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Chapter 15.7 : Management of Laboratory Accidents

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Management of Laboratory Accidents, Page 1 of 2

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Abstract:

Despite improved control measures (engineering controls, safe work practices, and PPE), laboratory workers remain at risk for acquiring laboratory-associated infections. Reported cases of fatal meningococcemia in clinical laboratory workers underscore the potential risks of handling clinical samples ( ). Every laboratory (e.g., anatomic pathology, clinical diagnostic, reference, and research laboratories) should implement a biosafety plan. The essential components of the plan should include written procedures to reduce risks of occupational exposure and mandatory training, health assessment of employees, and record keeping of all exposures and treatments. A risk assessment of the procedures carried out on samples, including the frequency of positive samples, should be determined. The potential risk of disease should also be evaluated along with the availability of postexposure prophylaxis (PEP) and preventive vaccines. The benefits and side effects of PEP and immunization must also be considered.

Citation: Garcia L. 2010. Management of Laboratory Accidents, p 725-731. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch15.7
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References

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1. Bolyard, E. A.,, O. C. Tablan,, W. W. Williams,, M. L. Pearson,, C. N. Shapiro,, and S.D. Deitchman, The Hospital Infection Control Practices Advisory Committee. 1998. Guidelines for infection control in health care personnel. Am. J. Infect. Control 26:289-354 and Infect. Control Hosp. Epidemiol. 19:407463.
2.Centers for Disease Control and Prevention. 2002. Laboratory-acquired meningococcal disease—United States, 2000. MMWR Morb. Mortal. Wkly. Rep. 51:141144.
3.Centers for Disease Control and Prevention. 2001. Updated U.S. Public Health Service guidelines for the management of occu-pational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. MMWR Morb. Mortal. Wkly. Rep. 50(RR-11):142.
4.Centers for Disease Control and Prevention. 2005. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HIV and recommendations for postexposure prophylaxis. MMWR Morb. Mortal. Wkly. Rep. 54:117.
5. Beltrami, E. M.,, I. T. Williams,, C. N. Shapiro,, and M. E. Chamberland. 2000. Risk management of blood-borne infections in health care workers. Clin. Microbiol. Rev. 13:385407.
6. Centers for Disease Control and Prevention. 2008. Update: potential exposures to attenuated vaccine strain Brucella abortus RB51 during laboratory proficiency test—United States and Canada, 2007. MMWR Morb. Mortal. Wkly. Rep. 57:3639.
7. Centers for Disease Control and Prevention. 2007. Recommended adult immunization schedule—United States, October 2007-September 2008. MMWR Morb. Mortal. Wkly. Rep. 56:Q1Q4.
8. Centers for Disease Control and Prevention. 1997. Immunization of health-care workers: recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infections Control Practices Advisory Committee (HICPAC). MMWR Morb. Mortal. Wkly. Rep. 46(RR-18):142.
9. CLSI. 2005. Protection of Laboratory Workers from Occupationally Acquired Infections. Document M29-A3. CLSI, Wayne, PA.
10. Peacock, S. J.,, H. P. Schweizer,, D. A. B. Dance,, T. L. Smith,, J. E. Gee,, V. Wuthiekanun,, D. DeShazer,, I. Steinmetz,, P. Tan,, and B. J. Currie. 2008. Management of accidental laboratory exposure to Burkholderia pseudomallei and B. mallei. Emerg. Infect. Dis. 14:e2.
11. Sejvar, J. J.,, D. Johnson,, T. Popovic,, J. M. Miller,, F. Downes,, P. Somsel,, R. Weyant,, D. S. Stephens,, B. A. Perkins,, and N. E. Rosenstein. 2005. Assessing the risk of laboratory-acquired meningococcal disease. J. Clin. Microbiol. 43:48114814.

Tables

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Bring completed form to your campus EOHS for evaluation.

Citation: Garcia L. 2010. Management of Laboratory Accidents, p 725-731. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch15.7
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Recommended PEP for exposure to HBV

. 2001. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. (RR-11):1–42.

Persons who have previously been infected with HBV are immune to reinfection and do not require PEP.

Dose is 0.06 ml/kg intramuscularly.

