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Copyright © 2009 by Limsoon Wong 1 Life Sciences Institute & Singapore Institute for Clinical Sciences (Brenner Centre) SAFETY DAY 2009 Overview of Laboratory.

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Presentation on theme: "Copyright © 2009 by Limsoon Wong 1 Life Sciences Institute & Singapore Institute for Clinical Sciences (Brenner Centre) SAFETY DAY 2009 Overview of Laboratory."— Presentation transcript:

1 Copyright © 2009 by Limsoon Wong 1 Life Sciences Institute & Singapore Institute for Clinical Sciences (Brenner Centre) SAFETY DAY 2009 Overview of Laboratory Acquired Infections

2 Contact Info Scott Patlovich, MPH, CBSP Senior Safety & Health Manager Office of Safety, Health, & Environment Office:

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4 Definition of LAI Laboratory acquired infection (LAI) = an infection obtained through laboratory or laboratory-related activities as a result of work with infectious biological agents, which may be either symptomatic of asymptomatic

5 History of LAIs Four hallmark studies by Pike and Sulkin collectively identified 4,079 LAIs resulting in 168 deaths between 1930 – causative agents identified, although >50% were caused by 10 most common organisms Many more LAIs likely unreported during this time period

6 Source: Pike, 1976 & 1978 ( )

7 History of LAIs Harding and Byers literature search of LAIs for 20 years following Pike and Sulkin publications found 1,267 overt infections with 22 deaths Harding and Byers also reported: – <20% of LAIs from known exposure or documented accident in the lab – Only 7 documented secondary infections from LAIs (1979 – 1999)

8 Despite Controls, LAIs Continue 1979 Pike concluded “the knowledge, the techniques, and the equipment to prevent most laboratory infections are available” Yet, laboratory acquired infections continue to occur…(even today)

9 “The conventional wisdom is that laboratory-acquired infections are kept under control by stringent CDC guidelines first introduced in 1984, at a time when investigations of pathogenic bacteria were just starting to bloom. The reality is that no one knows what the reality of laboratory-acquired infections is.”

10 Biosafety Guidelines & Regulations CDC/NIH. Biosafety in Microbiological and Biomedical Laboratories, 5 th Edition. (2007) World Health Organization. Laboratory Biosafety Manual, 3 rd Edition. (2004) Ministry of Health Singapore. Biological Agents and Toxins Act [BATA]. (2006)

11 Biosafety Controls Practices, procedures, and facility controls described in biosafety level criteria (BSLs) Risk grouping of infectious biological agents Emphasis on risk assessment, training, SOPs, disinfection, waste management, immunization, post-exposure prophylaxis, biosecurity, etc. LAIs are not exclusive to BSL-3 or BSL-4 laboratories – many occur in BSL-2 laboratories

12 Potential Routes of Transmission Inhalation – infectious aerosols, droplets Ingestion – mouth pipetting; eating, drinking Percutaneous inoculation – needlesticks and other contaminated sharps; animal bites; exposure to previously broken or damaged skin Mucous membrane exposure – infectious materials in contact with eyes, nose, mouth (splashes, contact from contaminated surfaces)

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15 “Laboratory A” (2002) Who: 1 unvaccinated worker at private lab (“laboratory A”) processing environmental samples following October 2001 anthrax mailings Agent: virulent Bacillus anthracis Route of Exposure: Cutaneous Source: Positive environmental sample not properly handled, plus individual had pre-existing fresh cut on neck from shaving Result: cutaneous anthrax disease including black eschar on neck Other findings: 70% ethanol used for storage vials when 10% bleach prescribed in SOPs; gloves not used to handle vials; wipe samples of lab surfaces indicated only vials were possible source of contamination

16 “Laboratory A” (2002) Who: 1 unvaccinated worker at private lab (“laboratory A”) processing environmental samples following October 2001 anthrax mailings Agent: virulent Bacillus anthracis Route of Exposure: Cutaneous Source: Positive environmental sample not properly handled, plus individual had pre-existing fresh cut on neck from shaving Result: cutaneous anthrax disease including black eschar on neck Other findings: 70% ethanol used for storage vials when 10% bleach prescribed in SOPs; gloves not used to handle vials; wipe samples of lab surfaces indicated only vials were possible source of contamination

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18 Boston University (2004) Who: 3 researchers suspected with pneumonic tularemia Agent: Live Vaccine Strain of Francisella tularensis (LVS stock contaminated with wild-type (Type A) virulent form of organism) Route of Exposure: Inhalation Source: Undetermined; several procedures occurring during time period (i.e. centrifuging, vortexing, colony counts not in a BSC) OSHA fine: US$8100 (for improper use of PPE) Other outcomes: City of Boston Public Health Department to survey lab; first ever City of Boston IBC review panel to review all biomedical research in city; construction of new BSL-4 labs highly controversial with public

