Campylobacter

Infection and Exposures 

Among Employees at a 

Poultry Processing Plant 

— Virginia

Marie A. de Perio, MD

John D. Gibbins, DVM, MPH

R. Todd Niemeier, MS, CIH

Health Hazard Evaluation Report

HETA 2011-0058-3157

April 2012

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

Workplace

Safety and Health

 National Institute for Occupational 

Safety and Health
The employer shall post a copy of this report 

for a period of 30 calendar days at or near 

the workplace(s) of affected employees. The 

employer shall take steps to insure that the 

posted determinations are not altered, defaced, 

or covered by other material during such 

period. [37 FR 23640, November 7, 1972, as 

amended at 45 FR 2653, January 14, 1980].
Health Hazard Evaluation Report 2011-0058-3157 Page i

Contents

RepoRt Abbreviations ................................................................................................ii

Highlights of the NIOSH Health Hazard Evaluation ........................iii

Summary .........................................................................................................v

Introduction ...................................................................................................1

Assessment .....................................................................................................5

Results ..............................................................................................................8

Discussion .................................................................................................... 17

Conclusions ................................................................................................. 20

Recommendations .................................................................................... 20

References .................................................................................................... 25

Appendix Hand Hygiene Signs ................................................................................. 29

ACknowledgments Acknowledgments and Availability of Report ................................ 31
Page ii Health Hazard Evaluation Report 2011-0058-3157

AbbReviAtions

CFR Code of Federal Regulations

CI Confidence interval

EIA Enzyme immunoassay

FSIS Food Safety and Inspection Service

GBS Guillain-Barré syndrome

HACCP Hazard analysis and critical control points

HHE Health hazard evaluation

HVAC Heating, ventilating, and air-conditioning

mL Milliliter

NAICS North American Industry Classification System

NIOSH National Institute for Occupational Safety and Health

OSHA Occupational Safety and Health Administration

PCR Polymerase chain reaction

PPE Personal protective equipment

ppm Parts per million

RR Relative risk

USDA U.S. Department of Agriculture
Health Hazard Evaluation Report 2011-0058-3157 Page iii

HigHligHts of tHe

niosH H What NIOSH Did eAltH

H e

● We visited the plant in May 2011.

AzARd vAluAtion

● We observed work practices and interviewed 88 employees.

● We reviewed records from the medical office at the plant.

● We evaluated the ventilation in the live hang area.

● We reviewed the water testing program for chlorine.

● We reviewed the chicken carcass testing program for 

Campylobacter. The National Institute for 

Occupational Safety and 

Health (NIOSH) received a 

health hazard evaluation 

request from management 

representatives at a 

poultry processing plant 

in Virginia. The request 

concerned the occurrence 

of Campylobacter

infections, which can 

cause diarrheal illness 

among employees, 

especially among live 

hang area employees.

● We reviewed the records from the cases of Campylobacter

infection at the plant.

What NIOSH Found

● We found 29 confirmed cases of Campylobacter infection 

among plant employees over 31⁄2 years.

● Most infected employees worked at the plant for less than a 

month, worked in the receiving/live hang area, and lived at a 

state-operated diversion center.

● Many employees reported that they had had diarrhea at some 

time between January and May 2011. Many did not report 

their illness to the plant.

● Supply air vents in the live hang area were above the heads of 

employees. The vents directed air down toward the conveyer 

belt. This may spread contamination.

● Chlorine levels in the chillers that were recorded by the plant 

were within USDA requirements.

● Employees had to buy some personal protective equipment (PPE).

What Managers Can Do

● Reduce Campylobacter contamination in the plant through 

improved sanitation and other engineering controls. The live 

hang area should be the initial focus of these efforts.

● Consider redirecting airflow from the ducts in the live hang 

area away from live chickens. This change should reduce the 

potential for spreading contamination.

● Improve employee training on hand washing and PPE use.

● Give employees all of the PPE that their jobs require free 

of charge.
Page iv Health Hazard Evaluation Report 2011-0058-3157

HigHligHts of tHe

niosH HeAltH What Employees Can Do

●

HAzARd e Wash your hands before and after work, breaks, smoking, vAluAtion contact with chickens and chicken products, and PPE use.

 (Continued) ● Wear PPE as directed.

 ● Inform the medical office in the plant if you have diarrhea.
Health Hazard Evaluation Report 2011-0058-3157 Page v

NIOSH investigators 

examined the occurrence 

of Campylobacter 

infection among 

employees at a poultry 

processing plant. We 

found 29 cases of 

laboratory-confirmed 

Campylobacter infection 

among employees during 

a 31⁄2-year period. On the 

basis of our interviews 

with employees, 

gastrointestinal illness 

appeared to be common, 

yet underreported.

SummAR

In February 2011, we received an 

representatives at a poultry process

request concerned the occurrence 

among employees, especially amon

area of the plant.

During our visit to the plant in May 2011, we reviewed work 

procedures and training materials for employees and records 

from the plant medical office. We learned more about the plant’s 

ventilation system and its environmental sampling program for 

chlorine and Campylobacter. We also interviewed 88 employees 

and observed work practices. We reviewed the confirmed cases of 

Campylobacter infection among plant employees.

We found 29 cases of laboratory-confirmed Campylobacter infection 

among plant employees during a 31⁄2-year period. Most of these 

employees worked in the live hang area, worked at the plant for 

less than a month before illness onset, and were residents of a 

diversion center (a residential program operated by the Virginia 

Department of Corrections). We also found that approximately 

15% of more than 3,000 encounters at the plant’s medical office 

from January 2010 through September 2011 were related to 

gastrointestinal symptoms. In addition, almost one third of the 

88 employees interviewed reported being ill with gastrointestinal 

symptoms in a 5-month period before the interview, and fewer 

than half of these employees reported their illness to the plant. 

Therefore, gastrointestinal illness was quite common and appeared 

to be underreported. The absence of paid sick leave may have 

played a role in this underreporting. Of all employees, receiving/

live hang area employees appeared to be particularly affected by 

gastrointestinal illness. We also observed inconsistent hand hygiene 

and PPE use in the live hang area; these observations agreed with 

the self-reported practices of interviewed employees. Employees 

also reported having to pay for some PPE.

We observed that the ventilation system had 20 supply air vents 

above the heads of the live hang area employees. These vents 

directed air at a downward angle toward the conveyor where the 

chickens were located before they were shackled. This could have 

led to the potential to aerosolize or spread potential contamination 

from the birds to the live hang area employees. Chlorine levels in 

the water immersion chillers, as reported on the company logs, 

were within the USDA requirement of 20–50 ppm.

HHE request from employer 

ing plant in Virginia. The 

of Campylobacter infections 

g those working in the live hang 
Page vi Health Hazard Evaluation Report 2011-0058-3157

summARy

 ( A health hazard from Campylobacter infection exists in this Continued) plant. Efforts to reduce Campylobacter contamination in the 

plant, particularly in the receiving/live hang area, should be 

strengthened. Such efforts should include improved sanitation and 

the use of other engineering controls, including redirecting airflow 

from the ducts in the live hang area away from the live birds. 

