GENS5013/AVIA3013

Workplace Safety

Module 5
Biological Hazards

Course Facilitator:
Dr. Carlo Caponecchia

2014 UNSW School of Aviation

Module 5 Biological Hazards

Learning outcomes
At the end of this module, it is expected that students will be able to:

List and comment on issues in risk control with respect to biological

hazards
List some common biohazards and the kinds of industries in which they
are most prevalent
Describe features of infectious biohazards dealt with zoonoses: Q fever,
Avian flu and the Hendra virus
Describe features of biohazards related to poor indoor air quality
Apply the hierarchy of controls, suggest and evaluate biohazard risk
control options e.g. for working in the Laboratory or with contagious
agents such as HIV and Hepatitis B

Introduction
Biohazards are sources of risk derived from biological sources. Biological
hazards refer to any micro-organism or material of biological origin that pose a
threat to the health of humans and other living organisms (Tranter, 2004).
Biological hazards include pathogenic micro-organisms, viruses (e.g. HIV,
Hepataitis and Avian flu), natural toxins (e.g. plant or animal toxins), fungi (e.g.
yeasts, moulds), spores and bio-active substances. Biological hazards can also
be considered to include biological vectors or transmitters of disease (AS/NZS
2243.3:2010, ASCC, 2011).
Many workers are exposed to workplace biological hazards and in a wide variety
of ways including via contact with human blood or body excretions, animals and
their products, sewerage and wastes. Examples of occupations that are at
significant risk of exposure to biological hazards are included health care and
social assistance, veterinary medicine, waste management, biomedical research
and agriculture, forestry and fishing. However, considering the nature of airborne
biological aerosols (known as bioaerosols), any worker can be at risk of exposure
to biohazards, if workplace health and safety is ignored (Davidson and Thornton,
2013).
Biological hazards present in different media, and in many cases are subtle and
poorly reported. Therefore, an increased level of knowledge about risk
assessment of biological hazards in the context of both general public and
workplace settings is needed. Validated methods of exposure assessment, doseeffect relationships and exposure standards are also required to properly assess
biological risks.

GENS5013/AVIA3013 - Workplace Safety - Module 5

Occupational Exposure to Biohazards

Although biological hazards have been an important workplace health issue for
some time, recent biological hazards events such as the outbreak of SARs and
avian flu have led to an increased awareness of such hazards in workplace
settings. Worldwide it is estimated that around 320 000 workers die each year
from communicable diseases caused by work-related exposures to biological
hazards (Driscoll et al., 2005; OSHA, 2007). As we mentioned before, biological
hazards pose risks for many workers in a wide variety of occupational settings
(ASCC, 2011; Davidson and Thornton, 2013), for example:
Health care workers can be exposed to biohazards via contact with human
blood, tissues, saliva, mucous, urine and faeces;
People who work with live animals or animal products (blood, tissue, milk,
eggs) can be exposed to animal diseases and infections, among which
zoonoses have a potential to infect humans (e.g. Q-fever, avian influenza or
Hendra virus) or cause serious allergy via sensitisation;
Occupational exposure to biohazards can occur in those people in contact
with laboratory cell cultures, soil and plant materials, organic dusts, food, solid
waste, wastewater and sewerage;
Exposure to moulds and yeasts is common in some industrial processes, in
workplaces with air conditioning systems and high humidity, and in the
construction industry.
Therefore, exposure to biological hazards is widespread and the associated risk
is not always fully understood.

In Australia, The National Hazard Exposure Worker Surveillance (NHEWS)

survey was developed and commenced in 2008 by the Australian Safety and
Compensation Council (ASCC, 2011). ASCC is now known as Safe Work
Australia. This report describes the exposure of Australian workers to biological
hazards and control measures provided in workplaces to eliminate, reduce or
control risks of biological hazards. The main findings of this survey showed that
19% of surveyed workers were considered to have been exposed to biological
hazards. Of this 19%, 75% were exposed to human blood or body excretions,
30% were exposed to live animals or animal products, and 2- 4% were exposed
to laboratory cultures and biohazard waste, sewerage or rubbish. Biohazards
exposure was most likely reported by health care and community services (57%),
followed by agriculture, forestry and fishing workers (33%). While biohazard
control provision was high for workers exposed to human bodily matter, cell
cultures and biohazard waste, sewerage and rubbish, control measures were
relatively low for workers exposed to animals and animal products (ASCC, 2011).

Links !

