Assignment No.

1 ii

Submitted to: Dr. Ghulam Muhammad ii ii ii ii

Submitted by: ii

Name: Muhammad Shakeelui i

Roll no.: BSZ-19-41

ii ii

Class: BS Zoology, 4th Semester, Morning

ii ii ii ii ii

Date: June04, 2021

ii ii

Department of Zoology ii ii

Topic: Descriptive Epidemiology of Occupat

i i i i

ional Infections of Laboratory Workers

i i i i
Descriptive Epidemiology of Occupational In i i i i

fections of Laboratory Workers i i i

Introduction:
The precise incidence of occupational infections among laborato
i i i i i i i

ry workers is not known. During the past century, however, an ext

i i i i i i i i i i i

ensive literature has documented that such infections have occur

i i i i i i i i

red with regularity and have occasionally resulted in death. The o

i i i i i i i i i i

verall mortality rate of reported cases is 4 percent. Published repo

i i i i i i i i i i

rts have dealt largely with single cases or outbreaks, retrospectiv

i i i i i i i i i

e studies, and passively collected anecdotal information. For the

i i i i i i i i i

most part, historical accounts of laboratory-

i i i i i

associated infections have listed only individual cases with no att i i i i i i i i i

empt at the difficult task of determining the size of the population

i i i i i i i i i i i

s at risk. Furthermore, there is no central focus of responsibility or

i i i i i i i i i i i i

authority in the United States that maintains a comprehensive da i i i i i i i i i

ta base or conducts surveillance of occupational infections in lab

i i i i i i i i i

oratory workers who regularly or occasionally handle microorg

i i i i i i i

anisms or viruses. i i i

B. Epidemiologic Triad
i i

The components of the epidemiologic triad associated with labor

i i i i i i i i

atory-
acquired infections are the host, the infectious agent, and the envi i i i i i i i i i i

ronment. Although most of the data relevant to these three factor i i i i i i i i i i

s have been collected retrospectively and are incomplete, an eval

i i i i i i i i i

uation of the information that is available provides some insight i

i i i i i i i i i i

nto the complexity of the problem.

i i i i i
1. The Host i i

Comprehensive and current data are not available on the demogr i i i i i i i i i

aphy of laboratory workers (the host) who risk occupational infe

i i i i i i i i i

ction with the agents they handle in their daily activities. Publishe
i i i i i i i i i i

d surveys, however, indicate that the number of workers employe

i i i i i i i i i

d by public health and clinical laboratories is substantial, having

i i i i i i i i i i

been estimated at 250,000 in 1977. A more recent survey conduct

i i i i i i i i i i

ed in 1983 by the Occupational Safety and Health Administration

i i i i i i i i i i

(OSHA) estimated that there are 370,000 employees in clinical la i i i i i i i i i

boratories, 45,000 employees in federal government laboratorie i i i i i i

s, and 127,000 employees in academic laboratories. Additionally,

i i i i i i i i

the number of physicians' office laboratories in which one or mor

i i i i i i i i i i

e persons are employed may exceed 100,000 facilities. Of the com

i i i i i i i i i i

bined total of more than 640,000 workers, as many as 500,000 ma

i i i i i i i i i i i

y regularly or occasionally work with infectious agents or with bl

i i i i i i i i i i

ood, serum, urine, or other body fluids or tissues that may contain
i i i i i i i i i i i i

an infectious agent. i i

The surveys cited above do not include all segments of the general
i i i i i i i i i i i i

population of laboratory workers at potential risk of occupation i i i i i i i i

al exposure to infectious agents or their toxic or sensitizing metab

i i i i i i i i i i

olic products. Among the segments inadvertently excluded are a s

i i i i i i i i i

ubstantial but unknown number of persons whose duties may inv i i i i i i i i i

olve either regular or occasional handling of infectious materials

i i i i i i i i

: e.g., those persons working in animal and avian disease diagnost

i i i i i i i i i i

ic or research laboratories, environmental laboratories, industri

i i i i i i

al and biologics production laboratories, forensic laboratories, a

i i i i i i i

nd in laboratory animal production and care facilities. Conseque

i i i i i i i i

ntly, the estimate of 500,000 workers who may be at risk of occupa

i i i i i i i i i i i i
tional infections probably represents a significant underestimati
i i i i i i

on of the true number.

