Under-shelf lighting is best to illuminate the work area. These potentially infectious contaminants can contaminate other vials in the dewar and generate an infectious aerosol as the liquid nitrogen evaporates. Occupational Safety and Health Administration. The Select Agent Rule and its impact on clinical laboratories. These are discussed in Section 3 and Sections 4, 5, 6, 7, 8 and 10, which deal with specific types of pathogens and testing. Laboratory biosafety manual, 3rd edition. Paris, France: World Organization of Animal Health (OIE), Office International Des Epizooties; 2008. Srinivasan A, Burton EC, Kuehnert MJ, et al. If enclosed spaces must be used, install oxygen monitors. Use of pneumatic tubes for transport of specimens is acceptable for most specimens but might be contraindicated for specimens without sealed caps, such as urine cups; these are to be delivered by hand (see 3.1.6). In this regard, the laboratory staff could become a cadre of safety "shoppers," who could be encouraged to report on any new safety ideas implemented by the staff as well as examples of unsafe practices or situations they see occurring in the laboratory. Source: Adapted from Biosafety and biosecurity in the veterinary microbiology laboratory and animal facilities. If the tissue has not been pretreated with formic acid before embedding, double gloves and eye protection are to be worn at all times, including during sectioning. Origin and properties of cytopathic agents SV1, SV2, SV4, SV5, SV6, SV11, SV12, and SV15. (If too much blood is applied to a test strip, it can cause inaccurately high glucose level readings.). Protection from flies would solve the potential problem. MMWR 2005;54:5379. Remove visible gross tissue from nondisposable instruments (knife handles, pans, aprons) before chemical disinfection or autoclaving. Homotransplantation of human cell lines. Secondary containment protects the environment external to the laboratory and is provided by facility design and construction. Am J Clin Pathol 1990;94:4225. Patel R, Paya CV. Cooperate fully with the laboratory's approved postexposure processes, and follow prudent medical advice. The director can examine the specimen and determine if it is suitable for testing and whether it constitutes a hazard to laboratory personnel. PPE includes an ANSI-specification, impact-resistant face shield, heavy gloves, and a buttoned laboratory coat during removal of cryotubes and ampoules from nitrogen tanks. Federal Register 2004;69:7604476187 (. See Section 3.5 for guidelines for decontamination and disposal of laboratory waste. http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10075, http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr;sid=4990e762d7b81851bef18f82dc851826;rgn0=div5;view=text;node=40%3A25.0.1.1.2;idno=40;cc=ecfr#40:25.0.1.1.2.3.1.5, http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9778, http://articles.latimes.com/1997-04-25/news/mn-52228_1_coroner-s-office, https://hazmatonline.phmsa.dot.gov/services/publication_documents/Transporting%20Infectious%20Substances%20Safely.pdf, http://www.labsafety.com/refinfo/fedreg/FRPDF/122004.pdf, http://pe.usps.com/cpim/ftp/manuals/dmm300/full/mailingStandards.pdf, http://www.who.int/csr/resources/publications/WHO_CDS_CSR_LYO_2004_9/en, http://www.who.int/csr/resources/publications/biosafety/WHO_HSE_EPR_2008_10/en/index.html. Wearing a respirator, such as N95, is highly recommended for protecting the laboratorian when processing and manipulating specimens or TB cultures. The material in this report originated in the National Center for Emerging and Zoonotic Infectious Diseases, Beth P. Bell, MD, MPH, Director. Close autoclave bags loosely with twist ties or other means that allow steam inside. 2007 (1). bar code and delivery Biosafety compendium on regulations and information sources. Also, technology specialists should be recruited and retained, particularly in microbiology where interpretive judgment is critical to specimen analysis and ultimately directly affects patient care and outcome. Many of these potential hazards can be minimized by adoption of safe handling practices. The electron microscopy laboratory uses a wide variety of flammable solvents, and the use of open flames is discouraged (see Section 8.2.13). 4.1.1. Transplantation 1987;1:214. Hazardous materials (601.10.1). A phlebotomy technician is preparing to draw a patients blood when the patient informs him that she is taking warfarin. Even with the substitution of dehydrating reagents other than xylene, fume hoods are recommended in order to eliminate fecal and solvent odors. Document the incident, and notify the supervisor if an exposure occurred. Follow the directions of the supervisor to the degree they are judged to be reasonable. Wayne, PA: Clinical and Laboratory Standards Institute; 2011. Engineering controls (2.1.5. Evaluate incoming employees to see if they meet these criteria. Consultation with the manufacturer may be warranted. Occupational allergy to antibiotics. Montreal, Canada: International Air Transport Association; 2005. International Air Transport Association. A common feature in newer systems is closed system sampling. Which of the following information should the technician record in the quality control record? Dispose of container and unused contents