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MICROBIOLOGY LABORATORY
Dr.T.V.Rao MD
DR.T.V.RAO MD 1
BIOSAFETY: PREVENTING
LAB-ACQUIRED INFECTIONS
• Bacteria
• Viruses
• Fungi
• Human blood, unfixed
tissue
• Human cell lines
• Recombinant DNA
DR.T.V.RAO MD 2
WHY IS BIOSAFETY IMPORTANT?
• Laboratories recognize
hazards of processing
infectious agents
• Guidelines developed
to protect workers in
microbiological and
medical labs through
engineering controls,
management policies,
work practices
DR.T.V.RAO MD 3
STANDARD MICROBIOLOGICAL
PRACTICES
• NOT permitted in
laboratories:
Eating
Drinking
Smoking
DR.T.V.RAO MD 4
BIOSAFETY LEVELS
• Precautions so people researching or trying to
identify organisms do not become infected
• While handling or testing clinical specimens,
workers could accidentally infect themselves or
coworkers
• Labs must adhere to very specific safety
regulations to work with organisms that pose a
threat to human health
DR.T.V.RAO MD 5
LABORATORIES DIVIDED ON BASIS OF
NATURE OF MICROBES
• Labs divided into 4 biosafety levels;
protective practices increase with each
• Biosafety Level 1 labs - work with least
dangerous agents, require fewest precautions
• Biosafety Level 4 labs - have strictest
methods because dealing with agents that are
most dangerous to human health
DR.T.V.RAO MD 6
BARRIERS - PRIMARY BARRIERS
• Primary barriers:
physical barriers or
personal protective
equipment between
lab worker and
pathogen
• Gloves, masks,
special breathing
apparatuses
DR.T.V.RAO MD 7
BARRIERS SECONDARY BARRIERS:
• Secondary barriers:
structural aspects of the
laboratory that make
working environment
safer against infection
• Sinks for handwashing,
special containment
areas, special air
ventilation patterns
DR.T.V.RAO MD 8
UNIVERSAL PRECAUTIONS
• Include hand hygiene, gloves,
gown, masks, eye protection,
face shields, safe injection
practices
• Require that all equipment or
contaminated items are
handled to prevent
transmission of infectious
agents
• Special circumstances may
require additional precautions
• Protective clothing, special
site decontamination
DR.T.V.RAO MD 9
RISK GROUPS, BIOSAFETY LEVELS, PRACTICES AND
EQUIPMENT
BSL Laboratory type Laboratory Safety equipment
practices
1 Basic teaching, Good microbiological None
research techniques Open bench work
2 Primary health Good microbiological Open bench PLUS
services; diagnostic techniques, biological safety cabinet for potential
services, research protective clothing, aerosols
biohazard sign
DR.T.V.RAO MD 11
CDC/NIH: BIOSAFETY LEVEL 3 AND LEVEL 4.
DR.T.V.RAO MD 12
LEVELS OF CONTAINMENT
• BL1 - microorganisms
that don’t consistently
cause disease in healthy
adults
• E. coli K12, S.