i i i i

2. The Infectious Agent

i i i

Data are also not uniformly available about the second epidemiol
i i i i i i i i i

ogic component, the infectious agent. Details about the kinds of in

i i i i i i i i i i

fectious agents encountered in the various categories of laborato

i i i i i i i i

ries and the frequency with which such agents are handled are un
i i i i i i i i i i i

known. National morbidity data indicate that hepatitis B virus (H

i i i i i i i i i

BV) infections are widespread in the general population and that

i i i i i i i i i i

a pool of new cases and chronic carriers numbering several millio

i i i i i i i i i i

n may exist. For example, 1.0 to 1.5 percent of all admissions to lar
i i i i i i i i i i i i i

ge urban hospitals are positive for hepatitis B surface antigen (H

i i i i i i i i i i

BsAg). Although blood samples from these patients are potentiall

i i i i i i i i

y infectious, their identity is usually unknown throughout the hos

i i i i i i i i i

pitalization. These data suggest that HBV represents the specific i i i i i i i i i i

nfectious agent most likely to be transmitted in the clinical labora i i i i i i i i i i

tory occupational setting.

i i

3. The Environment
i i

The third component of the epidemiologic triad, the laboratory e

i i i i i i i i i

nvironment, is also poorly defined. The physical features, includin i i i i i i i i

g safety equipment and adequacy of the facility, vary widely. Alth

i i i i i i i i i i

ough a number of federal, state, and private sector organizations

i i i i i i i i i i

(e.g., Health Care Financing Administration, OSHA, College of Am

i i i i i i i i

erican Pathologists, Joint Commission on the Accreditation of He

i i i i i i i i

althcare Organizations, American Association of Blood Banks, an

i i i i i i i

d various state agencies) do regulate, license, accredit, or inspect

i i i i i i i i i i

clinical laboratories, there is no consensus among these various o

i i i i i i i i i
rganizations about the standards for laboratories operating und i i i i i i i

er their respective jurisdictions. There is a current voluntary nati

i i i i i i i i i

onal code of laboratory practice that describes features of a labor

i i i i ii i i i i i

atory facility recommended for work with infectious agents, but t

i i i i i i i i i

here is no national authority that regulates laboratory operation

i i i i i i i i

s conducted solely on an intrastate basis.

i i i i i i i

Laboratory Associated Infections: i i

1. Infectious Agents Presenting the Highest Ri

i i i i i i

sk
The series of survey summaries of laboratory-
i i i i i i

associated infections described by Pike in 1976 indicates that, as i i i i i i ii i i i

a group, bacterial infections were the most frequently reported o

i i i i i i i i i

ccupationally associated infections of laboratory workers durin i i i i i i

g the first seven and one-

i i i i i

half decades of the twentieth century. Viral and rickettsial infecti

i i i i i i i i i

ons were more frequently reported during the latter half of this ti
i i i i i i i i i i i

me period. Of the 3921 cases reported, the five most frequently rec
i i i i i i i i i i i

orded infections in rank order were: brucellosis, Q fever, typhoid f

i i i i i i i i i i

ever, viral hepatitis (all types), and tuberculosis. Most of these dis
i i i i i i i i i i

eases were prevalent and important public health problems in ou

i i i i i i i i i

r recent past, and their etiologic agents were handled commonly i

i i i i i i i i i i

n clinical and diagnostic laboratories at that time.

