Contagion in Aviation

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1 NanoServices Contagion in Aviation Regulation and Realization of Aircraft Hygiene Research Report Kirsten Raaphorst, University of Applied Sciences, Amsterdam

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3 Preface After five months of research as part of my graduation internship, this report is the end result. In the process of obtaining information many difficulties and setbacks were encountered, as the aviation sector turned out to be all but transparent. Despite the delaying factors the end result is something that I am proud of. It explores new grounds and concerns a product that is new to the aviation sector. Before the research started I was immediately intrigued by the endless possibilities of Nano-coatings. Therefore this research was combining two subjects that I am really interested in. During the moments of adversity and confusion there were a number of people that were able to help me get back on track. A special thanks goes out to Victor Laban, who was always prepared to help me out with useful information and sources. I also want to thank Dimmen Breen and Theo Sijs for trusting me with inside information on NanoServices, letting me be part of interviews with customers and giving me complete freedom to perform my research. And last but not least Geert Boosten, for always being realistic and helping me get back in the right mindset. I very much appreciated your rapid responses and your encouragements that enabled me to make the most out of this internship. Kirsten Raaphorst Amsterdam, Kirsten Raaphorst University of Applied Sciences Amsterdam Student Aviation Management, Honors Program Geert Boosten University of Applied Sciences Amsterdam Graduation Mentor Dimmen Breen Managing Director at Nano Services BV Company supervisor Signature: Signature: Signature: 3

4 Introduction This report is the final product of a graduation internship research performed by Kirsten Raaphorst, Aviation Management student at the University of Applied Sciences Amsterdam (2011/2012) on behalf of NanoServices BV Nunspeet. The report consists out of two parts; Part 1 elaborates on the background and set up of the research and Part 2 describes the research results. Part 1: NanoServices provides non-biocide, anti-bacterial and self-cleaning coatings to different industries and businesses. As the aviation industry connects people worldwide it could potentially do the same with pathogens. To assess the opportunities for Nano-coatings in the aviation industry the current hygienic state of aircraft is to be assessed. (1.) This research is set up, based on four consecutive steps. First a desk research to determine current legislation in the field of aircraft hygiene. The second and third step are interviewing different hygiene and aviation related organizations. The final step is doing a field research, to determine what the current hygienic state of commercial aircraft today is. (2.) Part 2: The desk research focuses on national and international aviation legislators as well as on health organizations, to see in what way both branches cover hygiene in aviation. Additionally, previous studies on aircraft hygiene and the way the aircraft climate affects the number of pathogenic particles detected, helps steer the field research into the most effective direction. (1.) Complementing the information found on aircraft hygiene regulations and legislators, the Dutch aviation inspection body and the National public health monitoring agency are approached for additional information. Prior to the field research, to determine the need for clearness and to find out how topical hygiene is amongst aircraft employees, cabin attendants and the Dutch union for cabin attendants are interviewed. (2.) From the information available and the attitude of the Dutch Airline industry it can be concluded that much is still unknown and that in order to learn more, a larger group of stakeholders with different perspectives may be required. (3.) Through a Workshop themed How to make Hygiene in Aviation Discussable the final recommendations are put to discussion to obtain a new vision, different ways to approach the subject and more details on what steps to take in the future. (4.) The primary sources used for this research are WHO (2009) 3, IATA (2008) 4 and California Institute of Technology 16. For a full overview of all sources used for this report, a bibliography is enclosed on page 46. The main appendices of this report are the Brainstorm (II), IATA SGHA (III) and the Cabin Crew Questionnaire (VI). 4