cerevisiae, polyomaviru
s
• Basic laboratory
• Standard
Microbiological
Practices
DR.T.V.RAO MD 13
BIOSAFETY LEVEL 1 (BSL-1)
• Agents not known to cause
disease in healthy adults
• Some organisms may
cause disease in
immunocompromised
individuals
• Agents include Bacillus
subtilis, Naegleria
gruberi, infectious canine
hepatitis virus, non-
pathogenic E. coli species
DR.T.V.RAO MD 14
BIOSAFETY LEVEL 1 (BSL-1)
• Standard practices required:
• frequent handwashing
• door that can be kept closed when working;
• limits on access to the lab space when working;
• no smoking, eating, drinking, storage of food in laboratory;
• care to minimize splashes and actions that may create
aerosols (tiny droplets);
• decontamination of work surfaces after every use after any
spills;
DR.T.V.RAO MD 15
BIOSAFETY LEVEL 1 (BSL-1)
• Standard practices (continued):
• decontamination of laboratory wastes;
• use of mechanical pipettes only (no mouth pipetting);
• "sharps" precautions, including special containers for
disposing of needles and other sharp objects;
• maintenance of insect/rodent control program;
• use of personal protective equipment (lab coats, latex
gloves, eye protection or face shields)
• Open bench top sink for hand washing
DR.T.V.RAO MD 16
BIOSAFETY LEVEL 2 (BSL-2)
• Agents associated with human
disease
• Generally required for any
human-derived
blood, bodily fluids, tissues
in which infectious agent
may be unknown
• Agents include
measles
virus, Salmonella
species, pathogenic
Toxoplasma, Clostridiu
m botulinum, hepatitis
B virus
DR.T.V.RAO MD 17
LEVELS OF CONTAINMENT
• BL2 - microorganisms of
moderate potential
hazard, transmitted by
contact, ingestion, punctu
re
• Salmonella, herpesvir
us, human blood
• Basic laboratory
• Standard Practices
PLUS
DR.T.V.RAO MD 18
BIOSAFETY LEVEL 2 (BSL-2)
• Primary hazards:
• accidental needle sticks
• exposure to eyes and nose (mucous membranes)
• ingestion of infectious materials
• Agents do not cause lethal infections, are not transmissible via
airborne route
• (do not cause infection if tiny droplets become airborne and are inhaled,
which might occur if the material were spattered)
• Agents are pathogens for which immunization or antibiotic
treatment is available
• Extreme care should be taken with contaminated needles and
sharp lab instruments
DR.T.V.RAO MD 19
RISK GROUP 2
Pathogenic for humans
Unlikely a serious
hazard
Treatment and
preventive measures
available
Limited risk of spread
of infection
BIOSAFETY LEVEL 2 (BSL-2)
• Standard practices include BSL-1 plus:
• policies to restrict access to lab;
• biohazard warning signs posted outside lab;
• surveillance of laboratory personnel with appropriate
immunizations offered;
• biosafety manual with definitions of needed waste
decontamination or medical surveillance policies;
• supervisory staff who have experience working with
infectious agents and specific training for laboratory
personnel in handling these agents
DR.T.V.RAO MD 21
BIOSAFETY LEVEL 2 (BSL-2)
• Primary barriers: biosafety cabinets or other approved
containment devices
• Personal protective equipment: lab coats, gloves, face
protection as needed
• Protective clothing removed when personnel leave
laboratory area
• Cabinets thoroughly decontaminated daily and
monitored for radiation for personal protection
• Secondary barriers: BSL-1 barriers plus autoclave for
glassware
DR.T.V.RAO MD 22
LEVELS OF CONTAINMENT
• BL3 - microorganisms that
cause serious disease,
transmitted by inhalation
• M. tuberculosis, yellow
fever virus, hantavirus,
Y. pestis (plague)
• Containment lab:
double door entry;
directional airflow; all
work in biosafety
cabinet
DR.T.V.RAO MD 23
BIOSAFETY LEVEL 3 (BSL-3)
• Agents with potential for respiratory
transmission, may cause serious and
potentially lethal infection
• May be studied at BSL-2 for diagnosis
Mycobacterium
Agents include
tuberculosis, St. Louis encephalitis virus,
Francisella tularensis, Coxiella burnetii
()
DR.T.V.RAO MD 24
TB DIAGNOSTICS AND LABORATORY
STRENGTHENING
DR.T.V.RAO MD 25
MDR – TB , XMDR-TB AND BIOSAFETY
• With growing incidences of
MDR-TB and XMDR-TB it is
highly essential all
Microbiology laboratories
must install Grade 3
Biosafety cabinets to
prevent exposure to
Infection. It necessary
precaution's are not taken a
fraction of Medical and
Technical personal will be
infected with grave
consequences.
