Preventing Spread of Disease on Commercial Aircraft: Guidance for Cabin Crew

 

Purpose

This guidance provides cabin crew with practical methods to protect themselves, passengers, and other crew members when someone onboard is sick with a possible contagious disease. Included are instructions to protect yourself and others, manage a sick traveler, clean contaminated areas, and take actions after flight.

When interacting with a sick and potentially infectious traveler (passenger or crew), follow the steps in this guidance to reduce the risk of onboard disease transmission. Be sure to follow your company’s policy for managing in-flight medical emergencies.

This general guidance is NOT designed for:

Non-contagious illnesses or emergencies such as chest pain, possible stroke, asthma, or diabetic complications.

Key points

• Practice routine handwashing
• Identify sick and potentially infectious travelers
• Treat all body fluids (such as diarrhea, vomit, or blood) like they are infectious
• Wear recommended personal protective equipment (PPE)
• Clean and disinfect contaminated areas
• Dispose waste using recommended procedures

Since an illness is not yet known to be contagious when symptoms first appear, treat any body fluids (such as diarrhea, vomit, or blood) as potentially infectious. Once you identify a sick and potentially infectious passenger, use appropriate infection control measures.

Suspect a contagious disease when a traveler (passenger or crew) has:

1. A fever (a measured temperature of 100.4 °F [38 °C] or greater, or feels warm to the touch, or gives a history of feeling feverish) and one or more of these signs or symptoms:
   • skin rash
   • difficulty breathing
   • persistent cough
   • decreased consciousness or confusion of recent onset
   • new unexplained bruising or bleeding (without previous injury)
   • persistent diarrhea
   • persistent vomiting (other than air sickness)
   • headache with stiff neck, or
   • appears obviously unwell;

OR

2. Has a fever that has persisted for more than 48 hours

OR

3. Has symptoms or other indications of communicable disease, as the CDC may announce through posting of a notice in the Federal Register.

The U.S. Code of Federal Regulations [42 CFR 70.11 and 71.21] contain requirements for reporting death and illness to CDC that occur on domestic flights between U.S. states and territories, and on international flights arriving to the United States.

Protecting yourself and others

• Treat all body fluids (such as diarrhea, vomit, or blood) like they are infectious.
• Handwashing is the single most important infection control measure.
  • Wash hands often with soap and water for at least 20 seconds after assisting sick travelers or touching potentially contaminated body fluids or surfaces. Also, wash hands when visibly soiled.
  • Use alcohol-based hand rub (containing at least 60% alcohol) if soap and water are not available.
  • Avoid touching your mouth, eyes, and nose with unwashed or gloved hands.

Personal protective equipment (PPE)

• Protect yourself by using PPE, found in the universal precaution kit [PDF – 1 page] (UPK), when tending to a sick traveler. After use, PPE must be carefully removed to avoid contaminating your skin or clothing. Soiled items must be placed in a biohazard bag (or plastic bag labeled “biohazard” if biohazard bag not available).
• Always wash hands or use an alcohol-based hand rub after removing PPE.

Disposable gloves (Gloves don’t replace proper handwashing.)

• Wear disposable gloves when:
  • tending to a sick traveler
  • touching body fluids (such as blood, vomit, or diarrhea)
  • touching potentially contaminated surfaces, such as in bathrooms
• Remove gloves carefully [PDF – 1 page] to avoid contaminating yourself or your clothing.
• Properly dispose soiled gloves in a biohazard bag (or plastic bag labeled biohazard if none available); do not reuse gloves.
• After removing gloves, wash your hands with soap and water or use an alcohol-based hand rub.

Facemasks

• Facemasks should be considered:
  • for crew when you are helping sick travelers with respiratory symptoms such as coughing or sneezing
  • for sick travelers to help reduce the spread of respiratory germs
  • for people sitting near sick travelers (with respiratory symptoms) when the sick traveler cannot tolerate wearing a mask
• Facemasks are NOT needed:
  • for a sick traveler complaining of nausea or vomiting. This could result in choking or a blocked airway.
  • for sick travelers who can’t tolerate a facemask or refuse one. In this case, ask sick travelers to cover their coughs or sneezes.

