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Persons using assistive technology might not be able to fully access information in this file. The material in this report originated in the National Center for Emerging and Zoonotic Infectious Diseases, Beth P. Throughout these guidelines, quality laboratory science is reinforced by a common-sense approach to biosafety in day-to-day activities. This report offers guidance and recommends biosafety practices specifically for human and animal clinical diagnostic laboratories and is intended to supplement the 5th edition of Biosafety in Microbiological and Biomedical Laboratories (BMBL-5), developed by CDC and the National Institutes of Health (1). LAIs and exposures have been reported since early in the 20th century, but only in the 1970s were sufficient data available to attempt quantitative assessments of risk. Early surveys of LAIs found that laboratory personnel were three to nine times more likely than the general population to become infected with Mycobacterium tuberculosis (13,14). In clinical chemistry laboratories, data from 17 New York hospitals listed needle puncture (103 cases), acid or alkali spills (46), glass cuts (44), splash in eye (19), and bruises and cuts (45) as the most frequent exposures (21).
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. Panel members reviewed the guidelines that were developed and synthesized by the writing team.
Each section of recommendations was reviewed both within CDC and by the relevant national organizations whose members would embrace these guidelines. The Blue Ribbon Panel recognizes the need for a voluntary, nonpunitive surveillance and reporting system with the potential for anonymity to be implemented in the United States.
The concept of a "culture of safety," as described in this report, encourages all human and animal diagnostic laboratories to promote an organizational culture of systematic assessment of all work processes and procedures to identify associated risks and implement plans to mitigate those risks. Successful establishment of a culture of safety requires that laboratory safety become an integral and apparent priority to the organization, embraced first and foremost by top management and with the concomitant infrastructure support required to foster safe behaviors among its employees (29–31). Laboratory design is fundamental to the safety of laboratory workers, hospital staff, and patients. Design options for the microbiology laboratory should include an enclosed component of the overall laboratory, separated by closable doors from other laboratory sections.
Directional air is encouraged to provide zones of containment that proceed with increasing negative pressure toward work spaces in which higher-risk laboratory procedures are conducted. For microbiology laboratories, it is critical that the supervisor and laboratory director, along with a biosafety professional, provide input regarding the special needs of a new laboratory facility. If no BSL-3 facilities are available, BSL-2 plus negative airflow and use of respiratory precautions may be used for some agents, provided a risk assessment has been conducted.
For human laboratories, the separate tuberculosis and virology laboratories that manipulate cultures for identification and characterization would ideally meet BSL-3 requirements. The receiving and set-up areas in microbiology laboratories should be designed with sufficient space to accommodate the greatest number of specimens anticipated. The general laboratory should contain sit-down work spaces designed with adequate space for a computer at each station. If possible, locate carbon dioxide and anaerobic gas tanks outside the actual laboratory (preferably shielded or even installed outside the walls of the building). If waste will be decontaminated on-site before disposal, the laboratory must have an autoclave large enough to handle its needs. The availability of board-certified laboratory specialists in the laboratory is as important to a medical facility as highly trained, board-certified medical specialists and surgeons. The laboratory director is ultimately responsible for identifying potential hazards, assessing risks associated with those hazards, and establishing precautions and standard procedures to minimize employee exposure to those risks. Qualitative biological risk assessment is a subjective process that involves professional judgments.
Identifying potential hazards in the laboratory is the first step in performing a risk assessment. Evaluate and prioritize risks (evaluate the likelihood that an exposure would cause a laboratory-acquired infection [LAI] and the severity of consequences if such an infection occurs). Standardization of the risk assessment process at an institution can greatly improve the clarity and quality of this process. Aerosols can be generated from most routine laboratory procedures but often are undetectable. Examples of possible hazards are decreased dexterity or reaction time for workers wearing gloves, reduced ability to breathe when wearing N95 respirators, or improperly fitting personal protective equipment (PPE). No inherent biologic danger exists to a person working alone in the laboratory; however, the supervisor is responsible for knowing if and when a person is assigned to work alone. Risks are evaluated according to the likelihood of occurrence and severity of consequences (Table 2).
Consequences may depend on duration and frequency of exposure and on availability of vaccine and appropriate treatment. Risk assessment is an ongoing process that requires at least an annual review because of changes in new and emerging pathogens and in technologies and personnel.