GENS5013/AVIA3013 - Workplace Safety - Module 5

For more information see the full National Hazard Exposure Worker Surveillance
Report: Exposure to biological hazards and the provision of controls against
biological hazards in Australian workplaces at:
http://www.safeworkaustralia.gov.au/AboutSafeWorkAustralia/WhatWeDo/Public
ations/Documents/571/NHEWS_BiologicalMaterials.pdf
In this report you can see the percentage of workers who reported they were
exposed to biological hazards in the workplace and find out more about their
demographic and employment characteristics if you are interested. You can also
explore factors affecting the provision of controls against biological hazards and
see some recommendations for future research in this field and the development
of policy interventions.

Types of Biological Hazards

An understanding of basic microbiology is essential to understand the nature and
importance of biohazards. While animals reptiles and insects and toxic plants are
technically biological hazards the term is often applied to micro-organisms such
as viruses, bacteria, fungi, and microscopic parasites (see Table 1 and Figure 1).
However, not all micro-organisms are biohazards. Most do not cause disease in
humans or animals. Indeed, they have many beneficial uses. Some microorganisms, such as Eschericia coli (E.coli), are necessary components of the
gastrointestinal tract. Mucous membranes such as the mouth, nose and genital
regions have the greatest number of micro-organisms (Mims et al., 2004).
Micro-organisms that live on or in another organism and derive benefit without
injuring or benefiting the other organism are called commensal (normal flora)
organisms. Many micro-organisms act in this manner. However, this is not to say
that commensal micro-organisms cannot cause problems. For example, a
sudden increase in gut E. coli may lead to diarrhea, or Streptococcus viridians
may cause bacterial endocarditis and heart valve problems if it spreads from the
mouth (where it is usually found) to the blood in those people with rheumatic
fever. People with an impaired immune system, such as those living with
HIV/AIDS
(human
immunodeficiency
virus/acquired
immunodeficiency
syndrome), or workers exposed to immunotoxic chemicals, may be at greater risk
of attack by such organisms. In such cases normal microbial flora which already
exists in the skin, mucous membranes and gastrointestinal tract may cause
opportunistic infections.

GENS5013/AVIA3013 - Workplace Safety - Module 5

Table 1. The main types of biohazards

Agent

Examples (not a comprehensive list)

Viruses

Adenoviruses, herpes simplex, varicella zoster (chicken pox),

cytomegalovirus, contagious pustular dermatitis (orf), influenza, mumps,
rubella, rabies, lassa, ebola, reoviruses, hepatitis A, hepatitis B, HIV, bird flu
Rickettsiae, Chlamydiae, Lepstospira, Brucella, Pseudomonas, Legionella,
Salmonella, Enterobacter, Streptobacillus, Staphylococcus, Streptococcus,
Bacilla, Chlostridium, Listeria, Mycobacteria, Actinomycetes, SARS
Molds (Aspergillis, Penicillium), Yeasts, Mushrooms
Lichens, liverworts, ferns

Bacteria

Fungi
Lower plants other
than fungi
Higher plants
Invertebrate animals
other than arthopods
Arthopods
Vertebrate animals

Pollen, volatile oils (Rue, castor oil, soapwort, poison ivy), dusts (Western
red cedar, herbs, isphagula powder, plant proteases (papain)
Protozoa (Toxoplama. Entamoeba), sponges, coelenterates, flatworms
(Schistosoma), roundworms (Ascasris), Bryozoans, Sea squirts
Crustaceans, spiders, mites, ticks, insects (cockroachers, beetles, moths, flies
and mosquitoes, bees, wasps
Fish (extracts), Amphibians (extracts), Snake venom, Bird-derived material,
mammal derived material

Figure1. L) A typical rod-shaped bacteria,

R) Culture of a human handprint showing bacterial contamination
( LSF/Oxford Scientific Films)

Pathogenic and Infectious Agents

Organisms that give rise to symptoms of morbidity or diseases are called
pathogenic organisms. Less than 0.5% of all micro-organisms are capable of
being pathogenic. These are the organisms that give rise to microbiological
biohazards.
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The basic mechanism of adverse effects of pathogenic micro-organisms is

infection. Infection is the invasion and multiplication of micro-organisms in body
tissues (which may be clinically unobservable) that results in:
local cellular injury due to competitive metabolism,
release of endotoxins (toxins associated with the presence of bacteria) or
exotoxins (toxins that do not need the presence of bacteria to be active),
intracellular replication or
antibody- antigen response.
Micro-organisms undergo self-replication under optimal conditions including
availability of nutrients, water, pH and temperature. Many micro-organisms
undergo self-replication at an exponential rate, so that the number of colonies of
micro-organisms may quickly increase, thereby increasing the risk of exposure
and hence adverse health effects (Picot, 1995).
The chain of infection is a model used to describe the infection process (Figure
2). Each of the following links must be present in a sequential order for an
infection to occur including infectious agent, reservoir, portal of exit from the
reservoir, mode of transmission, and portal of entry into a susceptible host.
Understanding the characteristics of each link provides methods to prevent the
spread of infection by breaking the links, support vulnerable or infected
individuals and also recommend methods of self-protection for health care
workers (Perry, 1998; Rubino, 2001).

