Managing the Threat of Anthrax in
Occupational Health Principles
Health and Safety Branch
The Hague, The Netherlands
attacks within the United States of America resulted in 12 cases of
anthrax infection. In addition, thousands of subsequent hoaxes and false
alarms have caused severe disruptions throughout the US and in other
nations. This paper describes how application of the standard principles
of risk management and occupational health can be applied to address
the issue of potential biohazards in the mail. These principles were
successfully implemented by the Health and Safety, Security, and Mailroom
staff of the OPCW (Organisation for the Prohibition of Chemical Weapons)
in The Hague, and were able to prevent disruption from a number of false
alarm incidents, that might otherwise have caused significant impact.
In the post-9/11
climate, the high profile media coverage of the US anthrax attacks caused
fear and concern to mail workers and other staff around the globe. This
was intensified in many international organisations, due to their higher
visibility and international profile. Most organisations found themselves
having to assess and manage a completely new type of threat, and one
for which little previous experience was available. As was the case
with many other international organisations, the Management of the Technical
Secretariat of the OPCW decided that the threat and the concomitant
concerns of staff had to be taken seriously. The question, though, was
what steps to take. The standard steps of the risk management process
provided a structure for action.
step was to identify the potential hazards and to assess the related
risks. At that time, delivered mail (including a good deal of personal
mail) was received in a location inside the main administrative building.
Mail clerks then opened the official mail for registration, and delivered
it together with unopened private mail to respective addressees. Delivery
of Anthrax tainted mail opened within the mailroom or offices would
have resulted in an exposure of the staff present in the room, potential
contamination of the entire building, an immediate building evacuation,
and the associated cleanup costs. Mailroom and other staff may have
had to undergo personal decontamination and begin medical treatment
with antibiotics. An important consideration was that even a false alarm
or hoax would have had similar impact for the initial investigative
phases before an all-clear could be announced. This would include building
evacuation, the need for prophylactic antibiotics, and the psychological
issues associated with such an event.
hazards had been identified, and the risks assessed, the second step
was to develop appropriate risk control measures to reduce the identified
risks to an acceptable level. Possible attitudes could have been:
- "Find out what others are doing, and copy the best solution."
- "Ignore the problem and hope nothing happens."
- "Develop a plan, applying the principles of occupational safety."
Many organisations at this time primarily used Individual Protective
Equipment for the mail handlers as the only method of risk reduction.
Although a seemingly obvious solution, the provision of individual protective
equipment to the mailroom personnel would actually not have solved any
of the problems related to an actual or suspected contamination of the
building. Additionally, the protection provided even by well-fitted
air-filtrating respirators (AFR) is rather low (protection factor (PF)
50 - 400 depending on the type of AFR). A number of other solutions
encountered (such as radiating the mail with high energy particle radiation,
or treatment with formaldehyde vapours) would have been potentially
destructive to the mail, or just too expensive and technically too extravagant
in relation to the available means, and in relation to the level of
Taking potential costs into account, and particularly if one only uses
the objectively assessed risk of an actual attack as an indicator, the
approach of implementing none of the potential solutions and to conduct
business as normal could be adopted. However this does not take into
account the concerns of staff, and may be perceived as a "shoot the
messenger" type of attitude. An employer has the obligation to address
the concerns of employees even if they are related to low probability
events. In this case, the high media visibility of the Anthrax scares,
and the understandable fears this generated in millions of people around
the world, had to be taken into account. The impact even of a false
alarm or hoax on unprotected personnel could have been days of uncertainty
and fear, since the "all-clear" time might have taken that long.
After examining the alternatives, it was decided that application of
the basic principles of occupational health would be effective. By first
introducing administrative and engineering controls, it is possible
to eliminate the requirement for IPE for most staff, and to minimise
it for the few remaining people that have a reduced potential risk to
deal with. This was achieved in the following way:
- the entire mail-handling process was relocated to an available external
facility, that importantly was not connected to the ventilation system
of the headquarters building (administrative control). A mobile fume
cabinet usually used for the analysis of highly toxic substances,
was installed to provide a safe working area in which to open all
mail (engineering control). The cabinet, although not Bio Safety Level
(BSL) 4 rated, is equipped with a HEPA filter (99.99% efficiency at
0.3 micron) and a variable airflow (0.25 - 1.00 m/sec), capable of
providing containment equivalent to the BSL 4 requirements.
- further administrative controls were then implemented requiring
that all mail be x-rayed (to detect weapons, explosives, etc.) prior
to being transported to the auxiliary building, prohibiting any unopened
mail from entering the main building, and implementing a phased process
requiring all employees to begin making arrangements to reduce the
amount of personal mail received at work. Mailroom personnel were
trained in the use of the fume cabinet.
controls used in the contained mail-opening process consist of plastic
bags for the collection and transport of envelopes, and a small quantity
of decontamination solution and a shallow tray located within the cabinet
to allow for the immediate decontamination of suspicious mail. All surfaces
within the fume cabinet are easily cleaned and disinfected. The only
individual protective equipment required is a pair of impermeable gloves
worn by the clerk actually opening the mail inside the fume cabinet.
Respiratory protection is not required due to the efficiency of the
cabinet HEPA filter system (PF > 10.000).
this approach, two subsequent false alarms incidents were detected and
managed before the suspicious mail reached the main building. In both
cases there was no disruption of operations. The necessary actions were
initiated quickly, at minimal cost, using resources that were immediately
available. Finally, and perhaps most importantly, the staff that are
actually involved with the mail opening operations are reassured that
their employer is concerned with their welfare, and they expressed their
satisfaction with the solution that was implemented.
Editor's Note: Claus-Peter Polster's paper and presentation at
the CBMTS IV were outstanding. For additional information on this area,
please contact Claus-Peter at the Health and Safety Branch, The OPCW
in the Hague: tel: 31-70-376 1700, fax: 31-70-360-0944 and e-mail: firstname.lastname@example.org.