5 Executive Summary This study is performed on behalf of NanoServices BV and The University of Applied Sciences, Amsterdam. NanoServices provides non-biocide self-cleaning and anti-bacterial coatings to different types of industries. The aviation industry has been at the base of the global spreading of several diseases, among which Swine flu. In order to find out what the options are for Nano-coatings on board aircraft, the hygienic situation of today s commercial airline industry is assessed. Three hypothesis are researched to eventually answer the question: What are the standards for aircraft hygiene stated by the regulatory bodies, and is it feasible for an airline to comply with these regulations?. The research is performed following three methods. The first method is a desk research to look into the applicable laws and regulations concerning aircraft hygiene. The second method is to perform interviews with both parties from the aviation industry as well as governmental bodies. The final method is to have the current hygienic state of aircraft cabins measured by a specialized bureau. The desk research focused on both aviation related regulatory bodies as well as on public health institutes. From the available information, it became apparent that no specific thresholds or regulations on hygiene are in use. From previously done researches on this topic, it could be concluded that the air quality in aircraft is high; however, there was not much information on the surface hygiene in aircraft cabins. In order to obtain more detailed information on existing legislation on aircraft cabin hygiene and which governmental bodies are responsible for the airlines complying with these regulations, the Dutch ILT and RIVM were interviewed. Through these interviews it became apparent that the aviation industry is not regulated nor monitored in the field of hygiene, and the airlines themselves are responsible for setting up cleaning standards. In an interview with cabin attendants on their perception of hygiene, they generally answered that there was work to be done in this field. Cleaners only have little time to clean the cabin in between flights and some airlines have the aircraft cleaned only once a day. Several instances were recalled that could potentially endanger public health. Attempts to get permission from airlines to muster the hygienic state of general commercial aircraft in use, were rejected. Sources within the airlines tell that airlines are unwilling to disclose information on this topic because they do not want to be associated with a possible outcome that could harm the airline s image. When trying to answer the research question whether aircraft are able to comply with the regulations set for aircraft hygiene, the answer is negative, as there are no standards or regulations from the government for the airlines to comply with. The airlines are in control of the manner in which and to what extend the aircraft is hygienically maintained. Based on statements made by the cabin crew during the interviews, aircraft cleaning as it is done today is insufficient. There is not enough time to properly perform the activities and the methods and equipment used are unhygienic. However, there is no data obtained to underpin that aircraft are breeding grounds for pathogens and forms a risk to public health. The main element answering the workshop theme is: In order to open a discussion with (commercial) parties the matter could best be approached in a positive way; focusing on advantages and possibilities, rather than pointing out consequences. Avoid potentially uncomfortable and revealing tests by using successes from other industries with Nano-coatings as comparison. Key business words: Consciously controlling health matters and Corporate Social Responsibility (CSR). 5

6 Index Preface... 3 Introduction... 4 Executive Summary... 5 Abbreviations... 8 Tables and Figures... 9 Part 1: Background and Set up Research Design About NanoServices Company Description Product Description Research Objectives Company Goal Problem Definition Objectives Hypotheses Research Methodology Part 2: Research Hygiene Standards and Requirements Regulatory Bodies and Documentation Concerning Aircraft Hygiene International Civil Aviation Organization International Air Transport Association World Health Organization and International Health Regulations Rijksinstituut voor Volksgezondheid en Milieu Inspectie Leefomgeving en Transport Responsibilities of the Airport Authorities Aircraft Hygiene and Research Aircraft Manufacturers Previous Research on Aircraft Hygiene Common Communicable Diseases, Found in Public Areas Desk Research Conclusion Preparation and Implementations Hygiene Field Research Interviews Aviation Industry Vakbond Nederlands Cabinepersoneel

7 2.1.2 Cabin attendants Interviews Regulatory and Monitoring Agencies RIVM ILT Aircraft Sampling Aircraft Sampling Setup Sampling Results Conclusions Preparation and Implementations Hygiene Field Research Conclusions and Recommendations Conclusions Recommendations Workshop Workshop Theme Definition Around-the-Table Discussion Workshop Results Bibliography Appendices Appendix I Phase Pyramid Appendix II Brainstorm Appendix III IATA SGHA Appendix IV AAS Ground Handling Providers Appendix V Gram Negative / Gram Positive bacteria Appendix VI Questionnaire Cabin Crew Appendix VII Questionnaire RIVM Appendix VIII 40 GGD Hailing Diseases Appendix IX Questionnaire ILT Appendix X Letter Airlines

