1. Laboratory Acquired Infections
Overview of
Laboratory Acquired Infections
Life Sciences Institute &
Singapore Institute for Clinical Sciences (Brenner Centre)
SAFETY DAY 2009

2. Contact Info
Scott Patlovich, MPH, CBSP
Senior Safety & Health Manager
Office of Safety, Health, & Environment
Office:

4. Definition of LAI
Laboratory acquired infection (LAI) = an infection obtained through laboratory or laboratory-related activities as a result of work with infectious biological agents, which may be either symptomatic of asymptomatic

5. History of LAIs
Four hallmark studies by Pike and Sulkin collectively identified 4,079 LAIs resulting in 168 deaths between 1930 – 1978
159 causative agents identified, although >50% were caused by 10 most common organisms
Many more LAIs likely unreported during this time period

6. ( )
Source: Pike, 1976 & 1978

7. History of LAIs
Harding and Byers literature search of LAIs for 20 years following Pike and Sulkin publications found 1,267 overt infections with 22 deaths
Harding and Byers also reported:
<20% of LAIs from known exposure or documented accident in the lab
Only 7 documented secondary infections from LAIs (1979 – 1999)

8. Despite Controls, LAIs Continue
1979 Pike concluded “the knowledge, the techniques, and the equipment to prevent most laboratory infections are available”
Yet, laboratory acquired infections continue to occur…(even today)

9. “The conventional wisdom is that laboratory-acquired infections are kept under control by stringent CDC guidelines first introduced in 1984, at a time when investigations of pathogenic bacteria were just starting to bloom. The reality is that no one knows what the reality of laboratory-acquired infections is.”

10. Biosafety Guidelines & Regulations
CDC/NIH. Biosafety in Microbiological and Biomedical Laboratories, 5th Edition. (2007)
World Health Organization. Laboratory Biosafety Manual, 3rd Edition. (2004)
Ministry of Health Singapore. Biological Agents and Toxins Act [BATA]. (2006)

11. Biosafety Controls
Practices, procedures, and facility controls described in biosafety level criteria (BSLs)
Risk grouping of infectious biological agents
Emphasis on risk assessment, training, SOPs, disinfection, waste management, immunization, post-exposure prophylaxis, biosecurity, etc.
LAIs are not exclusive to BSL-3 or BSL-4 laboratories – many occur in BSL-2 laboratories

12. Potential Routes of Transmission
Inhalation – infectious aerosols, droplets
Ingestion – mouth pipetting; eating, drinking
Percutaneous inoculation – needlesticks and other contaminated sharps; animal bites; exposure to previously broken or damaged skin
Mucous membrane exposure – infectious materials in contact with eyes, nose, mouth (splashes, contact from contaminated surfaces)

15. “Laboratory A” (2002)
Who: 1 unvaccinated worker at private lab (“laboratory A”) processing environmental samples following October 2001 anthrax mailings
Agent: virulent Bacillus anthracis
Route of Exposure: Cutaneous
Source: Positive environmental sample not properly handled, plus individual had pre-existing fresh cut on neck from shaving
Result: cutaneous anthrax disease including black eschar on neck
Other findings: 70% ethanol used for storage vials when 10% bleach prescribed in SOPs; gloves not used to handle vials; wipe samples of lab surfaces indicated only vials were possible source of contamination

16. “Laboratory A” (2002)
Who: 1 unvaccinated worker at private lab (“laboratory A”) processing environmental samples following October 2001 anthrax mailings
Agent: virulent Bacillus anthracis
Route of Exposure: Cutaneous
Source: Positive environmental sample not properly handled, plus individual had pre-existing fresh cut on neck from shaving
Result: cutaneous anthrax disease including black eschar on neck
Other findings: 70% ethanol used for storage vials when 10% bleach prescribed in SOPs; gloves not used to handle vials; wipe samples of lab surfaces indicated only vials were possible source of contamination

18. Boston University (2004)
Who: 3 researchers suspected with pneumonic tularemia
Agent: Live Vaccine Strain of Francisella tularensis (LVS stock contaminated with wild-type (Type A) virulent form of organism)
Route of Exposure: Inhalation
Source: Undetermined; several procedures occurring during time period (i.e. centrifuging, vortexing, colony counts not in a BSC)
OSHA fine: US$8100 (for improper use of PPE)
Other outcomes: City of Boston Public Health Department to survey lab; first ever City of Boston IBC review panel to review all biomedical research in city; construction of new BSL-4 labs highly controversial with public