Host

Portal of
entry

Mode of
transmission

Infectious
agent

Reservoir

Portal of Exit

Figure 2. The chain of infection

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Zoonoses: Diseases Acquired from Animals

One form of infection is the transfer of the pathogen to humans through a host
animal. Such infections or diseases are called zoonoses and can cause serious
illnesses (Hart et al., 1997; Mims et al., 2004). Zoonoses are spread by inhalation
of infectious bioaerosols e.g. mists and dusts, direct contact or ingestion of
contaminated food or water. People who are most likely to be infected by
zoonoses include abattoir workers, farm workers, shearers, wool sorters,
veterinary personnel, tannery workers, livestock handlers and animal laboratory
workers (NOHSC, 1989).
Q fever, also known as abattoir fever is one of the zoonose diseases caused
by the bacterium Coxiella burnetii (Tranter, 2004). The microbe is usually
transmitted in aerosol form and the main source of infection is domestic animals
(e.g. cattle, sheep and goats). Agriculture and meat processing workers are at
high risk of contracting the disease. An infected animal excretes large amounts of
the organism via urine, faeces and milk and, in high concentrations in the birth
fluids and placenta. The bacteria survive for long periods in the environment as
they are resistant to heat, drying and many disinfectants. The disease was first
recognised in Australia during the 1930's when workers at a Brisbane meat
processor became ill with a fever. As the cause of the illness was unknown, the
workers were diagnosed with 'Query' fever. This was eventually abbreviated to
Q fever.

Links !
Q fever
NSW Department of Health
http://www.health.nsw.gov.au/Infectious/factsheets/Pages/Q-Fever.aspx
Victorian Work Cover Authority
Guidance Note - Q fever prevention
http://www.vwa.vic.gov.au/forms-and-publications/forms-and-publications/qfever-prevention/_nocache
This Guide provides information for employers about preventing the transmission
of Q fever in the workplace.

Exposure, Transmission and Infectious Dose

Exposure to variety of biological hazards can occur via several modes of entry.
Common exposure routes to biohazards are included:
ingestion (e.g. drinking contaminated water)
dermal (e.g. through wounds)
inhalation (e.g. inhalation of bioaerosols), and
injection (e.g. accidental needle-stick injuries).
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Modes of infection transmission are described by public health terminology as

direct transmission; indirect transmission (including vehicle-borne and vectorborne transmission); and airborne transmission. Ingestion is a type of direct
transmission and inhalation is equivalent to airborne transmission involving
droplet nuclei (e.g., tubercle bacilli) or dusts (e.g., aerosolised C. burnetii
rickettsiae or spores of A. fumigatus fungi) containing microorganisms. Inhalation
or airborne transmission is considered as the most common route of exposure
with over 80% of infectious organisms transmitted via this route (Harris, 2000).
Dose is directly related to infectivity; a sufficient dose must be received at a
target site in the body of a susceptible individual to initiate infection.
Experimentally, the infectious dose (ID) is the minimum number of
microorganisms required to establish infection in 50% of a group of hosts of the
same species. This quantity, called the ID50, is a function of the infectious agent,
the route of administration, the source of the agent, and host susceptibility
factors. The ID50 is determined in test animals and provides a means of ranking
infectious agents. Viral infectious doses are expressed similarly but with cells
grown in culture as the host. A TCID50 (tissue culture infectious dose) is the end
point of a quantal titration of virus that infects 50% of the inoculated cell culture.
Limited quantitative human infectivity data exists (Harris, 2000).