Training and compliance with hand hygiene and PPE use should 

also be improved.

Keywords: NAICS 311615 (Poultry Processing), Campylobacter, 

campylobacteriosis, infection, poultry processing, diarrhea, 

gastrointestinal, Hispanic workforce 
Health Hazard Evaluation Report 2011-0058-3157 Page 1

IntRoduCtio

In February 2011, NIOSH received an HHE request from 

management representatives at a poultry processing plant in 

Virginia. The request, suggested by the Virginia Department of 

Health, concerned the occurrence of Campylobacter infections 

among employees, especially among those working in the live hang

area of the plant.

In May 2011, we visited the plant and observed work processes, 

work practices, and workplace conditions. We interviewed plant 

employees, reviewed the encounter records from the plant’s 

medical office, and reviewed work procedures and health and 

safety-related policies and training materials. We learned more 

about the plant’s ventilation system and environmental sampling 

program for Campylobacter and chlorine and measured air flow in 

the live hang area. We also reviewed medical and work records of 

current and former plant employees diagnosed with confirmed 

Campylobacter infection.

Poultry Processing Operations

At the time of our visit, the plant in Virginia was one of several 

plants operated by the poultry processing company across the 

country. The plant processed approximately 1.6 million pounds 

of chicken, or an estimated 300,000–350,000 birds, per day. 

Chickens were transported in crates to the plant after a growth 

period on the farm. The plant comprised two processing areas. 

In “first processing,” birds were unloaded, shackled, stunned, 

killed, scalded, defeathered, eviscerated, and chilled in large 

water immersion chillers. In “second processing,” the carcasses 

were rehung, washed, cooled, and packaged. Further processing, 

including breast deboning, was also performed at the plant. A new

live hang area opened in January 2011 and was in operation when 

we visited the plant. However, the new break room and locker 

room adjacent to this area were not yet operational.

The plant employed approximately 1,000 individuals who typically 

worked 8-hour shifts. Employees were not unionized at this plant. 

Approximately 450 employees worked on the first shift, 375 on 

the second shift, and 175 on the third shift. Employees working 

the first and second shifts processed the chicken, while employees 

working the third shift performed duties related to shipping, 

maintenance, and sanitation. The areas employing the largest 

numbers of employees were the breast debone and second and 
Page 2 Health Hazard Evaluation Report 2011-0058-3157

Introduct

 (continued) further processing departments. The receiving area, which also

contained the live hang area, employed 29–31 individuals per shift, 

and this typically included 22–24 live hangers and 7 employees 

who worked either in the receiving yard or kill rooms.

At the time of our evaluation, the poultry processing plant had 

an agreement with the Virginia Department of Corrections to 

provide an opportunity for residents of two local diversion centers 

to work and earn salaries for part of their sentence. These diversion 

centers offered a 24-week residential program for nonviolent 

offenders sentenced in Virginia circuit courts. Diversion Center 

A housed approximately 108 inmates, while Diversion Center B 

housed approximately 80 inmates. A typical work assignment lasted 

16 weeks, and diversion center residents paid room and board, 

transportation, and a portion of their medical insurance. Diversion 

center residents were assigned to this and other poultry processing 

plants, manufacturing companies, fast food establishments, diversion 

center farms, or grounds keeping. The plant employed approximately 

24–35 residents from the diversion centers at any given time.

Background on Campylobacter Infection 

Campylobacter infection, or campylobacteriosis, is an infectious 

disease caused by bacteria of the genus, Campylobacter. 

Campylobacter is the one of the most common bacterial causes of 

gastrointestinal infection in the United States. It is most often 

associated with sporadic cases of illness rather than outbreaks. 

In 2010, the Foodborne Diseases Active Surveillance Network 

estimated about 14 cases are diagnosed each year for each 100,000 

persons in the United States [CDC 2011b]. Campylobacteriosis 

is estimated to affect 2.4 million persons each year [CDC 2011b]. 

Most human Campylobacter infections are caused by Campylobacter

jejuni [Friedman et al. 2000].

Campylobacter transmission typically occurs through consumption 

of undercooked poultry and/or the handling of raw poultry 

[Skirrow 1982; Hopkins et al. 1984; Oosterom et al. 1984; Tauxe 

et al. 1985; Harris et al. 1986; Kapperud et al. 1992; Blaser 1997; 

Altekruse et al. 1999]. Accidental ingestion of 1 drop of raw 

chicken juice, which can contain as few as 500 organisms can 

constitute an infectious dose [Friedman et al. 2000; Newell and 

Wagenaar 2000]. Cases and outbreaks have also been traced to raw 

milk, contaminated water, and contact with pets and farm animals 

[Korlath et al. 1985; Kapperud et al. 1992; Altekruse et al. 1999].
Health Hazard Evaluation Report 2011-0058-3157 Page 3

Introduct

 ( Most people who become ill with Campylobacter infection get Continued) diarrhea, cramping, abdominal pain, and fever within 2 to 5 days 

after exposure to the organism. The diarrhea may be bloody and 

can be accompanied by nausea and vomiting. The illness typically 

lasts 1 week, and most cases do not require the use of antibiotics. 

Some infected persons have no symptoms. In persons with 

compromised immune systems, Campylobacter occasionally spreads 

to the bloodstream and can cause a life-threatening infection.

In rare instances, some infected persons can develop GBS after 

having an infection with Campylobacter jejuni. GBS is a rare 

disorder in which a person’s own immune system damages the 

nerve cells, causing muscle weakness and sometimes paralysis. GBS 

can cause symptoms that last for a few weeks or several months. 

Most people recover fully from GBS, but some have permanent 

nerve damage. In the United States, an estimated 3,000 to 6,000 

people develop GBS each year [CDC 2011a].

Campylobacter is a commensal organism of poultry, which means 

it typically colonizes the gastrointestinal tract of these animals 

without causing disease. In poultry, Campylobacter can be found 

on the skin, feathers, and gastrointestinal tract. Colonization of 

chickens in high-density houses occurs rapidly, and prevalence 

can reach 90%–100% in commercial broiler flocks [McCrea et 

al. 2006a; McCrea et al. 2006b]. Because most Campylobacter

infections are attributed to poultry and poultry products, reducing 

levels of Campylobacter contamination associated with raw poultry 

is important.

In July 1996, the USDA FSIS implemented the Pathogen 

Reduction HACCP System final rule [USDA 1996]. HACCP 

is a management system that addresses food safety through the 

analysis and control of biological, chemical, and physical hazards 

from raw material production, procurement, and handling to 

manufacturing, distribution, and consumption of the finished 

product. The process includes microbial testing, pathogen 

reduction performance standards, and sanitation standard 

operating procedures, which significantly reduce contamination 

of meat and poultry with harmful bacteria and reduce the 

risk of foodborne illness. Currently, FSIS does not have a 

performance standard for Campylobacter, but establishments can 

choose to include Campylobacter in their HACCP analysis. If the 

establishment identifies Campylobacter as reasonably likely to occur, 

or if Campylobacter appears to be an emerging problem in their 
Page 4 Health Hazard Evaluation Report 2011-0058-3157

Introduct

 ( ) process, FSIS expects the establishment to implement controls to Continued address this microbial food safety hazard.

