Clinical Laboratory Biosafety Gaps: Lessons Learned from Past Outbreaks Reveal a Path to a Safer Future

Details

• Personal Author:
  Anderson NL ; Arambula DG ; Arduino MJ ; Bryan A ; Burton, Nancy C. ; Campbell S ; Chen B ; Cornish NE ; Dickson BA ; Giri JG ; Griffith NK ; Pentella MA ; Salerno RM ; Sandhu P ; Snyder JW ; Tormey CA ; Wagar EA ; Weirich EG
• Description:
  Patient care and public health require timely, reliable laboratory testing. However, clinical laboratory professionals rarely know whether patient specimens contain infectious agents, making ensuring biosafety while performing testing procedures challenging. The importance of biosafety in clinical laboratories was highlighted during the 2014 Ebola outbreak, where concerns about biosafety resulted in delayed diagnoses and contributed to patient deaths. This review is a collaboration between subject matter experts from large and small laboratories and the federal government to evaluate the capability of clinical laboratories to manage biosafety risks and safely test patient specimens. We discuss the complexity of clinical laboratories, including anatomic pathology, and describe how applying current biosafety guidance may be difficult as these guidelines, largely based on practices in research laboratories, do not always correspond to the unique clinical laboratory environments and their specialized equipment and processes. We retrospectively describe the biosafety gaps and opportunities for improvement in the areas of risk assessment and management; automated and manual laboratory disciplines; specimen collection, processing, and storage; test utilization; equipment and instrumentation safety; disinfection practices; personal protective equipment; waste management; laboratory personnel training and competency assessment; accreditation processes; and ethical guidance. Also addressed are the unique biosafety challenges successfully handled by a Texas community hospital clinical laboratory that performed testing for patients with Ebola without a formal biocontainment unit. The gaps in knowledge and practices identified in previous and ongoing outbreaks demonstrate the need for collaborative, comprehensive solutions to improve clinical laboratory biosafety and to better combat future emerging infectious disease outbreaks. [Description provided by NIOSH]
• Subjects:
  Anatomy Body Fluids Diagnosis Disinfectants Hazardous Substances Hazardous Waste Laboratories Occupational Health Pathology Personal Protective Equipment Risk Assessment Safety

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• Keywords:
  Author Keywords: Biosafety Biosafety Body Fluids Clinical Laboratories Clinical Tests Diagnostic Tests Disinfection Ethics Hazardous Waste Infectious Agents Infectious Waste Laboratory Equipment Laboratory Safety Laboratory Testing Laboratory Workers Personal Protective Equipment PPE Risk Assessment Risk Management Safety Measures Specimen Collection And Transport Waste Disposal Systems Waste Management Waste Treatment Worker Safety

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• ISSN:
  0893-8512
• Document Type:
  Text
• Genre:
  Journal Article
• Place as Subject:
  Connecticut ; Georgia ; Iowa ; Kentucky ; Ohio ; OSHA Region 1 ; OSHA Region 10 ; OSHA Region 4 ; OSHA Region 5 ; OSHA Region 6 ; OSHA Region 7 ; Texas ; Washington
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  DFSE - Division of Field Studies and Engineering
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  34
• Issue:
  3
• NIOSHTIC Number:
  nn:20062979
• Citation:
  Clin Microbiol Rev 2021 Jul; 34(3):e00126-18
• Contact Point Address:
  Nancy E. Cornish, Centers for Disease Control and Prevention, Center for Surveillance, Epidemiology and Laboratory Services (CSELS), Atlanta, Georgia, USA
• Email:
  NCornish@cdc.gov
• Federal Fiscal Year:
  2021
• NORA Priority Area:
  Services
• Peer Reviewed:
  True
• Source Full Name:
  Clinical Microbiology Reviews
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:f8f9c3b1468fbc75e18ddece53c55f57b7d24d843c7496197e4b9f0c19682cd94da44d2547fe5e159227807e526d48d79d27ca1faa60c68b0e4feeadb438dd09
• Download URL:
  https://stacks.cdc.gov/view/cdc/226125/cdc_226125_DS1.pdf
• File Type:
  [PDF - 4.62 MB ]