Because of the recent incidents involving possible exposures to anthrax, the Connecticut State Police Department is recommending the following procedures to be followed in the event of an incident occurring in a school or business. The protocols regarding anthrax exposure incorporate the guidelines adopted by the Connecticut Department of Public Health.

The anthrax bacteria may enter the body through the skin, through inhalation, or through ingestion. The main concerns at present are for inhalational anthrax and for cutaneous (skin) anthrax resulting from exposures to contaminated mail or anthrax-Iaced powder in the environment. Inhalational anthrax results from inhalation of a large number of spores that must be microscopically small to get into the lungs (i.e., a very fine mist). It is the most serious form of anthrax and can progress very rapidly. Cutaneous anthrax results from spores getting into an open wound or being rubbed into the skin. Usually, cutaneous anthrax can be readily recognized and treated.

When potential inhalational exposures are recognized, preventive antibiotics can be given to those exposed to treat inhalational anthrax. Settled powders in the environment generally present only a risk for cutaneous anthrax. Fine mists of that may be generated from opening a letter with fine powder in it or spraying powder into the air can present a risk for inhalation anthrax.

Personal hygiene goes a long way to prevent bacteria from entering the body. Persons opening the mail or cleaning up spills of anything, should wash their hands after completing the task and before eating or handling food or anything else that may go into someone's mouth.

Letters -Many of the calls the Emergency Responders have been called to were for suspicious letters that were not solicited, expected or wanted. These mailings normally had no return address because they were from marketing companies. If there is no return address and the letter is unwanted, it may be destroyed. The letter can be destroyed by sealing it in plastic bags and incinerating it or by soaking it in a 50/50 bleach-water solution for an hour or until thoroughly saturated. Do not put the unwanted letter through a shredder. Wash hands after handling the mail. If the letter was important it likely will be followed with a phone call or E-mail at a later date.

Letters with powders inside -If a letter is opened and either a threatening note or a suspicious powder is found inside DO NOT PANIC, there is plenty of time to manage the situation in a reasonable way without jeopardizing anyone's health. There have been many hoax powders found and threatening notes without any biological hazards. Many common items are dusted with a cornstarch powder from the shipper to prevent moisture, static electricity or to keep items from sticking to the packaging. Many cases can be easily resolved with a simple call to the manufacturer or shipping company.

If there is a suspicious substance or a threat; DO NOT SHAKE the letter or CARRY the suspected item away from the area. Either cover the item or place it inside a plastic bag or other container. Verbally move people away from you to limit the possibility of anyone else being exposed. It is much easier and safer to decontaminate one person and a small area than it is a large group and an entire building. After the suspect item is covered or sealed notify the police and supervisor by phone. Keep calm but isolate yourself from other people. Anthrax is not contagious but spores can be spread through direct contact. Before you leave the area make sure you know where you are going and your supervisor or someone else is aware of your location. If possible decontaminate yourself on site (see paragraph below).

When the police arrive, they will determine whether it is necessary to involve a HAZMAT team to clean up and, if necessary, to test the suspicious substance for anthrax

Self-decontamination - This is simply another term for a good cleaning of your body and packaging of possibly contaminated garments. First, wash your hands. If there is a shower facility close by, first make arrangements to have a change of clothing and two garbage bags brought to the area. Remove all clothing and jewelry and seal it in a plastic bag. Place the first bag inside of another plastic bag and seal the outer bag as well. Shower completely head to toe and rinse, then repeat the process. Dress in clothing provided and the process is complete.

On Site decontamination - Facilities that have no showers available will use standard decontamination procedures in portable enclosures set up at the scene. Contractors have contained shower trailers for comfort and privacy in non-emergency situations. While it is important to resolve the situation quickly, this is not a true emergency. There is no need for anyone to be put in a personally embarrassing situation.

Storing of personal items and clothing -The State Public Health Laboratory cannot possibly test, store and inventory personal belongings. Items submitted to the lab are not returned after testing. Take the double sealed clothing and secure it in a locker or a closet until test results are known. Once tests are determined to be negative for biological hazards, the bag and contents are safe to open and launder. If a test is positive for any type of biological hazard, additional instructions about contaminated effects will be given.

SUSPICIOUS PACKAGES: Packages are suspicious if they include excessive postage, poorly written or misspelled labels, incorrect titles, have titles of someone but no name, oily stains, unusual odors, no return address, or are marked personal or confidential. Every attempt should be made to identify and contact the sender of a package, to determine the legitimacy of the delivery. Once this has been verified and suspicions are explained, the package can be opened provided it does not appear to have been tampered with. Packages that cannot be verified or appear to have been tampered with should be handled by the State Police Emergency Services Unit by calling 1-800-842-0200.

