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Protection against lab-acquired infection: a new safety manual.

Protection against lab-acquired infection: A new safety manual

What amounts to a safety manual for hospital laboratorians potentially exposed to infectious blood and body tissue has been published by the National Committee for Clinical Laboratory Standards for review.

A 26-person NCCLS task force prepared the guideline. It synthesizes recommendations from the Centers for Disease Control and information in many articles, while proposing additional clinical and anatomical lab precautions against the hepatitis B virus and human immunodeficiency viruses.

A foreword to the new 120-page document--"Protection of Laboratory Workers from Infectious Disease Transmitted by Blood and Tissue; Proposed Guideline' (NCCLS Document M29-P)--points out that precautions recommended for HBV are considered sufficient for protection against most other viral pathogens.

The project was proposed by Stanley Bauer, M.D., director of pathology at Bronx-Lebanon Hospital Center in New York and a member of the NCCLS board, who served as task force chairman. Other members of the panel included representatives of laboratory professional associations, manufacturers of laboratory instruments and containment devices, and such government agencies as the CDC, the Food and Drug Administration, and state public health laboratories.

"The speed with which NCCLS acted on the proposal underlines the importance of this project,' Dr. Bauer commented. A typical NCCLS document would have spent at least a year passing through the same channels before reaching the proposed guideline level.

The task force met in East Rutherford, N.J., last August for 2 1/2 days of deliberation and writing. NCCLS provided 45 publications as source material, and the members formed subgroups to tackle different infectious disease concerns.

Dr. Bauer collected everyone's recommendations and prepared a draft. By late August, the other task force members had a copy; with some editing and a few additions, they approved it unanimously. The draft then moved on to NCCLS for more editing and to the board of directors for their review and a mail vote. With some additional changes, the document was published soon thereafter.

A key value of the guideline is its consolidation of information that has been widely dispersed in the literature. Most laboratorians have not seen much of the material that the guideline draws together, such as reports in the CDC's Morbidity and Mortality Weekly Report.

The NCCLS guideline essentially follows CDC safety recommendations for health care workers, narrowing the perspective to address laboratory issues. For example, the CDC advises wearing gloves for any patient contact and changing gloves between patients. The NCCLS guideline is less rigorous. It calls for "frequent' changing of gloves by phlebotomists and lab personnel who come in contact with body fluids or contaminated material (and an "immediate' change when gloves become visibly contaminated). "There is a difference between dealing with patients in the emergency room--where the environment may be grossly contaminated with blood--and just going up to the floor to draw specimens,' Dr. Bauer explained.

On the matter of labeling infectious specimens, NCCLS takes the CDC view: Don't, unless state or local regulations require it. Labeling can lull laboratorians into a false sense of security about unmarked specimens, Dr. Bauer said. "You don't always know a patient's infectious status. So all specimens should be treated as infectious and capable of transmitting serious infection.'

The document opens with a discussion of modes of HBV and HIV transmission and survival of HIV in the laboratory. Then it proceeds to personal protection techniques, including hand washing and barrier protection (gloves, goggles, masks, gowns, laboratory coats, and other attire); sterilization, disinfection, and decontamination; and universal precautions.

The next section, on special lab precautions, lists a number of ways to make the laboratory a safer workplace. It also outlines step-by-step protective procedures from specimen collection and handling to test analysis and ultimately to the disposal of needles and sharp objects and hazardous wastes. "This systematic approach to safety is one of the major advantages of the guideline,' Dr. Bauer said.

Three laboratory areas come in for special attention: the blood bank, hematology, and microbiology. On the issue of wearing gloves when drawing donors, the guideline states: "In 1985, 0.04 per cent of blood donations in the United States tested positive for HIV antibody by the Western blot test. This low prevalence has prompted the recommendation that phlebotomists drawing blood from volunter donors should not wear gloves, because doing so might frighten donors, giving them the impression that they can get AIDS from giving blood. Additionally, the cost of wearing gloves would be high.

"However, some regional blood banks have adopted a policy of wearing gloves when drawing blood from volunteer donors. These facts should be carefully considered before an appropriate policy is established by the institution.

"Blood bank workers who draw blood from patients for therapeutic purposes or from patients for autologous transfusion should wear gloves and a gown during the procedure.'

A section on management of laboratory accidents discusses what to do following potential exposure to HIV, HBV, or non-A, non-B hepatitis. It notes that the CDC's advisory committee on immunization practices recommends that medical technologists, phlebotomists, and pathologists be vaccinated with hepatitis B vaccine. "Vaccinating trainees in these disciplines is especially important because the risk of infection is often highest during the professional training period.'

Other subjects covered in the guideline include autopsies, handling surgical specimens, and training and monitoring of personnel.

NCCLS said it believes the guideline will be a vital educational resource for all clinical laboratories and help allay laboratorians' concern about protective measures appropriate to the infectious risk of their work. As a proposed document published at the first level of the NCCLS consensus-building process, the guideline is also intended to elicit comment from its readers. All comments will be evaluated and addressed in the next edition of the guideline.

Copies of the guideline are available for $15 from the National Committee for Clinical Laboratory Standards, 771 E. Lancaster Ave., Villanova, Pa. 19085, (215) 525-2435. Discounts are available for multiple copies, and payment should be included with orders.
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Title Annotation:by the National Committee for Clinical Laboratory Standards
Author:Hallam, Kris
Publication:Medical Laboratory Observer
Article Type:Bibliography
Date:Jan 1, 1988
Words:989
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