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

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Agent Summary Statements – Viral Agents In general, SARS patients present with fever (temperature greater than 100.4°F [>38.0°C]), malaise and myalgias quickly followed by respiratory symptoms including shortness of breath and cough. Ten to 20 percent of patients may have diarrhea. Review of probable cases indicates that the shortness of breath sometimes rapidly progresses to respiratory failure requiring ventilation. The case fatality rate is about 11%. Occupational Infections Healthcare workers are at increased risk of acquiring SARS from an infected patient especially if involved in pulmonary/respiratory procedures such as endotracheal intubation, aerosolization or nebulization of medications, diagnostic sputum induction, airway suctioning, positive pressure ventilation and high-frequency oscillatory ventilation. Two confirmed episodes of SARS-CoV transmission to laboratory workers occurred in research laboratories in Singapore and Taiwan. 84,85 Both occurrences were linked to breaches in laboratory practices. Laboratory-acquired infections in China, during 2004, demonstrated secondary and tertiary spread of the disease to close contacts and healthcare providers of one of the employees involved. 86 Although, to date, no laboratory-acquired cases have been associated with the routine processing of diagnostic specimens, SARS coronavirus represents an emerging infectious disease for which risk to the medical and laboratory community is not fully understood. Natural Modes of Infection The mode of transmission in nature is not well understood. It appears that SARS is transmitted from person to person through close contact such as caring for, living with, or having direct contact with respiratory secretions or body fluids of a suspect or probable case. 87 SARS is thought to be spread primarily through droplets, aerosols and possibly fomites. The natural reservoir for SARS CoV is unknown at this time. LABORATORY SAFETY SARS-CoV may be detected in respiratory, blood, or stool specimens. The exact mode of transmission of SARS-CoV laboratory-acquired infection has not been established, but in clinical settings, the primary mode of transmission appears through direct or indirect contact of mucous membranes with infectious respiratory droplets. 88,89 Containment Recommendations In clinical laboratories, whole blood, serum, plasma and urine specimens should be handled using Standard Precautions which includes use of gloves, gown, mask, and eye protection. Any procedure with the potential to generate aerosols (e.g., vortexing or sonication of specimens in an open tube) should be performed in a BSC. Use sealed centrifuge rotors or gasketed safety carriers for centrifugation. Rotors and safety carriers 236
Agent Summary Statements – Viral Agents should be loaded and unloaded in a BSC. Procedures conducted outside a BSC must be performed in a manner that minimizes the risk of personnel exposure and environmental release. The following procedures may be conducted in the BSL-2 setting: pathologic examination and processing of formalin-fixed or otherwise inactivated tissues, molecular analysis of extracted nucleic acid preparations, electron microscopic studies with glutaraldehyde-fixed grids, routine examination of bacterial and fungal cultures, routine staining and microscopic analysis of fixed smears, and final packaging of specimens for transport to diagnostic laboratories for additional testing (specimens should already be in a sealed, decontaminated primary container). Activities involving manipulation of untreated specimens should be performed in BSL-2 facilities following BSL-3 practices. In the rare event that a procedure or process involving untreated specimens cannot be conducted in a BSC, gloves, gown, eye protection, and respiratory protection (acceptable methods of respiratory protection include: a properly fit-tested, National Institute for Occupational Safety and Health (NIOSH)-approved filter respirator (N-95 or higher level) or a PAPR equipped with HEPA filters) should be used. All personnel that may use respiratory protective devices should be enrolled in an appropriately constituted respiratory protection program. Work surfaces should be decontaminated upon completion of work with appropriate disinfectants. All waste must be decontaminated prior to disposal. SARS-CoV propagation in cell culture and the initial characterization of viral agents recovered in cultures of SARS specimens must be performed in a BSL-3 facility using BSL-3 practices and procedures. Risk assessment may dictate the additional use of respiratory protection. Inoculation of animals for potential recovery of SARS-CoV from SARS samples, research studies and protocols involving animal inoculation for characterization of putative SARS agents must be performed in ABSL-3 facilities using ABSL-3 work practices. Respiratory protection should be used as warranted by risk assessment. In the event of any break in laboratory procedure or accidents (e.g. accidental spillage of material suspected of containing SARS-CoV), procedures for emergency exposure management and/or environmental decontamination should be immediately implemented and the supervisor should be notified. The worker and the supervisor, in consultation with occupational health or infection control personnel, should evaluate the break in procedure to determine if an exposure occurred (See Special Issues, below). SPECIAL ISSUES Occupational Health Considerations 237
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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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TABLE 1 SUMMARY OF RECOMMENDED BIOS
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Principles of Laboratory Biosecurit
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Occupational Health and Immunoproph
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Agent Summary Statements - Bacteria
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Page 185 and 186: • Section VIII-B: Fungal Agents A
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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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• 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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