Assessing Laboratory Risk Level and PEP
Laboratory Exposures
Once a potential exposure is recognized, the first task is to determine the activities performed that may have led to the exposure. Then identify:
- who was in the laboratory during the suspected time(s) of exposure
- where they were in relation to the exposure
- what they did with the isolates
The identified individuals should be assessed for exposure risk using the descriptions in the three tables below.
Specimen Handling | Exposure Scenario | PEP | Follow-Up/Monitoring |
---|---|---|---|
Routine clinical specimen (e.g., blood, serum, cerebrospinal fluid) | Person who manipulates a routine clinical specimen (e.g., blood, serum, cerebrospinal fluid) in a certified Class II biosafety cabinet, with appropriate personal protective equipment (i.e., gloves, gown, eye protection). | None | N/A |
Routine clinical specimen (e.g., blood, serum, cerebrospinal fluid) | Person present in the lab while someone manipulates a routine clinical specimen (e.g., blood, serum, cerebrospinal fluid) in a certified Class II biosafety cabinet, or on an open bench where manipulation did not involve occurrence of aerosol- generating events (e.g., centrifuging without sealed carriers, vortexing, sonicating, spillage/splashes). | None | May consider symptom watch for following scenarios:
|
Enriched material (e.g., a Brucella isolate, positive blood bottle) or reproductive clinical specimen (e.g., amniotic fluid, placental products) | Person who manipulates enriched material (e.g., a Brucella isolate, positive blood bottle) or reproductive clinical specimen (e.g., amniotic fluid, placental products) in a certified Class II biosafety cabinet, with appropriate personal protective equipment (i.e., gloves, gown, eye protection). | None | May consider symptom watch for following scenarios:
|
Enriched material (e.g., a Brucella isolate, positive blood bottle) or reproductive clinical specimen (e.g., amniotic fluid, placental products) | Person present in the lab while someone manipulates enriched material (e.g., a Brucella isolate, positive blood bottle) or reproductive clinical specimen (e.g., amniotic fluid, placental products) in a certified Class II biosafety cabinet. | None | May consider symptom watch for following scenarios:
|
Specimen Handling | Exposure Scenario | PEP | Follow-Up/Monitoring |
---|---|---|---|
Enriched material (e.g., a Brucella isolate, positive blood bottle) or reproductive clinical specimen (e.g., amniotic fluid, placental products) | Person present in the lab at a distance of greater than 5 feet from someone manipulating enriched material (e.g., a Brucella isolate, positive blood bottle) or reproductive clinical specimen (e.g., amniotic fluid, placental products), on an open bench, with no occurrence of aerosol-generating events (e.g., centrifuging without sealed carriers, vortexing, sonicating, spillage/splashes). | May consider if immunocompromised or pregnant. Discuss with health care provider (HCP).
Note: RB51 is resistant to rifampin in vitro, and therefore this drug should not be used for PEP or treatment courses. |
Regular symptom watch (e.g., weekly) and daily self-fever checks through 24 weeks post- exposure, after last known exposure. Sequential serological monitoring at 0 (baseline), 6, 12, 18, and 24 weeks post- exposure, after last known exposure. Note: no serological monitoring currently available for RB51 and B. canis exposures in humans. |
Specimen handling | Exposure scenario | PEP | Follow-Up/Monitoring |
---|---|---|---|
Routine clinical specimen (e.g., blood, serum, cerebrospinal fluid) | Person who manipulates a routine clinical specimen (e.g., blood, serum, cerebrospinal fluid), resulting in contact with broken skin or mucous membranes, regardless of working in a certified Class II biosafety cabinet, with or without appropriate personal protective equipment (i.e., gloves, gown, eye protection). |
|
|
Enriched material (e.g., a Brucella isolate, positive blood bottle) or reproductive clinical specimen (e.g., amniotic fluid, placental products) | Person who manipulates (or is ≤ 5 feet from someone manipulating) enriched material (e.g., a Brucella isolate, positive blood bottle) or reproductive clinical specimen (e.g., amniotic fluid, placental products), outside of a certified Class II biosafety cabinet. |
|
|
Enriched material (e.g., a Brucella isolate, positive blood bottle) or reproductive clinical specimen (e.g., amniotic fluid, placental products) | Person who manipulates enriched material (e.g., a Brucella isolate, positive blood bottle) or reproductive clinical specimen (e.g., amniotic fluid, placental products), within a certified Class II biosafety cabinet, without appropriate personal protective equipment (i.e., gloves, gown, eye protection). |
|
|
Enriched material (e.g., a Brucella isolate, positive blood bottle) or reproductive clinical specimen (e.g., amniotic fluid, placental products) | All persons present during the occurrence of aerosol-generating events (e.g., centrifuging without sealed carriers, vortexing, sonicating, spillage/splashes) with manipulation of enriched material (e.g., a Brucella isolate, positive blood bottle) or reproductive clinical specimen (e.g., amniotic fluid, placental products) on an open bench. |
|
|
Notes:
- RB51 is resistant to rifampin in vitro, and therefore this drug should not be used for PEP or treatment courses.
- No serological monitoring is currently available for RB51 and canis exposures in humans.
Examples of aerosol generating procedures include, but are not limited to:
- centrifuging without sealed carriers
- vortexing
- sonicating
- accidents resulting in spillage or splashes (e.g., breakage of tube containing specimen)
Other manipulations may require further investigation. These may include:
- automated pipetting of a suspension containing the organism
- grinding the specimen
- blending the specimen
- shaking the specimen
- other procedures for suspension in liquid to produce standard concentration for identification (i.e., inclusion of steps that could be considered major aerosol generating activities)
Page last reviewed: April 6, 2018