Infectious Epidemics
Infectious epidemics include a widespread range of diseases such as syphilis
that had spread throughout Europe by 1495 and the black death, which killed
one third of the population of Europe in the 15th and 16th centuries (Ziegler, 1969;
Singh and Romanowski, 1999). Infectious diseases that were responsible for
major mortality and morbidity in the 19th century Europe were considerably
different to those of major importance in the 20th century which now target the
developing world (Figure 3). In the late 20th century a worldwide outbreak of
HIV/AIDS had (and continues to have) a significant mortality rate associated with
it. This disease, first recognised in Africa, has become a spreading pandemic that
has overtaken one continent after another with terrible consequences (Sutter,
1996). A pandemic is referred to an epidemic of infectious disease that has
spread through human populations across a large region; multiple continents or
worldwide.
Even in the 21st century, we are still confronted with the emergence of new
pathogens, such as Severe Acute Respiratory Syndrome (SARS) or Avian
influenza (Bird flu) and the re-emergence of outbreak-prone diseases such as
cholera and yellow fever. When a new contagious pathogen emerges, given the
speed and volume of international traffic and trade, its worldwide spread is
inevitable and is likely to be very rapid starting a new pandemic (European
Agency for Safety and Health at Work, 2007).

GENS5013/AVIA3013 - Workplace Safety - Module 5

Figure 3. Comparison of major infectious diseases in the 19th and 20th Centuries

Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever is also
a severe, often fatal illness in humans with the case fatality rate of up to 90%.
Ebola first appeared in 1976 in two simultaneous outbreaks, in Nzara, Sudan,
and in Yambuku, Democratic Republic of Congo (Peters and LeDuc, 1999;
Sadek et. al., 1999). The latter was in a village near to the Ebola River, from
which the disease takes its name. The most recent Ebola outbreak is continuing
to cause many deaths in West Africa and the WHO held an emergency meeting
in Geneva to determine whether the outbreak constitutes a public-health
emergency and how to address it.
http://www.who.int/csr/don/2014_08_06_ebola/en/
The virus is transmitted to people from wild animals and spreads in the human
population through human-to-human transmission. The infection is transmitted by
direct contact with the blood, body fluids and tissues of infected animals or
people. During an outbreak, those at higher risk of infection are health care
workers, as well as family members and those in close contact with sick people
and deceased patients. It is one of the worlds most virulent diseases. Ebola virus
disease outbreaks can devastate families and communities, but the infection can
be controlled through the use of WHO recommended protective measures.

Links !
For more information about Ebola virus disease and EVD outbreaks see:
World Health Organisation
http://www.who.int/mediacentre/factsheets/fs103/en/

GENS5013/AVIA3013 - Workplace Safety - Module 5

US Centers for Disease Control and Prevention

http://www.cdc.gov/
For more information on bio-risk reduction also see:
http://www.who.int/csr/bioriskreduction/en/
For more information about H1N1 virus (swine flu) see:
The Centers for Disease Control and Prevention
http://www.cdc.gov/flu/swineflu/

Activity 5.1 The Hendra Virus !

The latest Hendra virus outbreak in southern Queensland and northern New
South Wales is another example of a zoonose. Flying foxes are the natural hosts
for Hendra virus. The disease can be transferred from flying fox to horse, from
horse to horse and from horse to human. The first recorded outbreak occurred in
1994 and more recently, in 2008/2009 when three veterinarians died. Overall,
seven people have died from the disease in 14 separate outbreaks in Australia.
The risk of contacting the Hendra virus can be reduced in many ways. A Hendra
virus vaccine for horses produced by a commercial manufacturer was released in
November 2012. Vaccination is the single most effective way of reducing the risk
of Hendra virus infection in horses. Human infection and death have occurred
following high-level exposure to body fluids from an infected horse.
Read the following links and outline the safe work practices to eliminate or
reduce the risks of zoonoses diseases at workplace.
Hendra virus
Biosecurity Queensland,
Department of Primary industries and fisheries
http://www.dpi.qld.gov.au/4790_2900.htmm
NSW Department of Health
http://www.health.nsw.gov.au/Infectious/factsheets/Pages/Hendra_virus.aspx
NSW Department of Primary Industries
http://www.dpi.nsw.gov.au/agriculture/livestock/horses/health/general/hendra-virus

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Activity 5.2 Emerging Workplace Biohazards!

Working environments are continuously changing with the introduction of new
technologies, substances and work processes, changes in the structure of the
workforce and the labour market, and new forms of employment and work
organisation. New work situations bring new risks and challenges for workers
and employers, which in turn demand political, administrative, technical and
regulatory approaches to ensure workplace health and safety (OSHA, 2007).
You can find more information regarding workplace biohazards and related
emerging issues worldwide and in Europe reviewing the Expert Forecast on
Emerging Biological Risks Related to Occupational Safety and Health (The
European Agency for Safety and Health at Work):
https://osha.europa.eu/en/publications/reports/7606488
Review the document linked above and find out:
What is an OHS emerging risk?
What is the biggest emerging issue related to occupational biological hazards?
Outline and discuss the other top emerging workplace related biological risks.
Why do you think it is important to remain current on emerging biological health
issues at workplace?