i i i i i i i

While the compilations of laboratory- i i i i

associated infections cited above provide a historical perspective i i i i i i i i

of the hazards of occupational infection, these data are not necess

i i i i i i i i i i

arily indicative of present- i i i

day risk of infection. For example, brucellosis, the most frequently

i i i i i i i i i i
reported occupational infection, was formerly a major and wides i i i i i i i i

pread disease in human and animal populations. More than 6000

i i i i i i i i i i

human cases were reported in the United States in 1947. As the inc
i i i i i i i i i i i i

idence of brucellosis declined in domestic animal reservoirs, ther

i i i i i i i i

e was a corresponding decline in cases in the human population. B

i i i i i i i i i i i

y 1963, the annual number of cases reported had declined to 407.

i i i i i i i i i i i i

Of this number, only one case, a Brucella suis infection, was specifi
i i i i i i i i i i i

cally identified as being laboratory associated.

i i i i i

Sharp decreases have been observed also in the annual number of

i i i i i i i i i i i

reported cases of typhoid fever. In 1942, there were almost 6000 c i i i i i i i i i i i

ases; in 1952, 2341 cases; and in 1984, 390 cases, of which approxi
i i i i i i i i i i i i

mately 70 percent were acquired during foreign travel. Similarly,

i i i i i i i i i

reported cases of tuberculosis decreased from 121,000 in 1950 to i i i i i i i i i i

22,500 in 1984. As the incidence of the ''top five" diseases has decr
i i i i i i i i i i i i

eased in the general population, there has been generally a corres

i i i i i i i i i i

ponding decrease in the number of laboratory specimens receive i i i i i i i i

d and examined that contain these agents. This decrease in numb

i i i i i i i i i i

ers of specimens containing the infectious agents has certainly re

i i i i i i i i i

duced the probability of occupational exposure. On the other han

i i i i i i i i i

d, newly emerging diseases or newly recognized organisms may i

i i i i i i i i i

ncrease the risks of infection for laboratory personnel. i i i i i i i

Tuberculosis is an interesting example of the latter situation. The i i i i i i i i i i

recognition of the existence of species of mycobacteria other than i i i i i i i i i i

Mycobacterium tuberculosis, M. bovis, and M. avium has required i i i i i i i i i

that specimens suspected of containing mycobacteria be subjecte

i i i i i i i

d to increased laboratory manipulations, in order to recover as w

i i i i i i i i i i

ell as to identify the organisms.

i i i i i

Such increased manipulations are not without inherent risks to la

i i i i i i i i i

boratory personnel. The recent report of Miller et al. summarizes i i i i i i i i i i

the collective experience of several investigators and shows that t
i i i i i i i i i

uberculosis has ranked among the top six causes of laboratory- i i i i i i i i i

associated infections for more than 25 years. These published rep i i i i i i i i i

orts probably represent only the "tip-of-the-

i i i i i

iceberg" of laboratory- i i

associated cases of tuberculosis. For example, the laboratory tub i i i i i i i i

erculosis consultant at the Centers for Disease Control (CDC) has, i i i i i i i i i i

at the time of this writing, been asked to assist in 13 investigations

i i i i i i i i i i i i i

of laboratory-
i

associated tuberculous infection, none of which has been publish i i i i i i i i

ed. In these 13 investigations, 72 of 275 (26 percent) exposed indiv

i i i i i i i i i i i

iduals were found to have been infected with tubercle bacilli (i.e., r
i i i i i i i i i i i

ecent tuberculin conversion); if untreated, 10 percent of these ind

i i i i i i i i i

ividuals would be expected to develop active tuberculosis. The fra

i i i i i i i i i

ction of exposed personnel infected in the different outbreaks ran

i i i i i i i i i

ged from 19 to 55 percent. Airborne dissemination was suspected

i i i i i i i i i i

in all instances.
i i

It has recently been recognized that both acquired immunodefici

i i i i i i i i

ency syndrome (AIDS) and intravenous drug abuse may be contri

i i i i i i i i i

buting factors to the recent increase in morbidity from tuberculos

i i i i i i i i i

is. Other factors that are suspected of playing a role are the influx
i i i i i i i i i i i i i