8 Abbreviations Abbreviation AAS AMM ARBO Meaning Amsterdam Airport Schiphol Aircraft Maintenance Manual Arbeidsomstandigheden; Labor conditions B767 Boeing Aircraft, type 767 CAA-NL CFM CFU C-MRSA CO 2 Clb CSR EPI FAR H1N1 H2O HEPA HMD IATA ICAO IGOM IHR ILT ISO IVW JAR MRSA NOx RIVM SANA SARS SGHA TB/ TBC TiO2 VLR VNC VpS Civil Aviation Authority Netherlands, former IVW Cubic Feet per Minute Colony Forming Units Community Acquired-Meticilline-Resistant Staphylococcus Aureus Carbon dioxide Centrum Infectieziektebestrijding; Infectious Disease Control Corporate Social Responsibility, Maatschappelijk Verantwoord Ondernemen (MVO) Epidemiology and Surveillance Federal Aviation Regulations Swine Flu, subtype of the Influenza A flu virus Water High Efficiency Particulate Air filter Hygiene monitor Deutschland International Air Transport Association International Civil Aviation Organization IATA Ground Operating Manual International Health Regulations Inspectie Leefbaarheid en Transport; Inspection for Habitat and Transport International Organization for Standardization Inspectie Verkeer en Waterstaat; Inspection of Transport and Watermanagement Joint Aviation requirements Meticilline-Resistant Staphylococcus Aureus mono-nitrogen Oxides Rijksinstituut voor Volksgezondheid en Milieu; National Institute for Public Health and Environment Safety Assessment of National Aircraft Severe Respiratory Syndrome IATA Standard Ground Handling Agreement Tuberculoses Titanium dioxide Visible Light Response Vakbond voor Nederlands Cabinepersoneel, Union for Dutch Cabin Attendants Veiligheidsplatform Schiphol; Safety Platform Schiphol 8

9 VROM VWS WHO Ministerie van Volkshuisvesting, Ruimtelijke Ordening en Milieu; Ministry of Housing, Spatial Planning and Environment. Ministerie van Volksgezondheid, Welzijn en Sport; Ministry of Health, Welfare and Sport World Health Organization Tables and Figures Tables Content Page Table 1 Five industries and branches NanoServices is serving 10 Table 2 General five phased model of implementation Nano-technology in Aviation 11/12 Table 3 Problem definition and research question 12 Figures Content Page Figure 1 Measurement performed on A310 and A Figure 2 Response RIVM 32 Figure 3 Response ILT 34/35 9

10 Part 1: Background and Set up 1. Research Design NanoServices provides non-biocide, anti-bacterial and self-cleaning coatings, called Environ-X, to many different industries and businesses (1.1). The aviation industry appears to be an interesting market, since it connects people and possibly also pathogens, worldwide (1.2). Exploring the opportunities and possibilities for Nano-coatings in aircraft, the current state of aircraft hygiene is assessed (1.3). 1.1 About NanoServices NanoServices currently serves five industries and is constantly working to expand its scope, which also means operating abroad (1.1.1). NanoServices introduced Nano-technology in the form of selfcleaning and antibacterial coatings under the name Environ-X (1.1.2) Company Description Dimmen Breen, Theo Sijs and Daniel Bock founded NanoServices in Dimmen Breen and Theo Sijs both owned 40% of the company s shares and Daniel Bock the remaining 20%. In January 2011, Dimmen and Theo both sold 2.4% of their shares to Forensic doctor and Physician Frank Dekker. NanoServices owns 50% of HMD Hygiene Monitor Deutschland in Tonisvorst near Krefeld. In Germany the activities will be similar to those in The Netherlands. The initial focus of the company was on the automotive industry. However, in 2007 NanoServices started to concentrate more on the anti-bacterial and self-cleaning coating Environ-X. NanoServices is currently active in five industries and branches (Table 1). Industry Healthcare Wellness Food sector Building industry Office buildings Specific areas Hospitals, Dental practices, Daycare centers Spas Food production and packaging facilities Construction fittings and the self-cleaning properties of the coating on glass, concrete, steal and carbon Applying coatings on keyboards, computer mice and landline phones at inter alia Banks, Municipalities, Ministries and the University of Applied Sciences, Utrecht. Table 1 Five industries and branches NanoServices is serving In order to guarantee and demonstrate the effectiveness of the coatings, NanoServices set up the European registered BacterieMonitor, which is offered to customers in the form of a three-year plan. NanoServices actively participates in conducting research on the safety of the Nano-particles and techniques it uses. In addition, many tests have been performed on the effectiveness of the coating under various conditions and on different organic and chemical substances. 10

