Interim Guidance for U.S. Businesses, Employers, and Business Travelers to Prevent Exposures to Ebola

Key Points

• People in most business settings in the United States are not likely to have contact with people with Ebola or have direct contact with infected blood or body fluids.

• Businesses should educate employees about how Ebola is spread, avoid nonessential travel to countries with widespread Ebola transmission or uncertain control measures, develop plans and policies that include provisions for medical care and evacuation if necessary, and know the monitoring procedures of public health authorities.

• Business travelers should check CDC Travel Health Notices, find out about health and evacuation insurance coverage, update vaccinations and medications, pack health supplies, and practice health behaviors.

• Businesses should develop a communications plan, examine company policies and plans for working overseas, encourage employees to practice good hygiene, and consider flexible work arrangements for employees returning from travel who may be at risk.

There is no ongoing Ebola transmission in the United States. In accordance with CDC guidelines, passengers traveling from or through countries with widespread Ebola transmission or uncertain control measures are screened prior to exiting those countries outbreaks and again upon entering airports in the United States.

For Businesses

• Inform employees that the current risk of Ebola exposure is low in workplaces in the United States. Currently, most employees in the United States are not likely to contract Ebola.
• Educate employees about how Ebola is spread, what the symptoms are, and how to prevent exposure.
• Educate employees to not stigmatize people from countries with current or former widespread Ebola transmission. Fellow employees or people who have recently traveled are not considered at risk unless they have traveled to countries with widespread Ebola transmission or to a country with uncertain control measures.
• Avoid nonessential travel to countries with widespread Ebola transmission or uncertain control measures. Postpone employee travel to such areas, if possible. Consider alternative ways of doing business.
• Develop plans and examine policies for employees traveling to countries with Ebola outbreaks; ensure this includes provisions for employee medical care and evacuation if such action becomes necessary.
• Review plans and policies for employees returning from countries with widespread Ebola transmission or uncertain control measures; ensure they are consistent with CDC guidance and best available science. Address potential stigma toward returning travelers in the workplace.
• Know the monitoring procedures of public health authorities for returning travelers.

For Business Travelers

• Check CDC Travel Health Notices for the latest guidance and recommendations for each country to which you will travel.
• If you must travel to an area with widespread Ebola transmission, follow the CDC Humanitarian Aid Guidance.
• Find out about health and evacuation insurance coverage. Have information about your employer’s plan for medical care or evacuation available during your trip.
• Visit a health care provider to update your vaccinations and medicines before your trip.
• Pack health supplies. Put together a travel health kit containing items such as over-the-counter medications, a thermometer, alcohol-based hand sanitizer, and basic first aid items.
• Practice healthy behaviors. Wash your hands often or use hand sanitizer and avoid touching your eyes, nose, or mouth. Avoid contact with people who are sick and do not touch objects or surfaces contaminated with blood or body fluids.

Avoid Nonessential Travel

CDC recommends avoiding nonessential travel, including business-related travel, to countries with widespread Ebola transmission or uncertain control measures in order to help control outbreaks and prevent continued spread of Ebola.

Even if employees are not planning to be in contact with people with Ebola (such as in healthcare settings), it is still important to consider the potential implications of an Ebola outbreak for their overall safety.

For example, employees injured in a motor vehicle crash may be sent to a hospital where patients with Ebola are cared for, which could put the employees at risk for infection. Also, because the healthcare systems in countries with Ebola outbreaks are severely strained, resources may not be available to treat either routine or emergency health needs of visiting U.S. citizens.

Guidance for U.S. Businesses

General recommendations

• Encourage employees to always practice good hand hygiene and other basic hygiene practices. This will help prevent the spread of many infectious diseases, including Ebola.
  • Provide employees with the tools they need to practice good hand hygiene, including soap and clean running water, or alcohol-based hand sanitizers containing at least 60% alcohol. Proper handwashing techniques should be followed.
  • Ensure employees do not come to work if they are sick; consider providing flexible leave policies and work arrangements.
• Continue routine cleaning procedures in the workplace.
• Do not handle or touch any objects or surfaces contaminated with blood or body fluids, especially from sick employees.
• Develop and start implementing an Ebola communication plan.
  • Provide accurate, reliable, and clear information about Ebola to all employees.
  • Educate employees that the risk of contracting Ebola in the United States is low.
  • Communicate clearly the low risk of exposure in nonhealthcare U.S. workplaces, which may help reduce workplace stress, anxiety, and stigmatization of staff from countries with Ebola outbreaks, and staff recently returned from countries with Ebola outbreaks.
• Communicate clearly about the public health monitoring procedures for returning travelers from areas with widespread Ebola transmission or uncertain control measures if you have employees who have recently traveled to these countries.