in accordance with applicable federal, state and local requirements. MMWR 2002;51:27981. Suspected cutaneous anthrax in a laboratory workerTexas, 2002. Which of the following actions should the technician take? Invariably, all of these substances must occasionally be stored in some form and for some length of time, and many of these substances will be manipulated, relocated, and otherwise touched by laboratory workers. Wear a laboratory coat, gloves, and eye protection whenever clinical specimens are handled. Sincerely, See Section 3.5 for discussion, including a waste management plan. Prepare multiple scalpels before autopsy so blade changes while hands are slippery and contaminated can be avoided. Clinical and Laboratory Standards Institute. Close the drain valve and pour disinfectant onto the surface and through the grille into the drain pan. In 2008, CDC convened a Blue Ribbon Panel of laboratory representatives from a variety of agencies, laboratory organizations, and facilities to review laboratory biosafety in diagnostic laboratories. TABLE 17. Attached Id band, full name, accession number, C. Accession number, full name, date of birth, D. Medical requisition number, full name, date of draw. Always use specially designed cylinder carts when moving cylinders. Dewars must be moved carefully. Ampoules and cryotubes can explode when removed from liquid nitrogen creating infectious aerosols and droplets. Liquid gases, even those considered inert, can present explosion hazards. Direct contact or inoculation of infectious material from patient lesion; accidental inoculation of material from culture or animal inoculation studies. Many of these chemicals are dissolved in flammable solvents, and they must be kept away from heat and ignition sources. A second test is performed and returns a reading within the expected reference range. All solutions, including water washes, are collected and treated with equal volumes of fresh, undiluted bleach or 1N NaOH for 60 minutes. If engineering controls are in place to prevent splashes or sprays, the requirement for PPE can be modified on the basis of a risk assessment and evidence of the effectiveness of the engineering control to prevent exposure from splashes or sprays. Likewise, PPE worn in the BSL-2 must be removed before exiting the laboratory. March 22. Consider effluents of clinical analyzers to be contaminated with pathogens; some may also be contaminated with hazardous chemicals. Plastic monomers will quickly penetrate latex and vinyl gloves; change these gloves frequently when embedding with plastics (. Wayne, PA: Clinical and Laboratory Standards Institute; 2004. Anal Biochem 1987;162:4538. Patient specimens that meet Category A or Category B criteria must be classified as Category A or Category B substances. If engineering controls are in place to prevent splashes or sprays at blood bank workbenches, the requirement for PPE may be modified on the basis of an assessment and evidence of the effectiveness of the engineering control to prevent exposure to splashes or sprays. PDF Specimen Collection and Preparation 1988;78:121315. Wilkins D WA, Cossar YE, Miller DC. Track and document all incidents of cracked tubes, loose caps, and leaking containers. Proper use of PPE is critical for worker safety, and strict adherence to protocols is essential. PDF Certification and Quality Check of Personal Protective Equipment A typical biological spill clean procedure involving a possible aerosol should include the following: If a spill occurs in a biological safety cabinet (BSC), do not turn off the cabinet fan. Sodium Citrate (Anticoagulant) - prevents coagulation by binding to calcium in the specimen. Such tissue may be processed either by hand or by machine. Never tamper with or defeat safety interlocks and power lockouts on electrophoresis equipment. Available at: Clinical and Laboratory Standards Institute. The appropriate PPE for this type of testing consists of a laboratory coat, gloves, eye protection and a face mask, such as a surgical, dental, medical procedure, isolation, or laser mask. Exempt human or animal specimens have less stringent packaging requirements than do Category A and Category B substances. The risk is never zero, and potential for human error always exists. When transporting dry ice, place the container in the trunk of the car or truck bed, and leave the car windows open for fresh air circulation. Step 2. See section 7.6 for further information. Work benches that have storage shelves above the center of the bench might be preferred; these would provide space for supplies without cluttering the work area. Exposure to Neisseria meningitidis. http://www.aabb.org/Pages/Homepage.aspx. However, because necropsy of large animal cadavers with suspected zoonotic agents is not practical in BSCs, use PPE, engineering controls, and procedures that have been specifically developed for clinical laboratories. Substances that do not contain infectious substances or are unlikely to cause disease in humans and animals; Most environmental samples (e.g., food, soil); Substances that contain neutralized or inactivated microorganisms; Substances to be tested for alcohol or drugs, pregnancy indicators, cancer, and antibodies; Dried blood spots and fecal occult blood screen specimens; Blood and blood components collected for the purpose of transfusion or transplantation; Food and Drug Administration (FDA)-approved and FDA-licensed biological products; and. Biosafety and biosecurity in the veterinary microbiology laboratory and animal facilities. To prevent reflux or backflow, the technician should instruct the patient to move her arm into which of the following positions? 