Primary containment protects personnel and the immediate laboratory environment and is provided by good microbiological technique and use of appropriate safety equipment. Secondary containment protects the environment external to the laboratory and is provided by facility design and construction. BSLs provide appropriate levels of containment needed for the operations performed, the documented or suspected routes of transmission of the infectious agent, and the laboratory function or activities. Material Safety Data Sheets (MSDS) for chemicals are available from the manufacturer, supplier, or an official Internet site. The laboratory director is responsible for ensuring that a laboratory-specific biosafety manual is developed, adopted, annually reviewed, and accessible to all laboratory personnel. The manual should be reviewed and updated annually and whenever procedures or policies change. Many safety procedures, guidelines, and principles apply to all sections of the diagnostic laboratory.
Microbiology specimens are to be received in uncontaminated containers that are intact and are consistent with laboratory specimen collection policy. Ideally, all specimens in a biosafety level (BSL) 2 or higher facility are to be processed in a biological safety cabinet (BSC) adhering to safe BSC practices. Limit the use of a 4-foot-wide BSC for inoculating plates and preparing smears to one employee at a time, wearing appropriate personal protective equipment (PPE). Submit specimens to the laboratory in transport bags that isolate the patient requisition from specimens; always limit bags to one patient to prevent misidentification and cross-contamination.
Visually examine containers for leaks upon arrival and before placing on rockers, in centrifuges, in racks, in closed-tube sampling (cap-piercing probe) systems, in automated aliquot stations or automated slide preparation systems, or on conveyor belts. Consider all sputum containers as coming from patients with tuberculosis or pneumonia, and handle with care.
Viral specimens with damaged or leaking containers may need to be discarded before opening. Do not rely on visible external contamination to confirm the potential source of contamination.
Wipe off visible contamination by using a towel or gauze pad moistened with acceptable decontaminant, such as a 1:10 dilution of household bleach, or use the established laboratory disinfectant.
Always grasp the tube or outside of the specimen container, not the stopper or cap, when picking up tubes or specimen containers to prevent spills and breakage. Ensure tops are tightly secured on all specimen containers, blood-collection tubes, and sample tubes before advancing for analysis or storage. Determine appropriate PPE on the basis of documented risk and hazard assessments of all the operations performed at each bench. Ensure that workstation procedure manuals include instructions for the organization of all instruments, materials, and supplies in each area as well as instructions for any cleaning and disinfection and the frequency of cleaning and disinfection for all surfaces and instruments. If decontamination of equipment or portions of such equipment is not feasible, do the following.
Always remove caps behind a bench-fixed splash shield, or wear additional PPE appropriate to protect from splashes and aerosols. Place a gauze pad over the cap, and then slowly pry or push the cap off with an away-from-body motion. Breakage or leakage of specimens transported using a PTS risks contamination of the transport system itself.
Protect requisition forms by a separate pouch, or enclose them in a separate secondary bag to prevent contamination. Place absorbent wadding between patient bags to help absorb spills and minimize contamination to the outside of the carrier. Disinfect contaminated carriers with bleach solution or other disinfectant following the protocol recommended by the manufacturer and approved by the hospital's infection control committee if the system is in use in a hospital.
Establish an emergency PTS shutdown plan, including roles and responsibilities; include implementation of an alternative specimen transport plan.
Develop a system to track and analyze incidents of improperly closed carriers, cracked tubes, loose caps, and leaking containers. Prepare SOPs for both laboratory operators and the nonlaboratory service providers with their input and consultation. Document training and competency assessment of service providers and bench operators for PTS maintenance and decontamination procedures. 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. Because no two workstations are identical, written procedures for each clinical laboratory workstation must include specific work practices and work practice controls to mitigate potential exposures. Install a dedicated handwashing sink with hot water in each work area for use after contamination of hands or gloves with blood or other potentially infectious materials.
In the general microbiology laboratory, masks and disposable gloves are not required in the open laboratory but may be voluntarily used. Splash guards at workstations are recommended during work at the blood culture bench or at any station at which the potential for splashing exists. Notify nearby workers and the supervisor if a splash or spill occurs, regardless of how small.
Sniffing of bacterial cultures growing on artificial media (to detect characteristic odors supposedly emitted by certain bacteria) is a potentially unsafe laboratory practice that has been associated with multiple types of LAI. Locate disinfectant-containing discard containers and sharps containers within easy reach of the work station. Use protective covers for computer keyboards at workstations; covers need to be easily cleanable and routinely disinfected along with the bench top, at least at the end of the work shift.
