Forrest M. Mims III, atmospheric science consultant and author of 60 books and 1,200 papers and articles (www.forrestmims.org)

Michael Nirenberg, DPM, nationally prominent podiatrist and author of numerous publications (www.americaspodiatrist.com)

Michael J. Dwyer, MD, general surgeon

Sherry L M Jimenez, RN, MSN in women’s health, author of 5 books and 350 articles on women’s health

David Reiff, RN, MSN, Instructor of Nursing, St. Philips College

Susie Reiff, RN, Clinical Associate Professor, School of Nursing, University of Texas Health Science Center at San Antonio

 

 

 

 

 

 

 

SUMMARY
TSA security checkpoints at more than 450 US airports constitute a vast network of public health nuisances, for each checkpoint poses a significant risk for the transmission of communicable diseases between travelers and between travelers and screeners. The TSA has ignored many public requests to employ standard hygienic practices, including the use of fresh, clean gloves when conducting searches of travelers and their possession and providing disposable footwear. Instead, the TSA has warned travelers they will be detained and subjected to fines of up to $11,000 if they disrupt the security procedures. The TSA officials responsible for establishing and enforcing their network of public health nuisances have ignored public demands for a sanitary screening. While it is not possible to trace infections to the airports screening experience, it is well known that the incidence of community methicillin-resistant Staphylococcus aureus (MRSA) has increased sharply across the US since the introduction of unsanitary airport screening procedures by the TSA.

INTRODUCTION
The public reaction to new TSA airport search procedures has mainly concerned the use of x-ray backscatter and millimeter wave technologies and the legality of highly invasive physical searches. The public has also expressed concerns about the possibility of being infected with communicable diseases due to unsanitary facilities and improper hand hygiene by TSA screeners.

Here we describe how the TSA’s frequently expressed concern for the safety of airline travelers is belied by its ongoing refusal to correct serious public health deficiencies at its vast network of security checkpoints at more than 450 airports.

Each day the TSA knowingly subjects some two million airline passengers to the possibility of infection from a wide range of pathogens while searching their persons and their belongings. Possible infection may occur when the bare skin of travelers is physically touched or stroked by screeners wearing contaminated gloves. Pathogens may also be exchanged when contaminated gloves are used to touch travelers’ clothing and personal belongings and by ordering travelers to remove their shoes and walk bare foot or in stocking feet 10 meters or more across contaminated floors that may be cleaned only once a day or carpets and rubber mats that are rarely or never properly cleaned. Pathogens may also be exchanged via the bins into which travelers are required to place everything from their dirty shoes to baby blankets and toys.

The TSA has ignored numerous requests from the traveling public to provide disposable foot wear for all travelers. The TSA has ignored numerous requests on its own blog and the web to use fresh gloves when searching travelers and their belongings. The TSA refuses to sanitize the bins into which travelers are ordered to place their shoes and belongings.

The abusive hygienic conditions practiced and enforced by the TSA are a result of serious mismanagement, for they violate specific guidelines of the US Centers for Disease Control and many public health and medical organizations. Yet a traveler who refuses to be subjected to possible infection by TSA screeners wearing contaminated gloves or by refusing to stand on unsanitary floors, carpets and mats may be shouted at, detained, arrested and threatened with civil penalties of up to $11,000.

Proper hand and foot hygiene and the cleansing of exposed surfaces are essential for reducing the spread of dangerous pathogens, some of which can lead to life threatening infections. A typical example of a proper hygienic protocol that minimizes the spread of pathogens is given by the CDC in Exhibit 1 and by John Muir Health:

“Transmission of MRSA tend[s] [to] occur in 5 general situations referred to as the 5 C’s: Crowding, frequent skin-to-skin Contact, Compromised skin (i.e., cuts or abrasions), Contaminated items and surfaces, and lack of Cleanliness. Healthcare workers’ hands are most often cited as the primary means of person to person MRSA transmission. Therefore, basic patient care dictates all healthcare workers wash all surfaces of their hands frequently; when personal protective equipment (PPE), such as gloves, are removed; when the hands become visibly soiled; and after contact with the patient or patient’s environment. Gloves, PPE, contaminated bandages and other materials should be discarded in a covered container or a sealed plastic bag.” (Bolding added. From http://www.johnmuirhealth.com/index.php/laboratory_infection_control3.html#mrsa Copyright 2010.)

The traveling public’s requests for correcting the TSA’s absence of proper hygienic standards for searches and their belongings have long been ignored by the TSA. Furthermore, there is no known method for tracking cross-infections of dangerous pathogens that might occur at such checkpoints. It is therefore essential that the TSA take immediate action to cease jeopardizing the health of the hundreds of millions of airline travelers who are required by law to pass through TSA checkpoints each year.

