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Contained Use of GMOs and pathogens
Bio-incidents and Laboratory-acquired Infections: Introduction
(Authors: N. Willemarck, P. Herman) (Last revised: September 17, 2015 )

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Introduction

A definition of Bio-incidents

A definition of Laboratory-Acquired Infections

How laboratory infections are acquired?

Notifying a Bio-incident or a Laboratory-Acquired infection

References

Recently reported laboratory-acquired infection (frequently updated)

LAI online survey in Flanders 2007-2012 (online survey)

Laboratory-acquired infections in Belgium: summary of the results and final report

Introduction

Laboratory-acquired infections (LAIs) also called occupational illness or laboratory-associated infections are not new phenomena in microbiological laboratories. LAIs can arise in clinical laboratories as well as in animal facilities, R&D, production installations. It is sometimes difficult to determine if a discovered infectious worker's disease is caused by a micro-organism that is present in the laboratory only or also in the community. LAIs are also of public health concern as an infected worker may present a risk of transmission to his colleagues, relatives, family members or other citizens.

Some biological agents responsible of LAIs are presented in Table1 and a study from Pike in 1976 giving the percentage of LAI per laboratory category is showed on Table 2.

Exhaustive reports on LAIs are scanty and are based on voluntary reporting by laboratories (case reports) or by more elaborated and detailed inquiries. The underreporting of such infections is widely acknowledged due to fear of reprisal and the stigma associated with such events (Sewell, 1995). Some comprehensive publications referencing a large number of LAIs were published in the past decade (see references).

The link between LAIs and Biosafety is obvious. These concerns are also to be considered as one of the underlying reasons for the elaboration of containment measures and application of safe work practices.

A definition of Bio-incidents

Bio-incidents are defined as all irregularities that occur while handling biological agents (pathogenic organisms), including those which have been genetically modified, cell cultures and parasites which may be able to provoke any infection, allergy or toxicity. They can be caused by human errors or technical failures.

A definition of Laboratory-Acquired Infections

LAIs are defined as all infection acquired through laboratory or laboratory-related activities regardless whether they are symptomatic or asymptomatic in nature.

How laboratory infections are acquired?

LAIs are resulting from occupational exposure to infectious agents. The most common route of exposure and accidental inoculation are the following:

  • Inhalation (see aerosols)
  • Percutaneous inoculation (needle and syringe, cuts or abrasions from contaminated items and animal bites)
  • Contact between mucous membranes and contaminated material (hands or surfaces)
  • Ingestion (aspiration through a pipette, smoking or eating)

Important factors to consider when assessing the risks for staff working in R&D, production or microbiology laboratory are the following:

  • Mode of transmission
  • Infectious doses for human (see Table 3)
  • Another useful information is the persistence or viability of infectious agents in the environment (Table 4 under revision)

Notifying a Bio-incident or a Laboratory-Acquired infection

Following a bio-incident there is a legal provision requiring to notify:

- Any accident or incident (in relation to a workplace) which may have resulted in the release of a biological agent (pathogenic and/or genetically modified organism) and which can cause serious illness or infection in humans;

- Any incident (in relation to a "contained use" workplace) during the contained use where a significant amount of pathogenic and/or genetically modified organisms is unintentionally released in the environment with immediate or long term risk to human and animal health and the environment;

Please use the notifiable Contained Use bio-incident form to notify a LAI or bio-incident in course of a Contained use activity.

If you are unsure about either a particular incident should be notified check the online occupational bio-incident notification platform in Belgium or contact the SBB (02 6425293 or contained.use@wiv-isp.be) for guidance.

References

Link to a webpage dedicated to literature references (LAI case reports) with Reviews, the most frequent laboratory-acquired infections, other infectious agents and non infectious agents.

Recently reported laboratory-acquired infection (frequently updated)

Link to a webpage gathering reported LAIs from year 2000 to the most recent references.

LAI online survey in Flanders 2007-2012 (online survey)

On request of the Flemish Agency for Care and Health, Public Health Surveillance, the  Biosafety and Biotechnology Unit (SBB), which belongs to the Scientific Institute of Public Health, developed a survey in the interest of mapping and evaluating the risk for “laboratory-acquired infections” (LAIs) related to bio-incidents with pathogenic organisms (genetically modified or not) in Flanders over the last 5 years (2007-2012).

The aim of this survey was to gather information on bio-incidents and LAIs in biological laboratories in the Flemish region and to gain insight into the possible underlying causes in order to provide biosafety officers, prevention officers and occupational health practitioners with tools that can enhance biological safety in the laboratory.

The survey was available in Dutch and English. In total ~50 questions and sub questions were addressed to each respondent, consisting of single-answer questions and multi-answer questions, most of the questions were mandatory. The survey documents are availbale here:

Enquête LAI bioveiligheidscoordinator, preventieadviseur en arbeidsgeneesheer (NL, pdf file)

Enquête LAI responsble de la biosécurité, conseiller en prévention et médecin du travail (FR, pdf file)

Enquête LAI bioveiligheidscoordinator, preventieadviseur en arbeidsgeneesheer (EN, pdf file)

Enquête LAI labo personeel (NL, pdf file)

Enquête LAI personnel de labo (FR, pdf file)

Enquête LAI labo personeel (EN, pdf file)

Report of the survey (2013): Laboratory-Acquired Infections in Flanders (2007-2012), An online survey.

Addendum 2015: LAI Incidentie in Vlaanderen 2007 - 2012 (NL, pdf file)

In 2013 the online survey has been extended to Wallonia and Brussels Capital regions (same covered period: 2007-2012). A power point presentation gathering information on bio-incidents and LAIs in Belgian micro-biological laboratories is available: Laboratory-acquired infections in Belgium: summary of the results (EN, pdf file)

Final Report of the survey (2015): Laboratory-Acquired Infections in Belgium (2007-2012), An online survey (EN, pdf file)

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