93 Q . RR-11). The extrinsic pathway is activated by _______trauma that causes blood to escape from the vascular system and the ____ test measures it. The potential hazards presented in this section are intended to be illustrative, not inclusive of all chemicals used, and educational in nature and are not intended to replace material safety data sheet (MSDS) information or state, local, or institutional policies. U239. If the medical waste contractor is registered with the Select Agent Program, the live cultures may be formally transferred to the contractor by using APHIS/CDC Form 2, "Request to Transfer Select Agents and Toxins." Specimens with a small amount of contamination (e.g., a dried blood spot) on the outside of the container are to be brought to the attention of the laboratory director. Selected adventitious agents associated with cell cultures, organs and tissues that could be used to generate cell cultures, and cell culture reagents, Human kidney, pancreas, some adenovirus transformed cell lines, rhesus monkey kidney cells, Bovine serum, fetal bovine serum (substantially lower risk today due to ultrafiltration of bovine serum), Kidney, human foreskin, monkey kidney cells, Some lymphoid cell lines and EBV-transformed cell lines, human kidney, Blood cells, serum, plasma, solid organs from infected humans or monkeys, Fetal porcine kidney cells, trypsin preparations, Human cornea, kidney, liver, iliac vessel conduit, Rhesus, cynomologous, and African green monkey kidney cells, Trypsin, swine-origin biological components, Multiple cell lines, commercial interferon preparations, Human blood, heart, kidney, liver, lung, pancreas, TABLE 10. See Section 8.2 and the MSDS materials provided by the manufacturers for guidelines for handling stains and fixatives. Special precautions for autopsy and autopsy suite decontamination, brain-cutting, and histologic tissue preparation procedures are required when processing cases of possible CJD (1,56,65,67,86). According to the BBP standard, employers must adhere to the concept of Universal Precautions, the infection and exposure control philosophy which advises that all human blood and certain body fluids are to be treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens [29 CFR 1910.1030(b) and 1910.1030(d)(1)]. The most common are included here. Never mix different chlorine solutions or store them with cleaning products containing ammonia, ammonium chloride, or phosphoric acid. Used alongside administrative and engineering control measures . Disinfect ELISA plate washers and the area around the washer each day of use. Nadler SH, Moore GE. Cell culture preparation and reagent preparation areas are often called "clean" areas because no specimens, amplified nucleic acids, or control materials are allowed in these areas. Although these instruments have the potential to replace much of the open bench testing in blood banks and donor collection settings, manual testing is still being used for some antibody detection and verification procedures and in smaller laboratories. Acetone is flammable and it is classified as an irritant, causing eye damage and skin and respiratory tract irritation. Decontaminate reusable materials and devices (e.g., telephone, clocks, computers, tissue boxes, work books) brought into the clean area unless they are known to be new, and immediately apply laboratory-designated, color-coded tape. In addition, some oils can form an explosive mixture when combined with liquid oxygen. 2004;53:8424. Instead, workers can wear chemical-resistant clothing such as: Overalls and long-sleeved jacket. Handle ELISA plates with gloves at all times, and consider them to be contaminated. The decision-making tools and processes can be applied to the patient collection area as well. Several heavy metal stains and aggressive fixatives are used in the electron microscopy laboratory. WorkplaceTesting Explains Aliquot. Many of the adventitious viruses do not produce cytopathic effects or alter the cell phenotype, and many can survive freezing and storage in liquid nitrogen for long periods. Never perform laboratory procedures, manipulate microorganisms, process patient specimens, or operate microbiology identification instruments if doing so will increase the risk for an LAI. Supply each workstation with alcohol hand rub to facilitate frequent hand cleaning, and with absorbent work pads to contain accidental spills. Wayne, PA: Clinical and Laboratory Standards Institute; 2011. The CDC estimates that the risk of infection is between 6% to 30%.). Wayne, PA: Clinical and Laboratory Standards Institute; 2007. Requirement not specified by IATA or DOT. A phlebotomy technician is preparing to aliquot a blood specimen. If any concern exists about external contamination, carefully disinfect the outside of the tubes or bottles before inserting them into the blood culture instruments. Acetone is the principal organic solvent used in the virology laboratory and is primarily used as a fixative for cell smears. Use a rack if possible. While collecting a blood specimen, a phlebotomy tech notices the glass of the collection tube is cracked. Water baths and humidification pans in CO incubators can harbor bacteria, algae, and fungi that become aerosolized when the water bath lid or incubator doors are opened. Each BSL builds on the previous level to provide additional containment. Quality assurance in the molecular virology laboratory. Occupational asthma in workers of a pharmaceutical company processing spiramycin. 