Virginia Department of Health 

Investigation 

In March 2008, the Virginia Department of Health was notified 

of multiple cases of Campylobacter infection among persons 

working the same shift at the plant who were also residents of 

the two diversion centers. Investigators conducted a retrospective 

cohort study, environmental inspections of the plant and 

diversion centers, and laboratory analysis of stool specimens. 

A case of Campylobacter infection was defined as illness in any 

English-speaking second shift employee at the plant who had 

either laboratory-confirmed Campylobacter culture or positive 

EIA result or who reported onset of diarrhea and one or more 

of the following symptoms: abdominal cramps, fever, nausea, 

and vomiting between January 1, 2008, and April 21, 2008. 

Investigators interviewed 38 English-speaking, second shift 

employees and found that 18 (47%) met the case definition for 

Campylobacter infection. Fifteen (83%) of these ill individuals were 

residents of a diversion center. Because Spanish interpreters were 

not readily available at the time of that investigation, the cohort 

was limited to English-speaking employees only.

Investigators found that residents of the diversion centers 

were more likely to have Campylobacter infection compared to 

nonresidents (P = 0.04). They also found that wearing PPE, such 

as a dust mask, safety glasses, gloves, coveralls, aprons, smock, and 

rain suit was not significantly protective against disease. However, 

individuals who reported washing their hands after the work 

break (RR = 0.4, 95% CI 0.3–0.7), after smoking (RR = 0.5, 95% 

CI 0.3–0.8), and before eating (RR = 0.5, 95% CI 0.3–0.7) had 

significantly lower risk of infection compared to those who did not 

report these behaviors. The investigation was not able to determine 

why residents of diversion centers were more likely to become 

infected with Campylobacter.

Recommendations from the investigation included improving PPE 

availability, training and enforcement of proper hand washing 

and PPE use, and addressing the plant sick leave policy to ensure 

employees do not work while ill. Despite these recommendations, 

subsequent cases of Campylobacter infection among employees were 

identified, prompting the HHE request by plant management.
Health Hazard Evaluation Report 2011-0058-3157 Page 5

Assessment

The purposes of our evaluation were to (1) estimate the incidence 

of acute gastrointestinal illness among current plant employees, 

(2) investigate the incidence of confirmed Campylobacter infection 

among plant employees from 2009–2011, and (3) assess the 

controls in place to reduce Campylobacter contamination.

During our visit to the plant on May 9–11, 2011, we observed work 

processes, work practices, and workplace conditions and spoke 

with employees about their work practices and health concerns. We 

discussed the request with the first shift USDA veterinarian, plant 

managers, and the medical staff on first and second shifts.

Our evaluation included the following methods: (1) a review 

of work procedures and training materials for employees; (2) a 

review of the encounter records from the plant medical office; 

(3) semistructured confidential medical interviews with current 

employees; (4) observation of the plant’s ventilation system and 

spot ventilation measurements in the live hang area; (5) a review 

of the water testing program for chlorine and Campylobacter; (6) 

observations of work practices; and (7) a review of the confirmed 

cases of Campylobacter infection among plant employees.

Review of Work Procedures and Training 

Materials

We reviewed work policies and procedures for the plant and 

written training materials for new employees.

Review of Encounter Records from the 

Plant Medical Office

We reviewed the encounter records from the plant’s medical office 

from January 2010–September 2011 both during and after our 

visit. We categorized an encounter as gastrointestinal illness-related 

if the employee reported diarrhea, abdominal cramps, nausea, 

or vomiting without a reason listed, such as nausea related to 

pregnancy, migraine headaches, or menstrual cramping. We then 

tabulated all gastrointestinal illness related encounters by month.
Page 6 Health Hazard Evaluation Report 2011-0058-3157

Assessment

 (continued) Confidential Medical Interview

During our visit, we held semistructured confidential interviews 

with employees from the first and second shifts to discuss their work 

history and history of diarrheal illness. We also asked open-ended 

questions about other health and workplace concerns. Because of 

the focus of the HHE request, these employees included all first 

and second shift employees working in the receiving/live hang 

area and all first and second shift employees residing at the two 

diversion centers working on the dates of the visit. We also invited a 

convenience sample of first and second shift employees working in 

other areas of the plant. During these interviews, we also educated 

employees on Campylobacter infection and discussed measures 

employees could take to reduce their risk of Campylobacter infection. 

We held interviews in English and Spanish.

Review of the Plant’s Ventilation System

We met with the maintenance manager and walked through the 

plant and on the rooftop with a maintenance employee to better 

understand the plant’s ventilation system. We also collected air 

velocity measurements across the face of some of the supply air 

diffusers in the live hang area and observed the direction of the 

air flow from these supply vents. Air velocity was measured at 

approximately 4-inch intervals across the face of the supply air 

vents with a TSI VelociCalc® Plus air velocity meter, model 8386A 

(TSI, Inc., Shoreview, Minnesota).

Review of Environmental Sampling 

Programs 

We met with the HACCP coordinator and laboratory technician 

to discuss the plant’s environmental sampling program and 

obtained the environmental sampling records for the presence of 

Campylobacter on carcasses after rehang in second processing, and 

chlorine testing in the immersion water chillers.
Health Hazard Evaluation Report 2011-0058-3157 Page 7

Assessment 

(continued) Observation of Work Practice

During our visit to the plant, we observed work practices among 

employees in all areas of the plant. We specifically observed 

employees’ adherence to hand hygiene, PPE use, and PPE 

removal policies.

Review of Confirmed Campylobacter

Infection Cases

We obtained lists of individuals diagnosed with confirmed 

Campylobacter infection while employed at the plant between 

January 2008 and May 2011 from the Virginia Department 

of Health and the diversion centers. A case was defined as an 

individual employed at the plant with laboratory-confirmed 

Campylobacter infection by culture or EIA. We then reviewed 

records of these cases from the Virginia Department of Health, the 

Virginia Department of Corrections, and local medical providers 

and obtained additional work history information on these 

individuals from the plant.
Page 8 Health Hazard Evaluation Report 2011-0058-3157

Results

Review of Work Procedures and Training 

Materials

In the plant’s “Take Home Policies and Procedures” manual, 

employees were instructed to wash their hands when reporting 

to work, after breaks, after smoking or eating, and after using 

restroom facilities. All employees were required to wear a hair net, 

safety glasses, ear plugs, and when applicable, beard nets, when on 

the plant floor. Additional required and recommended PPE by 

select areas in the plant are shown in Table 1.

Table 1. Additional required and recommended PPE for employees by select areas in the plant 

Area in plant/Job title Additional required PPE Recommended/Optional PPE

Receiving/live hanger Steel toe boots

Cotton gloves

Rubber gloves

Smock

Apron

Face shield

Disposable dust mask*†

Coveralls

Goggles

Receiving/backup killer Boots with good tread

Rubber gloves

Steel gloves

Arm guards

Smock

Face shield

Plastic apron

Rain suit

Disposable dust mask†

Evisceration/liver/gizzard 

inspector‡

Boots with good tread

Smock

None

Evisceration/drawer and venter Protective footwear with good tread

Sleeves worn past elbows

Smock

Rubber gloves

Plastic sleeves

Dapec/rehanger Boots with good tread

Sleeves worn past elbows

Smock

Apron

Rubber gloves

Glove liners

Plastic sleeves

Breast debone/shoulder cutter Protective footwear with good tread

Sleeves worn past elbows

Smock

Rubber gloves

Blaze glove

Apron

Glove liners

Plastic sleeves

*Disposable dust masks were previously required per plant policy in 2008.