19 Boston University (2004) Who: 3 researchers suspected with pneumonic tularemia Agent: Live Vaccine Strain of Francisella tularensis (LVS stock contaminated with wild-type (Type A) virulent form of organism) Route of Exposure: Inhalation Source: Undetermined; several procedures occurring during time period (i.e. centrifuging, vortexing, colony counts not in a BSC) OSHA fine: US$8100 (for improper use of PPE) Other outcomes: City of Boston Public Health Department to survey lab; first ever City of Boston IBC review panel to review all biomedical research in city; construction of new BSL-4 labs highly controversial with public

20 Science, September 2007

21 Madison Chamber Photo courtesy of Hillier Architecture

22 Texas A&M University (2007) Who: 1 student worker infected in Brucella lab exposure incident Agent: virulent Brucella spp. Route of Exposure: Mucous membrane exposure (eyes) Source: Improperly trained student worker entered Madison containment chamber to clean unit after aerosolization procedure CDC fine: US$1 million (plus lost grant dollars during lab shutdown) Other outcomes: Failure to properly report cases resulted in cease & desist order from CDC on all infectious disease lab work for nearly one year; significant reputational damage to university

23 Texas A&M University (2007) Who: 1 student worker infected in Brucella lab exposure incident Agent: virulent Brucella spp. Route of Exposure: Mucous membrane exposure (eyes) Source: Improperly trained student worker entered Madison containment chamber to clean unit after aerosolization procedure CDC fine: US$1 million (plus lost grant dollars during lab shutdown) Other outcomes: Failure to properly report cases resulted in cease & desist order from CDC on all infectious disease lab work for nearly one year; significant reputational damage to university

24 Vaccinia Virus (2007) Who: 1 unvaccinated worker at a Virginia academic institution Agent: Vaccinia Virus (live viral component of smallpox vaccine) Route of Exposure: Unknown currently Source: Recombinant stock likely to be contaminated with “Western Reserve” strain of virus Secondary Infections: 102 possible contacts identified; no secondary infections occurred

25 Vaccinia Virus (2007) Who: 1 unvaccinated worker at a Virginia academic institution Agent: Vaccinia Virus (live viral component of smallpox vaccine) Route of Exposure: Unknown currently Source: Recombinant stock likely to be contaminated with “Western Reserve” strain of virus Secondary Infections: 102 possible contacts identified; no secondary infections occurred

26 Recent Vaccinia LAI’s Source: US Centers for Disease Control & Prevention

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28 Emory University (1997) Who: 1 worker at the Yerkes Regional Primate Research Center at Emory University in Atlanta, Georgia engaged in behavioral research on hormonal influences in Rhesus macaques Agent: Cercopithecine Herpes Virus 1 (B-virus) Route of Exposure: Mucous membrane exposure (right eye) Source: Splash of bodily fluid from macaque to unprotected eyes (no safety glasses/goggles worn at time of exposure) Result: Fatality of 22-year old female (approx. 6 weeks following exposure) Other findings: No report of exposure until after onset of symptoms of disease; post-exposure treatment not adequate Note: infected macaques are often asymptomatic (no lesions)

29 Emory University (1997) Who: 1 worker at the Yerkes Regional Primate Research Center at Emory University in Atlanta, Georgia engaged in behavioral research on hormonal influences in Rhesus macaques Agent: Cercopithecine Herpes Virus 1 (B-virus) Route of Exposure: Mucous membrane exposure (right eye) Source: Splash of bodily fluid from macaque to unprotected eyes (no safety glasses/goggles worn at time of exposure) Result: Fatality of 22-year old female (approx. 6 weeks following exposure) Other findings: No report of exposure until after onset of symptoms of disease; post-exposure treatment not adequate Note: infected macaques are often asymptomatic (no lesions)

30 Other Infectious Disease Lab “Mishaps”

31 Texas Tech University Who: Thomas Butler Agent: Yersinia pestis What: Apparent loss of 30 vials containing bacteria How Much: 69 counts including illegal transportation, tax fraud, embezzlement, fraud, lying to federal officials Outcomes: 2 years jail time & US$38,000 fine

32 LAIs – Lessons Learned Prevention of LAIs can be achieved through: – Risk assessment! Risk assessment! Risk assessment! – Establishment of SOPs (controls) appropriate for infectious organisms used – Immunization, when available – Education and training – Use of appropriate precautions including engineering, administrative, and PPE controls – Understanding of disease signs & symptoms – Prompt injury/accident/illness reporting

33 Thank You!


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