Place blood culture bottles behind a safety splash shield or in a BSC when tapping with a needle.
Urine remaining from culture activities can be discarded down the sink drain or into the sanitary sewer.
Discard feces and other specimens such as body fluids and respiratory specimens remaining from culture activities with medical waste, and autoclave if warranted by risk assessment. Discard tissue remaining from culture activities of BSL-3 infectious agents into medical waste, and autoclave it.
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. PPE is often used in combination with BSCs and other devices that contain the agents or materials being handled.

The Occupational Safety and Health Administration (OSHA) defines PPE as "appropriate" if it does not permit blood or other potentially infectious materials to pass through or reach the employee's street clothes, undergarments, skin, eyes, mouth, or other mucous membranes under normal conditions of use (33).
The Class II-A1 or II-A2 BSC is best suited and recommended for the diagnostic laboratory (Table 5) (1).
Every diagnostic microbiology laboratory needs one or more BSCs as a primary means of containment for working safely with infectious organisms. Regardless of the method, the purpose of decontamination is to protect the laboratory worker, the environment, and any person who enters the laboratory or who handles laboratory materials that have been carried out of the laboratory.
Instructions for disinfecting a laboratory work bench are to be a part of each SOP and must include what PPE to wear, how to clean surfaces, what disinfectant to use, and how to dispose of cleaning materials. Routinely clean environmental surfaces before setting up work areas and again before leaving work areas. Reserve sterilants and high-level disinfectants cleared by FDA for processing reusable medical devices.
Use of disposable liners may reduce cleaning intervals of the equipment but does not replace the need to clean surface areas or equipment. Disposable, flexible, polyethylene film–backed, nonskid highly absorbent surface liners are available commercially and help to prevent soak-through of most solutions, including dyes and corrosive chemicals.
Allow dried blood or body fluid at least 20 minutes' contact with the laboratory-specified decontaminating solution to allow permeation and easy removal (1). Never mix different chlorine solutions or store them with cleaning products containing ammonia, ammonium chloride, or phosphoric acid. My doctor recently said my A1C sugar level is high & to avoid eating fruits, carbs, etc. Fats and proteins slow digestion and blunt the rise in blood sugar from the fruit, whereas adding starch will make blood sugar skyrocket.
Any views or opinions presented in this article are solely those of the author and do not necessarily represent the opinions or recommendations of Fitness International, LLC.
Because many of the same diagnostic techniques are used in human and animal diagnostic laboratories, the text is presented with this in mind.
This document was written not to replace existing biosafety guidelines, but to 1) improve the safety of activities in clinical diagnostic laboratories, 2) encourage laboratory workers to think about safety issues they might not previously have considered or addressed, and 3) encourage laboratorians to create and foster a culture of safety in their laboratories.
Bureau of Labor Statistics, in 2008, approximately 328,000 medical laboratory technicians and technologists worked in human diagnostic laboratories in the United States. The most common agents of laboratory-acquired fungal infections are the dimorphic fungi Blastomyces, Histoplasma, and Coccidioides (18,19); most reported infections were caused by inhalation of conidia. Needle puncture, glass cuts, splash in eye, and bruises and cuts have the highest potential for infection from microbes. In non-microbiology sections of the diagnostic laboratory, the primary mistake may be assuming that a given specimen contains no infectious agents and then working with little attention to risk for infection. However, there is a dearth of evidence-based research and publications focused on biosafety; particularly missing are studies documenting safe practices in the day-to-day operations of diagnostic laboratories.
Members of the panel were either selected by the invited national laboratory organization they represented or were invited by CDC because of their roles in biosafety at the national level.
Official endorsements by the organizations they represented were not required, although each representative was required to submit written approval of the recommendations. These included the College of American Pathologists, Greater New York Hospital Association Regional Laboratory Task Force, American Society for Microbiology, American Clinical Laboratory Association, Association of Public Health Laboratories, American Society for Clinical Laboratory Science, American Society for Clinical Pathology, American Biological Safety Association, American Association of Veterinary Laboratory Diagnosticians, and individual physicians and subject matter experts.
Whether the patients are humans or animals and whether laboratorians work in microbiology or elsewhere in the laboratory, the human and animal diagnostic laboratory is a challenging environment.
