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From page 213... ... autopsy precautions, 17, 159-160 health care workers with, 157 and tuberculosis morbidity, 10 see also Human immunodeficiency virus ~V) Actinomycetes, animal sources and routes of infection, 177 Aerosols and droplets containmentlcontrol equipment, 16, 25, 26, 28 handling of, 5, 22-25 HVB transmission in, 11 insect waste products in, 14 particulate size, 12, 22 procedures generating, 18, 19, 23, 50, 65-66,94 from sonicators, homogenizers, and mixers, 23-24, 26-28 from Stryker saw, 17, 122 African green monkeys, 15 Alcohol disinfection, 40 Allergies among laboratory workers to aerosolized proteins, 57 arumal-associate~l, 14, 57 insect-associated, 14, 15,57 medical evaluation of, 14, 56, 57 to nematode antigenic components, 14, 107 prevalence of, 14-15 prevention of, 15, 58 to vaccine components, 57 American Association for Accreditation of Laboratory Animal Care, 211 American Chemical Society, 53 American College of Physicians, 58 American Committee on Ardlropod-Bome Viruses, 123 American Industrial Hygiene Association, 30 American Occupational Medical Association, 59 American Society for Microbiology, 53 American Type Culture Collection, 21 Ammonium compounds, 40 Animal pathogens, restricted, 132-133 Animals, see Laboratory animals; and specific species Anthrax, 60, 110 Arboviruses Biosafety Level 2, 123-126 Biosafety Level 3, 12~128 Biosafety Level 4, 128-129 laboratory-associated infections, 85, 105 Arenavlruses animal sources and routes of infection, 185 Biosafety Level 3, 126-128 Biosafety Level 4, 128-129 Ascaris spp., 107 Association of Practitioners in l~fection Control, 53 Autopsy/moriician services cadaver/anatomical waste disposal, 17, 18, 36, 38, 42, 44 precautions against HIV transmission, 17, 159-160 tissue handling, 18 see also Necropsies B B-virus, 15, 119-120 Bacillus anthracis, 110 Bacillus subtilis, 69, 88 Bacterial agents, 11~117; see also specif c agents Biological safety cabinets air demand and energy requirements, 26 airflow patterns and operating velocities, 2~27,49 certification of, 31, 50, 97, 104, 129 characteristics, 129-131 213 Read the entire page →
From page 214... ... V handEng, 13, 147-149 laboratory design 49,50,87 INDEX maintenance on equipment in, 51 microorganisms assigned to, 23,88,126-128 principles, 88 reproductive hoards, 56 rickettsial agents, 117, 118 viral agents, 121-123 Biosafety Level 4 animals, 102-104 arboviruses, arenavwses, and filoviruses assigned to, 127,128-129 criteria, 26,94-98 emergencies, 55 laboratory design, 49, 87 for large-scale production, 31 microorganisms assigned to, 88,128-129 principles, 88 reproductive hazards, 56 viral agents, 120 Biosafety levels annals, 98-104,149-152 arbovinuses, 123-129 bacterial agents, 11~117 criteria, 11, 26,89-98,145-149 fungal agents, 108-110 human immunodeficiency viruses, 145-149 for large-scale production, 31 parasitic agents, 107-108 principles, 11, 26, 87~9 rickettsial agents, 117-119 selection of, 30, 10~105 Gaining requirements, 52 viral agents, 119-123 Blastomyces dermatidis, 108 Body fluids CDC caution, 152 disposal of, 43~4 HBV exposure risk Tom, 10 spill cleanup, 17 universal precautions, 33, 142, 144, 169-170 Botulism, 60, 105 British Committee on Dangerous Pathogens, 17 Brucella spp., 13 abortus, 110 cants, 110 laboratory-associated infection 2, 9, 85 melitensis, 110 suds, 9, 69, 110 Bunyavirus, 184-185 C Calomysspp. 128 Campylo:t~acter fetus jejune, 116 Canine }hepatitis virus, 88 Read the entire page →
From page 215... ... INDEX Centers for Disease Control guidelines for biosafety, 5,13, 30, 33, 52, 210 investigations of laboratory-associated tuberculosis, 10 universal precautions, 12, 22, 33 Cercopithecus spp., 128 Cestode parasites, 108, 181 Chickens, 15 Chimpanzees, hepatitis risk from, 10, 119 Chlamydiapsittaci 1 10-1 1 1 Chlamydia trachomatis, 110-111 Cholera, 12, 60, 85, 116, 131 Clostridium botulinum, 2, 12, 111 Clostridium tetani, 2, 11,12, 111-112 Clothing, masks, and face shields, 25, 28 Coccidia spp., 107 Coccidioides immitis, 13, 108-109 College of American Pathologists, 16,54, 211 Containment approaches, 30-31 Biosafety Level 1,90 Biosafety Level 2,92, 146, 150 Biosafety Level 3,94, 148, 151 Biosafety Level 4, 26, 96 Biosafety principles, 86-87 clothing, masks, and face shields, 25, 28 defined' 86 experimental animals, 15, 99, 100, 101, 103, 150, 151 filters, IS, 23, 25 for HIV handling, 146, 148 laboratory, 87 maintenance work on, 26, 31 maximum containment laboratory, 87 packaging for shipment, 20-21 physical, 3~31, 86-87 pipetting devices, 23, 26-29 purpose of, 86 on sonicators, homogenizers, and mixers, 23-24, 26, 28, 87 testing and certification of, 26, 31 see also Biological safety cabinets Coryr~acterium diphtherial, 112 Cowpox, 61, 122 Capella burnetti, 13, 88, 117 Creutzfeldt-Jakob agent Biosafety criteria, 122-123 consequences of infection, 105 inactivation of, 17, 123 in necropsy/surgical specimens, 16, 17, 123 occupational risks, 2, 11-12 Cryptococcus neoform~s, 109 Cultures biohazards from, 15, 24, 123 inactivation, 31-32,39, 41 large-scale, defined, 28 21S regulation of imports of, 21 see also Large-scale production Cutaneous leishmaniasis, 107 Cytomegalovirus, 56 D Decontamination animal cages, 99, 101 Biosafety Level 2,91, 99 Biosafety Level 3,50-51, 93 Biosafety Level 4,50-51, 95, 96,97 compounds and target organisms, 39, 40 freezers, 51 of HEPA filters, 39 of patient care equipment, 161 personnel, 65, 102, 131 validation of, 42 of wastes for disposal, 31-32, 33,35, 39-42, 104 of work surfaces, 6, 19,93, 144 Dentistry, precautions against HIV transmission, 159-160 Dialysis, precautions against HIV transmission, 160 Diphtheria, 60,105,112 Disinfectants formalin, 17-18 germicides, 17, 144 iodine-based, 18, 39 iodophors, 40 for radioactive spills, 66 sodium hypochlorite solution, 16, 17, 39, 40, 66 in vacuum system, 50 DNA viruses, animal sources and routes of infection, 186 E Eastern Equine Encephalomyelitis, 60, 124, 125, 126 Echinococcusgranulosus, 108 Emergencies alarm system, 50, 63~4, 97, 104 Biosafety Levels 3 and 4, 55 damaged shipments, 22 decontamination, 50 drills, 7, 63, 64 evacuation procedures, 63 64 fires, 63, 64 medical, 63 power failure, 49, 64, 67 preparation and general procedures, 7, 47, 63 shutdown procedures, 64 small-scale accidents, 63 spills and releases, 64 67 start-up procedures, 64 Entamaeba histolytica, 107 Enteroviruses, 56; see also specif c viruses Read the entire page →
