After concern over the spread of Ebola grew in the U.S. this fall, many laboratorians spent hours online dutifully clicking through the Centers for Disease Control and Prevention (CDC) website, as well as reviewing guidance from the World Health Organization (WHO), American Society for Microbiology (ASM), and other organizations. However, they found sometimes vague and even conflicting advice, leaving them with nagging questions about what was safe.
As the number of U.S. cases increased—from 2 in early August to 9 by the beginning of November—CDC moved swiftly to offer extra help to hospitals and reassure the public. On October 20, the agency issued stricter guidelines for the personal protective equipment (PPE) worn by healthcare workers who treat patients with Ebola. But for clinical labs, CDC has left the practical, detailed planning up to individual hospitals. Pressing laboratory-specific problems—such as which instruments to use, or how to decontaminate them—remain in the do-it-yourself category. At press time for CLN’s December issue, CDC’s recommendations for labs receiving samples from patients suspected of Ebola infection boiled down to following standard precautions and, as an added provision, using a certified class II biosafety cabinet or splash guard with PPE that protects skin and mucous membranes.
With the exception of phlebotomy, laboratorians are not exposed directly to patients; however, the laboratory’s instruments and environment create distinctive risks that are still not fully understood, Lance Peterson, MD, a clinical professor of pathology at the University of Chicago Pritzker School of Medicine, told CLN. “The laboratory is unique in that we may need to be even more cautious in certain ways because we have the potential to create hazards that the patients themselves would not create,” he said. “There is every reason to believe that if you had a tube rupture in a centrifuge or other kind of aerosolization, such an exposure could lead to infection. So even though the virus is not aerosolized from the same standpoint as tuberculosis, if you create an aerosol in the laboratory, that risk is quite real.” A leading expert on infection control, Peterson is also director of the microbiology and infectious disease research program for the North Shore University Health System in Evanston, Illinois.
A number of agencies and offices in the federal government have promulgated standards related to infectious agents over the years, including CDC’s National Institute for Occupational Safety and Health (NIOSH) and Healthcare Infection Control Practices Advisory Committee (HICPAC), as well as the Occupational Safety and Health Administration (OSHA). AACC held a webinar in October about laboratory practices for managing suspected Ebola specimens with CDC Medical Officer Nancy Cornish, MD. She advised that labs not depend solely on the government’s infection control library, but confer as well with experts about their specific circumstances. She warned that some of those answers could be surprising. “Laboratories should consult with an industrial hygienist, as well as instrument manufacturers,” Cornish said. “In one case, we asked a manufacturer how an instrument could be decontaminated, and the representative responded: incinerate it.”
Check out the December issue of CLN to read more about how to stay updated on Ebola precautions for laboratorians.