11 1.1.2 Product Description Environ-X is a multipurpose, water based, photo-catalyst coating. The main component is Titanium dioxide (TiO 2 ) and needs UV light to operate. Environ-X is produced with the VLR (Visible Light Response) technology; a formula that enables the coating to work for a longer time in the dark. Environ-X mineralizes Bacteria, Fungi, Algae and Virus particles. In addition, the coating is able to convert chemicals and harmful particles in the air, such as mono-nitrogen Oxides (NOx), into Carbon dioxide (CO 2 ), Water (H 2 O) and various other harmless inorganic anions. In this process of mineralization the TiO 2 functions as a catalyst and is not consumed in the process. Therefore, Environ-X is according to the European Commission (98/8 EC MoD Titanium dioxide) not considered a Biocide. 1,2 1.2 Research Objectives NanoServices is interested in the new possibilities the aviation industry has to offer, and vice versa (1.2.1). Before approaching airlines, airports and aviation associated governmental agencies, having a clear view on the issues and areas where progress can be made is a sensible first step (1.2.2). The main objective is to create a report that gives a clear and objective view on the current state of aircraft hygiene and the regulations behind it (1.2.3) Company Goal The goal of NanoServices regarding Aviation is to enter the aviation industry by demonstrating the need for their coatings. There are two main elements that are taken into consideration, namely: applying the coatings post fabrication and implementation of the coatings into the manufacturing or installation process of the aircraft components. The Dutch Aviation Industry can be divided into three sectors: Airlines, Airports and the Regulatory/ Governmental bodies. To demonstrate the potential of antibacterial and self-cleaning coatings for aircraft and airports, perhaps eventually leading to governmental awareness and support, data on the current situation of hygiene in aviation is needed. Therefore the process of introducing Nanotechnology can be divided into five different phases (Table 2). Phase Sector Description Phase 1 General Regulations in Aviation, concerning hygiene. Gather data on the hygienic state of nonspecific commercial aircraft. Consequences current CFU state compared to set standards/ limitations. Phase 2 Airline Formulate risks for airlines: Financial, Reputation, Absenteeism Perform tests on aircraft by coating one and comparing to non-coated one. Determine strategic and financial advantages of Nano-coatings Phase 3 Airport Determine need for coatings in airports (example Shanghai airport, completely coated) Strategic advantages: Popularity airport, Cleaning costs and environmental aspects Phase 4 Government Interest for Dutch economy: Aviation sector, reputation country, potential expenses saved by averting health crisis Public safety 11