From page 216... ... 216 Environmental Protection Agency, 43, 46, 209-210 Epidemiology of occupational infections environment, 9 infectious agents, 2, 9-12 laboratory workers, 8-9 Epidermophyton spp., 109-110 Equipment aerosol-generating, 23-24, 26, 28 cell sorters, 25 centrifuges and ultracentrifuges, 24, 32, 65, 87 clean benches, 25, 129 decont~n~nation of, 39 eye wash fountains, 48, 50 inoculating loops, 24 pipetting devices, 26 respirators, 15, 58, 111 safety, 15, 47, 50, 86-87 sonicators, homogenizers, and mixers, 23, 26, 28 see also Biological safety cabinets; Containment Escherichia colt, 65 Ethylene oxide, 41 Exposure contact route, 12, 18-19, 22 ocular rouse, 11,12, 19 inoculation route, 1 1,12, 19 management and reporting of, 17 monitoring, 32-33 from necropsy/surgical specimens, 16, 18 oral route, 11, 12, 19 prevention of, 4-5, 18-19 respiratory route, 10, 19, 22 during waste disposal, 36 F Facilities Biosafety Level 1, 90 Biosafety Level 2, 21, 92, 147, 150 Biosafety Level 3, 94, 148-149, 151-152 Biosafety Level 4, 96-98 constructing, remodeling, and decommissioning, 7, 51 e~imental animals, 48, 99, 100, 101-102, 103-104, 150, 151-152 for HIV handling, 147, 148-149 housekeeping, 51 laboratory design' 44, 48, 49-51, 87 maintenance, 51 specimen receiving areas, 21 traffic flow pattems, 48, 49, 50 Fasciola spp., 107 Ferrets, 120 Filoviruses, Biosafety Level 4, 128-129 Flavivirus, 182-183 Food and Drug A&ninistration, 210 INDEX Formaldehyde, 39, 40 Pormalin, 17 Francisella tularensis, 112 Fungal agents, 108-110, see also specif c agents G Giardia spp., 107 Glanders, 85 Glutaraldehyde, 40 Gonorrhea, 114 Gram negative bacteria, 176 Gram positive bacteria, 176-177 H Hantasn virus, 126, 127 Health Care Financing Administration, 211 Health care workers with AIDS/HIV infection, 142, 143, 157, 16~166 definition of, 156 exposure routes for, 16 HIV infection risks, 157-158 precautions to prevent HIV transmissions, 158-166 serologic testing for HIV, 165 Hemorrhagic fever, 89 HEPA falters for air recirculation in animal rooms, 104 on biological safety cabinets, 25, 94, 102, 129-131 decontamination of, 39 on fer.mentors, 32 in personnel suit areas, 131 on sewer and ventilation lines, 49, 96, 101 on Stryker saws, 17 on ultracentrifuges, 24 on vacuum cleaners/lines, 66, 93, 97 Hepatitis A virus biosafetylevels, 119 immunization, 60 incidence of infection, 10 laboratory hazards of, 10 Hepatitis B virus (HBV) Biosafety levels, 88, 119, 144 body fluid sources, 16, 169-170 c~riers, 11 containment equipment for animals, 144 decontamination procedures, 144 immunization against, 4, 14, 58, 60 inactivation of, 17-18 incidence of infection, 10, 85 laboratory contamination, 11 monitoring employees for, 58, 144 mortality rates, 11 prevalence in general population, 9 Read the entire page →
From page 217... ... animal biosafety level criteria, 149-152 autopsy/mortician service precaution, 160 biosafety level criteria, 13, 145-149 body fluid sources, 16, 169-170 containment equipment, 146, 148 dentistry precautions, 159-160 dialysis precautions, 160 exposure management, 166 federal health advisory, 11 guidelines for handling, 12, 13, 143-145 housekeeping precautions, 162 inactivation of, 17-18, 144 invasive procedure precautions, 159 laboratory hazards, 143 laboratory facilities, 147, 148-149 laboratory precautions, 13, 145-149, 16Q-161 laundry precautions, 162-163 management of infected workers, 165-166 medical surveillance programs, 144 145 occupationalrisk from, 2, 11, 12, 13, 142-143, 156 prevention of transmission in health care settings, 156, 158-161 protective barriers, 170-171 reproductive risks, 56 routes of exposure, 56, 143, 156, 157-158 seroconversions in laboratory workers, 12, 142-143 serological testing for, 163-165 spill cleanup/decontamination, 162 sterilization and disinfection, 161 2~7 survival in the environment, 162 universal precautions, 158-159, 168-172 in waste, 163 see also Health care workers I Ibaraki, 127 Immunization of workers allergies precluding, 57 documented evidence of, 14, 58 with experimental vaccines, 14 recommendations, 4, 58, 60-63, 131 see also Vaccinationslvaccines Importation of biologicals, 21, 89, 132-133, 189-2Q4 Inactivation Creutzfeldt-Jakob agent, 17, 123 botulinum toxin 111 of cultures, 31-32 hepatitis B virus, 17-18 human immunodeficiency virus, 17-18, 144, 161-162 Mycobacterimnspp., 17, 18, 114 of parasites, 108 Q fever, 10 tissue samples, 17 validation of, 32 of waste, 43 see also Decontamination; Disinfectants Infectious agents bacterial, 110-117 descriptive epidemiology, 9 fung al, 108-110 highest risk, 2, 9-11, 13-14 lowest risk, 2, 11-12 parasitic, 107-108 rickettsial, 117-119 spills and releases, 6~66 viral, 119-123 see also specific agents l~fluenza virus, 60, 105, 12Q-121 Insects, hazards to laboratory workers from, 1~15, s7 International Civil Aviation Organization, 20 Invasive procedures precautions against HIV transmission, 159 wastes from, 36 see also Surgical pathology Israel turkey meriingoencephalitis, 127 J Japanese encephalitis, 60, 126, 127 Joint Commission for Accreditation of Health Care Organizations, 49, 54, 211 Justin virus, 128 Read the entire page →
From page 218... ... 111 M Macaques, 15, 119-120 Machupo virus, 128 Marburg disease, 15, 85, 12~129 Mastomys natalensis, 128 Material Safety Data Sheets, 48 Measles, 61 Medical program Read the entire page →
From page 219... ... INDEX assessment of employee risk, 7, 14, 55-57 design, 57 HIV surveillance programs, 144, 163-166 host defense deficiencies, 56, 57 immunizations, 14, 58, 60-62, 131 laboratory and other testing, 58, 69, 92, 94, 104, 144 management of HlV-infectedlexposed workers, 165-166 medical history, 14, 57 occupational health history, 57 periodic monitoring examination, 55, 58-59, 63 physical examination, 57-58 postemployment evaluation, 55, 59 preplacement examination, 14, 55, 57-58 reproductive hazards, 13, 56-57 resources, 59, 63 serum bank, 4, 14, 58 surveillance of personnel for rickettsial infections, 131-132 treatment and documentation of exposures, 55 Medical Research Council of Canada, 30 Melioidosis, 115 Meningococcal meningitis, 61, 115 Mice, 15, 109 Microsporum, 109~110 Monitoring accident reporting, 59, 96, 103 agent-specific surveillance, 58, 59 exposure in large-scale production facilities, 32-33 postemployment evaluation, 59 recordkeeping and result notification, 59 safety program compliance, 47, 48 ventilation characteristics, 49 Monkeypax, 61, 121,122 Mycobacterium animal sources and routes of infection, 