when sick.

These masks should not be shared. They may become contaminated with germs (viruses and bacteria) that can be spread between people.

It is important to understand that if you are exposed to infectious material while wearing a surgical mask and high filtration mask, it should be considered contaminated. Immediately remove it and dispose of it properly, wash your hands thoroughly with soap and water.

         Crews having close contact with an ill person should wear a surgical mask at a minimum or, ideally, high filtration mask rated N-95 or better.

         Dispose of soiled material, gloves, items contaminated with body fluids, and disposable surgical masks/high filtration masks in a plastic bag that is tied shut and not reopened, and disposed of according to the solid waste regulations.

         Crews should ensure that standard hand hygiene protocols are followed after attending to the ill person.

         If a person shows observable signs of influenza A (H1N1) illness while on a flight bound for the Maldives, the captain is required to report the illness to the air traffic control staff prior to arrival or as soon as illness is noted. Air traffic control officials will notify the port health officials in the airport and arrange for appropriate medical assistance to be available when the airplane lands.

Port health officials will work with the airline and airport staff to arrange for health screening, taking sample for testing, providing medication and transferring to a quarantine facility if the ill person meets these criteria. Port health staff will also take appropriate disease control and containment measures, passenger and crew notification and surveillance activities, and advice on airline disinfection procedures.

         The flight crew should ensure that the aircraft air conditioning/ventilation system stays on until all passengers and crew have disembarked in order to maximize continued removal of virus particles from the cabin air.

         For the benefit of airline crew and fellow passengers, transit passengers are also required to undergo screening in the Maldives and if they fit the criteria for a suspected case of influenza A (H1N1), they will be kept in quarantine.

 

 

 

4.7 Waste management

Potentially infectious waste or waste contaminated by secretions of a symptomatic passenger should be collected separately in a polythene bag and labeled with a biohazard sticker. Biohazard waste should be disposed as per the national guidelines.

 

 

 

4.8 Management of crew exposure after flight completed

Flight deck and cabin crew members and ground personnel who may have been exposed to a passenger or worker suspected of having influenza should monitor their health for 7 days after the exposure. If they become ill with influenza-like symptoms described in section 2 above, they should immediately take the following steps:

         Stay home except to seek medical care; do not report to work

         Notify their employer and National Emergency Operations Centre (Hotline: 3304829)

         Do not travel, unless it is critical to travel locally for health care

         Limit contact with others as much as possible

         When not alone or in a public place, wear a surgical mask to reduce the number of droplets coughed or sneezed into the air.

 

 

 

 

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