A responder is a person with adequate levels of serum antibody to HBsAg (i.e., anti-HBs ≥10 mlU/ml).

A nonresponder is a person with inadequate response to vaccination (i.e., serum anti-HBs <10 mlU/ml).

The option of giving one dose of HBIG and reinitiating the vaccine series is preferred for nonresponders who have not completed a second three-dose vaccine series. For persons who previously completed a second vaccine series but failed to respond, two doses of HBIG are preferred.

Citation: Garcia L. 2010. Management of Laboratory Accidents, p 725-731. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch15.7
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Recommended HIV PEP for percutaneous injuries

From . 2001. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. 50(RR-11):1–42.

HIV positive, class 1, asymptomatic HIV infection or known low viral load (e.g., <1,500 RNA copies/ml); HIV positive, class 2, symptomatic HIV infection, AIDS, acute seroconversion, or known high viral load. If drug resistance is a concern, obtain expert consultation. Initiation of PEP should not be delayed pending expert consultation, and because expert consultation alone cannot substitute for face-to-face counseling, resources should be available to provide immediate evaluation and follow-up care for all exposures.

For example, deceased source person with no samples available for HIV testing.

For example, a needle from a sharps disposal container.

For example, solid needle and superficial injury.

The designation “consider PEP” indicates that PEP is optional and should be based on an individualized decision between the exposed person and the treating clinician.

For example, large-bore hollow needle, deep puncture, visible blood on device, or needle used in patient's artery or vein.

If PEP is offered and taken and the source is later determined to be HIV negative, PEP should be discontinued.

Citation: Garcia L. 2010. Management of Laboratory Accidents, p 725-731. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch15.7
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Recommended HIV PEP for mucous membrane exposures and nonintact skinexposures

For skin exposures, follow-up is indicated only if there is evidence of compromised skin integrity (e.g., dermatitis, abrasion, or open wound).

From Centers for Disease Control and Prevention. 2001. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. 50(RR-11):1–42.

HIV positive, class 1, asymptomatic HIV infection or known low viral load (e.g., 1,500 RNA copies/ml); HIV positive, class 2, symptomatic HIV infection, AIDS, acute seroconversion, or known high viral load. If drug resistance is a concern, obtain expert consultation. Initiation of PEP should not be delayed pending expert consultation, and because expert consultation alone cannot substitute for face-to-face counseling, resources should be available to provide immediate evaluation and follow-up care for all exposures.

For example, deceased source person with no samples available for HIV testing.

For example, splash from inappropriately disposed blood.

In other words, a few drops.

The designation “consider PEP” indicates that PEP is optional and should be based on an individualized decision between the exposed person and the treating clinician.

If PEP is offered and taken and the source is later determined to be HIV negative, PEP should be discontinued.

In other words, major blood splash.

Citation: Garcia L. 2010. Management of Laboratory Accidents, p 725-731. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch15.7
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Immunization available for laboratory workers in special circumstancesa

Modified from Centers for Disease Control and Prevention. 1997. Immunization of health-care workers: recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infections Control Practices Advisory Committee (HICPAC). 46(RR-18):1–42. Abbreviations: HDCV, human diploid cell rabies vaccine; RVA, rabies vaccine absorbed; IPV, inactivated poliovirus vaccine; OPV, oral poliovirus vaccine; i.d., intradermally; i.m., intramuscularly; s.c., subcutaneously.

Citation: Garcia L. 2010. Management of Laboratory Accidents, p 725-731. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch15.7
Generic image for table

Immunization available for laboratory workers in special circumstancesa

Modified from Centers for Disease Control and Prevention. 1997. Immunization of health-care workers: recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infections Control Practices Advisory Committee (HICPAC). 46(RR-18):1–42. Abbreviations: HDCV, human diploid cell rabies vaccine; RVA, rabies vaccine absorbed; IPV, inactivated poliovirus vaccine; OPV, oral poliovirus vaccine; i.d., intradermally; i.m., intramuscularly; s.c., subcutaneously.

Citation: Garcia L. 2010. Management of Laboratory Accidents, p 725-731. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch15.7

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