Allergens and Organic Dusts

A wide range of biological contaminants can cause asthma and other allergic
responses in workers. These include organic substances such as animal dander
and hair, pollens, fungal spores and hyphae, bird droppings and feathers, insects
such as house dust mites and cockroaches. Exposure to many organic dusts can
cause occupational asthma with the potential symptoms of wheeze and cough,
reduction of peak expiratory flow rate and breathlessness. Important examples of
such organic dusts include flour dust in bakeries and mills, cotton dust in textile
industries and wood dust in wood related industries. Organic dust toxic syndrome
is a general term to describe illnesses with the symptoms similar to allergic
extrinsic alveolities except with no permanent lung damage and it has been
reported in farmers who handle moulding hay, grain silo workers and sewage
treatment workers (Tranter, 2004; Davidson and Thornton, 2013).

Indoor Air Quality and Biohazards

In response to energy crises in 1970s, building construction focused on
construction of air tight buildings with artificial ventilation to minimise energy loss.
Unfortunately, this has contributed to a degradation of indoor air quality in such
buildings. People working in such buildings suffer from symptoms of ill health or

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feel unwell for no apparent reason which referred to as sick building syndrome
(SBS). As they spend more time in the building, the severity of symptoms tend to
increase, and when they are away (e.g. during weekends), the symptoms
become minor or disappear. SBS can disrupt the work performance, personal
relationships and affect productivity. SBS may occur in offices, homes, hospitals,
restaurants, schools and day care centres (Tranter, 2004).
The main factors contributing to poor indoor air quality are chemical and
biological airborne contaminants combined with some physical conditions
(Tranter, 2004), including:
volatile organic compounds (VOCs), such as formaldehyde
environmental tobacco smoke
asbestos and fiberglass
carbon monoxide and other chemical contaminants
endotoxins and mycotoxins
house dust mites
legionella organisms and pollens
physical conditions such as temperature, humidity and air velocity
electromagnetic radiation
radon
Therefore, biohazards such as endotoxins and mycotoxins, house dust mites,
legionella organisms and pollens may contribute to poor indoor air quality.
Dust mites have been associated with a range of respiratory and dermatological
allergies, such as asthma and eczema. The main component of dust is shed skin
flakes, which is the mite's preferred food source. There are approximately 1-2
million house dust mites in the average bedroom in Australia (Tranter, 2004).
Paper mites may also be found in offices using or storing large amounts of
papers or in libraries, which can cause a rash and itchiness.
Legionella pneumophila is a bacteria occurs naturally in reservoirs such as
cooling towers of buildings. It can cause legionnaires disease and Pontiac fever.
While legionnaires disease manifests as a kind of pneumonia with a fairly high
mortality rate, in the majority of cases, the condition is a non-pneumonia flu-like
illness, often called Pontiac fever.
The main route of exposure is by inhalation of aerosol droplets containing the
bacteria. Because of the conditions of growth and dispersal (conditions of
temperature and presence of algae) legionella bacteria proliferate in water tanks
of poorly maintained air conditioning systems in large buildings such as hospitals,
shopping malls and hotels. As such systems contain a means of developing and
dispersing an aerosol, this is where cases of legionnaires disease are often
reported.

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Endotoxins are produced by gram-negative bacteria, and mycotoxines by fungi.

The contribution of these organisms in poor indoor air quality is still not very
clear.
Solutions to poor indoor air quality usually include walkthrough and indoor air
quality investigation, pollutant source removal or modification, efficient and well
maintained ventilation and air distribution, air cleaning systems and education
and communication.

Activity 5.3 Legionnaires Disease !

See the following webpages and find out more information about Legionnaires
disease and Pontiac fever:
US Centers for Disease Control and Prevention
http://www.cdc.gov/legionella/about/index.html
Department of Health, Victoria, Australia
http://docs.health.vic.gov.au/docs/doc/9DDDD28E25371760CA2578A4001D86C
4/$FILE/Leginnaire's%20disease%20the%20facts%200511.pdf
The Victorian Trades Hall Council's
Occupational Health and Safety Unit
http://www.ohsrep.org.au/hazards/infectious-diseases/air-conditioning-andlegionnaires-disease#problem
Explain the history and pattern of Legionnaires disease.
List and compare symptoms of the Legionnaires disease and Pontiac fever.
What are the major causes?
Who is at risk for Legionnaires disease?
What types of occupations can be at risk of contracting the disease?
Discuss some prevention measures of poor air conditioning and Legionnaires
disease on discussion board.