• Minimize the number of people directly exposed to sick travelers. If possible, designate one crew member to interact with the sick traveler.
• Keep interactions with sick travelers as brief as possible. Provide a plastic bag for disposal of used tissues, air sickness bag(s), or other contaminated items.
• Encourage sick travelers to wash their hands or use an alcohol-based hand rub (if available).
• If possible, separate the sick traveler from others by 6 feet or move adjacent passengers without compromising flight safety or exposing additional passengers.
• Use infection control measures based on symptoms:

 

Possible Symptoms	Illness Category (examples of possible diseases transmitted)	How Infection Spreads	Infection Control Measures (use in addition to general infection control measures)
Coughing, sneezing, fever, rash, or difficulty breathing	Respiratory (e.g., measles, tuberculosis, influenza, whooping cough [pertussis], meningococcal disease and Middle East Respiratory Syndrome [MERS])	Via droplets in the air or from contact with contaminated surfaces	Ask sick travelers to cover their mouth with a tissue if coughing or sneezing. Offer a facemask for persistent cough, if available, but don’t give masks to travelers who say they are nauseated or vomiting due to risk of choking.
Nausea, stomach pain, vomiting, fever, or diarrhea	Gastrointestinal (e.g., norovirus and cholera)	Contact with contaminated surfaces, stool or vomit, or from contaminated food or water	Seat sick travelers with diarrhea or vomiting close to a bathroom, if possible. Restrict the use of that bathroom to only sick traveler(s), if possible. Disinfect, per company policy, if restriction is not possible. Provide air-sickness bags if travelers say they are nauseated or vomiting.
Visible bleeding, whether due to injury or not	Bloodborne (e.g., HIV, hepatitis B and C, and viral hemorrhagic fevers, including Ebola)	Contact with open cuts, scrapes, or mucous membranes (lining of mouth, eyes, or nose).	If sick travelers are actively bleeding, such as from an injury or nosebleed, provide first aid according to your airline’s guidelines. Provide towels, tissues, or other items to absorb blood, if possible. Refer to OSHA’s Bloodborne Pathogens Fact Sheet [ PDF – 2 pages ] for more information.

Reporting illness or death

Reporting illness or death is required as per federal regulations. Crew need to report to the pilot all sick travelers with certain symptoms on flights to or within the United States as soon as possible. Refer to the CDC Death and Disease Reporting Tool for information on reportable illnesses. For assistance, contact the CDC Quarantine Station closest to your arrival city.

Targeting clean-up in-flight

• Employees should put on PPE in the UPK before cleaning or disinfecting any area.
• Take the following actions in areas contaminated with diarrhea, vomit, blood, or other body fluids.
  • For hard (nonporous) surfaces such as tray tables, TV monitors, seat arms, windows, and walls:  remove any visible contamination and clean and disinfect the area with products approved by your company.
  • For soft (porous) surfaces such as carpeted floor or seat cushions: remove as much of the contaminant as possible, cover the area with an absorbent substance, and contain the area as much as possible. Remove the absorbent substance and any remaining material, and then clean and disinfect the area with products approved by your company.

Bagging and disposal

• Carefully place all contaminated items inside a biohazard bag (or plastic bag labeled “biohazard” if none available). Tie or tape the bag shut securely to avoid leaking. Keep the bag in a secure place until it can be safely collected for disposal.
• Dispose all waste according to your company policy.
• For areas not contaminated with diarrhea, vomit, blood, or other body fluids, routine cleaning and disinfection should be performed.

Post-flight measures

• Properly dispose contaminated items. Notify cleaning crew of areas contaminated with diarrhea, vomit, blood, or other body fluids, needing more than routine cleaning or possible removal. For example:
  • Soft materials (e.g., seat cushion)
  • Hard surfaces like arm rests and tray tables
  • Bathroom(s) used by sick traveler
• Remind cleaning crew this situation may require additional PPE, and they should follow company policy for such situations.
  • If the sick traveler changed seats, ensure both areas are adequately cleaned.
• Consult a healthcare provider, as needed.
  • Risk of infection depends on many factors, including the type of disease, flight duration, level of exposure, and your level of immunity.
  • Follow company policy for reporting contact with a sick passenger or potentially infectious materials such as items contaminated with diarrhea, vomit, blood, or other body fluids.
  • After the flight, you could choose to consult with your private healthcare provider if you develop symptoms (such as fever, rash, persistent cough, vomiting, or diarrhea) or have other concerns that have not been addressed.
  • CDC will collaborate with your airline’s occupational medicine consultant to provide guidance for certain confirmed infectious diseases, such as measles.
  • The state health department where your flight arrived or where you live may also contact you to ensure your well-being and prevent further spread of the identified contagious disease.

Sick crew members

If you have a possible contagious illness, please follow your company policy and don’t report to work until you have recovered to avoid exposing others. If you develop symptoms of a contagious illness during flight, discontinue your work duties as soon as it is safe to do so and follow the procedures outlined for sick passengers. Do not prepare or serve food or beverages if you have symptoms of illness that could be contagious.

Immunizations and healthy travel tips

Be prepared. Many contagious diseases can be prevented by vaccines. To protect yourself, be up-to-date on all routine immunizations, as well as recommended immunizations and other preventive measures, such as preventive treatment for malaria, specific to your destination(s). Check out CDC’s Traveler Information Center on common topics, Advice for Air Crews and travel health notices for disease outbreaks.

• Get vaccinated
• Postpone travel when you’re sick
• Follow healthy travel tips
• Read travel health notices