SPECIFIC COMPLAINTS
Threats to the health of airline passengers enforced by abusive TSA policies, procedures and threats of significant fines for noncompliance include:

1. Abuse of Authority and Mistreatment: Travelers and their belongings are searched by screeners who are not required to comply with CDC guidelines for the proper use of gloves. (Exhibit 1.)

The right of airline passengers to experience a sanitary screening procedure that avoids conditions having the potential to acquire or spread pathogens has long been ignored by the TSA. The TSA does not require screeners to change gloves between travelers and their belongings.

According to the TSA web site, only “Travelers with Disabilities and Medical Conditions” are allowed to request fresh gloves for searches of their person and belonging. (“You have the right to ask a Security Officer to change her/his gloves during the physical inspection of your accessible property, before performing a physical search (pat-down,) or any time a Security Officer handles your footwear.” http://www.tsa.gov/travelers/airtravel/specialneeds/editorial_1567.shtm, accessed on 28 November 2010.)

Nor have we observed that the TSA follows CDC protocols for the proper use of gloves. This is a clear violation of the universally recommended public health practice of hand washing and changing gloves prior to touching and examining a patient (see CDC guidelines for the safe use of gloves in Exhibit 1). Various online posts and media reports allege and even depict in videos that TSA screeners are inserting their gloved fingers inside passenger’s waistbands and other private regions. These and many other reported incidents describe a scenario for the transmission of pathogens, especially if the screener did not properly don and use fresh, clean gloves for the search and then properly dispose of them in the recycle bin. Some screeners report they keep spare gloves in their pockets, which contaminates the gloves. Failure to properly wash hands before donning gloves also contaminates the gloves.

Many travelers have notified TSA about its failure to follow hygienic practices for gloves, as can be verified by going to the TSA blog and entering “gloves” in the search window. Recently there have been many reports of direct touching of breasts and genitalia by TSA screeners wearing gloves that may have been used to conduct prior searches. For example,

a. Erin Chase, who was traveling with her baby, reported on her blog (http://www.ourlittlechatterboxes.com/) the following incident at the hands of a TSA screener on 12 November 2010 at Dayton, Ohio:

“… She felt along my waistline, moved behind me, then proceeded to feel both of my buttocks. She reached from behind in the middle of my buttocks towards my vagina area.

“She did not tell me that she was going to touch my buttocks, or reach forward to my vagina area.

“She then moved in front of my and touched the top and underneath portions of both of my breasts.

“She did not tell me that she was going to touch my breasts.

“She then felt around my waist. She then moved to the bottoms of my legs.

“She then felt my inner thighs and my vagina area, touching both of my labia.

“She did not tell me that she was going to touch my vagina area or my labia.”

b. On 22 November 2010, ABC News reported (http://abcnews.go.com/Travel/tsa-responds-passenger-outrages-underwear-search-happen/story?id=12208932):

“An ABC News employee said she was subject to a “demeaning” search at Newark Liberty International Airport Sunday morning.

“’The woman who checked me reached her hands inside my underwear and felt her way around,’ she said. ‘It was basically worse than going to the gynecologist. It was embarrassing. It was demeaning. It was inappropriate.’”

TSA Administrator Pistole did not issue a public response to the incident involving the young mother with her baby on 16 November described above. However, he did respond to the second incident related by a female employee of a major national news organization. Pistole stated on “good Morning America” “That search was against protocols and ‘never’ should have happened.”

The search that “never should have happened” would never have happened if Pistole had promptly responded to prior reports from women who described essentially the same kind of invasive touching that the ABC News employee experienced. Instead, Pistole waited until he was questioned by a major television network. The regrets provided by Pistole for the benefit of the ABC employee followed the abuse of unknown numbers of women, children and men without major media connections. This adds to the mismanagement reported in this complaint and provides more justification for the dismissal of Pistole as TSA Administrator.

2. Abuse of Authority and Mistreatment: Travelers, especially those with diabetes, peripheral arterial disease and immunodeficiency, are at risk of acquiring potentially serious infections of the foot by being required to walk across and stand on dirty floors, rubber mats and carpets in their bare or stocking feet.

Each day some two million airline passengers are required to remove their shoes and walk tens of feet across floors or carpets that are clearly unsanitary and sometimes littered with unknown objects and possible sharps. Travelers, including children, are then required to place their feet within rectangular or foot shaped outlines marked on the floor where their persons are electronically scanned and/or physically searched. During this time travelers are standing on a rarely cleaned surface exactly where hundreds or even thousands of other travelers stood before them, many with bare feet.

The TSA fails to provide travelers with disposable footwear for use during the screening process. This is a violation of the universally recommended public health practice that people not walk across public areas without protective footwear.