Other laboratory incidents such as minor scrapes or cuts, insignificant spills, or unrecognized aerosols occur even more frequently and might not cause an exposure that results in an LAI. Such a system would allow for reporting and evaluation of all LAIs and would potentially lead to training and interventions to facilitate a negligible incidence rate. The Clinical and Laboratory Standards Institute document, Laboratory Design; Approved Guideline (32), discusses laboratory design in detail. Although not required, directional inward airflow from the main laboratory into the microbiology laboratory is also recommended in newly constructed diagnostic laboratories.
Air handling systems within the microbiology laboratory suite must be able to be adjusted and balanced with directional airflow from the corridor into the microbiology laboratory and from the general microbiology laboratory into separate and enclosed tuberculosis, mycology, and virology specialty laboratories. For animal diagnostic virology laboratories in which most manipulated viruses are not human pathogens, the practice is to meet BSL-2 requirements unless a risk analysis indicates a high probability that an agent in a specimen needs BSL-3 containment. This area needs a Class IIA2 BSC, a sink for hand washing, and an emergency eye wash station. 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. Placing the tanks outside the laboratory or the building in a locked area will allow easy access for exchange of tanks.
Locate the autoclave in a well-ventilated area, or ensure it is exhausted through a capture hood above it. The room might need to be renovated to accommodate a Class IIA2 BSC, directional air flow, telephone jacks, and communication devices such as intercoms. Some identification instruments require at least 8 feet of footprint space for the unit, printer, and modules. Because the identity of an infectious agent is initially unknown in the clinical laboratory, the general recommendation is that the biosafety level (BSL)-2 standard and special practices in Biosafety in Microbiological and Biomedical Laboratories, 5th edition (1) be followed for all work in the clinical laboratory, and the Occupational Safety and Health Administration's (OSHA's) Standard Precautions (gloves, gowns, and protective eyewear) (33) and BSL-2 practices (2) be employed during handling of all blood and body fluids. Because of uncertainties or insufficient scientific data, risk assessments often are based on incomplete knowledge or information. Many categories of microbiological hazards are encountered from the time a specimen is collected until it is disposed of permanently.
Because assigning a person to work alone is a facility-specific decision, a risk assessment should be conducted that accounts for all safety considerations, including type of work, physical safety, laboratory security, emergency response, potential exposure or injury, and other laboratory-specific issues.
The four BSLs, designated 1–4, are based on combinations of laboratory practice and techniques, safety equipment (primary barriers), and laboratory facilities (secondary barriers). All laboratory employees must read this manual, and the director must maintain records of personnel who have read it.
Annual training in biosafety practices is recommended for all personnel who access the laboratory. The recommendations presented in this section represent a broad view of safety throughout the laboratory. However, routine clinical laboratory testing may provide the first evidence of an unexpected bioterrorism event. Adopt specific standard operating procedures (SOPs) in the event that irreplaceable specimens are considered for transportation using these systems. If a BSC is unavailable in the laboratory, the laboratorian processing intake specimens must wear a laboratory coat and gloves, employ an effective splash shield, and continue to follow universal precautions. These containers are unacceptable for culture because the contents may have become contaminated.
Increases in documented events may indicate the need to clarify or strengthen specimen acceptance policies or improve specimen collection or transportation practices, or they might identify defective container lot numbers.
External contamination caused by inappropriate lid closure can contaminate the gloves of the laboratorian and all contents of the BSC. If any concern exists about external contamination, carefully disinfect the outside of the tubes or bottles before inserting them into the blood culture instruments.
Contact the supervisor for instructions on whether or not to continue processing, and be prepared to notify the submitter and request another specimen.
Try to incorporate engineering controls and PPE information in the same location in all procedure manuals, and clearly post the information for each operation carried out at the bench. Gloves provide protection from the live organisms as smears are prepared and provide protection from unintentional exposure to stain. Examine equipment contaminated with blood or other potentially infectious materials before servicing or shipping, and decontaminate as necessary.
Limit specimen size, volume, weight, and container types sent through the tube system, if warranted. Documented training and assessment of competency will include knowledge of the risks associated with using a PTS and the precautions to be taken to control those risks.