Recommendations if someone is potentially sick

• Develop a plan to manage this unlikely scenario: an employee or customer with an Ebola exposure history develops symptoms consistent with Ebola in the workplace. An individual with an Ebola exposure history has had one or more of the following experiences within the last 21 days: 1) lived in or traveled to a country with widespread transmission or to a country with uncertain control measures; 2) had contact with an individual with confirmed Ebola; or 3) has been identified by public health authorities as a contact to a patient with confirmed Ebola.

Train employees on the plan, which includes these steps:

1. Isolate the employee or customer and the area where he or she became sick. Tell the other employees and customers to avoid the person who is sick and the area where he or she became sick.
2. Notify the state or local health department and the occupational health clinic, if available. If medical attention is needed, call 9-1-1. Work with local public health authorities to determine if additional action is needed.
3. Prevent contact with potentially infectious body fluids such as blood, feces, or vomit. Only trained professionals with the proper personal protective equipment (PPE) are to clean up contaminated surfaces and potentially infectious body fluids.
   • A qualified, trained professional or contract company is specialized in cleaning, handling, and discarding toxic chemicals and infectious agents, such as a company with experience in cleaning biohazard or crime scenes, and complies with all health and safety regulations.
     • • The state or local health department or local assigned authorities can assist in finding a qualified, trained professional or contract company for cleaning the workplace, if needed.
4. Make a record of everyone who came into contact with the sick employee or customer, and any potentially infectious body fluids. The state or local health department may need this information to help reach others who may have been exposed.

Considerations for Working Overseas

Examine company policies and plans

If work requires employees to travel to countries with Ebola outbreaks, businesses are encouraged to examine their existing policies concerning international travel, to explore ways of protecting the health of traveling employees, and to incorporate information from this document into educational and training materials for employees. Businesses and employees can also access information available from agencies and organizations responding to the outbreak, many of which are linked at the bottom of this page.

Businesses need to develop plans for dealing with an employee who may become seriously ill while working for the company overseas. Before employees travel, determine the availability of housing, medical care, hospitals, and security at the destination. Companies also need to make arrangements for travel insurance and medical evacuations. CDC recommends that everyone traveling to countries where outbreaks of Ebola are occurring has full healthcare insurance coverage, including coverage for emergency medical evacuation.

• Information about medical evacuation services can be found on the U.S. Department of State’s Air Ambulance/MedEvac/Medical Escort Providers page.
• Some insurance providers are excluding medical evacuation coverage for people with Ebola. Check with providers to ensure employees have the coverage they need.
• Be sure to check coverage limits for evacuation insurance. Also, check to see if the policy covers evacuation to the United States or to the nearest location where adequate medical care is offered.

Check current travel health information

• Companies and travelers can check CDC’s Travel Health Notices for the latest guidance and recommendations for each country, including information about the health screening of incoming and outgoing travelers and restrictions on travel within countries.
• If travel is not recommended (avoidance of nonessential travel), then companies should, whenever possible, consider alternative ways of doing business (such as use of teleconferencing).
• Due to the complicated nature of the Ebola outbreak, businesses need to consider that the outbreak could continue for an extended period of time and that CDC’s recommendation to avoid nonessential travel may remain in place for as long as the outbreak lasts.
• Pay attention to the situation in all countries. At this time, there is no known risk of contracting Ebola in countries where Ebola cases have not been reported. Check the Ebola webpage often for the most recent information.
• To stay up-to-date, check reliable news sources, stay in touch with your local business contacts, and check for updated information on CDC’s Travelers’ Health website.

