Genera Safety and Specit OBJECTIVES sterilization, disinfection, decon- 1, Define and diferentiate tamination, and antiseptic. 2. List the factors that influence the effectiveness of tants in the microbiology laboratory. 3. Describe the methods used forthe disposal of hazardous ‘waste, including physical and chemical methods, and the material and/or organisms effectively eliminated by each method. ‘4, Define a chemical hygiene plan and describe the purpose cof the methods and items that are elements of the plan, including proper labeling of hazardous materials, training programs, and material safety data sheets. 5, Name the four types of fire extinguishers and the specific ‘armmables that each is effective in controlling, 6. Deserbe the process of Universal or Standard Precautions inthe microbiology laboratory, including handling of infec: tious materials, personal hygiene, use of personel protective ‘equipment, hanling of sharp objects, and hand-washing procedures 7. Define Biosafety Levels 1 through 4 including the precau- tions required for each, and identify a representative ‘organism foreach, ‘Outline the basie guidelines for packing and shipping Infectious substances. 9, Describe the management and response required during biologic or chemical exposure incident inthe laboratory disinfec- ierobiology laboratory safery practices were frst pub- lished in 1913. They included admonitions such as the necesiy 0 (1) wear gloves, (2) wash hands after ‘working with infecious materials, 3) disinfect ll instruments immediatly after use, (4 use water 10 moisten specimen labels rater than the ong) dif all contaminated waste before discarding, and (6) report to appropriate personne ee ‘These guidelines are sill incomporaced inco safety pro- grams in the diagnostic microbiology laboratory. Safety programs have been expanded to include the proper han- ling of biologic hazards encountered in processing patienc Specimens and handling infectious microorganisms; fireand 42 men Management lecrical safer; the safe handling, storage, and disposi cemicals and radioactive substances; and techniques fy ‘fly lifing or moving heavy objees. In areas of the cous ural disasters (eg, earthquakes, hurricane, aeons), safety programs include disaster prepared fuse plans that outline che steps C0 take in an emergency ‘Although all microbiologists are responsible for their ow fealth and safey, che institution and supervising person pet are required co provide safety training to familiarie mricrebiologiss with known hazards in the workplace and to prevent exposute. Laboratory safety is considered ani tegral part of overall laboratory services, and federal lw in the United States mandates preemployment safety train ing, followed by quarerly safety in-services. Safety taining regulations are enforced by the United States Deparment of Labor Occupational Safety and Health Administration (OSHA), Regulations and requirements may vary based on the type of laboratory and updated regulations. Ik i re ‘ommended thatthe laboratory review these requirements ‘outlined by OSHA (wwww.osha.gov). Microbiologists should be knowledgeable, propey trained, and equipped with the proper protective macerials and working controls while performing duties in the labore tory, Investigation of the causes of accidents indicates that unnecessary exposures to infectious agents occur when ind viduals become sloppy in performing theit duties or when they deviate from standardized safety precautions try prone 0 nat Sterilzati ! Sterilization isa process cha kills all forms of microbi life, including bacterial endospores. Disinfection is 2 p10” cs hat destos pathogenic organisms bus noe necessarily all microorganisms, endospores, or prions. However: som disinfectants will kill endospores with prolonged exposut® times. Decontamination is the removal of pathogen: microorganisms 50 items are safe to handle or dispose Many factors limit the success or degree of sterilization disinfection, or decontamination in a health cave setin such as organic load (organisms and other contaminati"6 Scanned By Scanner Appsical or chemical CHAPTER 4 Laboratory Safety soaker. Moist heat in the form of savurated steam under 1 atmosphere (15 pounds per square inch [psi of pressure csauses the irreversible denaturation of enzymes and st tural proteins. The most commonly used steam sterilizer in the microbiology laboratory is the gravity displacement autoclave (Figure 4-1). Steam enters at the top of the ste izing chamber; because steam is lighter than air, it displaces, the ar inthe chamber and forces it out the bottom through the drain vent. The evo common sterilization temperatures are 121°C and 132°C. Biologic waste that includes broth or solid media is usually auroclaved for 30 minutes at 121°C in 2 displacement sterilizer or 4 minutes at 132°C in a prevac- ‘sum sterilizer. Infectious medical waste containing body flu- ids or blood, on the other hand, is often sterilized at 132°C. for 30 t0 60 minutes to allow penetration of the steam throughout the waste and the displacement of air crapped inside the auroclave bag. Prions require a muuch more exten- sive sterilization process. Several options