Links !
The lists of outbreaks of the legionnaires disease in US and worldwide are
available at the following webpages:
http://www.hcinfo.com/legionnaires-disease/outbreaks/70-outbreaks
http://en.wikipedia.org/wiki/List_of_Legionnaires'_disease_outbreaks
For more information on Sick Building Syndrome (SBS) see:
Safe Work Australia
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https://www.safework.sa.gov.au/uploaded_files/gs41i.pdf
US EPA
http://www.epa.gov/iaq/pdfs/sick_building_factsheet.pdf

Monitoring and Risk Assessment

There are three main types of sampling to identify the presence and nature of
potential workplace biohazards including air, bulk and surface/wipe sampling
(Davidson and Thornton, 2013). Several air monitoring and counting techniques
have been also developed to assess the potential risks of workplace bioaerosols.
Impactors are among the most commonly used bioaerosol sampling devices for
indoor air quality assessments, clean room testing and industrial operations
(Figure 4). Impactors operate on the principle of the inertial impaction. The single
and cascade (or multi stage) impactors work by directing an air stream onto a
plate covered by agar culture medium or onto a filter. The sample collected on
agar can be incubated and the cultivated microorganisms counted, while filter
samples can be analysed using different methods such as direct microscopy
analysis (Tranter, 2004; Davidson and Thornton, 2013).

Figure 4. SKC BioStage, Single-stage Viable Cascade Impactor

(skcinc.com/prod/225-9611.asp)

Prior to biological sampling it is important to consult with a microbiology

laboratory, microbiologist or communicable disease expert. As we mentioned
before, the state of knowledge on biohazards is still relatively immature and
proper risk assessment of biological risks is difficult. Validated methods of
exposure assessment, dose-effect relationships and exposure standards are
required to properly assess biological risks.

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Controlling Biohazards at the Workplace (Biosafety)

Effectively implementing the Hierarchy of controls means to first use controls at
the top of the hierarchy whenever possible, as discussed in previous units.
However, in those situations where no clear method of elimination or substitution
of a hazard may exist, in order to minimise the hazard in the workplace,
engineering controls should be considered followed by appropriate administrative
and personal protection measures (Tranter, 2004, Davidson and Thorton, 2013),
examples of such controls include:
elimination or substitution of biological hazard (e.g. replacing in vitro
experiments instead of animal models)
Engineering (e.g. using well maintained ventilation systems, biological
safety cabinets)
Isolation (e.g. isolation of infected patients and animals)
Administrative measures (e.g. Universal/Standard precautions, training
hygiene and sterility)
PPE (e.g. uniforms, gown, gloves, goggles, face shields and respirators).
In the context of biological hazards, control methods should be adopted
according to their source, route of entry, transmission path and nature of
exposure. Usually a combination of engineering, administrative and personal
protection is required to control biohazards in the laboratory. The main examples
of such combined control measures include the use of biological safety cabinets
(BSCs), standard precautions and appropriate PPE.

Biological Safety Cabinets

An important example of engineering controls for biohazards in the laboratory is
the use of biological safety cabinets (BSCs). Biological safety cabinets, also
known as laminar flow cabinets, are designed to provide personal, environmental
and product protection when appropriate practices and procedures are followed
(Figure 5). Three kinds of BSCs have been developed as Class I, II, and III to
meet varying requirements of biosafety. Details of three kinds of biological safety
cabinets can be found, for example, from Centre for Diseases Control and
Prevention (CDC): (http://www.cdc.gov/biosafety/).
Due to an increased need for clean air in industry, laminar flow cabinets (also
then known as clean benches) were first developed in the 1960s to provide
product protection for small-scale experimental procedures. They are now a
common control for the handling of microbiological organisms in the workplace
(Cullimore, 1970). A laminar flow cabinet provides a controlled environment in
which levels of particulates, micro-organisms, and contamination of all kinds are
regulated and kept to a minimum by constant air filtration with industrial-grade
filters (Stratt and Beakley, 1968; Newson, 1979).

