14.5 Transmissible, Quarantinable & Epidemic Diseases, the Universal Precaution Kit & Disinsection

Categories the syllabus distinguishes

The practical point for cabin crew is that the response is the same for any suspected case: contain, protect, report. Diagnosis is not a cabin crew function.

The universal precaution kit

Nig. CARs 7.9.1.11(b) requires:

• No person shall operate an aircraft that requires a cabin crew member unless it is equipped with at least one universal precaution kit;
• Contents shall comply with Implementing Standard IS 7.9.1.11;
• Each aircraft authorised to carry more than 250 passengers shall carry two kits, plus additional kits as determined by the Authority at times of increased public health risk, such as during an outbreak of a serious communicable disease with pandemic potential.

The kit is designed for the safe management of blood, vomit, urine, faeces and other body fluids. Typical contents include a dry powder or gelling agent to solidify liquid spillage, a germicidal disinfectant, skin wipes, face and eye masks, protective gloves and apron, an absorbent towel, a scoop and scraper, and biohazard waste bags with instructions.

Universal precautions means treating all blood and body fluids as potentially infectious, regardless of what is or is not known about the individual. Crew do not adjust their protection according to appearance, nationality, seat class or assumption.

Managing a suspected communicable disease case

The steps below are the internationally recognised sequence and are what an examiner will expect.

1. Recognise. Fever with one or more of: cough or difficulty breathing, persistent vomiting or diarrhoea, an unexplained rash, unexplained bruising or bleeding, jaundice, severe headache with a stiff neck, or a marked deterioration in a passenger who was well at boarding.
2. Contain. Relocate the passenger to an isolated area of the cabin where practicable, ideally with a row of empty seats around them and towards the rear. Offer a face mask if the passenger can tolerate it.
3. Designate one lavatory for the passenger's exclusive use, and place it out of use for others.
4. Designate one crew member to attend the passenger for the remainder of the flight, minimising the number of people exposed. That crew member wears gloves and a mask, and uses eye protection where indicated.
5. Protect and clean. Use the universal precaution kit for any spillage: gloves, mask, apron, solidify the liquid, disinfect, and seal all waste in the biohazard bags.
6. Record contacts. Note the passenger's seat and the seats of those seated nearby, since public health authorities may need to trace them.
7. Notify the flight deck immediately with the passenger's condition, symptoms, seat, and actions taken. The flight deck notifies air traffic control and the operator so that the destination public health authority can be told in advance and the aircraft met.
8. Complete the required documentation — the operator's medical event report and any public health declaration required at the destination.
9. Do not clean the affected area with normal service materials after landing; the aircraft may require specific cleaning, and ground staff and engineering must be told exactly where the contamination occurred.

Public health reporting

The reporting chain is fixed and worth memorising as a sequence: cabin crew to flight deck, flight deck to air traffic control and the operator, and the authorities to meet the aircraft. Advance notification is what allows the destination to have appropriate personnel and equipment at the stand rather than discovering the case at immigration.

Nigerian operators also apply national public health directives during outbreaks, which may add temperature screening, health declaration forms and additional protective equipment. Those directives sit on top of the standing requirements described here.

Aircraft disinsection

Disinsection is the treatment of the aircraft interior with an approved insecticide to kill insects that could transmit disease or establish themselves in a new territory. Certain States require it on arriving flights, and the requirement applies to the route rather than to the operator's preference.

Recognised methods include:

• Blocks-away spraying — aerosol applied in the cabin after doors close and before take-off;
• Top-of-descent spraying — applied in flight before arrival;
• Residual disinsection — a long-acting treatment applied to internal surfaces on a scheduled cycle;
• Pre-flight and top-of-descent combination, where a State requires both.

Cabin crew responsibilities: use only the approved product specified for the route; follow the method and dosage exactly, including the number of cans and the pattern of application; inform passengers before spraying begins, using the standard announcement; advise passengers who wish to cover their nose and mouth that they may do so; be alert for a passenger with respiratory symptoms and manage them; and retain the empty cans and the record where the destination requires proof of treatment. A crew member with a known sensitivity should raise it before the flight so the task can be reallocated.