of immigrants from Central America and the increasing numbers

i i i i i i i i i

of homeless people. These factors can only cause an increase in th

i i i i i i i i i i i

e risk of mycobacterial infection for laboratory personnel. Despit

i i i i i i i i

e excellent published surveys of the frequency of such infections, it

i i i i i i i i i i i

appears obvious that many cases occur that are not reported in thi i i i i i i i i i i

e medical literature.
i i

Q fever differs from the other "top five" occupational infections in

i i i i i i i i i i i

that this rickettsial disease has remained a relatively obscure pub

i i i i i i i i i
lic health problem of unknown incidence and sporadic distributio
i i i i i i i i

n. However, Q fever is a proven and continuing hazard in those few

i i i i i i i i i i i i i

facilities in which work with infected animals or human tissues is i i i i i i i i i i i

conducted, or in which the agent is propagated. This rickettsial a i i i i i i i i i i

gent is remarkably resistant to dessication and inactivation, and

i i i i i i i i i

10 or fewer organisms may produce infection via the respiratory

i i i i i i i i i i

route.
Hepatitis of varied etiology continues to be a community as well a i i i i i i i i i i i

s an occupational health hazard among certain high-

i i i i i i i

risk groups, including laboratory workers. Over the past 15 years,

i i i i i i i i i i

the incidence of HBV infections has shown a progressive annual in

i i i i i i i i i i

crease, while in the same period, the number of reported cases of h

i i i i i i i i i i i i

epatitis A virus (HAV) infection has decreased. In 1983, for the firsi i i i i i i i i i i

t time, the number of HBV cases exceeded those caused by HAV. W

i i i i i i i i i i i i

hile laboratory hazards of HAV infection are restricted primarily

i i i i i i i i i

to persons working with experimentally or naturally infected chi

i i i i i i i i

mpanzees, HBV poses a persistent and continuing hazard to all ca i i i i i i i i i i

tegories of laboratory workers handling clinical specimens of hu i i i i i i i i

man origin. HBV has been demonstrated in a wide range of body fl

i i i i i i i i i i i i

uids and tissues typical of those received and handled in clinical la

i i i i i i i i i i i

boratories. The number of infectious virus particles may reach co i i i i i i i i i

ncentrations in excess of 100,000,000 per milliliter of blood. Since i i i i i i i i i i

the early 1970s, when procedures for the serologic differentiatio

i i i i i i i i

n of HAV and HBV came into general use, HBV has become the lead
i i i i i i i i i i i i i

ing cause of occupationally acquired infection among laboratory

i i i i i i i i

and health care workers. Studies by Jacobsen and co-

i i i i i i i i

workers in Utah demonstrated a prevalence of clinical HBV infect i i i i i i i i i

ion in clinical laboratory personnel that was 14 times greater tha

i i i i i i i i i i

n that in the general population, i.e., 0.84 cases/100,000 versus 0.

i i i i i i i i i i

06 cases/100,000, respectively. Elevated HBV infection rates or i

i i i i i i i i
ncidences of serologic markers were demonstrated in public heal i i i i i i i i

th laboratory workers in the United Kingdom, in clinical chemistr

i i i i i i i i i

y workers in Denmark, and in small rural hospitals, as well as in la

i i i i i i i i i i i i i

rge urban hospitals in the United States. Osterholm and Andrews

i i i i i i i i i ii

have demonstrated annual infection rates for HBV and non-

i i i i i i i i

A/non-
B hepatitis that exceeded 10,500 cases/100,000 in the staffs of ho
i i i i i i i i i i

spital dialysis units, while employees in nondialysis units of these

i i i i i i i i i i

hospitals exhibited a rate of approximately 500 cases/100,000. T

i i i i i i i i

he ratio of HBV to non-A/non-

i i i i i

B hepatitis infections was greater than 5 to 1.

