credits bmbl December 7 '06.doc - Central Michigan University

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Occupational Health and Immunoprophylaxis • The potential infectious agent. • The mechanism and route of exposure (percutaneous, splash to mucous membranes or skin, aerosol, etc.). • Time and place of the incident. • Personal protective equipment used at the time of the injury. • Prior first aid provided (e.g., nature and duration of cleaning and other aid, time that lapsed from exposure to treatment). • Aspects of the worker’s personal medical history relevant to risk of infection or complications of treatment. First aid should be repeated if the initial adequacy is in question. Healthcare providers must use appropriate barrier precautions to avoid exposure to infectious agents and toxins. In some instances, it may be possible to prevent or ameliorate illness through post-exposure prophylaxis. Protocols should be developed in advance that clearly identify the situations in which post-exposure prophylaxis are to be considered, the appropriate treatment, and the source of products and expert consultation. Accurate quantification of risk associated with all exposures is not possible, and the decision to administer postexposure prophylaxis may have to be made quickly and in the absence of confirmatory laboratory testing. Post-exposure regimens may involve off-label use of licensed products (e.g., use of smallpox vaccine for workers exposed to monkeypox) in settings where there is insufficient experience to provide exact guidance on the safety or likely protective efficacy of the prophylactic regimen. Thus, protocols should exist that delineate the circumstances under which it would be appropriate to consider use of each product following exposure, as well as the limits of our understanding of the value of some postexposure interventions. In these cases, consultations with subject matter experts are especially useful. Estimating the significance of an exposure may be difficult, despite having established protocols. The clinician may need to make a “best-estimate” based upon knowledge of similar agents, exposure circumstances, and advice received from knowledgeable experts. Appropriate post-exposure prophylactic response is always pathogen- and exposure-dependent, may be host-factor dependent, and may also be influenced by immediate post-exposure management. Before prophylactic treatment is undertaken, confirm the likelihood that an exposure occurred, that prophylaxis is indicated and is not contraindicated by past medical history. Conveying this information to the injured worker requires clear, honest communication. The clinical risk assessment and treatment decision process should be carefully explained, the worker’s questions addressed with relevant, preprinted educational materials provided. Prompt treatment 134
Occupational Health and Immunoprophylaxis should be provided, with a mutually agreed plan to follow the individual’s clinical course. The applicable workers’ compensation claim form should be provided with appropriate explanations for its completion. 19 The supervisor must receive a description of the accident or incident, confirm the circumstances of the injury or exposure and provide relevant advice. The report also should be distributed to all other relevant parties, such as the safety professional. Each incident should receive prompt reconsideration of the initial risk assessment and reevaluation of current strategies to reduce the possibility of future exposures. Post-exposure serologic testing may be useful, but it is important to determine how information obtained from serologic testing will be interpreted. It is also essential to collect serum specimens at the appropriate interval for a given situation. Assessment of sero-reactivity in exposed workers is most helpful when the results of specimens collected over time can be compared. Ideally specimens collected prior to, at the time of and several weeks following exposure should be tested simultaneously and results compared to assess changes in the pattern of sero-reactivity. Serum collected too early after exposure may fail to react even when infection has occurred, because antibodies have not yet been produced in detectable quantities. When immediate institution of postexposure prophylaxis may delay seroconversion, or when the agent to which the worker was exposed results in seroconversion completed over months (e.g., retroviruses), testing of specimens collected late after exposure is particularly important. Testing of a single serum specimen is generally discouraged and can result in misinterpretation of nonspecific sero-reactivity. Evidence of sero-conversion or a significant (> 4 fold) increase in titer associated with a compatible clinical syndrome is highly suggestive of acute infection. However, the significance of and appropriate response to sero-conversion in the absence of illness is not always clear. If sero-reactivity is evident in the earliest specimen, it is important to re-test that specimen in tandem with serum specimens archived prior to occupational exposure and/or collected serially over time to investigate whether a change in titer suggestive of new infection can be identified. In some exposure situations, it may be appropriate to store serially collected serum samples, and to send them for testing as evidence of seroconversion only if symptoms develop that suggest an infection may have occurred (e.g., monkey B virus exposures). Serum collected at the time of employment, and any other specimens not immediately tested should be stored frozen at a temperature of -20 o C or lower in a freezer that does not experience freeze-thaw cycles. An inventory system should be established to ensure the accurate and timely retrieval of samples, while protecting patient privacy. When investigational or other non-commercial assays are utilized, the importance of appropriate controls and the ability to compare serially collected specimens for quantification/characterization of reactivity is increased. The availability of aliquoted samples that allow additional testing may be essential to assist interpretation of 135
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Biosafety in Microbiological and Bi
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SECTION VIII-H: Prion Diseases 299
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Forward Biosafety in Microbiologica
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Editors: L. Casey Chosewood, MD Dir
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Guest Editors: Matthew J. Arduino,
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Charles B. Millard, PhD Lieutenant
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Robert Bull Karen B. Byers Jane Cap
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Thomas L. Miller Douglas M. Moore M
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Robert Yarchoan Uri Yokel Lisa Youn
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Introduction laboratories chose not
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Introduction RISK CRITERIA FOR ESTA
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Introduction BMBL includes an impor
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Section II Biological Risk Assessme
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Biological Risk Assessment informat
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Biological Risk Assessment The NIH
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Biological Risk Assessment effectiv
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Biological Risk Assessment Third, m
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Biological Risk Assessment 14. Oxma