19. Boston University (2004)
Who: 3 researchers suspected with pneumonic tularemia
Agent: Live Vaccine Strain of Francisella tularensis (LVS stock contaminated with wild-type (Type A) virulent form of organism)
Route of Exposure: Inhalation
Source: Undetermined; several procedures occurring during time period (i.e. centrifuging, vortexing, colony counts not in a BSC)
OSHA fine: US$8100 (for improper use of PPE)
Other outcomes: City of Boston Public Health Department to survey lab; first ever City of Boston IBC review panel to review all biomedical research in city; construction of new BSL-4 labs highly controversial with public

20. Science, September 2007

21. Madison Chamber
Photo courtesy of Hillier Architecture

22. Texas A&M University (2007)
Who: 1 student worker infected in Brucella lab exposure incident
Agent: virulent Brucella spp.
Route of Exposure: Mucous membrane exposure (eyes)
Source: Improperly trained student worker entered Madison containment chamber to clean unit after aerosolization procedure
CDC fine: US$1 million (plus lost grant dollars during lab shutdown)
Other outcomes: Failure to properly report cases resulted in cease & desist order from CDC on all infectious disease lab work for nearly one year; significant reputational damage to university

23. Texas A&M University (2007)
Who: 1 student worker infected in Brucella lab exposure incident
Agent: virulent Brucella spp.
Route of Exposure: Mucous membrane exposure (eyes)
Source: Improperly trained student worker entered Madison containment chamber to clean unit after aerosolization procedure
CDC fine: US$1 million (plus lost grant dollars during lab shutdown)
Other outcomes: Failure to properly report cases resulted in cease & desist order from CDC on all infectious disease lab work for nearly one year; significant reputational damage to university

24. Vaccinia Virus (2007)
Who: 1 unvaccinated worker at a Virginia academic institution
Agent: Vaccinia Virus (live viral component of smallpox vaccine)
Route of Exposure: Unknown currently
Source: Recombinant stock likely to be contaminated with “Western Reserve” strain of virus
Secondary Infections: 102 possible contacts identified; no secondary infections occurred

25. Vaccinia Virus (2007)
Who: 1 unvaccinated worker at a Virginia academic institution
Agent: Vaccinia Virus (live viral component of smallpox vaccine)
Route of Exposure: Unknown currently
Source: Recombinant stock likely to be contaminated with “Western Reserve” strain of virus
Secondary Infections: 102 possible contacts identified; no secondary infections occurred

26. Source: US Centers for Disease Control & Prevention
Recent Vaccinia LAI’s
Source: US Centers for Disease Control & Prevention

28. Emory University (1997)
Who: 1 worker at the Yerkes Regional Primate Research Center at Emory University in Atlanta, Georgia engaged in behavioral research on hormonal influences in Rhesus macaques
Agent: Cercopithecine Herpes Virus 1 (B-virus)
Route of Exposure: Mucous membrane exposure (right eye)
Source: Splash of bodily fluid from macaque to unprotected eyes (no safety glasses/goggles worn at time of exposure)
Result: Fatality of 22-year old female (approx. 6 weeks following exposure)
Other findings: No report of exposure until after onset of symptoms of disease; post-exposure treatment not adequate
Note: infected macaques are often asymptomatic (no lesions)

29. Emory University (1997)
Who: 1 worker at the Yerkes Regional Primate Research Center at Emory University in Atlanta, Georgia engaged in behavioral research on hormonal influences in Rhesus macaques
Agent: Cercopithecine Herpes Virus 1 (B-virus)
Route of Exposure: Mucous membrane exposure (right eye)
Source: Splash of bodily fluid from macaque to unprotected eyes (no safety glasses/goggles worn at time of exposure)
Result: Fatality of 22-year old female (approx. 6 weeks following exposure)
Other findings: No report of exposure until after onset of symptoms of disease; post-exposure treatment not adequate
Note: infected macaques are often asymptomatic (no lesions)

30. Other Infectious Disease Lab “Mishaps”

31. Texas Tech University Who: Thomas Butler Agent: Yersinia pestis
What: Apparent loss of 30 vials containing bacteria
How Much: 69 counts including illegal transportation, tax fraud, embezzlement, fraud, lying to federal officials
Outcomes: 2 years jail time & US$38,000 fine

32. LAIs – Lessons Learned Prevention of LAIs can be achieved through:
Risk assessment! Risk assessment! Risk assessment!
Establishment of SOPs (controls) appropriate for infectious organisms used
Immunization, when available
Education and training
Use of appropriate precautions including engineering, administrative, and PPE controls
Understanding of disease signs & symptoms
Prompt injury/accident/illness reporting

33. Thank You!