12 Phase 5 Manufacturers Approach aircraft and component manufacturers: Airbus, Boeing etc. Table 2 General five-phased model of implementation Nano-technology in Aviation The fifth phase is not necessarily dependent on the other phases and can therefore be executed simultaneously. The first phase has priority, since it provides data that can be used to substantiate analysis made in the following phases (Appendix I) Problem Definition The past years the world has encountered many cases of contamination and global spreading of contagious pathogens. The Aviation sector, more than any other sector, is at the basis of the rapid spreading of these communicable diseases. Before aviation existed, diseases were transported overseas by boats and ships, which could take weeks and sometimes months. Through air travel, a contaminated person can arrive at any destination within hours. In addition, the person may not only contaminate people at his destination, he is also able to infect his fellow passengers; possibly leaving traces, in the form of viral and bacterial units, behind in the aircraft. The entire aircraft could become a reproduction ground for bacteria and other colony forming units. What is the scale on which the aircraft are already acting in this manner today? This led to the following Problem definition and research questions (Table 3): Problem definition Research question Increasing number of new communicable diseases (H1N1, TBC) Number of immune bacteria growing and spreading (MRSA, C-MRSA) Biochemical terrorism (SARS, ANTRAX) + Easy and fast global spreading opportunities for communicable diseases by aircraft + Aircraft themselves could be breeding grounds for CFUs What are the standards for aircraft hygiene stated by the regulatory bodies, and is it feasible for an airline to comply with these regulations? Table 3 Problem definition and research question Objectives The objective of phase 1 is to determine whether there will be a market for NanoServices in Aviation, based on the regulations concerning aircraft hygiene and the awareness and interest for this subject by the airline industry. The document can be used as a tool to approach airlines, airports and the Dutch governmental agencies in the future. 12

13 1.3 Hypotheses When determining the need for Nano-coatings in the Aviation industry, the starting point in phase 1 is from a disease controlling and heath security perspective. Two additional categories that are taken into consideration when introducing the product to the aviation sector are: Regulations and Cash savings. Hypothesis 1 (H1): There are regulations concerning aircraft cabin hygiene. Hypothesis 2 (H2): Passengers can get infected during flight because of the hygienic conditions. Hypothesis 3 (H3): Airlines are able to comply with hygiene regulations. In order to test whether these Hypotheses are true or false multiple relating research questions are researched, including: H1 - Are there any measures to prevent passengers from infecting each other during their stay in an aircraft cabin (by the Government, Airline or Aircraft manufacturer)? - What are the regulations concerning aircraft Hygiene and cleaning procedures? - Have there been any researches conducted on this subject? - What agencies are responsible for creating rules and monitoring compliance with regulations concerning hygiene? H2 - Are airlines aware of any risks of communicable diseases spreading amongst passengers? - Are there any signs of increasing illnesses amongst air travelers known to the authorities? - Has there been an increase in absenteeism amongst airline (cabin) personnel? - Has there been an epidemic threat since the Swine Flu outbreak in 2009? - Is it common for multiple passengers to become sick after traveling in the same aircraft with a sick passenger? - Have there been any researches conducted on this subject? - What is the scale at which aircraft are serving as a breeding ground for bacteria and other CFUs today? - Are there consequences for the aircraft being in the state that they are in? H3 - How does the cabin crew feel about hygiene on board commercial aircraft? - What is the hygienic state of commercial aircraft? - What are the standards for aircraft hygiene stated by the regulatory bodies, and is it feasible for airlines to comply with these regulations? 13

14 2. Research Methodology Prior to the research a brainstorm session was held at the office of NanoServices in Nunspeet, to determine whether the research questions and Hypotheses were representative for the current situation in Aviation hygiene. Present at this brainstorm meeting were the three members from the board of NanoServices, a pilot a flight attendant and a physician. The likelihood of contaminations with pathogens through air travel (airborne particle contaminations and surface contact contaminations) were discussed as well as the perception of the airline crew regarding the cleanliness of the aircraft pre and post flight. The results of this brainstorm session (Appendix II) indicated that the aviation industry could very well be a market with great potential for improvements on Hygiene. To inquire the previously stated research questions and associated Hypotheses, the following methods are used: 1. Desk Research 2. Interviews Aviation Industry 3. Interview Regulatory and Monitoring Agencies 4. Measurements ad 1. Desk research This method is used for gathering information from regulatory bodies as well as media and university publications. Here, aircraft hygiene, air quality and cleaning methods are all taken into consideration. ad 2. Interviews Aviation Industry To find out how topical hygiene and health related issues are in aviation, Interviews are requested among cabin attendants, the Vakbond Nederlands Cabinepersoneel (VNC) and several commercial airlines and maintenance companies. ad 3. Interviews Regulatory and Monitoring Agencies Supplementing the information found during the desk research, the RIVM and ILT are contacted to see if there are new laws and regulations in the making and to find out how topical this subject is. ad 4. Measurements Complimenting the gathered data a company visit will be requested to take (swab) samples from the cabin interior from several randomly selected commercial aircraft. In order to do so several Commercial Airlines and maintenance companies are approached. 14