Examples of engineering controls include use of a BSC, having sealed safety cups or heads in centrifuges, and negative air flow into the laboratory. Employees cannot rely solely on a sink in a rest room for washing their hands after work in a technical area. If gloves are used, they can easily become contaminated during routine use; therefore, gloves are not to be washed and reused. In some situations where working in a BSC is impractical, PPE, including splash shields, may form the primary barrier between personnel and hazardous materials (1). The employer must provide laundry service for reusable protective laboratory coats, gowns, uniforms, or scrubs that are potentially or visibly contaminated with blood or other potentially infectious materials at no cost to the employee. FDA has indicated that patient examination gloves used during patient care and vascular access procedures meet its adulteration requirements and have a 510(k) medical device registration with this agency.
This includes opening containers and pipetting, manipulating, aliquoting, or testing specimens, cultures, biological agents, or other hazardous materials outside the BSC. An overview and summary of the different classes and types of BSCs is available in Appendix A of BMBL-5 (1). It protects personnel and the room environment but is not designed to protect the product inside the cabinet. FDA has identified manufacturers, active ingredients and contact conditions for these products. Never use a knife or other instrument to scrape dried blood or body fluid from surface areas; doing so can cause percutaneous injury or generate aerosols. Undiluted bleach solution is corrosive to stainless steel, and thorough rinsing must follow its use in the BSC and stainless steel sinks to remove the residue. Combining these chemicals could result in release of chlorine gas, which can cause nausea, eye irritation, tearing, headache, and shortness of breath. Sounds crazy, but when you see how hard it is, you also realize how important it is (and how addictive sugar is). CDC and the National Institutes of Health addressed the topic in their publication Biosafety in Microbiological and Biomedical Laboratories, now in its 5th edition (BMBL-5). Should any of the guidelines provided herein conflict with federal, state, or local laws or regulatory requirements, the laboratorian should defer to the federal, state, or local requirements. An estimated 500,000 persons in all professions work in human and animal diagnostic laboratories. Reported parasite-associated LAIs were caused primarily by Leishmania, Plasmodium, Toxoplasma, Chagas disease organism, and other trypanosomes (20). This scenario can be particularly problematic in laboratories developing new technologies, such as molecular and biochemical technologies, and in point-of-care diagnostics performed by staff unaccustomed to testing that requires biosafety considerations and use of barrier techniques such as personal protective equipment. The organizations participating in the panel represented the majority of laboratory technologists in the United States.
Edits and comments from each participant were carefully considered and incorporated where appropriate. Future research in biosafety practices in the laboratory will contribute to further recommendations and will substantiate others as well as provide opportunities to revise this document. The more that laboratorians become aware of and adhere to recommended, science-based safety precautions, the lower the risk.
In this report, "laboratory exposures" refer to events that put employees at risk for an LAI and events that result in actual acquisition of LAIs. In many cases, the only association was that the infected person worked with a microbiological agent or was in the vicinity of a person handling a microbiological agent.
These risks typically are associated with design flaws or lack of or inadequacy of safety procedures and training (1,2).

Because remediating poorly designed laboratory workspace is difficult, or even impossible, design warrants careful planning and consideration of safety issues. If the facility is an open design and has no drop ceiling, the microbiology laboratory can have clear glass or Plexiglas walls, which give an appearance of openness but provide a floor-to-ceiling safety barrier from possible aerosol exposures.
The microbiology section must have a decontamination facility or have a medical waste contract in place, and it must provide a sink for hand washing.
Risk assessments should be performed on each facility to include consideration of the specific risks encountered in each laboratory.
Telephone jacks, computer jacks, and electrical outlets should be built into the module (Use of wireless technologies can reduce the need for telephone or computer wiring in each module.) along with refrigerator space for one or two side-by-side glass-front refrigerators or one double refrigerator to enable easy access by the set-up staff. Where appropriate, lines that connect gas tanks to specific areas of the laboratory should be made of synthetic tubing to allow future moving if necessary. If the laboratory will provide the service, it should plan for a medium-sized anaerobe chamber, about 6 feet of footprint. Additionally, diplomates of the American Board of Medical Microbiology or the American Board of Medical Laboratory Immunology or equivalent specialists in leadership positions are valuable assets to laboratories that receive and manipulate microbes. Inherent limitations of and assumptions made in the process also exist, and the perception of acceptable risk differs for everyone. A comprehensive approach for identifying hazards in the laboratory will include information from a variety of sources. At BSL-2 and above, a BSC or similar containment device is required for procedures with splash or aerosol potential (Table 3).