Some travelers have posted online statements to the effect they have acquired a foot infection or fungus at a security checkpoint, and there is good reason to take their complaints seriously.

a. Dr. Marybeth Crane is a board certified podiatric foot and ankle surgeon. In “Barefoot Passengers in Disgusting Airports” http://ezinearticles.com/?Barefoot-Passengers-in-Disgusting-Airports&id=1674095), Dr. Crane describes how carpets in screening areas can potentially spread cutaneous herpes, plantar warts (verruca vulgaris), foot and toenail fungus and staph, including MRSA.

Dr. Crane observes that airport restroom floors are cleaned several times a day and are probably much cleaner than the floor at security checkpoints. On 19 November 2010, a TSA supervisor at the San Antonio International Airport reluctantly told one of us that the checkpoint floor is cleaned only once a day. He did not comment on the cleaning of rubber mats with worn markings for the placement of feet or the cleaning of the baggage bins.

b. Dr. Michael Nirenberg is a nationally prominent podiatrist. In “What You Can’t See Can Hurt You: Simple Steps to Protect Your Feet from Infection” (http://www.americaspodiatrist.com/2009/07/what-you-can%e2%80%99t-see-can-hurt-you-simple-steps-to-protect-your-feet-from-infection/), Dr. Nirenberg discusses the serious nature of infections that can result from exposure to methicillin-resistant Staphylococcus aureus (MRSA) by walking with bare feet across contaminated surfaces. Diabetics are particularly at risk.

c. Dr. David Armstrong is a Professor of Surgery, Chair of Research and Assistant Dean at the William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine in Chicago and a member of the National Board of Directors of the American Diabetes Association. In “MRSA: Where Do We Go From Here?” (Podiatry Today 18, Mar 01, 2005 (http://www.podiatrytoday.com/article/3695), Dr. Armstrong wrote that, “…the majority of diabetes-related amputations result from peripheral arterial disease, peripheral neuropathy or infection…. Antibiotic resistance is a growing problem in diabetic foot infections. In particular, methicillin-resistant Staphylococcus aureus (MRSA) pathogens have been isolated with increasing frequency from wound and skin infections that commonly affect the lower extremities of patients with diabetes. For these individuals, foot infections caused by MRSA organisms have been associated with poorer outcomes related to an increased risk of amputations and infection-related mortality.”

3. Abuse of Authority and Mistreatment: Travelers are denied the right to fly if they refuse to comply with nonhygienic screening procedures.

The TSA states, “If you refuse to be screened at any point during the screening process, the Security Officer will deny you entry beyond the screening area. You will not be able to fly.” (http://www.tsa.gov/travelers/airtravel/assistant/editorial_1049.shtm) This policy is a direct abuse of a passenger’s basic right to a safe and healthy screening experience, including the provision of disposable foot wear to travelers and the use of approved hand hygiene and fresh gloves by screeners. Airport restrooms often post signs requesting that travelers report unsanitary conditions. Likewise, travelers who observe and report unsanitary conditions or procedures at TSA checkpoints should be thanked and not banned from making their flight.

4. Abuse and Mistreatment: The emotional health of travelers is abused by the TSA when it orders screeners to conduct intimate body searches.

To this day the TSA has failed to fully inform the public that their new intimate search procedure involves the touching of the most private parts of travelers, including their genitals. Instead, DHS Secretary Janet Napalitano misleadingly described the invasive searches as a “revised pat down procedure” during an interview with Charlie Rose (PBS, 22 Nov 2010).

There is abundant evidence that intimate body searches by the TSA of ordinary citizens simply trying to catch a plane have caused serious emotional distress to many of those who are searched, their friends and relatives, nearby travelers who observe such searches and even the general public.

Many online videos and media broadcasts show the wide range of emotions elicited by the new, intimate search procedure. Many travelers, especially children and women, are especially upset by the highly invasive nature of the searches, which are often described as sexual molestation, particularly when a child is the target. Many people have also expressed concern about possible infection from the poor sanitation practices at checkpoints and the absence of proper hand hygiene by TSA screeners.

Some women who have been the victims of sexual assault report being especially troubled by being intimately searched by the TSA, or the mere thought of the possibility as they make their travel plans and when they wait in line at a checkpoint. Many people, including some of us, have canceled flight plans to avoid such abuse.

The TSA must immediately cease employing any search methods that involve intimate touching and threaten the emotional and physical health of airline passengers. The TSA must immediately accommodate the reasonable public health concerns of travelers by providing sanitary, temporary footwear for all travelers required to remove their shoes at checkpoints. The TSA must also relieve legitimate traveler concerns about disease transmission via contaminated baggage bins by providing sanitized bins for the placement of personal effects and separate bins for shoes.