† Though disposable dust masks were specified in the plant’s written policies, during our visit, we observed that 

the PPE supply room stocked N95 filtering facepiece respirators.

‡ Liver/gizzard inspectors in the evisceration area were specifically instructed not to wear gloves because of 

safety concerns related to glove use.
Health Hazard Evaluation Report 2011-0058-3157 Page 9

Results

 (continued) According to the plant’s written policy, on hire, employees were

issued an initial stock of PPE at no charge, which included 

earplugs, safety glasses, a hair net, a beard net, green rubber gloves, 

cotton liner gloves, plastic sleeves, and a plastic apron. Employees 

were also provided with a smock, which must be turned in every 

day after work in exchange for a token. The employees then must 

bring in the token the following day to receive a clean smock. 

Employees may exchange their smock for a new one during the 

work day if soiled. Employees were not allowed to wear smocks into 

the bathroom, into the break room, or outside. Employees working 

in the receiving/live hang or first processing areas were required to 

change their smocks if they needed to go into second processing or 

the breast deboning areas.

At the time of our visit, a licensed practical nurse was present at 

the plant during the first and second shifts to evaluate medical 

issues that arose in employees. The plant did not provide paid sick 

leave for nonmanagement employees, but used a point system. 

Employees accrued two points for a full day absence or arriving late 

or leaving more than 4 hours early, and they accrued one point for 

arriving late or leaving less than 4 hours early. However, properly 

documented absences of more than one day for the same illness 

resulted in only two points. In contrast, undocumented absences 

of more than one day accrued points for each day. Employees were 

terminated if they accumulated 20 points. Any new employee 

who accrued six points in the first 30 days of employment was 

terminated regardless of the reason. Employees could reduce 

their point total by two points for each 30 consecutive days of 

employment with no accrued points.

Review of Encounter Records from the 

Plant Medical Office

In 2010, 1,716 encounters at the plant’s medical office were 

recorded. Of these, 273 (16%) were related to gastrointestinal 

symptoms. From January 2011 through September 2011, 1,543 

encounters at the plant’s medical office were recorded. Of these, 

221 (15%) were related to gastrointestinal symptoms. Figure 1 

displays the number of gastrointestinal-related visits by month over 

this time period. Multiple peaks were seen in summer 2010 and 

winter 2010–2011 and a smaller peak in summer 2011.
Page 10 Health Hazard Evaluation Report 2011-0058-3157

f 

Results

 (Continued)

Figure 1. Number of visits related to gastrointestinal illness at the plant’s 

medical office.

Other reasons for visits to the plant’s medical office included 

injury reporting and first aid, musculoskeletal complaints and 

treatment, and other miscellaneous medical complaints.

Confidential Medical Interviews

Of the 89 invited first and second shift employees, 88 (99%) 

participated in the interviews. Nine interviews were conducted in 

Spanish. Five (6%) of the 88 interviewed employees were female; 

83 (94%) were male. The median age was 32 with a range of 18–67

years. Of these 88 employees, 31 (35%) were current residents of 

Diversion Centers A or B, and 5 (6%) had been former residents o

these diversion centers.

Work History and Practices

Forty-three (49%) employees worked first shift, and 45 (51%) 

worked second shift. The median amount of time worked by 

interviewed employees at the plant was 8 months, with a range 

of 1 day–39 years. The most common areas where interviewed 

employees worked were receiving/live hang (64%), rehang (10%), 

evisceration (8%), and stack-off (5%). The remaining employees 

worked in breast debone, cut-up, dapec (a type of processing), 

further processing, paws, packaging, maintenance, and support 

areas. Of the 31 employees who were current residents of either 

diversion center, the most common areas worked were receiving/

live hang (32%) and rehang (29%). Twenty (23%) employees 
Health Hazard Evaluation Report 2011-0058-3157 Page 11

Results

 (continued) reported working at another poultry processing plant prior to this

plant, with length of employment ranging from 2 weeks–17 years.

Regarding work practices, 70 (83%) of 88 interviewed employees 

reported receiving training on possible health effects related 

to their work upon hire. In addition, 78 (91%) of interviewed 

employees reported being provided with written policies regarding 

PPE use, and 84 (97%) reported having education or training 

about PPE when they started work. Sixty-three (75%) employees 

reported ever having to pay for any PPE themselves.

Table 2 shows the reported frequency of PPE use at work. Most 

interviewed employees reported always wearing gloves (89%), 

rubber boots (72%), full length smock (92%), safety glasses or 

goggles (91%), and hair covers (95%). In addition, 12 (14%) of 88 

interviewed employees reported handling poultry without wearing 

gloves in the 2 weeks before their interview or the 2 weeks before 

illness onset.

Table 2. Frequency of PPE use reported by interviewed employees while at work

No. (%) Employees, n= 74–86

PPE component Always Sometimes Never

Gloves 76 (89) 5 (6) 4 (5)

Rubber apron 24 (28) 8 (9) 53 (62)

Rubber boots 62 (72) 2 (2) 21 (24)

Full-length smock 81 (94) 2 (2) 3 (3)

Disposable dust mask 23 (27) 7 (8) 54 (64)

Plastic face shield 6 (7) 3 (3) 74 (89)

Safety glasses or goggles 77 (91) 1 (1) 7 (8)

Hair cover 82 (95) 0 (0) 4 (5)

Regarding hand hygiene practices, 73 (87%) of interviewed 

employees reported always washing their hands before starting 

work while 78 (92%) reported always washing their hands after 

completing work. Seventy-two (85%) reported always washing their 

hands before a break while 66 (79%) reported always washing their 

hands after a break.
Page 12 Health Hazard Evaluation Report 2011-0058-3157

Results

 ( Reports of Gastrointestinal Illness Continued) Twenty-eight (32%) interviewed employees reported being ill with 

gastrointestinal symptoms in the period from January 1, 2011, to 

the date of the interviews in May 2011. All 28 of these employees 

were male and 15 (54%) were residents of a diversion center at the 

time of the interviews. Eighteen (64%) had started working at the 

plant after January 1, 2011. Fifteen (65%) of the 23 employees who 

could recall when symptom onset occurred developed symptoms 

within the first month of working at the plant. Nineteen (68%) of 

the 28 ill employees worked in the receiving/live hang area. This 

represented 34% of the 56 employees who work in that area. The 

other 9 employees reporting a gastrointestinal illness worked in 

rehang (n = 3), evisceration (n = 2), deboning (n = 2), and stack-off 

(n = 2).

The number of illnesses reported by the 28 employees reporting 

a gastrointestinal illness ranged from 1–6 illnesses. Four (5%) 

interviewed employees reported being ill with gastrointestinal 

symptoms at the time of the interview. The median duration of 

symptoms reported by ill employees was 4 days, with a range of 

1–14 days. Table 3 displays the symptoms reported by ill employees.