Routine clinical specimens also may harbor unusual or exotic infectious agents that are dangerous to amplify in culture. Check the manufacturer's recommendations before allowing two employees to work simultaneously in the larger cabinet, and then allow only after a risk assessment. For mycobacteriology and virology laboratories where organism manipulation is conducted, workers should wear a fit tested N95 respirator or select other appropriate respiratory protection, as indicated by the risk assessment. If the specimen is leaking or contaminated, consider rejecting it and requesting another specimen if feasible. Otherwise, disinfect the outside of the container before culturing the contents, and change and discard gloves before proceeding. Laboratories without the ability to determine or rule out Brucella or Francisella (gram-negative coccobacilli) should consider directly shipping these isolates to a reference laboratory and not try to isolate and identify them.
Dispose of single-use protective clothing with other contaminated waste or deposit reusable clothing for laundering by the institution.
OSHA recommends that selection be based on the tasks performed and the performance and construction characteristics of the glove material.
For those who need corrected vision, wear prescription safety glasses with side shields in the laboratory.
The lack of a BSC is a Phase II deficiency for microbiology departments that handle specimens or organisms considered contagious by airborne routes.
The Class I BSC could be used in the general laboratory setup area as a second choice of cabinet. Air can be recirculated back into the room through high-efficiency particulate air (HEPA) filters with little risk if the cabinet is maintained properly and certified annually. Moving the cabinet can damage the filter at the glue joint or at the gasket, resulting in dangerous leaks, so filter and cabinet integrity must be tested after each move.
BMBL-5, however, was not designed to address the day-to-day operations of diagnostic laboratories in human and animal medicine. A specific section for veterinary diagnostic laboratories addresses the veterinary issues not shared by other human laboratory departments. This culture of safety is also supported by the Clinical and Laboratory Standards Institute (2).
Any of these workers who have chronic medical conditions or receive immunosuppressive therapy would be at increased risk for a laboratory-acquired infection (LAI) after a laboratory exposure.
Of the 52 cases of laboratory-acquired malaria, 56% were vector borne (from mosquitoes used in research, not clinical laboratories). The guidelines provided herein are synthesized and supported from systematic reviews of peer-reviewed publications of evidence-based data from which recommendations could be made, justifying common-sense approaches that should be articulated, and where safe procedures have been described and proven.
The goal of a safety program is to lower the risk to as close as possible to zero, although zero risk is as yet unattainable as long as patient specimens and live organisms are manipulated. Except for reporting requirements imposed by CDC's Select Agent Program, which deals with handling of specific, potentially hazardous biological agents and toxins, no national surveillance system is in place to which medical laboratory exposures and subsequent work-related infections are reported.
The inability to identify a specific event was also reported in a more recent study (27), which found that the probable sources of LAIs were apparent in only 50% of cases.
In addition, the day-to-day operations of a human or animal diagnostic laboratory differ markedly from those of an academic or research laboratory and require different biosafety guidelines; these differences prompted the focus of this report on medical laboratory communities, their occupational risks, potential for exposure, and opportunities to mitigate those risks. The following are suggestions to consider in the design or renovation of the diagnostic laboratory.
If a drop ceiling is in place, the clear wall needs to penetrate the deck beyond the ceiling to seal the area.
Hands-free sinks (foot-pedal operated) are required for biosafety level (BSL)-3 facilities and are recommended for BSL-2 facilities. Accommodations need to be made for daily reading of the gauges in the laboratory unless alarms can be installed. Double-door autoclaves can be installed so that one side opens into the mycobacteriology laboratory and the other side opens into a disposal area used by the laboratory for disposing of other waste.
Risk assessments must include evaluation of the infectious aerosols that might be produced by automated procedural equipment to determine whether containment ventilation is recommended. Using their skills as laboratory director or as consultant is invaluable and highly recommended.
Risk assessment, as outlined here and in Section 12, may determine that decreasing or increasing the BSL practices or facilities is warranted (Figure 1). Methods to ascertain hazard information can include benchmarking, walkabouts, interviews, detailed inspections, incident reviews, workflow and process analysis, and facility design. Laboratory directors are responsible for determining which BSL is appropriate for work in their specific laboratories. These agents are often difficult to identify, and the routine bench technologist might continue work on the culture by passage, repeated staining, nucleic acid testing, neutralization, and other methods.