i i i i i i i i

Lauer found HBV antigen on one- i i i i i

third of the surfaces of work areas, equipment, and laboratory im

i i i i i i i i i i

plements sampled in a large, modern medical center laboratory.

i i i i i i i i i

Collins found visible blood on the labels of 17 percent of tubes of bl

i i i i i i i i i i i i i

ood specimens, and feces on the external surfaces of 6 percent of th

i i i i i i i i i i i i

e containers of the stool samples received at a public health labor

i i i i i i i i i i i

atory in England. Four to five percent of laboratory services reque

i i i i i i i i i i

st forms received by another public health laboratory in England

i i i i i i i i i i

were visibly blood stained. Bond et al. demonstrated that HBV re

i i i i i i i i i i

mains viable and infectious after being dried in serum and held fo
i i i i i i i i i i i

r seven days at ambient laboratory environmental conditions of 2

i i i i i i i i i

5°C and 42 percent relative humidity.

i i i i i

The primary routes of occupational infection with HBV, in rank or

i i i i i i i i i i

der, are as follows: accidental parenteral self-

i i i i i i

inoculation with infectious fluids (needle sticks); exposure of the i i i i i i i i i

mucous membranes of the eyes, nose, or mouth to infectious mate

i i i i i i i i i i

rials; and, possibly, contamination of the skin with infectious mat

i i i i i i i i i

erials.
In a joint advisory notice, the U.S. Departments of Labor, and Heal
i i i i i i i i i i i

th and Human Services, have informed employers about the serio

i i i i i i i i i

us occupational infection problems of HBV, human immunodefici

i i i i i i i

ency virus (HIV), and other blood- i i i i i

borne diseases[139 ]. In this advisory, federal health officials estim

i i i i i i i i i

ated that as many as 18,000 health- i i i i i i

care workers may be infected in a single year with HBV. Of these ca

i i i i i i i i i i i i i

ses, as many as 12,000 may be occupationally associated. It was fu

i i i i i i i i i i i

rther estimated that nearly 10 percent of the cases will become lo

i i i i i i i i i i i

ng-
term carriers of the virus, and that more than 200 health care wor
i i i i i i i i i i i i

kers may die as the result of the HBV infection or associated compl
i i i i i i i i i i i i

ications.
The evidence is overwhelming that, of all indigenous pathogens,
i i i i i i i i i

HBV has the greatest potential for transmission within the occup
i i i i i i i i i

ational setting of the clinical laboratory. This conclusion is based i i i i i i i i i i

upon the comparatively high frequency of asymptomatic carrier

i i i i i i i

s, the high titers of virus in blood and other body fluids, the stabilit
i i i i i i i i i i i i i

y of the virus on work surfaces and other items in the laboratory, t

i i i i i i i i i i i i i

he low infectious dose, the multiple routes of infection, and the de

i i i i i i i i i i i

monstrated occupational incidence of infection. i i i i

An essential consideration in the occupational risk assessment of

i i i i i i i i i

HBV and other infectious agents for which only Biosafety Level 2 p
i i i i i i i i i i ii

ractices are recommended is the lack of evidence suggesting that i i i i i i i i i i

occupational transmission occurs by means of true infectious aer i i i i i i i i

osols, i.e., inhalation of respirable particulates typically less than

i i i i i i i i i

5 microns in diameter.
i i i

While not among the most prevalent occupational infections reco

i i i i i i i i

rded by Pike (i.e., the "top five"), shigellosis is historically and curr
i i i i i i i i i i i
ently a continuing occupational risk. The low oral infectious dose
i i i i i i i i i i