3.2.2. Wear gloves and use gauze pads with impermeable plastic coating on one side when using instruments for which the operator is required to wipe sample probes after sampling. Blohme I, Nyberg G, Jeansson S, Svalander C. Adenovirus infection in a renal transplant patient. Southam CM. CDC. To find state laws governing medical waste, visit, OSHA. Originally designed for point-of-care or near point-of-care testing, many of these tests are being used for testing in clinical virology laboratories. Clinical laboratory waste management; approved guidelinethird edition (CLSI document GP05-A3). Infections acquired in clinical laboratories in Utah. Available at, Kappel T, Reinarts J, Schmid J, Holter J, Azar M. The viability of. BSL-1 is appropriate for work with agents not known to consistently cause disease in healthy human adults (i.e., laboratories that do not work with disease-causing agents or specimens from humans or animals). 3815 Highland Avenue, Tower 2; Suite 206 Do not open plates containing moulds on the open bench, even if it is a bacteriology work station. Dispose of gloves after leaving the room. Visually inspect all specimen containers for leakage. No standards are currently available that describe operating procedures within dirty areas of the laboratory. Tuberculosis infection associated with tissue processingCalifornia. Personnel who operate the autoclave must be trained to package, load, and label materials to be autoclaved in accordance with the procedures used to validate the sterilization cycle of the unit. Montreal, Canada: International Air Transport Association; 2005. Document biosafety training (date and content of training) in the employee's training record, and maintain the record for 3 years. Contact the appropriate reference laboratory in advance of any forwarding. These vacuum attachments are difficult to keep clean and are to be handled as a potential risk of infection. Discharge of a Class I or Class II, Type A2 cabinet into a room should not occur if volatile chemicals are used. Always discard with medical waste after contamination and at the end of the shift. Wash hands with soap and water upon removal of gloves when exiting the room. Special precautions for suspicious specimens. telephone: (202) 512-1800. In addition, if a handwritten name and a label are on the container, the information must match exactly. *, Infrequent (greater than population at large). Cycloheximide is inactivated by alkaline solutions (pH >7.0). Incidence of tuberculosis among workers in laboratories. Sodium azide reacts with heavy metals (such as silver, gold, lead, copper, brass, or solder in plumbing systems) and metal salts to form highly explosive compounds such as lead azide and copper azide. The person most at risk of exposure and laboratory-acquired infection is the laboratorian working to identify a suspect infectious agent within the diagnostic specimen; therefore, the choice of laboratory work practices to prevent personal exposure is one of the most important decisions in designing a laboratory biosafety plan. Whenever possible, place aerosol containment covers over ELISA plate washers to minimize aerosol contamination of laboratory workers and the environment. ** Bite or nonbite exposure. Decontaminate the inside of the carrier if a leak occurs in the specimen container. Which of the following actions should the technician take? Z. Breakage or leakage of specimens transported using a PTS risks contamination of the transport system itself. Drain disposal is recommended with the permission of local wastewater treatment authorities. It preserves the coagulation factors in the specimen. Flow cytometric applications, e.g., phenotypic analysis, calcium flux evaluations, and apoptosis measurements of unfixed cells, when performed using jet-in-air flow cytometers with extremely high pressure settings can expose operators to potentially hazardous aerosols. Use disinfectants recommended for environmental surfaces, such as 1:10 dilution of household bleach or other EPA- registered disinfectants effective against hepatitis B virus, human immunodeficiency virus, and other bloodborne pathogens (. Discard gloves, and don a new pair when leaving the workstation. Hazardous materials: infectious substances; harmonization with the United Nations recommendations; final rule (49 CFR Parts 171 et al.). For clarification, your questions have been paraphrased below, followed by OSHA's responses. Do not allow laboratory personnel with known antibiotic sensitivities to prepare concentrated antibiotic solutions. Specimens that produce an altered melting curve shape, too many peaks, and/or an altered melting temperature (. Their disposal must comply with state and local regulations. Pealer