177 atypical, 113-114 avium, 10 basis, 10, 114 contamination of cultures, 24 inactivation of, 17, 18 leprae, 113 tuberculosis, 10, 13, 16, 18, 65, 88, 105, 114; see also Tuberculosis Mycoses, animal sources and routes of infection, 178-179 N Naegleriafowleri, 107 Naegleria gruberi, 88 National Animal Disease Center, 85 National Committee for Clinical Laboratory Standards, 16 National Institute for Occupational Safety and Health 209 National Institutes of Health guidelines for biosafety, 5, 13, 30, 31, 33, 52, 210 2~19 National Sanitation Foundation, 129 Necropsies on bodies known to be infected, 16-18 routine, 16 see also Autopsy/mortician services Needles and over "sharps" Biosafety Level 2, 91-92, 9~100 Biosafet',r Level 3, 93, 101 Biosafety Level 4, 96, 103 disposal of, 17, 33, 35, 38, 44 45 exposure rouses, 19 infections related to, 85 limiting use of, =5, 19, 143 reporting of accidents with, 59 Neisseriagonorrhocae, 114-115 Neisseria meningitidis, 11~115 Nematode parasites, 107, 180-181 Newcastle Disease virus, 15 Nuclear Regulatory Commission, 43, 46, 52, 210 o Occupational infections assessment of risk, 35, 53 highestriskorganisms,9-11, 13-14 incidence and mortality rates, 8-11, 85-86 potential for, 1, 8, 18 risk in large-scale production facilities, 28-29 routes of exposure, 18-19, 36 from waste disposal, 37 see also specif c infectious agents Occupational Safety and Health Administration, 46, 48, 54, 209 Office of Science and Technology Policy, 211 Old World monkeys, 15, 119 Orbivirus, 185 p Packaging of biological materials for disposal 33 needles and other "sharps," 33 for shipment, 20-21, 1B8 Paraformaldehyde, 40 Parasitic agents cestodes, 108 nematodes, 107 protozoa, 107 trematodes, 107-108 Pedicul~ h. hurnaru", 118 Phenolic compounds, 40 Physician laboratory/small-volume laboratory, 33, 54 Picomavirus, 185 Pipetting devices Read the entire page →
From page 220... ... 220 hazards of, 4, 18, 19, 23, 26, 85 safety aids, 26, 28-29 Plague, 61, 117 Plasmodimn cynomolgi, 107 Plasm~dium spp. 107 Poliomyelitis, 61,105, 121, 131 Potomac fever agent, 113 Pox viruses, 61, 121-122 Presbytis spp., 128 Programs In laboratory safety academic laboratories, 68-69 accident reporting and investigation, 54, 69 auditing, 54-55 communications, 48 design, 3, 46 employee orientation and education, 47, 50, 52-53 evaluation of hazards, 53 goals, 46 meetings and committees, 47-48 monitoring, 47, 48 plans, 47 policy and procedure manuals, 3, 7, 47, 53-54, 86 recordkeeping, 46, 54, 69 registry of infectious agents, 55 responsibility for safety, 46-47 signs for hazardous areas, 55 waste management, 55 Protective clothing activities requinng, 87 Biosafety Level 2, 91 Biosafety Level 3, 93 Biosafety Level 4, 95, 96 for cleanup and disposal tasks, 17, 39, 64-65, 66 dispersal of contaminants on, 19 facial 19 gloves, 25, 39, 143, 171-172 for HIV handling, 143, 144 for necropsy/surgical specimen handling, 16-17 for phlebotomy, 171 positive pressure personnel suits, 95, 96, 131 precautions against HIV or HBV transmission, 170-171 for vivanum operations, 15, 99, 100, 101 for waste handling, 39 Protozoal parasites, 107, 182 Pseu~naspseudomallei, 115 Pulmonary diseases, Myc~acterium spp., 113 Q Q fever animal hosts, 117 immunization, 61 resistance to inactivation, 10 INDEX route of infection, 10, 85-86 risk of infection from, 2, 9, 10, 117 R Rabies virus, 2, 11, 58, 61, 122, 131 Radioactive materials emergencies, 63, 66-67 isotopes posing external and internal hazards, 66 regulation of, 46 safety training, 52 waste disposal, 39, 42-44 Regulations agency-specific responsibilities, 209-211 definitions, 20~209 emergency plar~iing, 63 importation of biological specimens, 5, 21, 89, 132, 189-204 information sources on, 67 recordkeeping requirements, 67 shipment of biologicals, 5, 20, 21, 89, 132, 188 teaching laboratories, 68 waste disposal, 37, 42-43 Reovirus, 185 Reproductive hazards, to employees, 56-57, 107 Rhabdovirus, 185 Rhesus monkey kidney cells, 15 Rickettsia Atari, 117-118 animal sources and routes of infection, 177-178 Biosafety levels, 117-119 Canada, 118 prowazekii, 118 ricketsii, 11~119, 131 risk to laboratory workers, 13 ruminantium, 132 surveillance of laboratory personnel for infections, 131-132 tsutsugamushi, 1 18 typhi, 118 Rift Valley fever virus, 12~128, 132 RNA viruses, animal sources and routes of infection, 182-186 Rochalimaeaquintana, 117-118 Rochalimaeavinsonii, 117-118 Rocky Mountain spotted fever, 118 Rubella virus, 56, 58, 62 S Safety management administrative organization and responsibilities, 3, 7, 46J,8 Read the entire page →
From page 221... ... Department of Agriculture, 21, 30, 89, 133, 210 U.S. Department of Health and Human Services, warning to laboratory workers, 11 U.S. Read the entire page →
From page 222... ... 222 V Vaccinations/vaccines, prophylactic, 14, 22, 60-62, 105, 111,112,114,116,126,127,131 Vaccinia virus, 61, 121, 122 Varicella virus, 56 Venezuelan equine encephalitis, 62, 85, 124, 126-128 Vesicular stomatitis virus, 123, 124, 126 Vibrio cholerae, 2, 11, 116 Vibrioparah~ernolyticus, 116 Vibrionic enteritis, 116 Viral agents biosafety levels, 119-123; see also specif c agents immunization of workers against, 14 Viral hepatitis risk of infection from, 9, 10,11 see also Hepatitis A virus; Hepatitis B virus (HBV) ; Hepatitis, non-Alnon-B W Waste handling and disposal animal bedding matenal, 38, 44, 99 basic principles, 37-38 Biosafety Level 2,91 Biosafety Level 4,97 cadavers and anatomical waste, 17,18,38, 42, 44,101 chemical decontamination, 33, 39, 43; see also Disinfectants containment/packaging, 7, 19,32, 35, 3~39, 43-45 cultures, 31-32 dioxin compounds, 44 INDEX haulers and waste disposal facilities, 36,37 HIV precautions, 163 human excrete, 33, 34, 43 incinerations, 6,18, 32, 35, 36,39, 41-42, 44 laboratory design for, 50 liquid waste, 33,38, 97, 104 mixed waste, 39, 42-44 needles and other "sharps," 17, 33, 35,38,41 45 personnel protection, 3,37, 39, 45 radioactive materials, 18,39, 42-44, 67 recordkeeping, 37 regulation of, 37, 42-43 responsibility for, 36-37, 55 risks from, 3, 6, 37, 50 in sanitary Landfills, 3, 6,3~35, 36 sewage system, 3, 6, 32-35, 43,50, 108 solid waste, 32, 38 steam autoclaving, 33, 39, 41-44 validation of decontamination methods, 42,43 Water emergency requirements, SO treatment and filtering, 32 Westem equine encephalomyelitis, 62, 124, 126 y Yaba virus infection, 121 Yellow fever, 62, 126-128 Yers~uaPestis, 117 z Zooq~otic pathogens, 14, 48, 17~186 Read the entire page →