 

RECOMMENDATIONS

We respectfully offer the following recommendations for consideration by the DHS and TSA:

1. SHOE REMOVAL: All travelers who are required to remove their shoes should be provided with sanitary, recyclable, disposable footwear BEFORE removing their shoes. Travelers should be provided with chairs or benches for removing shoes and placing on their feet disposable footwear.

2. X-RAY BINS: The TSA should provide separate shoe bins having a unique color and marked with a shoe outline. Shoe bins must be smaller than bins for personal belongings so they cannot be stacked with standard bins. Travelers, especially those traveling with babies and young children, must be allowed to request sanitized personal effects bins. All bins must be sanitized at frequent intervals during each day.

3. FOOT PADS: All foot pads where travelers are required to stand over marked outlines should be hygienically cleaned throughout the day.

4. TSA SCREENER HEALTH: Screeners with communicable diseases should not be allowed to conduct physical searches of travelers.

5. TSA CLOTHING HYGIENE: Screeners should wear uniforms that are washed each day. Screeners should be allowed the option of wearing clean gowns or aprons while searching travelers.

6. TSA HAND HYGIENE: Screeners should follow CDC hand hygiene standards by wearing fresh gloves when searching each passenger and the personal effects of each passenger.

7. EMOTIONAL DISTRESS: Screeners should never touch the intimate parts of any passenger. They should never embarrass, shout at, laugh at or threaten travelers with detainment, arrest or fines. Only supervisors should inform travelers about their responsibilities.

8. PUBLIC NOTIFICATION OF TSA RIGHTS AND RESPONSIBILITIES: TSA should prominently display on its web site and at its security checkpoints concise information about its right to conduct screening.

9. PUBLIC NOTIFICATION OF TRAVELER RIGHTS AND RESPONSIBILITIES: TSA should prominently display on its web site and at its security checkpoints the right of all travelers to a prompt, hygienic screening process that respects the personal privacy of travelers, especially those traveling with children and or having special needs. Travelers should never be embarrassed or humiliated. They should be informed they have the right to report non-hygienic conditions to the TSA without public ridicule, threats of fines and detainment or any other retribution. The TSA should recommend that airlines advise travelers to arrive at the airport in clean attire and without insects in their baggage. (The latter is a real problem.)

10. TSA REVIEW OF SECURITY PROTOCOLS: DHS should establish a framework for the establishment of a fully independent, non-government oversight panel that periodically reviews the status of airport security, including traveler concerns and the compliance of screening with public health guidelines and civil rights. The panel should include a public health expert, a communicable disease physician, a licensed psychologist or psychiatrist, a sexual assault counselor, a child care expert and a Constitutional attorney. The panel should deploy a staff of investigators to visit airport screening checkpoints unannounced and at random intervals.

DISCLAIMER
This report does not cover whole body x-ray and millimeter wave screening to which most passengers are subjected. To the best of our knowledge, the facts and allegations in this report are accurate. If we are informed of any errors we will promptly correct them. Likewise, we expect any response to our allegations by the DHS and TSA to be fully accurate.

 

EXHIBIT 1. CDC GUIDELINES REGARDING USE OF GLOVES

The TSA’s unsanitary practices violate various public health guidelines, including those of the Center for Disease Control and various public health and medical organizations.

The transmission of the increasing incidence of methicillin-resistant Staphylococcus aureus (MRSA) is of special concern to the CDC. From http://www.cdc.gov/mrsa/prevent/healthcare/precautions.html:

Precautions to Prevent the Spread of MRSA in Healthcare Settings

The following Standard Precautions and Contact Precautions are from the Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007

Standard Precautions

These standard precautions should control the spread of MRSA in most instances.

1) Hand Hygiene

Perform hand hygiene after touching blood, body fluids, secretions, excretions, and contaminated items, whether or not gloves are worn. Perform hand hygiene immediately after gloves are removed, between patient contacts, and when otherwise indicated to avoid transfer of microorganisms to other patients or environments. When hands are visibly soiled with blood or other body fluids, wash hands with soap and water. It may be necessary to perform hand hygiene between tasks and procedures on the same patient to prevent cross-contamination of different body sites.

2) Gloving

Wear gloves (clean nonsterile gloves are adequate) when it can be reasonably anticipated that contact with blood or other potentially infectious materials, mucous membranes, nonintact skin, or potentially contaminated intact skin (e.g., of a patient incontinent of stool or urine) could occur. Remove gloves after contact with a patient and/or the surrounding environment (including medical equipment) using proper technique to prevent hand contamination. Do not wear the same pair of gloves for the care of more than one patient. Do not wash gloves for the purpose of reuse since this practice has been associated with transmission of pathogens.