Table 3. Symptoms reported by interviewed employees who reported 

being ill with gastrointestinal symptoms since January 2011

Symptom Reported No. (%) Employees

n = 28

Diarrhea 28 (100)

Abdominal cramps 23 (82)

Nausea 19 (68)

Muscle aches 17 (61)

Fever 14 (50)

Headache 14 (50)

Vomiting 13 (46)

Bloody stool 2 (7)

Thirteen (46%) of the 28 employees reported seeing a healthcare 

provider at the plant for their illness, and 13 (46%) reported seeing 

a healthcare provider outside of the plant for their illness. Eight 

(29%) reported that they did not see any healthcare provider for 

their illness.
Health Hazard Evaluation Report 2011-0058-3157 Page 13

Results

 (Continu d) Six (21%) employees reported that they provided a stool specimen e for laboratory testing, and five (18%) reported a diagnosis of 

Campylobacter infection (four with Campylobacter jejuni and one 

with Campylobacter coli). These five diagnoses were confirmed by 

medical record review. None of the ill employees reported being 

hospitalized. Nineteen (68%) of the 28 ill employees reported 

being absent from work as a result of their illness, and this ranged 

1–4 days.

Review of the Plant’s Ventilation System

At the time of our visit, the plant’s ventilation system was designed 

to move air in the direction opposite the process flow (clean to 

dirty). This was intended to reduce the risk of airborne crosscontamination with potential pathogens in the finished product, 

similar to the design recommended for poultry processing plants 

by the American Society of Heating, Refrigerating, and AirConditioning Engineers, Inc. [ASHRAE 2010]. The scalding area 

had large exhaust fans that drew air from the second processing 

area and from the live hang area. Some areas in second processing, 

including cut up and fast food, recirculated and filtered 100% of 

the air.

The live hang area was renovated in 2010 to provide conditioned 

outdoor air to its occupants. The HVAC system provided 100% 

outdoor air in this area. Twenty supply air vents above the heads 

of the live hangers directed air at a downward angle toward the 

conveyor where the chickens were kept before they were shackled 

(see Figure 2). The supply air vents were located on both sides of 

the conveyor. Face velocity measurements ranged from 423–628 

feet per minute across six of the supply vents that were measured. 

Design criteria were not available for comparison with our 

measurements. Air moved from the live hang area into the scalding 

area where it was exhausted from the building.

Review of Environmental Sampling 

Programs

In 2010, USDA proposed a performance standard to test poultry 

carcasses for Campylobacter contamination [USDA 2010]. The 

plant randomly tested carcasses for Campylobacter immediately after 

chickens were rehung in the second processing area. A random 

Figure 2. Employees in the live hang 

area. Supply air from ducts located 

above the employees’ heads is 

directed toward the conveyor that is 

holding chickens to be shackled.
Page 14 Health Hazard Evaluation Report 2011-0058-3157

Results

 ( ) whole carcass was selected from the line and placed in a bag. A sterile Continued buffered peptone water solution (400 mL) was washed over the 

carcass, collected, and analyzed for Campylobacter bacteria using the 

BAX® System real-time PCR assay. If a positive result was obtained, 

the test was rerun using additional sample water. If a positive 

result was detected in the second sample, the result was recorded 

as positive on the log sheet. The USDA performance standard 

guidelines allow for up to 8 of 51(16%) 1 mL samples or 27 of 51 

(53%) 30 mL samples to be positive for Campylobacter. According to 

plant management, if more than seven occurrences per 51 samples 

are found, USDA requires changes to the antimicrobial program. 

The plant also indicated that USDA may begin independent 

testing for Campylobacter in the future. According to the log sheets, 

approximately 415 samples were collected from December 21, 2010 

to April 20, 2011; six carcasses were determined to be Campylobacter

positive. Nine additional carcasses were positive on the first test, but 

negative on retest.

Both chiller water tanks were tested for the presence of chlorine 

5–6 times per day using wet chemistry methods. Tanks were held 

between 20–50 ppm of chlorine. Logs indicated that both chiller 

tanks were held between 44–48 ppm on May 9, 2011 to May 11, 

2011.

Observation of Work Practices

During our visit, we observed activities in each work area and 

employee PPE use. Footwear sanitizers containing quaternary 

ammonium compounds for work boots were located at the plant 

entryways. Eating food and chewing gum were permitted only in 

the break room and cafeteria; we did not observe employees doing 

either while in the work area.

During our visit, we noticed two water coolers in the live hang area 

(Figure 3). Live hang employees were permitted to leave the line 

briefly to drink water from these water coolers. We observed live 

hang employees obtaining water from these coolers without removing 

their PPE, including their gloves. This practice may be a potential 

source of exposure (i.e., ingestion) of Campylobacter bacteria.

We observed inconsistent hand washing procedures across many 

areas of the plant, especially at break times. Before entering the 

break room, some employees washed their aprons and gloves with 

Figure 3. Water cooler in the live 

hang area.

Figure 4. Waste receptacle near a 

hand washing station. The receptacle 

required an employee to push back 

the lid to dispose of waste.
Health Hazard Evaluation Report 2011-0058-3157 Page 15

Results

 (continued) soap, then removed this PPE, but did not wash their hands. Other

employees washed their hands and then removed and rinsed their 

unwashed apron. Also, while most of the hand washing stations 

had hands-free sink operations, most of the soap dispensers and 

waste receptacles were not hands-free (Figures 4 and 5). Thus, these 

surfaces may become contaminated with Campylobacter bacteria or 

other infectious organisms and pose another source of exposure.

We observed inconsistent and suboptimal use and removal of PPE 

within the plant. For example, not all live hang employees wore 

safety glasses as required. We also observed some live hang employees 

wearing smocks in the break room. Also, though N95 filtering 

facepiece respirators were not required in the receiving/live hang 

area, we observed some employees wearing them incorrectly.

Liver/gizzard inspectors, drawer/venters in the evisceration area, 

and dapec/rehang employees were not required to wear gloves 

because they could become caught in the machinery and cause 

injury. We observed that all of the liver/gizzard inspectors and 

most of the rehangers did not wear gloves.

At the time of our visit, the new live hang area was open and 

operating, but the new locker room and break room were not yet 

open. Because of this, at the beginning of breaks, we observed 

live hang employees removing their PPE as they exited the area, 

walking approximately 25 yards outside and around the corner, 

and depositing their PPE in the marked bins (Figure 6). This 

configuration may increase the potential for cross-contamination.

Though the new locker room and break room adjacent to the live 

hang area were not open and operating, we did tour this part of the 

plant during our visit. This area contained hand washing stations 

featuring air hand dryers, a small shower facility, lockers for personal 

effects, and a small dining area with tables and vending machines. 

The opening of this new locker room and break room should 

facilitate the disposal of used PPE if bins are placed in this area.