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16 Part 2: Research 1. Hygiene Standards and Requirements The aviation industry is a closely monitored industry, built up out of rules and regulations. These regulatory bodies and their documentation concern aircraft hygiene as well, although it seems focused on damage control more than on incident and accident prevention (1.1). Previous researches show that the air quality in aircraft is high, because of the use of special High Efficiency Carbon Filters. The surface hygiene however appears to be neglected (1.2). Common Communicable diseases, found in public areas thrive best under certain air and moist conditions. Despite the unique aircraft climate, previous studies have shown traces of these particles in aircraft cabins (1.3). From all results found in the Desk Research the definitive direction of the field research is deduced (1.4). 1.1 Regulatory Bodies and Documentation Concerning Aircraft Hygiene The main organizations that determine international standards for regular and comprehensive aircraft cleaning and disinfection procedures are ICAO (1.1.1), IATA (1.1.2) and the WHO - IHR. The IHR is aware that different views on situations by different governments may result in different ways of handling situations (1.1.3). 3 The national governments are responsible for ensuring compliance with regulations; modifications and adjustments are permitted. The RIVM is the Dutch governmental health institute, researching health and safety issues on national behalf (1.1.4). Ground handing falls under the responsibility of the airline and airport and consists of all pre departure and post landing activities around the aircraft, except for all technical and engineering activities. The ILT monitors the ground handling activities indirectly through audits made by the airport authorities (1.1.5). Therefore, the consultation procedures concerning contractors performing the service of aircraft cleaning will be performed by the airport authority (1.1.6) International Civil Aviation Organization The International Civil Aviation Organization (ICAO) is a body of the United Nations that was established to prevent aircraft accidents. It sets regulatory standards in order to achieve a safe, secure and environmentally conscious aviation sector and is respected by 191 Member States. In 2004 ICAO stated that the protection of the health of passengers and crews on international flights is an integral element of safe air travel. Therefore, it has been cooperating with the World Health Organization (moreover in paragraph 1.1.3, WHO -IHR) in the field of hygiene in Aviation International Air Transport Association The International Air Transport Association (IATA) represents and serves the airline industry by monitoring the regulators and governments of airlines worldwide, to ensure that regulations stay rational. Through this, IATA works on improving efficiency and passenger comfort while keeping costs down. Globally, 240 airlines joined IATA, which equals approximately 84% of the total air traffic industry. 4 As IATA describes it: IATA allows airlines to operate safely, securely, efficiently and economically under clearly defined rules. 16

17 IATA publishes manuals and information for airlines as well as other aviation related businesses. The Ground Handling agencies usually make use of the Airport Handling Manual, and in particular the IATA Ground Operations Manual (IGOM) or the Standard Ground Handling Agreement (SGHA). In the field of Cabin Cleaning IATA provides a list of steps, to be taken by the cleaning crew for normal cleaning, deep-cleaning, as well as in case of a suspected communicable outbreak on board (Appendix III). The list does not elaborate on what chemicals or detergents to use, minimal time needed for the services nor on the level of hygiene that is to be achieved World Health Organization and International Health Regulations The World Health Organization (WHO) promotes and conducts health research and directs and manages health related issues worldwide, for its 193 member countries. Within the United Nations the WHO is the main body in the field of health and engages in the following health matters: - Shaping the health research agenda - Setting norms and standards - Articulating evidence-based policy options - Providing technical support to countries - Monitoring and assessing health trends 6 With the support of the WHO, International Health Regulations (IHR) was established. The legally binding agreement between the member states of the WHO and the IHR enhance public health awareness and responsiveness to health threats and outbreaks of infectious diseases. It also gives the WHO a clearer view on aspects that require further investigating and intervention. Airlines are obliged to comply with the requirements stated in the IHR (2005) as well as the specific regulations of the countries these airlines serve. The IHR states several basic rights and obligations for its members: Citation IHR (2005) - Documentation, notification and verification by members to the WHO in cases of certain specified deceases and events concerning two or more of the four following criteria: Seriousness of public health impact Unusual or unexpected nature Risk of international spread Risk of interference with international trade - The state parties are obligated to develop a means of detecting, assessing, controlling and reporting public health events at airports or ground crossings. It is the duty of the ILT to ensure that airports and aircraft are kept free of sources of infection and contamination. 7 Citation WHO (2008) - Authorizations and limits on health/ sanitary measures that may be applied by state parties to international travelers. - Certificate/ document requirement in sanitary requirements for international air and sea traffic. 8 17