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Figure 5. Biological Safety Cabinets

Biosafety cabinets have a range of features, depending on the type of organisms

being handled, and the level of containment required. These cabinets create a
particle-free working environment by taking air through a filtration system and
exhausting it across a work surface in a laminar or unidirectional air stream away
from the worker. Commonly, the filtration system compromises of a pre-filter and
a high efficiency particulate air (HEPA) filter. The laminar flow cabinet is usually
enclosed on the sides and kept under constant positive pressure in order to
prevent the infiltration of contaminated room air.

Standard Precautions
Another control strategy to achieve biosafety in the laboratory and other related
settings is the use of standard precautions. They are somewhat further down the
hierarchy of controls, but are required as a part of good work practices in
laboratories as well as health related occupational settings. Standard precautions
alert the health-care or laboratory workers to situations that require special
barrier techniques. These barrier techniques are used when working with any
patient or sample where potential or actual contact with blood or body fluids
exists.
Universal precautions were originally devised by the US CDC in about 1985
(http://www.cdc.gov/), in response to increasing concerns in health care workers

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to the HIV/AIDS epidemic. At the time, and subsequently, there was an urgent
need for strategies to protect health care personnel from blood borne pathogens.
Due to the confusion in the use of the term universal precautions, the
Australian National Health and Medical Research Council (1993) recommended
the adoption of the term standard precautions as the basic infection control
risk minimisation strategy. This change in terminology is consistent with changes
in terminology at the CDC.
The concept of standard precautions is very simple. All blood and body fluids
must be regarded as if they are a potential source of infection. Direct
exposure to any of these substances must always be considered dangerous, and
all possible steps must be taken to ensure that exposure does not occur,
regardless of whether any infectious disease has been diagnosed.
Standard precautions are work practices for the basic level of infection control.
They include:
good hygiene control, particularly washing and drying hands before and
after patient/substance contact;
the use of protective barriers which may include gloves, gowns, plastic
aprons, masks, eye shields or goggles;
appropriate handling and disposal of sharps and other contaminated or
infectious wastes; and
the use of aseptic techniques (i.e., procedures are performed under sterile
conditions).
Standard precautions apply to all patients and samples regardless of their
diagnosis or presumed infection status or content respectively. This includes
when handling:

blood samples;
all other body fluids, secretions and excretions (except sweat), regardless
of whether they contain visible blood;
non intact skin;
mucous membranes; and
all dried blood and other body substances, including saliva.

The safest procedure to adopt while working with micro-organisms is to regard all
micro-organisms as potential pathogens, and treat them accordingly. A thorough
knowledge and use of good laboratory practice are of the utmost importance in
the safe handling of micro-organisms in the workplace (WHO, 1983; Hansen,
1992; Cappuccino and Sherman, 2001). Certain micro-organisms are hazardous
if they are handled on the open bench, usually because they are readily
transmitted by aerosols, or their infectious dose is small. Others present special
hazards from the risk of accidental self-inoculation. Special containment
equipment and laboratory designs have been developed for the safe handling of

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hazardous organisms (AS/NZS 2243.3: 2010). The biological hazards sign

(Figure 6) is specified in the Australian Standard AS 1319:1994, Safety Signs for
the Occupational Environment and is recognised worldwide by the WHO
http://www.who.int and the United Nation (UN) as the UN Transport symbol for
infectious substances.

Figure 6. The Biological Hazards Sign

Links !
More information about standard precautions can be found at
http://www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html
Safe Use of Biological Safety Cabinet Video
http://www.youtube.com/watch?v=ZnUW1N-JJz8

Case Study: HIV and Hepatitis B in the Workplace

Hepatitis is an inflammation of the liver. This disease can be caused by a range
of agents, including workplace chemicals, alcohol consumption and infection.
Viral Hepatitis is divided into types A, B and C, although more types and subtypes are being identified. Hepatitis A is regarded as a less serious problem than