Review of Confirmed Campylobacter

Infection Cases

Between January 2008 and May 2011, 29 cases of laboratoryconfirmed Campylobacter infection in individuals employed at 

the poultry processing plant were identified by the Virginia 

Department of Health and the Virginia Department of 

Figure 5. Hand washing station in the 

plant. The soap dispenser required 

the employee to push the lever to 

release the soap.

Figure 6. Deposit bin for PPE used 

by live hang employees at the time of 

our visit.
Page 16 Health Hazard Evaluation Report 2011-0058-3157

Results

 (continued) Corrections. Of these, 23 had diagnoses of Campylobacte

jejuni, 1 had a diagnosis of Campylobacter coli, 4 had diagnoses 

of unspecified Campylobacter species, and 1 was an unknown 

species. Twenty-seven cases were diagnosed by stool culture; 2 were 

diagnosed by stool EIA. None were diagnosed with Guillain-Barre 

syndrome. A graph displaying the number of these confirmed cases 

by month of symptom onset is shown in Figure 7.

The median age of the 29 cases was 29 years with a range of 19–52 

years. Twenty-eight of these were male; one was female. A total of 23 

cases were residents of Diversion Center A, 3 cases were residents of 

Diversion Center B, and 3 cases lived at a private residence.

Of the 29 cases, 18 (62%) worked in the live hang area, 8 (28%) in 

the evisceration area, 1 (3%) in the kill room, 1 (3%) in the rehang 

area, and 1 (3%) in the cut-up area. The median amount of time 

worked at the plant before illness onset was 11 days, with a range of 

3 days–865 days. Twenty-four (83%) cases worked at the plant for 

fewer than 30 days before illness onset.

Medical records from the Virginia Department of Corrections and 

other medical care providers were obtained for 24 employee cases. 

Three cases were reported to have been seen in the plant medical 

office. One case was hospitalized, and there were no deaths. All 24 

cases were reported to have diarrhea. Other symptoms recorded 

included abdominal cramping (n = 14), fever (n = 9), nausea 

(n = 6), headache (n = 7), vomiting (n = 6), and muscle aches 

(n = 3). Seventeen cases were treated with antibiotics for their infection.

Figure 7. Number of confirmed Campylobacter infections in 

employees at the poultry processing plant by month of illness onset.
Health Hazard Evaluation Report 2011-0058-3157 Page 17

Discussi

Our investigation revealed 29 cases of laboratory-confirmed 

Campylobacter infection in individuals employed at the poultry 

processing plant during the 31⁄2-year period from January 2008 to May 

2011. Most of these individuals worked in the live hang and evisceration 

areas, which are areas of higher contamination [Keener et al. 2004]. All 

but three individuals were residents of a diversion center. Most (83%) 

had worked at the plant for fewer than 30 days before illness onset.

These findings of illness in relatively new employees are similar to those 

from previous investigations of poultry processing workers [Christenson 

et al. 1983; Cawthraw et al. 2000]. An outbreak investigation by 

Christenson et al. of Campylobacter infection among poultry abattoir 

workers in Sweden revealed that attack rates of infection were higher 

in inexperienced teenage holiday workers than in the experienced staff 

[Christenson et al. 1983]. Similarly, an investigation by Cawthraw et al. 

found that long-term workers (> 1 month) in Sweden had significantly 

higher levels of anti-Campylobacter antibodies compared to short-term 

workers (≤1 month) and compared to blood donors with no special 

exposure to poultry. Those findings indicated that poultry workers are 

at most risk of developing Campylobacter infection in their first weeks 

of working and then develop immunity that may be protective against 

future symptomatic infection [Cawthraw et al. 2000].

While there were 29 confirmed cases of Campylobacter infection, our 

interviews and review of the plant medical office records revealed that 

gastrointestinal illness was quite common. We found that approximately 

15% of the more than 3,000 encounters at the plant’s medical 

office from January 2010 through September 2011 were related to 

gastrointestinal symptoms. In addition, 28 (32%) of 88 interviewed 

employees reported being ill with gastrointestinal symptoms between 

January–May 2011. As with the employees with confirmed infection, 

most interviewed employees reporting illness reported that symptoms 

occurred within the first month of working at the plant. Most of these 

ill employees worked in the live hang area, but others worked in the 

rehang, evisceration, deboning, and stack-off areas.

We found that most (62%) of the 29 confirmed cases of Campylobacter

infection occurred in live hang employees. Only approximately 50 

employees out of the 1,000 person workforce work in the live hang area, 

suggesting that employees in this area are disproportionately affected. 

Similarly, in our interviews, we found that 34% of the 56 employees 

who worked in the receiving/live hang area reported a gastrointestinal 

illness in the preceding 5 months. The receiving/live hang areas were 

known to be areas of high contamination with Campylobacter, as the 
Page 18 Health Hazard Evaluation Report 2011-0058-3157

Discussi

 (continued) feathers, skin, crop, cloaca, and feces of birds brought to slaughter are

often highly contaminated with Campylobacter [Berrang and Dickens 

2000]. Transport cages are important sources of cross-contamination 

[Berrang et al. 2003], and the presence of Campylobacter on birds at 

receiving has been linked to dirty cages [Slader et al. 2002].

The high number of Campylobacter infections that was observed in 

live hang employees suggests that preharvest practices in use by the 

plant and hatcheries may not be sufficient to control Campylobacter

contamination on live birds. USDA has noted that high levels of 

Campylobacter loads on live birds can undermine other in-plant 

interventions [USDA 2010].

According to plant records, 15 (3%) of 451 carcass wash samples 

collected from second processing were found to have Campylobacter

contamination over the 5 months prior to our site visit. This 

suggests that second processing employees had some risk of 

Campylobacter exposure. However, chlorine levels in the water 

immersion chillers, as reported on the company log sheets, were 

within USDA requirements [USDA 2010].

In the live hang area, airflow originating from the supply ducts 

above the employees’ heads was directed from both sides of the 

live hang conveyor and may have aerosolized or spread potential 

contamination from the birds to the live hang employees. This 

is of concern because it has been suggested that Campylobacter

exposure may occur through both airborne and droplet aerosol 

transmission [Wilson 2004]. It is also of concern because it may 

increase live hang employees’ exposures to other contaminants 

on the chickens including organic dusts, nuisance dust particles, 

endotoxin, and other biological agents that have been identified as 

potential exposures in this environment [Lenhart and Olenchock 

1984; Rylander 1984; Rees et al. 1998; OSHA 2011]. OSHA has 

provided some guidance on the design of ventilation controls in 

live hang areas indicating that make-up air should be provided 

behind the employee and exhausted from the far side of the 

conveyor [OSHA 2011]. However, because live hang employees 

worked on both sides of the conveyor at this plant, this would not 

be effective in reducing potential bioaerosol exposures among live 

hang employees. Alternative ventilation system design strategies are 

provided in the recommendations section.

In the live hang area, the water coolers inside the area posed a 

potential for cross-contamination, as employees left the line to 
Health Hazard Evaluation Report 2011-0058-3157 Page 19

Discussi

 (continued) obtain water without washing their hands or removing PPE. In

addition, we observed inconsistent hand hygiene and PPE use 

in the live hang area, and these observations corroborated the 

self-reported practices of interviewed employees. In addition to 

exploring methods to reduce contamination of incoming birds, 

efforts to educate receiving and live hang area employees about 

their risk of Campylobacter infection and the importance of hand 

hygiene and PPE use should be strengthened.