DR.T.V.RAO MD 26
RISK GROUP 3
Pathogenic, cause
serious disease
Effective treatment
and preventive
measures usually
available
Little person-to-
person spread
DR.T.V.RAO MD 27
BIOSAFETY LEVEL 3 (BSL-3)
• Standard practices include BSL-2 plus:
• strictly controlled access to the lab;
• specific training for lab personnel in handling potentially
lethal agents;
• decontaminating all waste;
• changing contaminated protective lab clothing,
decontaminating lab clothing before laundering;
• institutional policies regarding specimen collection and
storage from workers to establish exposure
DR.T.V.RAO MD 28
BIOSAFETY LEVEL 3 (BSL-3)
• Primary barriers:
• Similar to BSL-2 personal protective equipment
• Respiratory equipment if risk of infection through inhalation
• Secondary barriers:
• All BSL-2 barriers
• Corridors separated from direct access to lab
• Access through self-closing double doors
• Air handling systems to ensure negative air flow (air flows into the lab)
• Air pumped into lab not re-circulated in building
DR.T.V.RAO MD 29
LEVELS OF CONTAINMENT
• BL4 - microorganisms
that cause lethal
disease, with no known
treatment or vaccine
Ebola virus, Marburg
virus
Maximum
containment lab;
positive pressure
ventilated suits
(moon suits)
DR.T.V.RAO MD 30
RISK GROUP 4
Lethal, pathogenic
agent
Readily transmittable
• direct, indirect
Effective treatment and
preventive measures
not usually available
BIOSAFETY LEVEL 4 (BSL-4)
Myco
BG+ BG- Spores Yeast Virus Prions
B
Alcohol 70° ++ ++ ++ 0 + + 0
Aldéhydes +++ +++ ++ + +++ ++ 0
Ammonium IV +++ + 0 0 + + 0
Anilides + 0 NP NP 0 NP 0
Chlorhexidine +++ ++ 0 0 + + 0
Cl compounds +++ +++ ++ ++ ++ ++ + (a)
Iodine (+ der.) +++ +++ ++ ++ ++ ++ 0
Hg compounds ++ ++ 0 0 + 0 ou + 0
Phénols : Variable activity depending on components (b)
Hexachlorophène +++ + 0 0 + 0 0
(a) Bleach (6%) during 60 min at 20°C ; (b) discussion on efficacy of phénol on prions
LABORATORY LOCATIONS
• BSL-1: high schools, community colleges, municipal drinking water
treatment facilities
• BSL-2: local health departments, universities, state laboratories, private
laboratories (hospitals, health care systems), industrial laboratories
(clinical diagnostic companies)
• BSL-3: state health departments, universities, private
companies, industry, federal government (NIH, CDC)
• BSL-4: only 15 facilities in the US
• 9 federal (CDC, NIH), 4 university (Georgia State University, University of Texas
Medical Branch), 1 state, 1 private
• Renovations underway at several labs, new facilities proposed at additional sites
DR.T.V.RAO MD 37
STANDARD MICROBIOLOGICAL
PRACTICES
• NEVER
• recap, bend, or
break needles
• discard needles or
sharps into
biological waste
bags
• discard needles
into regular trash
DR.T.V.RAO MD 38
BIOSAFETY IS EVERYONE'S CONCERN
• Laboratorians have long recognized hazards of processing
infectious agents
• Biosafety guidelines developed to protect workers in
microbiological and medical labs through a combination of
safeguards including engineering controls, management
policies and work practices.
• Issue described differences between biosafety levels
• Help you understand process labs may have to undertake to
identify microorganism, why every lab cannot test for every
organism
DR.T.V.RAO MD 39
REFERENCES
• UNC School of Public Health Laboratory Safety Levels
• WHO guidelines on laboratory training for Field Epidemiologists
DR.T.V.RAO MD 40
• Programme created by Dr.T.V.Rao MD for
Medical ,Technical and Health care workers
in the Developing World
• Email
• doctortvrao@gmail.com
DR.T.V.RAO MD 41