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Hepatitis B or C, which are chronic disease and sometimes fatal. Vaccines are
available for Hepatitis B and are effective in most people (about 90%).
HIV (Human Immunodeficiency Virus) or AIDS (Acquired Immune Deficiency
Syndrome) is a virus that affects the immune system. A category of white blood
cells (the helper T-cells) are essential for immune response are disrupted or
killed by the virus, and the bodys ability to fight infection is progressively eroded.
HIV is a disease of long latency, and people infected with the virus can remain
healthy, and can live and work normally for many years.
HIV and Hepatitis B represent special problems, because of the potentially lethal
nature of the diseases they cause, and the stigma attached to these conditions,
especially HIV. While these diseases are mainly transmitted by non-occupational
causes (through unprotected sexual intercourse with an infected person, through
exchange of infected blood, and from infected mother to infant) it is possible that
workers may come into contact with the infectious agents that cause these
conditions during the course of their work (Collins, et. al., 1991 and Cohen, et. al.
1993).
In 1993, NOHSC issued a National Consensus Statement and Code of Practice
and for workers at risk of the transmission of the Human Immunodeficiency Virus
(HIV) and Hepatitis B in the workplace (NOHSC, 1993). This provided a
recommended procedure for dealing and controlling these diseases.
There are a wide variety of occupations where a problem of transmission of HIV
or hepatitis B might exist, including:
o in the health care industry, most notably during anaesthetic procedures, in
operating theatres, during obstetrics procedures, during pathological and
post mortems procedures and in accident or emergency departments;
o in emergency response workers, e.g. ambulance officers and the police;
o in laboratory workers;
o in cleaners;
o in dentists;
o in prison officers.
Hepatitis can also be a problem in sewerage workers.
The main sources of transmission of HIV or Hepatitis B in the workplace are
related to the following situations when:
o sharps contaminated with infected blood or body fluids penetrate the skin;
o infected blood or body fluids splash into the eyes or other mucous
membranes onto broken skin or into a cut.

Policy Considerations

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Development of a policy to deal with these diseases should contain a number of

explicit commitments, in a standard of fair management, justice and compassion.
The policy should contain principles that:
o
HIV and Hepatitis B should be treated as any other chronic or life
threatening disease;
o
support is provided to allow employees to continue work as long as
it is reasonably practicable to do so, and that support does not
pose a risk to the health and safety of themselves or others;
o
other employees are advised that there is no danger of
transmission through normal workplace contact;
o
training is provided for employees about the disease, ways of
transmission and the importance of prevention and maintaining
confidentiality;
o
suitable non-discriminatory practices are used and that screening of
workers is probably unnecessary;
o
appropriate first aid and infection control procedures are available.

Managing Risks of HIV and Hepatitis B

Where a problem of transmission of HIV or hepatitis exists, employers should
develop a four-stage risk management approach that prevents transmission
(Conte, 1986). This Program should be developed in consultation with
employees. Consultation should occur when: the employer is identifying risks;
determining the approach and methods involved in risk assessment; making
decisions about control of risks; when new information becomes available about
the diseases or safe work practices; when the control program (or individual
aspects) are being evaluated.
Stage 1: Hazard Identification
o
Consultation with employees
o
Direct workplace observation/survey
o
Identification of activities which have the potential to led to exposure
o
Analysis of exposure reports for trends and to identify high risk
activities
Stage 2: Risk Assessment
The potential for transmission of blood borne diseases is greatest when needles,
scalpels and other "sharps" are being used (Carsons, 1994; Di Mino, 2000). The
first case of a health care worker contracting HIV occurred in 1984.
The likelihood of acquiring infection (seroconversion) from a needlestick incident
depends on:

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o
o
o
o

the nature of the exposure (precautions used, depth of penetration, etc.);

the amount of blood or body fluid that entered the body (the inoculum);
the concentration of the infectious agent in the inoculum;
the virulence of the infectious agent.

A single needlestick with a needle contaminated with Hepatitis B carries up to a

35% risk of infection (Newman and Poole, 1998).
In general, the likelihood consequences will occur depends on
o How employees are exposed to risks
o Frequency of exposure
o Workplace layout and equipment
o Workplace practices
o Level of experience and training
o Current Infection control procedures
o Assessment of risks as acceptable or unacceptable
o Establishing priorities to the tasks which require action
Stage 3: Risk Control
o
Universal control (a strategy that requires the treatment of all blood
or body fluids as potential sources of infection)
o
Evaluation of adequacy of existing controls
o
Evaluation of options for new controls using the hierarchy of
controls
o
Disinfection and sterilisation procedures
o
Immunisation of employees (vaccines only available for Hepatitis B)
o
Provision of first aid in the workplace appropriate with the risk
o
Procedures for the management of employee exposures to blood or
body fluids
Stage 4: Monitoring and Review
o
Monitoring and evaluation of work practices
o
Review of the control measures
While the nature of the risks of HIV and Hepatitis B (and other infectious agents
in the workplace) are different from other hazards and risks, the basic approach
for the prevention of risks to workers uses the same occupational risk
assessment approach of identification, assessment and control (NHMRC,1993;
NHMRC, 2010).

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