Plant policy required employees to report illnesses, yet fewer than 

half of the employees who reported illness during our interviews 

stated that they saw a plant healthcare provider for their illness. 

In addition, almost one third of employees reporting illness stated 

that they did not see any healthcare provider for their illness. Thus, 

illness appears to be underreported among employees, and 29 

cases are likely an underestimation of the actual number of cases 

of Campylobacter infection among employees. The lack of paid sick 

leave may play a role in this lack of reporting and suggests a need to 

re-examine this policy.

Our HHE was subject to some limitations. First, because of 

the large number of employees at the plant, it was not possible 

for us to interview all of them during our visit. As a result, we 

limited the interviews to all first and second shift employees in 

the receiving/live hang areas, all employees residing at diversion 

centers, and a convenience sample of employees from other 

locations. We also were not able to characterize the employees 

seeking medical care from the plant medical office by work area. 

Thus, we were unable to capture the self-reported incidence of 

gastrointestinal illness across most of the other areas of the plant. 

However, our analysis of the confirmed cases of Campylobacter

infection demonstrates that the attack rate appears to be highest 

among the receiving/live hang employees. Also, the likelihood 

of selection bias that occurred with the interviews prevented us 

from making any comparisons between those employees who 

reported illness and those who did not as we specifically focused 

on receiving employees and other employees who were also 

residents of diversion centers. In addition, our interview findings 

may have been subject to recall bias, as employees were asked to 

recall events of the previous 51⁄2 months.
Page 20 Health Hazard Evaluation Report 2011-0058-3157

Conclusion

A health hazard from Campylobacter infection existed in this plant. 

Most confirmed cases of infection occurred in employees in the live 

hang area, those who were also residents of a diversion center, and 

those who worked at the plant for less than a month before illness 

onset. Our interviews and review of the plant medical office records 

revealed that gastrointestinal illness was quite common but appears 

to be underreported.

Recommendatio

On the basis of our findings, we recommend the actions listed 

below to decrease the incidence of Campylobacter infection and 

create a more healthful workplace. We encourage the poultry 

processing plant to use a labor-management health and safety 

committee or working group to discuss the recommendations 

in this report and develop an action plan. Those involved in 

the work can best set priorities and assess the feasibility of our 

recommendations for the specific situation at the plant. Our 

recommendations are based on the hierarchy of controls approach. 

This approach groups actions by their likely effectiveness in 

reducing or removing hazards. In most cases, the preferred 

approach is to eliminate hazardous materials or processes and 

install engineering controls to reduce exposure or shield employees. 

If they are not effective or feasible, administrative measures and/or 

PPE may be needed.

Comprehensive recommendations and best practices for 

controlling Campylobacter throughout the entire cycle in poultry 

processing plants can be found in the USDA FSIS “Compliance 

Guideline for Controlling Salmonella and Campylobacter in 

Poultry” at http://www.fsis.usda.gov/PDF/Compliance_Guide_

Controling_Salmonella_Campylobacter_Poultry_0510.pdf

[USDA2010]. The primary purpose of these recommendations, 

however, is to increase food safety for consumers, not necessarily 

to protect the health and safety of employees at poultry processing 

plants. Although these recommendations have implications for 

protecting the health of employees, additional measures are needed 

to improve this protection.
Health Hazard Evaluation Report 2011-0058-3157 Page 21

Recommendation

(continued) Engineering Control

Engineering controls reduce exposures to employees by removing 

the hazard from the process or placing a barrier between the 

hazard and the employee. Engineering controls are very effective 

at protecting employees without placing primary responsibility of 

implementation on the employee.

1. Install hands-free soap dispensers and hands-free waste 

receptacles at all hand washing stations to minimize 

employee contact with surfaces that may be contaminated 

with Campylobacter bacteria or other infectious organisms.

2. Move the two water coolers from the live hang area to 

help limit contamination of drinking water with poultry 

matter. Consider placing the coolers in a covered/shaded 

area outside the live hang area, or in the adjacent locker 

room/break room. Consider providing hands-free water 

dispensers.

3. Sanitize and dry transport cages thoroughly as 

recommended by the USDA FSIS [USDA 2010]. Research 

suggests that a two-step process that first cleans and 

disinfects cages is effective in reducing bacterial burden 

[Ramesh et al. 2004].

4. Modify the supply vents in the live hang area to redirect 

airflow vertically downward from above the employees’ 

heads toward the floor and away from the live hang 

conveyor. This may help to reduce aerosolization of 

contaminants on the conveyor and also provide an air 

shower to help reduce inhalation of contaminants. If 

adjustments to the supply air ducts cause eye irritation or 

dry eyes, require employees to wear face shields or goggles.

5. Other strategies that could be used to reduce airborne 

contaminants in the live hang area include the following:

•	 Reposition supply air ducts away from the 

employees and conveyors.

•	 Add local exhaust ventilation near the conveyor to 

capture contaminants near the chickens. Consult 

a ventilation engineer familiar with poultry 

processing plants for specific designs.
Page 22 Health Hazard Evaluation Report 2011-0058-3157

ReCommendAtions 

( ) •	 Wet down birds before they are shackled [Ortiz Continued et al. 1990]. This may reduce aerosolization of 

contaminants on birds but may make the chickens 

harder to grasp.

Administrative Controls

Administrative controls are management-dictated work practices and 

policies to reduce or prevent exposures to workplace hazards. The 

effectiveness of administrative changes in work practices for controlling 

workplace hazards is dependent on management commitment and 

employee acceptance. Regular monitoring and reinforcement are 

necessary to ensure that control policies and procedures are not 

circumvented in the name of convenience or production.

1. Provide detailed training to all employees upon hire and at 

least annually thereafter on when and how to wash their 

hands. Employees should wash their hands before and 

after work; after contact with chickens or related products; 

before eating, drinking, or smoking; and before putting on 

and after removing PPE including gloves. Consider placing 

copies of the signs found in the Appendix, illustrating proper 

technique, above all hand washing stations throughout the 

plant. Supervisors and managers should periodically observe 

hand washing procedures and provide re-education on proper 

technique as necessary. The Centers for Disease Control and 

Prevention recommends washing hands with soap and water 

for 20 seconds. Additional information on hand hygiene can 

be found at http://www.cdc.gov/handwashing/.

2. Continue to offer all training to employees in English and 

Spanish to ensure employee comprehension.

3. Recommend that employees change clothes before going 

home from work to prevent cross-contamination of vehicles 

and homes and potential secondary exposure and infection 

of household members.

4. Train medical staff at the plant to recognize and inquire 

about diarrheal illness in employees, make appropriate 

recommendations to seek additional healthcare, and 

encourage employees to stay home while ill.
Health Hazard Evaluation Report 2011-0058-3157 Page 23

Recommendation

(continued) 5. Examine the plant’s sick leave policy for employees and

make changes to ensure that employees do not work when 

ill. Consider a paid sick leave policy.

