(Note: cette page n'existe qu'en anglais - Nota: deze pagina bestaat enkel in het Engels)
Content
- Introduction
- Definitions
- How are infections acquired in the laboratory?
- Notifying a bio-incident or a laboratory-acquired infection
- Laboratory-acquired infections in Belgium 2007-2012: an online survey
- References (opens in a new page)
- Recently reported laboratory-acquired infections (opens in a new page)
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 or production installations. It is sometimes difficult to determine if a worker's infectious disease is caused by a micro-organism that is present in the laboratory only or also in the community. LAIs are of public health concern, as an infected worker may present a risk of transmission to his colleagues, relatives, family members or other citizens.
Biological agent (with links, when available, to the corresponding Material Safety Data Sheet (MSDS) from the Office of Laboratory Security, Health Canada |
Class of risk or risk group Classes of risk are given for human. More information on this page |
Disease |
---|---|---|
Brucella spp. | 3 | Brucellosis |
Coxiella burnetii | 3 | Q fever |
Hepatitis B, C and D viruses | 3 (class of risk 3 infectious agents that are normally not airborne pathogens) |
Hepatitis |
Salmonella thyphi | 3 (class of risk 3 infectious agents that are normally not airborne pathogens) |
Typhoid fever |
Francisella tularensis | 3 | Tularaemia |
Mycobacterium tuberculosis complex | 3 | Tuberculosis |
Trycophyton mentagrophytes | 2 | Dermatomycosis |
Venuzeelan equine encephalitis virus | 3 | Venezuelan equine encephalitis |
Chlamydia psittaci (avian) | 3 | Psittacosis |
Coccidioides immitis | 3 | Coccidioidomycosis |
Laboratory category | Number | Percentage |
---|---|---|
Research | 2307 | 58.8 |
Diagnostic | 677 | 17.3 |
Production | 134 | 3.4 |
Teaching | 106 | 2.7 |
Unspecified | 697 | 17.8 |
Exhaustive reports on LAIs are scanty and are based on voluntary reporting by laboratories (case reports) or on 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.
Definitions
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 can cause any infection, allergy or toxicity. They can be due to human errors or technical failures.
Laboratory-acquired infections (LAIs) are defined as all infections acquired through laboratory or laboratory-related activities regardless of whether they are symptomatic or asymptomatic in nature.
How are infections acquired in the laboratory?
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 below)
- Persistence or viability of infectious agents in the environment
Biological agent | Infectious dose* | Route of inoculation |
---|---|---|
Escherichi coli | 108 | Ingestion |
Escherichi coli O157: H7 | 10 | Ingestion |
Bacillus cereus | > or = 105 per gram | Ingestion |
Campylobacter jejuni | < or = 500 | Ingestion |
Treponema pallidum | 57 | Intradermal |
Francisella tularensis | 10 | Inhalation, Ingestion |
Bacillus anthracis | 8 - 503 | Inhalation, Ingestion |
Mycobacterium tuberculosis and bovis | < 10 | Inhalation |
Coxiella burnetii | 10 | Inhalation |
Salmonella typhi | 105 | Ingestion |
Shigella flexneri | 180 | Ingestion |
Treponema pallidum | 57 | Intradermal |
Vibrio cholerae | 108 | Ingestion |
Yersinia pestis | 100 - 500 | Ingestion, Inhalation |
Smallpox virus (V. major) | 10 - 100 | Ingestion, Inhalation (rare) |
Poliovirus | 2 | Ingestion |
Influenza A2 virus | < 790 | Inhalation |
Venezuelan encephalitis virus | 1 | Subcutaneous |
Hepatitis A virus | 10 - 100 | Ingestion, intravenous |
Adenovirus | > 150 | Intranasal |
Respiratory syncitial virus | > 100 - 640 | Intranasal |
Plasmodium falciparum | 10 | Intravenous |
Histoplasma capsulatum | 10 (mice) | Inhalation |
*Dose is the number of micro-organism otherwise indicated. These data are collected from different peer reviewed resources. For discussion about the definition of "infectious dose" see: Johnson B. OSHA Infectious Dose White Paper. Applied Biosafety 2003; 8(4): 160-165.
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.
To help determining whether a particular bio-incident should be notified and what the notification requirements are, the SBB has developed a dynamic online tool
=> Online occupational bio-incident notification platform
Please use the Biological incident report form to notify and/or optimize the assessment and management of health and safety consequences posed by a bio-incident which occurred during an activity of contained use.
Further guidance can be obtained at the SBB (02/642.52.93 or contained.use@sciensano.be).
Laboratory-acquired infections in Belgium: an online survey
On request of the Flemish Agency for Care and Health, Public Health Surveillance, the Biosafety and Biotechnology Unit (SBB) has developed a survey aiming at mapping and evaluating the risk for “laboratory-acquired infections” (LAIs) related to bio-incidents with pathogenic organisms (genetically modified or not) over the period 2007-2012.
This survey was initially limited to the Flemish region with the aim to gather information on bio-incidents and LAIs in biological laboratories 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 them being mandatory.
- Questions addressed to biosafety officers, prevention advisors and occupational physicians (PDF File)
- Questions addressed to laboratory staff (PDF File)
- Report of the survey (published in 2013): Laboratory-Acquired Infections in Flanders (2007-2012), An online survey (PDF File)
- Addendum 2015: LAI Incidentie in Vlaanderen 2007 - 2012 (PDF file, in Dutch)
In 2013 the online survey has been extended to Wallonia and the Brussels-Capital Region (same covered period: 2007-2012).
- PowerPoint presentation: Laboratory-acquired infections in Belgium: summary of the results (PDF file)
- Final Report of the survey (published in 2015): Laboratory-Acquired Infections in Belgium (2007-2012), An online survey (PDF file)