From page 213...

... autopsy precautions, 17, 159-160 health care workers with, 157 and tuberculosis morbidity, 10 see also Human immunodeficiency virus ~V) Actinomycetes, animal sources and routes of infection, 177 Aerosols and droplets containmentlcontrol equipment, 16, 25, 26, 28 handling of, 5, 22-25 HVB transmission in, 11 insect waste products in, 14 particulate size, 12, 22 procedures generating, 18, 19, 23, 50, 65-66,94 from sonicators, homogenizers, and mixers, 23-24, 26-28 from Stryker saw, 17, 122 African green monkeys, 15 Alcohol disinfection, 40 Allergies among laboratory workers to aerosolized proteins, 57 arumal-associate~l, 14, 57 insect-associated, 14, 15,57 medical evaluation of, 14, 56, 57 to nematode antigenic components, 14, 107 prevalence of, 14-15 prevention of, 15, 58 to vaccine components, 57 American Association for Accreditation of Laboratory Animal Care, 211 American Chemical Society, 53 American College of Physicians, 58 American Committee on Ardlropod-Bome Viruses, 123 American Industrial Hygiene Association, 30 American Occupational Medical Association, 59 American Society for Microbiology, 53 American Type Culture Collection, 21 Ammonium compounds, 40 Animal pathogens, restricted, 132-133 Animals, see Laboratory animals; and specific species Anthrax, 60, 110 Arboviruses Biosafety Level 2, 123-126 Biosafety Level 3, 12~128 Biosafety Level 4, 128-129 laboratory-associated infections, 85, 105 Arenavlruses animal sources and routes of infection, 185 Biosafety Level 3, 126-128 Biosafety Level 4, 128-129 Ascaris spp., 107 Association of Practitioners in l~fection Control, 53 Autopsy/moriician services cadaver/anatomical waste disposal, 17, 18, 36, 38, 42, 44 precautions against HIV transmission, 17, 159-160 tissue handling, 18 see also Necropsies B B-virus, 15, 119-120 Bacillus anthracis, 110 Bacillus subtilis, 69, 88 Bacterial agents, 11~117; see also specif c agents Biological safety cabinets air demand and energy requirements, 26 airflow patterns and operating velocities, 2~27,49 certification of, 31, 50, 97, 104, 129 characteristics, 129-131 213