18 In association with the IHR, the WHO published the Guide to Hygiene and Sanitation in Aviation, Third Edition (Geneva 2009). This report is divided into two parts: - Module 1: Water - Module 2: Cleaning and Disinfection of Facilities The reason for the development of this edition was the adjustment of the IHR It describes standard practices that are in line with those delineated in the IHR. It states that Airlines and Airport operators are responsible for communication and cooperation with the public health authorities in monitoring health aspects of international passenger transport. The group of international air travelers is difficult to monitor since they are exposed to numerous sources of infection. Fellow passengers are the main cause of the spreading of communicable diseases and are tough to keep track of since upon arrival at an airport the groups usually spread out rapidly. This is why the Airport and the airlines are both expected to work together on gathering public health data. Citation WHO (2009) Public health surveillance, defined as the ongoing, systematic collection, analysis and interpretation of data ( ) for use in the planning, implementation and evaluation of public health programs, must be implemented in the aviation sector, including airports and aircraft. 3B Within Hygiene and Sanitation in Aviation a distinction is made between Cleaning and Disinfecting. Cleaning refers to cleaning up and removing visible clutter. Removing and killing Colony Forming Units (CFUs), bacteria and virus particles is referred to by Disinfection. This is usually done during periodic maintenance or when the presence of an infected passenger is suspected. The document distinguishes three different ways of contamination: trough inhalation of infected particles, through contact with bodily fluids and matter, and through secreted bodily fluids, particles and excrement through surface contact and via air ventilation systems. According to the IHR, infestations within aircraft largely depend on the extent to which the cabin air is being ventilated and by which patterns the air is circulated through the cabin. It also has to do with the size of the particles in relation to the filters. The degree of contamination of surfaces is dependent on the viability and quantity of the particles present, in combination with the frequency at which these surfaces are touched, and how often it is cleaned/ disinfected. 3C However, no standards concerning CFUs or basic conditions are mentioned Rijksinstituut voor Volksgezondheid en Milieu The National Institute for Health and Environment, in Dutch Rijksinstituut voor Volksgezondheid en Milieu (RIVM), consists of multiple divisions. These divisions are composed of laboratories, research teams and research centers. Through performing continuous research on subjects such as health and health care, food, nature and environment and disaster prevention the RIVM advices national and international governments on how these matters should be dealt with. The RIVM collects information globally through surveys and the help of inspectors, scientists and policy makers. Their findings are published. The RIVM has a subdivision called the Center of Infection Control, in Dutch: Centrum Infectiebestrijding (Clb), which manages the prevention of infectious diseases by high vigilance and 18