Implications of traveling to countries with Ebola outbreaks

• The U.S. Department of State takes actions through a number of diplomatic channels to protect U.S. citizens who travel outside the United States. However, during an outbreak, any country may enact measures to protect its citizens and to prevent the spread of an outbreak to other countries such as quarantining exposed people, isolating sick people, and screening people entering or exiting the country for sickness or disease exposure. These measures may affect U.S. citizens who appear to be infected with, or may have been exposed to, a serious contagious disease. The ability of the U.S. Department of State to intervene in such situations may be limited. For more information, see U.S. Department of State’s Emergency Resources.
• Enroll in the Department of State’s Smart Traveler Enrollment Program (STEP), a free service that allows U.S. citizens and nationals travelling abroad to register their trip with the nearest U.S. Embassy or Consulate.
• Traveling to countries with Ebola outbreaks could affect employees’ ability to return home. Travelers may be screened for symptoms of Ebola at the airports as they depart countries with Ebola outbreaks and upon entry to the United States. As part of the screening process, travelers departing from countries with widespread Ebola transmission or uncertain control measures and entering the United States are checked for fever and other symptoms and are asked if they have had any exposures to Ebola. Those who are sick with symptoms of Ebola will not be allowed to travel on commercial flights to the United States or potentially to other countries. These travelers may need to be medically evacuated to receive needed care. Businesses can find additional details in CDC’s Monitoring and Movement Guidance.

Recommendations for returning employees

• Employees need to follow the appropriate public health actions for monitoring for Ebola according to their exposure level or risk while traveling to – areas with Ebola outbreaks.
  • Active monitoring means that public health workers are responsible for checking at least once a day to see if people in the “high,” “some,” and “low” risk levels have a fever or other symptoms of Ebola.
  • Direct active monitoring means that public health workers will make a direct observation at least once a day to see if people have a fever or other symptoms. An example of direct observation is an in-person visit.
• Employees in the “high,” “some,” and “low” risk categories are subject to active monitoring or direct active monitoring by state or local health departments and may have additional restrictions placed on them by these health departments regarding work, travel, public transportation, or large gatherings. There are no active monitoring or direct active monitoring requirements for employees in the “no risk” category.

Recommendations for employers

• If an employee falls into a risk category that could affect his or her ability to be present at work, employers can consider providing more flexible work arrangements, such as working from home, during the active monitoring period. If employees cannot work from home, consider implementing policies that provide full salary and benefits for the time they are required to be away from work.
• Provide returning employees access to mental health counseling, if needed, to assist with their transition back to the United States.
• Educate supervisors and coworkers that the risk of getting an Ebola infection in the workplace from employees returning from countries with Ebola outbreaks is low, especially if they do not have Ebola symptoms. Teach staff about how Ebola is spread, what the symptoms are, and how to prevent exposure. Also, educate them not to stigmatize people from countries with an Ebola outbreak. Fellow employees or people who travel, except to countries with widespread transmission of Ebola or countries with uncertain control measures, are not considered at risk.
• Make sure your business has continuity plans so operations can continue even if some key staff members are unable to work.

Resources

CDC guidance

• Monitoring and Movement Guidance
• Monitoring and Movement Fact Sheet
• Questions and Answers about CDC’s Ebola Movement & Monitoring Guidance
• Humanitarian Aid Organization Guidance
• Humanitarian Aid Worker Guidance
• Questions and Answers on Ebola
• Proper handwashing techniqueswww.cdc.gov/handwashing/
• Workplace Safety and Health, Ebola
• U.S. Residence Decontamination
• Ambulatory Care Evaluation of Patients with Ebola
• State Ebola Protocols
• EMS systems and 9-1-1 Public Safety Answering Points for Management of Patients Under Investigation for Ebola Virus Disease

CDC infographics

• Facts about Ebola in the United States
• Facts about Ebola in the United States (Spanish version)

CDC Travelers’ Health

• Travelers’ Health
• Travel notices
• Can I Eat This? Mobile app
• Health information for international travel (the Yellow Book)
• Infographics for Travelers

CDC for business travelers

• Business Travel
• Find a Clinic
• Pack Smart
• Last-Minute Travelers
• Your Survival Guide to Safe and Healthy Travel
• Travel health topic fact sheets
• Travel insurance information

From other Federal agencies and partners

• Department of State:
  • Air Ambulance/MedEvac/Medical Escort Providers
  • Emergency Resources
• Occupational Safety and Health Administration (OSHA):
  • Ebola topic page
  • Cleaning and Decontamination of Ebola on Surfaces
  • Safe Handling, Treatment, Transport, and Disposal of Ebola-Contaminated Waste
• World Health Organization (WHO):
  • Ebola virus disease
  • Infographic, Travel to and from Evola-affected countries: What you need to know
  • Interim guidance for international meetings