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From page 214...

... V handEng, 13, 147-149 laboratory design 49,50,87 INDEX maintenance on equipment in, 51 microorganisms assigned to, 23,88,126-128 principles, 88 reproductive hoards, 56 rickettsial agents, 117, 118 viral agents, 121-123 Biosafety Level 4 animals, 102-104 arboviruses, arenavwses, and filoviruses assigned to, 127,128-129 criteria, 26,94-98 emergencies, 55 laboratory design, 49, 87 for large-scale production, 31 microorganisms assigned to, 88,128-129 principles, 88 reproductive hazards, 56 viral agents, 120 Biosafety levels annals, 98-104,149-152 arbovinuses, 123-129 bacterial agents, 11~117 criteria, 11, 26,89-98,145-149 fungal agents, 108-110 human immunodeficiency viruses, 145-149 for large-scale production, 31 parasitic agents, 107-108 principles, 11, 26, 87~9 rickettsial agents, 117-119 selection of, 30, 10~105 Gaining requirements, 52 viral agents, 119-123 Blastomyces dermatidis, 108 Body fluids CDC caution, 152 disposal of, 43~4 HBV exposure risk Tom, 10 spill cleanup, 17 universal precautions, 33, 142, 144, 169-170 Botulism, 60, 105 British Committee on Dangerous Pathogens, 17 Brucella spp., 13 abortus, 110 cants, 110 laboratory-associated infection 2, 9, 85 melitensis, 110 suds, 9, 69, 110 Bunyavirus, 184-185 C Calomysspp. 128 Campylo:t~acter fetus jejune, 116 Canine }hepatitis virus, 88

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From page 215...