19 fast response in case on an outbreak. Within the Clb the division Epidemiology and Surveillance (EPI) is appointed to identify and document the past and current situation regarding infectious diseases and outbreaks, focusing on outbreak frequencies, risk factors and analyzing effectiveness of interventions. The Clb is inter alia in direct contact with the WHO, which is also one of the main sponsors of the RIVM. Other Sponsors are: The European Union The United Nations - WHO The Dutch Ministry of Health, Welfare and Sport (VWS) The Dutch Ministry of Economic Affairs, Agriculture and Innovation The Dutch Ministry of Infrastructure and Environment Inspection Habitat and Environment Inspectie Leefomgeving en Transport As from January 2012, the former Ministries of Housing, Spatial Planning and Environment, in Dutch: Ministeries van Volkshuisvesting, Ruimtelijke Ordening en Milieu (VROM), and the Inspection of Transport and Water Management, in Ducth: Inspectie Verkeer en Waterstaat (IVW = CAA-NL), merged into Inspection Habitat and Environment, in Ducth: Inspectie Leefomgeving en Transport (ILT). Instead of the IWV - Division Aviation, the ILT - Division Aviation will now be ensuring that National law and international aviation related regulations, such as those described in EASA, are complied with. The tasks of the ILT are to create yearly surveillance programs that aim to improve the safety and environmental protection according to previously mentioned legislation. The inspections that will be performed by the ILT Division Aviation are also listed in the program. Safety Assessment of National Aircraft (SANA) are safety specifications that are meant for inspections of Dutch Airliners. It monitors for compliance with ICAO recommendations by checking the aircraft, the flight documents and the preparations in the fields of: Operations Technical Aspects Passenger Safety The inspection results will be used to analyze risks and perform trend analysis; also using results obtained from other researches that were done nationally and internationally. The results from these inspections are entered into a central database from the Joined Aviation Authorities. This enables parties from member states, performing risk analysis or researching corrective measures, to access all data. The inspections are unannounced and are performed during technical handling, post landing. Since 2010, the ILT handed over the responsibility of supervising ground Handling Procedures and Quality in Amsterdam to Amsterdam Airport Schiphol (AAS). All ground handling agencies now communicate to one monitoring organization (AAS), which is subsequently monitored by the ILT through System Monitoring of audits and checklists. 9 At AAS there are multiple ground handling parties present. These companies typically outsource tasks such as cleaning, fueling and catering; therefore, they do not offer a complete ground handling package. At AAS there are three major cleaning companies active, which are all certified by the Inter- 19

20 national Organization for Standardization (ISO) which is the world's largest developer and publisher of International Standards. 10 In addition, all companies at AAS that are involved in aviation operations, inter alia the handling agencies and the fueling service providers, are associated with Schiphol s Safety Platform Veiligheidsplatform Schiphol (VpS). VpS takes care of quality and manages safety in all areas of Schiphol. 11 A 2008 survey on ground handling in the Netherlands, performed by the ILT, showed that, despite the safety management systems that the ground handling agencies have drawn up from the ISO publications, no real standard information appeared to be available. It was also apparent that cleaning companies were not part of the VpS, preventing the exchange of information between the different providers (Appendix IV). The trainings for the cleaners is also done independently by the cleaning companies. The conclusion of this survey was that, despite the independent trainings, and lack of standardization and intercommunication, flight safety is not affected, since the cleaning activities are not considered risky. In addition, the inspectors found that the cleaning companies had never been subjected to inspections before. The inspectors finally stated that because of the low risk activities of the cleaners standardization is not considered required and further inspections are unnecessary Responsibilities of the Airport Authorities As mentioned in the previous paragraph, ground handling falls under the responsibility of the Airline and the Airport. In the case of AAS, the airport is responsible for supervising quality and safety of ground handling procedures and, in turn, is monitored by the ILT. The airline and airport operators are responsible for communication and cooperation with the health authorities and for monitoring the health aspects of international passenger transport. The information concerning the cleaning procedures should be available upon request for those concerned. In addition the engineering department of the airline needs to be able to show an overview of all cleaning products used on board, with reference to the manufacturers recommendations. It is common for these detergents to be listed in the Aircraft Maintenance Manual as well. The cleaning program should contain routine cleaning procedures along with a time-scheme. The main criteria for this program is that it is written for properly educated cleaning personnel and listing harmless detergents that can be used. 1.2 Aircraft Hygiene and Research In the area of air circulation aircraft manufacturers follow internationally determined minimal ratios. The air is filtered during these circulation processes through high efficiency filters (1.2.1). Many researches have been conducted on the air quality in aircraft, testing the risks for in flight pathogenic contaminations (1.2.2). 20

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