An N95 respirator is usually not required for biocontainment levels up through BSL-2, although it provides a higher degree of protection than a surgical mask.
Supply each workstation with alcohol hand rub to facilitate frequent hand cleaning, and with absorbent work pads to contain accidental spills. Disposable gloves must be made available in a variety of sizes to ensure that employees are able to select the size that best fits their hands. In a chemical splash, contact lenses can intensify eye damage because the lens will hold the chemical against the eye for a longer period. The A-1 or A-2 BSC in the mycobacteriology laboratory is also an option with a thimble connection to a building exhaust duct and annual certification. A worker exposed to an unpleasantly strong odor after mixing of a chlorine solution with a cleaning product should leave the room or area immediately and remain out of the area until the fumes have cleared completely (see Section 9.1). Use of bleach solutions with lower hypochlorite concentrations might not provide the proper level of disinfection. What are the best fruits to eat that are low in sugar & what are the worst fruits to avoid that are high in sugar? Work in a diagnostic laboratory entails safety considerations beyond the biological component; therefore, these guidelines also address a few of the more important day-to-day safety issues that affect laboratorians in settings where biological safety is a major focus.
Precise risk for infection after exposure is unknown because determining the source or the mode of transmission often is difficult. Most infected health-care workers acquired infection from needle sticks during preparation of blood smears or while drawing blood.
The Blue Ribbon Panel recommended that biosafety guidelines be developed to address the unique operational needs of the diagnostic laboratory community and that they be science based and made available broadly. Protection of laboratorians, coworkers, patients, families, and the environment is the greatest safety concern. Increased attention has been focused on laboratory biosafety and biosecurity since 2001 but has been largely limited to precautions required for agents of bioterrorism. These data suggest that unsuspected infectious aerosols can play a large role in LAIs (1,23,24,28).
Although there is no national standard requirement for an amount of space per person working in the laboratory, 300–350 sq. In a previously constructed laboratory without directional room air, the continual operation of biological safety cabinets (BSCs) is encouraged to provide some direction to potential aerosols. Bench-tops must be constructed of impervious materials; laminate materials can delaminate and become difficult to disinfect. For convenience, electrical outlets are recommended at each work station, along with telephone and computer jacks. Validation of the autoclave cycles for effective decontamination of the projected loads is recommended in addition to a regular maintenance and quality-assurance program.
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.
This continued workup places the technologist and others in the laboratory at risk for infection.
Make safety glasses, splash shield, respiratory protection, and gloves available for use and when determined necessary by the type of isolate, as described in BMBL-5 (1). Never hard-duct the Class A BSC to the building exhaust system because building airflow patterns cannot be matched to the cabinet. The members of this panel recommended that biosafety guidelines be developed to address the unique operational needs of the diagnostic laboratory community and that they be science based and made available broadly. In the absence of supporting evidence-based research and documentation, some recommendations are based on expert opinion by international experts in the field of microbiology and must be appropriately applied until evidence-based research can substantiate their validity.
Other laboratory exposures and LAIs continue to occur, almost always because of a breakdown of established safety protocols. For BSCs that vent to the outside, air handling should be planned carefully to ensure that the air is vented to the outside after filtration and that the outside vents are placed away from the facility's air intake units. Ideally, these specimens are not to be processed or tested in the routine laboratory, and they can be removed from the testing stream if the suspected agent is known. Mycobacterial, fungal, viral, and molecular specimens may require specific additional safeguards. These guidelines promote a culture of safety and include recommendations that supplement BMBL-5 by addressing the unique needs of the diagnostic laboratory. The authors reviewed and approved their own sections and also evaluated how their topics accurately reflected and supported the goals of the entire document. Because of the lack of an official surveillance mechanism for reporting LAIs and because of the fear of punitive action by an oversight agency if injuries are reported, the data needed to determine the extent and cause of LAIs are unavailable.
Ideally, allow a minimum 5-foot space between the worker (at a laboratory chair) and any object behind the worker to provide reasonable maneuverability. For laboratories that contain multiple classes of BSCs, the hazards that are permitted to be manipulated within the specific unit need to be clearly indicated (by label) to staff (1). Relationships with the state public health laboratory, and subsequently with the Laboratory Response Network, are critical in this effort. They are not requirements but recommendations that represent current science and sound judgment that can foster a safe working environment for all laboratorians.

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