... INDEX Centers for Disease Control guidelines for biosafety, 5,13, 30, 33, 52, 210 investigations of laboratory-associated tuberculosis, 10 universal precautions, 12, 22, 33 Cercopithecus spp., 128 Cestode parasites, 108, 181 Chickens, 15 Chimpanzees, hepatitis risk from, 10, 119 Chlamydiapsittaci 1 10-1 1 1 Chlamydia trachomatis, 110-111 Cholera, 12, 60, 85, 116, 131 Clostridium botulinum, 2, 12, 111 Clostridium tetani, 2, 11,12, 111-112 Clothing, masks, and face shields, 25, 28 Coccidia spp., 107 Coccidioides immitis, 13, 108-109 College of American Pathologists, 16,54, 211 Containment approaches, 30-31 Biosafety Level 1,90 Biosafety Level 2,92, 146, 150 Biosafety Level 3,94, 148, 151 Biosafety Level 4, 26, 96 Biosafety principles, 86-87 clothing, masks, and face shields, 25, 28 defined' 86 experimental animals, 15, 99, 100, 101, 103, 150, 151 filters, IS, 23, 25 for HIV handling, 146, 148 laboratory, 87 maintenance work on, 26, 31 maximum containment laboratory, 87 packaging for shipment, 20-21 physical, 3~31, 86-87 pipetting devices, 23, 26-29 purpose of, 86 on sonicators, homogenizers, and mixers, 23-24, 26, 28, 87 testing and certification of, 26, 31 see also Biological safety cabinets Coryr~acterium diphtherial, 112 Cowpox, 61, 122 Capella burnetti, 13, 88, 117 Creutzfeldt-Jakob agent Biosafety criteria, 122-123 consequences of infection, 105 inactivation of, 17, 123 in necropsy/surgical specimens, 16, 17, 123 occupational risks, 2, 11-12 Cryptococcus neoform~s, 109 Cultures biohazards from, 15, 24, 123 inactivation, 31-32,39, 41 large-scale, defined, 28 21S regulation of imports of, 21 see also Large-scale production Cutaneous leishmaniasis, 107 Cytomegalovirus, 56 D Decontamination animal cages, 99, 101 Biosafety Level 2,91, 99 Biosafety Level 3,50-51, 93 Biosafety Level 4,50-51, 95, 96,97 compounds and target organisms, 39, 40 freezers, 51 of HEPA filters, 39 of patient care equipment, 161 personnel, 65, 102, 131 validation of, 42 of wastes for disposal, 31-32, 33,35, 39-42, 104 of work surfaces, 6, 19,93, 144 Dentistry, precautions against HIV transmission, 159-160 Dialysis, precautions against HIV transmission, 160 Diphtheria, 60,105,112 Disinfectants formalin, 17-18 germicides, 17, 144 iodine-based, 18, 39 iodophors, 40 for radioactive spills, 66 sodium hypochlorite solution, 16, 17, 39, 40, 66 in vacuum system, 50 DNA viruses, animal sources and routes of infection, 186 E Eastern Equine Encephalomyelitis, 60, 124, 125, 126 Echinococcusgranulosus, 108 Emergencies alarm system, 50, 63~4, 97, 104 Biosafety Levels 3 and 4, 55 damaged shipments, 22 decontamination, 50 drills, 7, 63, 64 evacuation procedures, 63 64 fires, 63, 64 medical, 63 power failure, 49, 64, 67 preparation and general procedures, 7, 47, 63 shutdown procedures, 64 small-scale accidents, 63 spills and releases, 64 67 start-up procedures, 64 Entamaeba histolytica, 107 Enteroviruses, 56; see also specif c viruses

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From page 216...

... 216 Environmental Protection Agency, 43, 46, 209-210 Epidemiology of occupational infections environment, 9 infectious agents, 2, 9-12 laboratory workers, 8-9 Epidermophyton spp., 109-110 Equipment aerosol-generating, 23-24, 26, 28 cell sorters, 25 centrifuges and ultracentrifuges, 24, 32, 65, 87 clean benches, 25, 129 decont~n~nation of, 39 eye wash fountains, 48, 50 inoculating loops, 24 pipetting devices, 26 respirators, 15, 58, 111 safety, 15, 47, 50, 86-87 sonicators, homogenizers, and mixers, 23, 26, 28 see also Biological safety cabinets; Containment Escherichia colt, 65 Ethylene oxide, 41 Exposure contact route, 12, 18-19, 22 ocular rouse, 11,12, 19 inoculation route, 1 1,12, 19 management and reporting of, 17 monitoring, 32-33 from necropsy/surgical specimens, 16, 18 oral route, 11, 12, 19 prevention of, 4-5, 18-19 respiratory route, 10, 19, 22 during waste disposal, 36 F Facilities Biosafety Level 1, 90 Biosafety Level 2, 21, 92, 147, 150 Biosafety Level 3, 94, 148-149, 151-152 Biosafety Level 4, 96-98 constructing, remodeling, and decommissioning, 7, 51 e~imental animals, 48, 99, 100, 101-102, 103-104, 150, 151-152 for HIV handling, 147, 148-149 housekeeping, 51 laboratory design' 44, 48, 49-51, 87 maintenance, 51 specimen receiving areas, 21 traffic flow pattems, 48, 49, 50 Fasciola spp., 107 Ferrets, 120 Filoviruses, Biosafety Level 4, 128-129 Flavivirus, 182-183 Food and Drug A&ninistration, 210 INDEX Formaldehyde, 39, 40 Pormalin, 17 Francisella tularensis, 112 Fungal agents, 108-110, see also specif c agents G Giardia spp., 107 Glanders, 85 Glutaraldehyde, 40 Gonorrhea, 114 Gram negative bacteria, 176 Gram positive bacteria, 176-177 H Hantasn virus, 126, 127 Health Care Financing Administration, 211 Health care workers with AIDS/HIV infection, 142, 143, 157, 16~166 definition of, 156 exposure routes for, 16 HIV infection risks, 157-158 precautions to prevent HIV transmissions, 158-166 serologic testing for HIV, 165 Hemorrhagic fever, 89 HEPA falters for air recirculation in animal rooms, 104 on biological safety cabinets, 25, 94, 102, 129-131 decontamination of, 39 on fer.mentors, 32 in personnel suit areas, 131 on sewer and ventilation lines, 49, 96, 101 on Stryker saws, 17 on ultracentrifuges, 24 on vacuum cleaners/lines, 66, 93, 97 Hepatitis A virus biosafetylevels, 119 immunization, 60 incidence of infection, 10 laboratory hazards of, 10 Hepatitis B virus (HBV) Biosafety levels, 88, 119, 144 body fluid sources, 16, 169-170 c~riers, 11 containment equipment for animals, 144 decontamination procedures, 144 immunization against, 4, 14, 58, 60 inactivation of, 17-18 incidence of infection, 10, 85 laboratory contamination, 11 monitoring employees for, 58, 144 mortality rates, 11 prevalence in general population, 9

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From page 217...