(on the order of 100 viable organisms) facilitates transmission in

i i i i i i i i i i

the occupational setting, as well as in the general population. In a

i i i i i i i i i i i i

retrospective study of more than 20,000 British medical laborato i i i i i i i i

ry workers, shigellosis was the third most frequently recorded occ

i i i i i i i i i

upational infection, following viral hepatitis and tuberculosis. i i i i i i

2. Infectious Agents Presenting the Lowest Ri

i i i i i i

sk
In contrast to the proven occupational infection hazard of HBV an
i i i i i i i i i i

d the other "top five" agents, a number of infectious agents handle

i i i i i i i i i i i

d in laboratories have exhibited a consistent history of remarkabl

i i i i i i i i i

y low incidence or absence of reported occupational infections. Ex

i i i i i i i i i

amples of such agents include rabies virus, Creutzfeldt- i i i i i i i

Jakob agent (CJA), Vibrio cholerae, Clostridium tetani, and HIV. W

i i i i i i i i i

hile the consequences of infection with any of these five agents are
i i i i i i i i i i i i

serious, the cumulative history of laboratory experience attests t

i i i i i i i i

o the low risk of transmission in the laboratory setting.

i i i i i i i i i

In the almost 100-

i i i

year history of work with rabies virus in diagnostic and research l

i i i i i i i i i i i

aboratories, often in the most primitive of facilities and without p i i i i i i i i i i

reexposure immunization of personnel, only two documented cas i i i i i i i

es of laboratory-
i i

associated infections have been recorded. Both cases occurred un i i i i i i i i

der conditions involving the manipulation of relatively large qua

i i i i i i i i

ntities of high- i i

titer virus suspensions: one in a production facility and the other i

i i i i i i i i i i i

n a research laboratory. Exposure of personnel to aerosols of high

i i i i i i i i i i

-
titer virus suspensions was the most plausible explanation for eac
i i i i i i i i i

h of these two unusual cases. Neither the quantity nor the concent
i i i i i i i i i i i

ration of the virus in the materials handled, nor the procedures pe

i i i i i i i i i i i

rformed, was typical of the conditions in a diagnostic or clinical la

i i i i i i i i i i i

boratory.
Creutzfeldt-
Jakob agent, a slow virus causing transmissible viral dementia, is
i i i i i i i i i i

an infectious agent that can be passed serially from human to hu

i i i i i i i i i i i

man, and from human to susceptible nonhuman primates or rode

i i i i i i i i i

nts. Extensive experience with CJA and the clinical disease (CJD) u
i i i i i i i i i i

p until the present time has indicated that "none of the people in cl
i i i i i i i i i i i i i

osest contact with patients with CJD (wives, friends, employee con
i i i i i i i i i

tacts, members of the medical or nursing professions, or paramed

i i i i i i i i i

ical personnel) appears to have a higher risk of contracting CJD th

i i i i i i i i i i i

an does the general population. Not a single case of CJD has yet bee
i i i i i i i i i i i i i

n reported to have occurred in workers most exposed to infectious

i i i i i i i i i i i

tissues from patients with CJD (neuropathologists,

i i i i i

research scientists, and laboratory personnel). Thus, despite pro

i i i i i i i

ven person-to-
i

person transmissibility of the disease by invasive procedures, the

i i i i i i i i i

risk of acquiring CJD by any means other than tissue penetration b

i i i i i i i i i i i

y contaminated materials must be very small indeed". It should be

i i i i i i i i i i i

noted that two accounts of the occurrence of CJD in laboratory wo

i i i i i i i i i i i

rkers were recently published, although the causal relationship b

i i i i i i i i

etween the disease and occupational exposure was not establishe

i i i i i i i i

d in either case.
i i i

While cholera is periodically epidemic in tropical and subtropical

i i i i i i i i i

countries, only 12 laboratory- i i i

associated infections have been reported during this century. The i i i i i i i i i

very high oral dose required for infection, of the order of 100,000,
i i i i i i i i i i i

000 viable organisms, is undoubtedly a major reason for the small

i i i i i i i i i i i

number of laboratory-associated cases. i i i

Although Pike recorded five laboratory exposures to toxin of Clost i i i i i i i i i

ridium tetani produced in vitro, there have been no recorded case

i i i i i i i i i i

s in laboratory workers of occupational infections or intoxication

i i i i i i i i

s with C. tetani, C. botulinum, or their respective toxins.