LN, Marfin AA, Petersen LR, et al. T when controls and other patient curves are normal, Genetic variation in agent; poor extraction; primer dimers, Unusual/unexpected pathogen; more than one agent present; chimeric, recombinant or reassortant pathogen, Change in the slope of the amplification curve, Genetic variation in agent; poor extraction; specimen inhibition, Unusual/unexpected pathogen; chimeric, recombinant or reassortant pathogen. Pegum JS, Medhurst FA. The purpose of the regulations is to protect the public, emergency responders, laboratory workers, and personnel in the transportation industry from accidental exposure to the infectious contents of the packages. Change and discard gloves after cleanup and decontamination of the immediate area. PLease sit for at least 5 minutes before a test, B. There must be absorbent material between the primary receptacle (tube/container) and the secondary packaging (bag) that is able to absorb the entire contents of the bag. Refer to the material safety data sheet for guidance (, Lactophenol cotton blue (lactophenol aniline blue or Poirrier's blue). The Class II-A1 or II-A2 BSC is best suited and recommended for the diagnostic laboratory (. Use shrink seals or tape to seal petri plates (especially if mould begins to grow) in order to prevent accidental opening and spread of hyphal segments, conidia, or spores. Available at. As part of an on-site waste management plan, the responsibilities of the laboratory management or the designated safety officer or safety team are to. Cover the spill with paper towels and saturate the area with a disinfectant or a detergent solution, or use a mop followed by disinfection of the spill area with 1:10 bleach solution. GIve the consent form to the adult accompanying the patient. These activities can present a freezing hazard. Large animal necropsy generally requires multiple prosectors working together in a way that will avoid accidental lacerations. NOTE: A minimum of 1 mL blood in a 4.5 mL tube is required for a correct blood/anticoagulant ratio. Category A substances must be assigned UN number UN2814 or UN2900 (, Certain Category A pathogens have been designated as agents of bioterrorism and are known as select agents (. Vetter J. Microbial aerosols from a freezing microtome. However, because the prion infectious particle cannot be rendered noninfectious by normal decontamination and sterilization methods, enhanced precautions are mandatory. Methods to ascertain hazard information can include benchmarking, walkabouts, interviews, detailed inspections, incident reviews, workflow and process analysis, and facility design. In: Pope AM, Patterson R, eds. Clinical and Laboratory Standards Institute. Virology 2008;370:6376. These cells may produce infectious virus or they may have viral genomic material within the cells. 10.9.1. If an employee wishes to choose, wear, and maintain his or her uniform or work smock, then he or she would need to don additional employer-handled and employer-controlled PPE when performing tasks where it is reasonable to anticipate exposure which may contact the skin or clothing. Handle all stored infectious substances using Standard Precautions and aseptic technique. Use of disposable liners may reduce cleaning intervals of the equipment but does not replace the need to clean surface areas or equipment. Virus present continuously, often in high concentrations. Medical waste that is reasonably believed to have a low probability of containing infectious substances must be packed and shipped as "medical waste not otherwise specified" (n.o.s) (UN3291). Wear different color laboratory coats in clean and dirty areas of the laboratory (have them available at entrance to clean areas), or require no laboratory coats in clean areas. Davies RJ, Hendrick DJ, Pepys J. Hazelton PR, Gelderblom HR. Level B is similar to Level A but it provides for situations in which the threat of injury to the eyes or skin is less severe. Microbiologists who are routinely exposed to isolates of, Immunization of employees in general, and these special situations in particular, is most effectively addressed in institutional employee health or infection control policies. When opening a closed cargo area containing dry ice, allow the closed space to ventilate for 5 minutes before entering. Porcine parvovirus: frequency of naturally occurring transplacental infection and viral contamination of fetal porcine kidney cell cultures. Manufacturer instructions for use and care of blood bank refrigerators and freezers usually include recommended PPE and type of disinfectant. PPE includes a variety of items, such as gloves, laboratory coats, gowns, shoe covers, boots, respirators, face shields, safety glasses, and goggles, that are designed to protect the laboratory worker from exposure to physical, biological, and chemical hazards. Personal protective equipment. Consider that bleach will corrode stainless steel and aluminum devices. A completely labeled outer package. Discard tissue remaining from culture activities of BSL-3 infectious agents into medical waste, and autoclave it. Mycobacterium tuberculosis is the prototypical pathogen most noted to be transmitted by aerosolization, persons who had meningococcemia, anthrax, rickettsiosis and legionellosis are other examples.