... animal biosafety level criteria, 149-152 autopsy/mortician service precaution, 160 biosafety level criteria, 13, 145-149 body fluid sources, 16, 169-170 containment equipment, 146, 148 dentistry precautions, 159-160 dialysis precautions, 160 exposure management, 166 federal health advisory, 11 guidelines for handling, 12, 13, 143-145 housekeeping precautions, 162 inactivation of, 17-18, 144 invasive procedure precautions, 159 laboratory hazards, 143 laboratory facilities, 147, 148-149 laboratory precautions, 13, 145-149, 16Q-161 laundry precautions, 162-163 management of infected workers, 165-166 medical surveillance programs, 144 145 occupationalrisk from, 2, 11, 12, 13, 142-143, 156 prevention of transmission in health care settings, 156, 158-161 protective barriers, 170-171 reproductive risks, 56 routes of exposure, 56, 143, 156, 157-158 seroconversions in laboratory workers, 12, 142-143 serological testing for, 163-165 spill cleanup/decontamination, 162 sterilization and disinfection, 161 2~7 survival in the environment, 162 universal precautions, 158-159, 168-172 in waste, 163 see also Health care workers I Ibaraki, 127 Immunization of workers allergies precluding, 57 documented evidence of, 14, 58 with experimental vaccines, 14 recommendations, 4, 58, 60-63, 131 see also Vaccinationslvaccines Importation of biologicals, 21, 89, 132-133, 189-2Q4 Inactivation Creutzfeldt-Jakob agent, 17, 123 botulinum toxin 111 of cultures, 31-32 hepatitis B virus, 17-18 human immunodeficiency virus, 17-18, 144, 161-162 Mycobacterimnspp., 17, 18, 114 of parasites, 108 Q fever, 10 tissue samples, 17 validation of, 32 of waste, 43 see also Decontamination; Disinfectants Infectious agents bacterial, 110-117 descriptive epidemiology, 9 fung al, 108-110 highest risk, 2, 9-11, 13-14 lowest risk, 2, 11-12 parasitic, 107-108 rickettsial, 117-119 spills and releases, 6~66 viral, 119-123 see also specific agents l~fluenza virus, 60, 105, 12Q-121 Insects, hazards to laboratory workers from, 1~15, s7 International Civil Aviation Organization, 20 Invasive procedures precautions against HIV transmission, 159 wastes from, 36 see also Surgical pathology Israel turkey meriingoencephalitis, 127 J Japanese encephalitis, 60, 126, 127 Joint Commission for Accreditation of Health Care Organizations, 49, 54, 211 Justin virus, 128

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From page 218...

... 111 M Macaques, 15, 119-120 Machupo virus, 128 Marburg disease, 15, 85, 12~129 Mastomys natalensis, 128 Material Safety Data Sheets, 48 Measles, 61 Medical program

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From page 219...

... INDEX assessment of employee risk, 7, 14, 55-57 design, 57 HIV surveillance programs, 144, 163-166 host defense deficiencies, 56, 57 immunizations, 14, 58, 60-62, 131 laboratory and other testing, 58, 69, 92, 94, 104, 144 management of HlV-infectedlexposed workers, 165-166 medical history, 14, 57 occupational health history, 57 periodic monitoring examination, 55, 58-59, 63 physical examination, 57-58 postemployment evaluation, 55, 59 preplacement examination, 14, 55, 57-58 reproductive hazards, 13, 56-57 resources, 59, 63 serum bank, 4, 14, 58 surveillance of personnel for rickettsial infections, 131-132 treatment and documentation of exposures, 55 Medical Research Council of Canada, 30 Melioidosis, 115 Meningococcal meningitis, 61, 115 Mice, 15, 109 Microsporum, 109~110 Monitoring accident reporting, 59, 96, 103 agent-specific surveillance, 58, 59 exposure in large-scale production facilities, 32-33 postemployment evaluation, 59 recordkeeping and result notification, 59 safety program compliance, 47, 48 ventilation characteristics, 49 Monkeypax, 61, 121,122 Mycobacterium animal sources and routes of infection, 177 atypical, 113-114 avium, 10 basis, 10, 114 contamination of cultures, 24 inactivation of, 17, 18 leprae, 113 tuberculosis, 10, 13, 16, 18, 65, 88, 105, 114; see also Tuberculosis Mycoses, animal sources and routes of infection, 178-179 N Naegleriafowleri, 107 Naegleria gruberi, 88 National Animal Disease Center, 85 National Committee for Clinical Laboratory Standards, 16 National Institute for Occupational Safety and Health 209 National Institutes of Health guidelines for biosafety, 5, 13, 30, 31, 33, 52, 210 2~19 National Sanitation Foundation, 129 Necropsies on bodies known to be infected, 16-18 routine, 16 see also Autopsy/mortician services Needles and over "sharps" Biosafety Level 2, 91-92, 9~100 Biosafet',r Level 3, 93, 101 Biosafety Level 4, 96, 103 disposal of, 17, 33, 35, 38, 44 45 exposure rouses, 19 infections related to, 85 limiting use of, =5, 19, 143 reporting of accidents with, 59 Neisseriagonorrhocae, 114-115 Neisseria meningitidis, 11~115 Nematode parasites, 107, 180-181 Newcastle Disease virus, 15 Nuclear Regulatory Commission, 43, 46, 52, 210 o Occupational infections assessment of risk, 35, 53 highestriskorganisms,9-11, 13-14 incidence and mortality rates, 8-11, 85-86 potential for, 1, 8, 18 risk in large-scale production facilities, 28-29 routes of exposure, 18-19, 36 from waste disposal, 37 see also specif c infectious agents Occupational Safety and Health Administration, 46, 48, 54, 209 Office of Science and Technology Policy, 211 Old World monkeys, 15, 119 Orbivirus, 185 p Packaging of biological materials for disposal 33 needles and other "sharps," 33 for shipment, 20-21, 1B8 Paraformaldehyde, 40 Parasitic agents cestodes, 108 nematodes, 107 protozoa, 107 trematodes, 107-108 Pedicul~ h. hurnaru", 118 Phenolic compounds, 40 Physician laboratory/small-volume laboratory, 33, 54 Picomavirus, 185 Pipetting devices

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From page 220...

