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Chapter 16.13 : Clinical Laboratory Bioterrorism Readiness Plan

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Clinical Laboratory Bioterrorism Readiness Plan, Page 1 of 2

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Abstract:

The purpose of this template is to provide a model for laboratories to use for developing a bioterrorism (BT) preparedness plan. The components of this template can be used to develop a readiness plan to meet the needs of the institution. It is not meant to be all-inclusive. Rather, it is to serve as an aid in the process of developing a specific plan for each institution.

Citation: Garcia L. 2010. Clinical Laboratory Bioterrorism Readiness Plan, p 808-834. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch16.13
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Figures

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Figure 16.13-1

LRN structure for BT agent testing.

Citation: Garcia L. 2010. Clinical Laboratory Bioterrorism Readiness Plan, p 808-834. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch16.13
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References

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1.Department of Health and Human Services. 1999. Biosafety in Microbiological and Biomedical Laboratories, 4th ed. U.S. Government Printing Office, Washington, DC.
2.Department of Health, Education, and Welfare. 1974. Biohazards Safety Guide. Department of Health, Education, and Welfare, Bethesda, MD.
3. Pike, R. M. 1976. Laboratory-associated infections. Summary and analysis of 3921 cases. Health Lab. Sci. 13:105114.

Tables

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Information Checklist

Citation: Garcia L. 2010. Clinical Laboratory Bioterrorism Readiness Plan, p 808-834. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch16.13
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Information Checklist

Citation: Garcia L. 2010. Clinical Laboratory Bioterrorism Readiness Plan, p 808-834. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch16.13
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Policy Sign-Off List

Citation: Garcia L. 2010. Clinical Laboratory Bioterrorism Readiness Plan, p 808-834. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch16.13
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Training Sign-Off List

Citation: Garcia L. 2010. Clinical Laboratory Bioterrorism Readiness Plan, p 808-834. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch16.13
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CDC BSL designations for laboratories

BSC, biological safety cabinet.

Citation: Garcia L. 2010. Clinical Laboratory Bioterrorism Readiness Plan, p 808-834. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch16.13
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Recommended BSL for BT agents

Laboratory-acquired brucellosis has occurred by “sniffing” cultures; aerosols generated by centrifugation; mouth pipetting; accidental parenteral inoculations; sprays into eyes, nose, and mouth; direct contact with clinical specimens; and when no breach in technique could be identified.

Laboratory-acquired infections have been acquired from virulent phase I organisms due to infectious aerosols from cell culture and the use of embryonated eggs to propagate

Exposure to toxin is the primary laboratory hazard, since absorption can occur with direct contact with skin, eyes, or mucous membranes, including the respiratory tract. The toxin can be neutralized by 0.1 M sodium hydroxide. is inactivated by a 1:10 dilution of household bleach. Contact time is 20 min. If material contains both toxin and organisms, the spill must be sequentially treated with bleach and sodium hydroxide for a total contact time of 40 min.

Laboratory-acquired tularemia infection has been more commonly associated with cultures than with clinical materials or animals. Direct skin/mucous membrane contact with cultures, parenteral inoculation, ingestion, and aerosol exposure have resulted in infection.

Special care should be taken to avoid the generation of aerosols.

Ingestion, parenteral inoculation, and droplet or aerosol exposure of mucous membranes or broken skin with infectious fluids or tissues are the primary hazards to laboratory workers.

Respiratory exposure to infectious aerosols, mucous membrane exposure to infectious droplets, and accidental parenteral inoculation are the primary hazards to laboratory workers.

Citation: Garcia L. 2010. Clinical Laboratory Bioterrorism Readiness Plan, p 808-834. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch16.13
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Recommended BSL for BT agents

Laboratory-acquired brucellosis has occurred by “sniffing” cultures; aerosols generated by centrifugation; mouth pipetting; accidental parenteral inoculations; sprays into eyes, nose, and mouth; direct contact with clinical specimens; and when no breach in technique could be identified.

Laboratory-acquired infections have been acquired from virulent phase I organisms due to infectious aerosols from cell culture and the use of embryonated eggs to propagate

Exposure to toxin is the primary laboratory hazard, since absorption can occur with direct contact with skin, eyes, or mucous membranes, including the respiratory tract. The toxin can be neutralized by 0.1 M sodium hydroxide. is inactivated by a 1:10 dilution of household bleach. Contact time is 20 min. If material contains both toxin and organisms, the spill must be sequentially treated with bleach and sodium hydroxide for a total contact time of 40 min.

Laboratory-acquired tularemia infection has been more commonly associated with cultures than with clinical materials or animals. Direct skin/mucous membrane contact with cultures, parenteral inoculation, ingestion, and aerosol exposure have resulted in infection.

Special care should be taken to avoid the generation of aerosols.

Ingestion, parenteral inoculation, and droplet or aerosol exposure of mucous membranes or broken skin with infectious fluids or tissues are the primary hazards to laboratory workers.

Respiratory exposure to infectious aerosols, mucous membrane exposure to infectious droplets, and accidental parenteral inoculation are the primary hazards to laboratory workers.

Citation: Garcia L. 2010. Clinical Laboratory Bioterrorism Readiness Plan, p 808-834. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch16.13
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Specimen selection for suspected BT agents

CNA, colistin-nalidixic acid agar; PEA, phenylethyl alcohol blood agar; RT, room temperature; X, yes.

Citation: Garcia L. 2010. Clinical Laboratory Bioterrorism Readiness Plan, p 808-834. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch16.13
Generic image for table

Specimen selection for suspected BT agents

CNA, colistin-nalidixic acid agar; PEA, phenylethyl alcohol blood agar; RT, room temperature; X, yes.