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Principles of Biosafety Safety equi
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Principles of Biosafety Often an in
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Principles of Biosafety Four standa
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Principles of Biosafety 4. Centers
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Laboratory Biosafety Level Criteria
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Section V Vertebrate Animal Biosafe
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Vertebrate Animal Biosafety Level C
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Page 83 and 84: Vertebrate Animal Biosafety Level C
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Agent Summary Statements - Bacteria
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• Section VIII-B: Fungal Agents A
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Agent Summary Statements - Fungal A
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• Section VIII-C: Parasitic Agent
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Agent Summary Statements - Parasiti
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• Section VIII-D: Rickettsial Age
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Agent Summary Statements - Ricketts
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Agent Summary Statements - Ricketts
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• Section VIII-E: Viral Agents Ag
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Agent Summary Statements - Viral Ag
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Agent Summary Statements - Arboviru
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• Section VIII-G: Toxin Agents Se
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Agent Summary Statements - Toxins i
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Agent Summary Statements - Toxins A
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Agent Summary Statements - Toxins L
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Agent Summary Statements - Toxins e
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Agent Summary Statements - Toxins o
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Agent Summary Statements - Toxins t
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• Section VIII-H: Prion Diseases
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Agent Summary Statement - Prion Dis
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Appendix A Proper maintenance of ca
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Appendix A declined. However, in ma
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Appendix A It is possible to exhaus
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Appendix A 4. The Class II, Type A2
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Appendix A prohibited. Furthermore,
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Appendix A plastic wrappers, pipett
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Appendix A touch-plate microburners
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Appendix A SECTION VI FACILITY AND
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Appendix A Development of Containme
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Appendix A C. Airflow Smoke Pattern
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Appendix A TABLES Table 1. Selectio
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Appendix A Table 3. Field Performan
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Appendix A FIGURES Figure 1. HEPA f
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Appendix A Figure 3. The Class II,
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Appendix A Figure 5B. The Class II,
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Appendix A Figure 8. The Class III
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Appendix A Figure 9B. The vertical
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Appendix A Figure 11. A typical lay
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Appendix A REFERENCES 1. Centers fo
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Appendix B Decontamination and Disi
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Appendix B surfaces are contaminate
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Appendix B TABLE 1 DESCENDING ORDER
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Appendix B dioxide gas exits the ge
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Appendix B d The effectiveness of a
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Appendix C Transportation of Infect
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Appendix C 1600 Clifton Road, N.E.,
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Appendix C disease in humans or in
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Appendix C Biological specimen, Cat
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Appendix D Agriculture Pathogen Bio
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Appendix D simultaneous opening of
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Appendix D 14. Pathological inciner
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Appendix D Wastes and other materia
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Appendix D Camelpox virus b a, b, c
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Appendix D SPECIAL ISSUES The impor
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Appendix D required by the USDA and
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Appendix D depression, anorexia, an
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Appendix D laboratory with enhancem
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Appendix D five day period of conta
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Appendix D slaughterhouses or indus
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Appendix D virus does not cause any
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Appendix D NDV is classified in the
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Appendix D movement permit is requi
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Appendix D Spring Viremia of Carp V
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Appendix D REFERENCES 1. Hess WR. A
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Appendix D 37. Alexander DJ. Newcas
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Appendix E Arthropod Containment Gu
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Appendix F Select Agents and Toxins
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Appendix G IPM issues and requireme
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Appendix H Working with Human, NHP
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Appendix I Guidelines for Work with
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decontaminated periodically, for ex
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0.25N, and/or sodium hypochlorite (
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k Irradiation causes a dose-depende
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7. Morin R, Kozlovac J. Biological
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Appendix J NIH Oversight of Researc
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Appendix K Resources for Informatio
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Appendix K E-mail: http://www2.gsu.
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Appendix K and http://www.who.int/c
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Appendix L HEPA High Efficiency Par
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