... 220 hazards of, 4, 18, 19, 23, 26, 85 safety aids, 26, 28-29 Plague, 61, 117 Plasmodimn cynomolgi, 107 Plasm~dium spp. 107 Poliomyelitis, 61,105, 121, 131 Potomac fever agent, 113 Pox viruses, 61, 121-122 Presbytis spp., 128 Programs In laboratory safety academic laboratories, 68-69 accident reporting and investigation, 54, 69 auditing, 54-55 communications, 48 design, 3, 46 employee orientation and education, 47, 50, 52-53 evaluation of hazards, 53 goals, 46 meetings and committees, 47-48 monitoring, 47, 48 plans, 47 policy and procedure manuals, 3, 7, 47, 53-54, 86 recordkeeping, 46, 54, 69 registry of infectious agents, 55 responsibility for safety, 46-47 signs for hazardous areas, 55 waste management, 55 Protective clothing activities requinng, 87 Biosafety Level 2, 91 Biosafety Level 3, 93 Biosafety Level 4, 95, 96 for cleanup and disposal tasks, 17, 39, 64-65, 66 dispersal of contaminants on, 19 facial 19 gloves, 25, 39, 143, 171-172 for HIV handling, 143, 144 for necropsy/surgical specimen handling, 16-17 for phlebotomy, 171 positive pressure personnel suits, 95, 96, 131 precautions against HIV or HBV transmission, 170-171 for vivanum operations, 15, 99, 100, 101 for waste handling, 39 Protozoal parasites, 107, 182 Pseu~naspseudomallei, 115 Pulmonary diseases, Myc~acterium spp., 113 Q Q fever animal hosts, 117 immunization, 61 resistance to inactivation, 10 INDEX route of infection, 10, 85-86 risk of infection from, 2, 9, 10, 117 R Rabies virus, 2, 11, 58, 61, 122, 131 Radioactive materials emergencies, 63, 66-67 isotopes posing external and internal hazards, 66 regulation of, 46 safety training, 52 waste disposal, 39, 42-44 Regulations agency-specific responsibilities, 209-211 definitions, 20~209 emergency plar~iing, 63 importation of biological specimens, 5, 21, 89, 132, 189-204 information sources on, 67 recordkeeping requirements, 67 shipment of biologicals, 5, 20, 21, 89, 132, 188 teaching laboratories, 68 waste disposal, 37, 42-43 Reovirus, 185 Reproductive hazards, to employees, 56-57, 107 Rhabdovirus, 185 Rhesus monkey kidney cells, 15 Rickettsia Atari, 117-118 animal sources and routes of infection, 177-178 Biosafety levels, 117-119 Canada, 118 prowazekii, 118 ricketsii, 11~119, 131 risk to laboratory workers, 13 ruminantium, 132 surveillance of laboratory personnel for infections, 131-132 tsutsugamushi, 1 18 typhi, 118 Rift Valley fever virus, 12~128, 132 RNA viruses, animal sources and routes of infection, 182-186 Rochalimaeaquintana, 117-118 Rochalimaeavinsonii, 117-118 Rocky Mountain spotted fever, 118 Rubella virus, 56, 58, 62 S Safety management administrative organization and responsibilities, 3, 7, 46J,8

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From page 221...

... Department of Agriculture, 21, 30, 89, 133, 210 U.S. Department of Health and Human Services, warning to laboratory workers, 11 U.S.

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From page 222...

... 222 V Vaccinations/vaccines, prophylactic, 14, 22, 60-62, 105, 111,112,114,116,126,127,131 Vaccinia virus, 61, 121, 122 Varicella virus, 56 Venezuelan equine encephalitis, 62, 85, 124, 126-128 Vesicular stomatitis virus, 123, 124, 126 Vibrio cholerae, 2, 11, 116 Vibrioparah~ernolyticus, 116 Vibrionic enteritis, 116 Viral agents biosafety levels, 119-123; see also specif c agents immunization of workers against, 14 Viral hepatitis risk of infection from, 9, 10,11 see also Hepatitis A virus; Hepatitis B virus (HBV) ; Hepatitis, non-Alnon-B W Waste handling and disposal animal bedding matenal, 38, 44, 99 basic principles, 37-38 Biosafety Level 2,91 Biosafety Level 4,97 cadavers and anatomical waste, 17,18,38, 42, 44,101 chemical decontamination, 33, 39, 43; see also Disinfectants containment/packaging, 7, 19,32, 35, 3~39, 43-45 cultures, 31-32 dioxin compounds, 44 INDEX haulers and waste disposal facilities, 36,37 HIV precautions, 163 human excrete, 33, 34, 43 incinerations, 6,18, 32, 35, 36,39, 41-42, 44 laboratory design for, 50 liquid waste, 33,38, 97, 104 mixed waste, 39, 42-44 needles and other "sharps," 17, 33, 35,38,41 45 personnel protection, 3,37, 39, 45 radioactive materials, 18,39, 42-44, 67 recordkeeping, 37 regulation of, 37, 42-43 responsibility for, 36-37, 55 risks from, 3, 6, 37, 50 in sanitary Landfills, 3, 6,3~35, 36 sewage system, 3, 6, 32-35, 43,50, 108 solid waste, 32, 38 steam autoclaving, 33, 39, 41-44 validation of decontamination methods, 42,43 Water emergency requirements, SO treatment and filtering, 32 Westem equine encephalomyelitis, 62, 124, 126 y Yaba virus infection, 121 Yellow fever, 62, 126-128 Yers~uaPestis, 117 z Zooq~otic pathogens, 14, 48, 17~186

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Index Pages 213-222

Index
Pages 213-222