i i i i i i i i i

Few infectious agents have generated more concern and anxiety

i i i i i i i i i

over potential occupational exposure and hazards of infection th

i i i i i i i i

an has HIV. Active prospective surveillance, however, has shown t

i i i i i i i i i

hat fewer than 1 percent of overt exposures (including needle stic

i i i i i i i i i i

ks) of people attending patients with AIDS or with other manifest

i i i i i i i i i i

ations of HIV infection, have resulted in seroconversion of the exp

i i i i i i i i i i

osed individuals. The majority of those health care workers with r

i i i i i i i i i i

eported occupationally acquired HIV infection have a history of n i i i i i i i i i

eedle stick exposure to blood of infected patients in the clinical set

i i i i i i i i i i i

ting. As of February 1988, there have been three reported serocon

i i i i i i i i i i

versions in laboratory workers. One of these cases occurred in a m i i i i i i i i i i i

edical technologist who spilled blood from an infected patient on

i i i i i i i i i i

her ungloved hands and forearms while manipulating an aphere

i i i i i i i i

sis machine. The other two recorded cases occurred in employees

i i i i i i i i i i

of large-
i

scale virus production facilities propagating HIV for research or r

i i i i i i i i i

eagent use. One of these two workers had an overt parenteral exp
i i i i i i i i i i i

osure to a concentrated virus preparation. The other worker had

i i i i i i i i i i

no recognized accidental occupational exposure or any risk beha

i i i i i i i i

vior linked to HIV infection.

i i i i

Despite the low incidence of transmission in the laboratory, the p

i i i i i i i i i i

otentially life- i
threatening consequences of HIV infection mandates that all labo i i i i i i i i

ratory workers who handle blood, body fluids, tissues, or cultures

i i i i i i i i i i

utilize those laboratory practices and personal protective measu

i i i i i i i

res identified as "Universal Precautions" by the CDC, which are re

i i i i i i i i i i

commended for the prevention of transmission of HIV and other b i i i i i i i i i i

lood-borne diseases. i

Common to each of these infectious agents with a demonstrated l i i i i i i i i i i

ow risk of occupational infection is the fact that primary occupati

i i i i i i i i i i

onal infection is associated with one of the following exposures: a

i i i i i i i i i i

ccidental parenteral inoculation (e.g., needle stick); contaminati i i i i i i

on of the mucous membranes of the eyes, nose, or mouth with infec

i i i i i i i i i i i i

tious droplets (particulates typically greater than 5 microns in di

i i i i i i i i i

ameter); ingestion; or penetration of the intact or broken skin by t i i i i i i i i i i i

he agent. There is no documented risk of transmission by means of

i i i i i i i i i i i i

an infectious aerosol (particulates typically less than 5 microns in

i i i i i i i i i i

diameter) generated during the manipulation of clinical materia i i i i i i i

ls or of diagnostic quantities of the agent.

i i i i i i i

3. Other Infectious Agents

i i i

Except for some exotic microbial agents, the occupational risk of i

i i i i i i i i i i

nfection with virtually any biological agent falls between the extr i i i i i i i i i

emes observed with the "top five" and the "low- i i i i i i i i

risk" groups of infectious agents described above. The recommen

i i i i i i i i

ded facilities, equipment, and microbiological practices necessar

i i i i i i

y for the handling of infectious agents are detailed, which is a repr

i i i i i i i i i i i i

inting of the Centers for Disease Control (CDC)/National Institute

i i i i i i i i

s of Health (NIH) publication, Biosafety in Microbiological and Bi

i i i i i i i i i

omedical Laboratories . These guidelines should be followed whe i i i i i i i i

n contemplating work with any potentially infectious agent. Reco

i i i i i i i i
mmendations for handling HIV, an infectious agent that was iden
i i i i i i i i i

tified after the CDC/NIH publication, are reproduced in Appendix

i i i i i i i i

es B and .
i i i