Citation: Garcia L. 2010. Clinical Laboratory Bioterrorism Readiness Plan, p 808-834. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch16.13
Generic image for table

Specimen selection for suspected BT agents

CNA, colistin-nalidixic acid agar; PEA, phenylethyl alcohol blood agar; RT, room temperature; X, yes.

Citation: Garcia L. 2010. Clinical Laboratory Bioterrorism Readiness Plan, p 808-834. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch16.13
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Specimen selection: bioterrorism agents

A, autopsy; RT, room temperature; X, yes.

Citation: Garcia L. 2010. Clinical Laboratory Bioterrorism Readiness Plan, p 808-834. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch16.13
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Specimen selection: bioterrorism agents

X, yes.

Citation: Garcia L. 2010. Clinical Laboratory Bioterrorism Readiness Plan, p 808-834. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch16.13
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Specimen selection: bioterrorism agents

BYCE, buffered charcoal-yeast extract agar; DFA, direct fluorescent antibody; RT, room temperature; X, yes.

Citation: Garcia L. 2010. Clinical Laboratory Bioterrorism Readiness Plan, p 808-834. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch16.13
Generic image for table

Specimen selection: bioterrorism agents

BYCE, buffered charcoal-yeast extract agar; DFA, direct fluorescent antibody; RT, room temperature; X, yes.

Citation: Garcia L. 2010. Clinical Laboratory Bioterrorism Readiness Plan, p 808-834. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch16.13
Generic image for table

Specimen selection: bioterrorism agents

BYCE, buffered charcoal-yeast extract agar; DFA, direct fluorescent antibody; RT, room temperature; X, yes.

Citation: Garcia L. 2010. Clinical Laboratory Bioterrorism Readiness Plan, p 808-834. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch16.13
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Specimen selection: bioterrorism agents

RT, room temperature; VHF, viral hemorrhagic fever.

Citation: Garcia L. 2010. Clinical Laboratory Bioterrorism Readiness Plan, p 808-834. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch16.13
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Specimen selection: bioterrorism agents

RT, room temperature; VHF, viral hemorrhagic fever.

Citation: Garcia L. 2010. Clinical Laboratory Bioterrorism Readiness Plan, p 808-834. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch16.13
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Specimen selection: bioterrorism agents

PC, selective medium for ; RT, room temperature; X, yes.

Citation: Garcia L. 2010. Clinical Laboratory Bioterrorism Readiness Plan, p 808-834. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch16.13
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BT agent characteristics summary: microorganisms

a GNCB, gram-negative coccobacillus; CPE, cytopathic effect; Cat, catalase; Ox, oxidase; (R), resistant; NG, no growth; Lac, lactose.

Citation: Garcia L. 2010. Clinical Laboratory Bioterrorism Readiness Plan, p 808-834. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch16.13
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BT agent clinical summary

exotoxin or exotoxins consist of three components: the edema factor and lethal factor exert their effect within cells by interacting with a common transport protein designated “protective antigen” (so named because, when modified, it contributes to vaccine efficacy). Expression of toxic factors is mediated by one plasmid, and that of the capsule (D-glutamic acid polypeptide) is mediated by a second plasmid. Strains repeatedly subcultured at 42°C become avirulent as a result of losing virulence-determining plasmids, which is thought to be the basis for Pasteur's attenuated anthrax vaccine used at Pouilly-le-Fort in 1881.

The estimate that nine inhaled spores would infect 2% of the exposed human population is based on data from 1202–1208, 1994. The dose needed to infect 50% of the exposed human population may be 8,000 or higher.

The major virulence factor for brucellosis appears to be an endotoxic lipopolysaccharide (LPS) among smooth strains. Pathogenicity is related to an LPS containing poly -formyl perosamine O chain, Cu-Zn superoxide dismutase, erythrulose phosphate dehydrogenase, intracellular survival stress-induced proteins, and adenine and guanine monophosphate inhibitors of phagocyte functions.

The V and W antigens and the F1 capsular antigens are only expressed at 7°C and not at the lower temperature of the flea (20 to 25°C).

Periods of communicability are as follows: for inhalation anthrax and botulism, none (no evidence of person-to-person transmission); pneumonic plague, 72 h following initiation of appropriate antimicrobial therapy or until sputum culture is negative; smallpox, approximately 3 weeks (usually corresponds with the initial appearance of skin lesions to their final disappearance and is most infectious during the first week of rash via inhalation of virus released from oropharyngeal lesion secretions of the index case); VHF, varies with virus, but at minimum, all for the duration of illness, and for Ebola/Marburg, transmission through semen may occur up to 7 weeks after clinical recovery

Guidelines for isolation precautions in hospitals can be found in 53–80, 1996, in addition to the standard precautions that apply to all patients.

Published reports of possible transmission of brucellosis via human breast milk may be found in 55–56, 2000; 305–307, 1990; 346–348, 1993; and 151–152, 1988.

Published reports of possible sexual transmission of brucellosis can be found in 773, 1983; 165–166, 1991; 848–849, 1991; 1763, 1996; 14–15, 1991; 313–314, 1983; and 615, 1996.

See 1290–1291, 1991.

Published reports of possible sexual transmission of Q fever can be found in 1087–1088, 1996, and 399–402, 2001.

Citation: Garcia L. 2010. Clinical Laboratory Bioterrorism Readiness Plan, p 808-834. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch16.13
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Alternative names for BT

Citation: Garcia L. 2010. Clinical Laboratory Bioterrorism Readiness Plan, p 808-834. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch16.13

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