6. Work closely with diversion center medical staff and health 

district staff to ensure that all cases of diarrheal illness are 

reported as appropriate.

7. Continue to work with growers and veterinary staff to 

explore on-farm strategies to reduce the incidence rates 

of poultry contamination. Sound management practices 

incorporate good husbandry and hygiene practices. The 

USDA FSIS guidelines include preharvest strategies 

designed to lower Campylobacter contamination among 

incoming birds [USDA 2010].

Personal Protective Equipment

PPE is the least effective means for controlling employee exposures. 

Proper use of PPE requires a comprehensive program, and calls 

for a high level of employee involvement and commitment to be 

effective. The use of PPE requires the choice of the appropriate 

equipment to reduce the hazard and the development of 

supporting programs such as training. PPE should not be relied 

upon as the sole method for limiting employee exposures.

1. Provide training to all employees on proper use of required 

and recommended PPE specific to their job as defined in 

the OSHA PPE general requirements standard [29 CFR 

1910.132]. Training should include how to put on, wear, 

and remove each PPE component and should include 

indications for cleaning or changing out PPE and how to 

dispose of used PPE. This training should be provided 

and documented on hire and at least annually thereafter. 

Retraining is also necessary when (1) changes in the 

workplace or types of PPE used render previous PPE 

training obsolete and when (2) employees are observed using 

PPE incorrectly. It is important to note that the OSHA 

respiratory protection standard [29 CFR 1910.134] and 

electrical protective equipment standard [29 CFR 1910.137], 

when applicable, have different training requirements that 

supersede those noted above.
Page 24 Health Hazard Evaluation Report 2011-0058-3157

Recommendation

( 2. Provide PPE at no cost to employees as defined in the Continued) OSHA PPE general requirements standard [29 CFR 

1910.132]. This standard states that the employer is not 

required to pay for non-specialty safety-toe protective 

footwear (including steel-toe shoes or steel-toe boots) and 

non-specialty prescription safety eyewear, provided that the 

employer permits such items to be worn off the job site. In 

addition, the employer is not required to pay for everyday 

clothing. However, the employer must pay for replacement 

PPE, except when the employee has lost or intentionally 

damaged the PPE.

3. Ensure that line leaders, supervisors, and managers are 

familiar with the required PPE for their areas and encourage 

them to enforce its use among employees.

4. Encourage all employees to use the footwear sanitizers upon 

entry and exit from the plant floor.

5. Define when voluntary use of respirators by employees 

is permitted. Follow the OSHA respiratory protection 

standard [29 CFR 1910.134] regarding voluntary use, 

including providing a copy of Appendix D of the OSHA 

respiratory protection standard [29 CFR 1910.134] to 

employees.

6. Consider making the use of face shields mandatory in the 

live hang area to help limit employee exposure to poultry 

materials likely contaminated with zoonotic pathogens such 

as Campylobacter. Face shields provide additional protection 

over goggles or safety glasses by helping to prevent oral 

exposure. The use of respiratory protection against both 

infectious agents as well as dust from feathers, litter, and 

fecal matter should be considered in accordance with the 

OSHA respiratory protection standard [29 CFR 1910.134].
Health Hazard Evaluation Report 2011-0058-3157 Page 25

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 ( USDA [2010]. Compliance guidelines for controlling SalmonellaContinued) and Campylobacter in poultry, 3rd ed. [http://www.fsis.usda.

gov/PDF/Compliance_Guide_Controling_Salmonella_

Campylobacter_Poultry_0510.pdf]. Date accessed: December 2011.

Wilson IG [2004]. Airborne Campylobacter infection in a poultry 

worker: case report and review of the literature. Commun Dis 

Public Health 7(4):349–353.
Health Hazard Evaluation Report 2011-0058-3157 Page 29

Appendix: Hand Hygiene Sig

The two signs on the next two pages present proper hand washing technique in English and Spanish.
Page 30 Health Hazard Evaluation Report 2011-0058-3157

Appendix: Hand Hygiene Sig

 (continued
Health Hazard Evaluation Report 2011-0058-3157 Page 31

Acknowledgments a

Availability of Rep

The Hazard Evaluations and Technical Assistance Branch (HETAB) 

of the National Institute for Occupational Safety and Health 

(NIOSH) conducts field investigations of possible health hazards 

in the workplace. These investigations are conducted under the 

authority of Section 20(a)(6) of the Occupational Safety and Health 

Act of 1970, 29 U.S.C. 669(a)(6) which authorizes the Secretary of 

Health and Human Services, following a written request from any 

employer or authorized representative of employees, to determine 

whether any substance normally found in the place of employment 

has potentially toxic effects in such concentrations as used or found. 

HETAB also provides, upon request, technical and consultative 

assistance to federal, state, and local agencies; labor; industry; and 

other groups or individuals to control occupational health hazards 

and to prevent related trauma and disease.

Mention of any company or product does not constitute 

endorsement by NIOSH. In addition, citations to websites 

external to NIOSH do not constitute NIOSH endorsement of 

the sponsoring organizations or their programs or products. 

Furthermore, NIOSH is not responsible for the content of these 

websites. All Web addresses referenced in this document were 

accessible as of the publication date.

This report was prepared by Marie A. de Perio, John D. Gibbins, 

and R. Todd Niemeier of HETAB, Division of Surveillance, Hazard 

Evaluations and Field Studies. Consultation and field assistance 

were provided by Seth Levine, Karen Gruszynski, Thomas Bender, 

Jonathan Falk, and Patricia Shobe of the Virginia Department of 

Health and Johnette Cleaton, Kerry Michael, and Jeanne Hudson 

of the Virginia Department of Corrections. Industrial hygiene 

equipment and logistical support were provided by Donald Booher 

and Karl Feldmann. Health communication assistance was provided 

by Stefanie Evans. Editorial assistance was provided by Ellen 

Galloway. Desktop publishing was performed by Greg Hartle.

Copies of this report have been sent to employee and management 

representatives at the poultry processing plant, the state 

health department, and the Occupational Safety and Health 

Administration Regional Office. This report is not copyrighted and 

may be freely reproduced. The report may be viewed and printed at 

http://www.cdc.gov/niosh/hhe/. Copies may be purchased from 

the National Technical Information Service at 5825 Port Royal 

Road, Springfield, Virginia 22161.
Below is a recommended citation for this report:

NIOSH [2012]. Health hazard evaluation report: Campylobacter infection and 

exposures among employees at a poultry processing plant — Virginia. By de Perio 

MA, Gibbins JD, Niemeier RT. Cincinnati, OH: U.S. Department of Health and 

Human Services, Centers for Disease Control and Prevention, National Institute for 

Occupational Safety and Health, NIOSH HETA No. 2011-0058-3157.

To receive NIOSH documents or information about 

occupational safety and health topics, contact NIOSH at:

1-800-CDC-INFO (1-800-232-4636)

TTY: 1-888-232-6348

E-mail: cdcinfo@cdc.gov

or visit the NIOSH web site at: www.cdc.gov/niosh.

For a monthly update on news at NIOSH, subscribe to 

NIOSH eNews by visiting www.cdc.gov/niosh/eNews.

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through research and prevention.

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Safety and Health