SUSPICIOUS POWDERS: Numerous calls and disruptions to schools and businesses have been caused by unknown powders being discovered. Many of these unknown powders can be identified by making simple inquiries and isolating the part of the building affected rather than a mass evacuation. In addition, they are usually only situations with a settled pile of powder, a situation that only presents a threat of skin anthrax, not inhaled anthrax. First, do your own risk assessment. Consider the placement of the suspected powder and whether it was likely to have been a fine mist earlier. It has to get to your nose and lungs -not your toes -for it to be a serious threat. Things like carpet fresh, talcum power in bathrooms and even powdered sugar in bakeries have caused panic to many people. Try to put things back into perspective. Ask yourself...why would I be a target? Does this powder that is obvious to you have a way of getting into someone' s lungs?

ISOLATE THE AREA: If powder has been found by a sink in a bathroom, close off the bathroom until the matter can be checked into. If possible isolate the air handling system to the bathroom to prevent spreading of any contaminants. Has anyone been in direct contact with the substance or could anyone have been exposed? These people should be removed from the contaminated area to a safe area but should be kept together until the matter can be resolved. Question cleaning staff, fellow employees and visitors. One recent call involved an accidental spillage of coffee creamer that was not cleaned up. The building was evacuated and the business was disrupted until a visitor admitted to their error.

If there is no exposure to anyone and there is no threat involved, spray the substance with the I:10 dilution of household bleach in water that will kill any anthrax bacteria if it was ever there in the first place. Allow the solution to soak for 15 minutes, then clean up the powder paste, discard it and then wash your hands. Please remember anthrax is a bacteria and we deal with harmful bacteria on a daily basis. Cleaning bathrooms with bleach and washing countertops after handling meats are examples of "decontamination procedures."

If unknown powders associated with a threat or suspicious circumstances exist, police should be notified immediately. Follow the same rules set forth in the paragraph regarding isolating the area. Remove those exposed to another area and keep them together as a group. Isolate this group from the employees or students not exposed to reduce the number of possible decontamination subjects. Collection and sampling of the material will be performed by DEP HAZMAT Units, State Police Emergency Services Unit or the FBI. Samples must be handled as evidence because these incidents will be prosecuted. If the school or business is in an area of local police jurisdiction they will investigate the matter as well.

A determination will be made by the first responder police and/or HAZMAT team cleaning up the suspicious powder as to how much of the area being decontaminated needs to remain off limits until test results come back. In general, for a settled powder without a clear threat, the area may be able to be used again immediately. The local health department can also help make this determination.

If adopting a plan of action in the event of such an emergency, there are some considerations that will go a long way after the incident is resolved. Keep in mind those exposed may be frightened or at the least embarrassed about the incident. Going through a decontamination process is uncomfortable but necessary. When putting together such a plan, identify areas where an employee can be comfortable after decontamination. Try to pick an area out of sight of onlookers and media and an area where a family member can be contacted to bring them fresh clothing. The area should have a bathroom and telephone, It would also be a good idea to have a small supply of antibacterial soap for personal showers, feminine products, and sweat clothes or garments to change into after a shower. Since no one knows what area may be isolated, contingency plans should be considered.

Contact the available employee assistance representative, company nurse or reliable contact person that those involved can contact to ask questions during the night or after everyone else has left. As managers, please make sure that you have a complete list of everyone potentially exposed and a positive way to contact them once the test results are known. The State Public Health Laboratory has one contact number on their submission sheet and they do not call each individual.

Sometimes preliminary tests are used in the field. These tests are not 100% reliable and are just used for screening. They can be falsely negative or falsely positive. More definitive testing takes 24 hours after the specimen is received at the State Laboratory.

To become exposed to anthrax does not mean a person is infected with the bacteria. When genuine exposures are recognized, it is possible to prevent inhalational anthrax and cutaneous anthrax and their consequences with antibiotics.

Symptom onset following exposure to anthrax spores generally takes from a day to several weeks. For inhalational anthrax, initial symptoms mimic the flu and may include feeling poorly, a cough and fever that generally progress over the course of the next several days to week. When treated early, inhalational anthrax can be successfully treated.

When the skin lesion of cutaneous anthrax first appears, it looks like a small spider bite - a small red lesion. Over the course of the next several days to week, it may progress to a blister-like form, then break down and develops a black crust. If undiagnosed and untreated, bacteria from the skin lesion can invade the bloodstream and cause a more serious infection. However, it is usually easy to diagnose and treat without severe consequences.