are recommended for the removal of prions ftom surgical instruments or other ch as brain, spinal cord, and eye tissue, According to the eighth edition of Principles and Practices of infectious Diseates (Elsevier, 2015), there are four options for sterilization: (2) autoclave at 134°C for 18 minutes in a prevacuum seeril ines (2) auroclave at 132°C for 1 hour ina gravity displace- ‘ment sterilizer: (3) immerse in 1 N sodium hydroxide for 1 hour, remove and rinse with water, then autoclave at 121°C in a gravity displacement or 134°C in a prevacuum sxerilzer for 1 hour: or (4) immerse in 1 N sodium hydrox ide for 1 hour and heat in a gravity displacement at 121°C for 30 minutes, chen clean and subject ro routine equipment Steam from Jacket to chamber Chamber wat veeat OUST Scanned By Scanner AppGeneral Peincpes ncn eTOBIIOS? Pry tay stest physica srvitzaion, Aa eat ise dest a simplest method of sterilization sans (15003 00) aries Hoge spose MEG. 1A and higher tenperatntes 40 Dry heat ovens ae cil, petrolacan, 0 ehoce fr atic hn { carhotiyarates: opis fe are all cat 960 1 by paling the solut selenite meme or comps sing bigh= i Jigned to remove Pileeaton of igi Through a cellulose act mn, Flraion of alt is Hee aie (EDAD filters les " 1h am fon isolation fooMs OPE Mier cabinets (BSC), The ion ing aio eg aa hgh eee NE is compos of HA se ov zing lapses such i dheters, or gloves before use. The most tae oid (40), ich ates. The swith a vac efeney pl gas Lange th ing roms atu biolosi an chem ster ten oti sa amare of EO we are the Keng a tat heh hazaih pots. Vapor phi > a rede an enaingae hs bon sed to sere Hi rnin BSC metal, and neta cevicessch 8 ial ran sn Tae 6 x t jlasma is another method that uses rec pls by etn the Bos ve ep acu with the use of Fyalgen peraside gas pl Inydrogen peroxide and g in an enclosed chamber tadifiyqueney oF microwave energy Methods of Disinfection Physical Methods of Disinfection The dice physical methods of dsif + ‘Bolling at 100°C for 15 minutes, which kills vegetative tuactria + Pascurzing at 70° pashogens withour da minutes, which kills food ig the nutritional value or vor filet (UV) ation such as ult UV rays are long wavelength and low energy, They do not penetrate well, and organisms must have direct surbice copes, such asthe working surface of a BSC, for this form of disinfection vo work. Bete Chemical Methods of Disinfection ‘Chemical disinfectants comprise man Chena prise many clases, + Aldehydes os (chlorine al chlorine 5 Habs chlorine compounds) + Hyalogen peroxide + Quiternary ammonium compo + Phenolics oe including: Chemicals used 10 destroy all life are cal sterilants, or biocides; however, these sa lied hsteat me chemicals, coda, act as disinfectants. Dis (kin) are called anciseptics, swith the type of ry. such as Bacillus spp mycobacteria (acd-fay poliovieus) Fungi: wy teria (ego BFAM-NeBALIVE rod, ie i Tepes simplex virus), which ines, 8 Teton of disinfectants Th ane the 08 Tn Agency (EPA) registers chemi Environmental Prom e United Stares and requires manu ans we Te ach cmon fFacturers to specify TT fore microbiologists who mux, the wrkng an wefoMctanes should. check the xl appro «(product information) for the I be killed. General, rot microorganisms that wil eas ra ling microongnios ince hee tot pietabial load (number of organ: tiect proportion £0 pea ene iret prep ariclrly tue of instruments contain ea ie earreral such as blood, pus oF mucus. The vit or tal should be mechanically removed befor omen Meiizaion 10 decrease the microbial load. This cremfogous to removing dried food from utensils before vain fem in a dahwasher and iis important for col res Tneaion of instruments such as bronchoscopes. The type of water and ics concentration in a solution a also imporean. Hard water may reduce the rate of killing of reroorganisms. In addition, 60% ro 90% ethyl or isopropy ‘Teoh solution (volume/volume) is optimally bactericidal Irectse the increased ability of water (HO) to hydrolyze Bonds in protein molecules males the killing of microorgan- inns mot effective. Ethyl or isopropyl alcohol is nonsporicid- a (les not kill endospores) and evaporaces quickly. Therefore its use is limited to the skin as an antiseptic or on thermon 1 injection vial rubber septa asa disinfectant ized hydrogen peroxide has demonstrated bactei Ll, sporcidal, and fungicidal activities, Commerc sre 39 dog pooh been wed as ain on inanienatesuices. The most common disinfectant in the United States hypochlorite solutions (NaOCD, 5.2596-6.159%, refered wos Rowehold bleach The disinfecting capably of blah baci, virucidl,ungiidal, myeobact and spoticidal. It is inexpensive and effectiveness not decreased based on the quality of dhe water used in he sluon preparation, One disadvantage is shat hypochl ay cause minot ocular, oropharyngeal, and esophag ination fan individual is exposed eh Se ioe without proper ventilation. Ie also corr seals it high concentrations, discolors fabrics, and can produce 4 texie ga ifimpropely mixed with ammonia or acid in oth ceaming age. The Center for Diese Control and Pre rntion (CDC) recommends chat ‘ cet Ld spills with a 1:10, ‘ilu i ve be cleaned aftet tecause of their irritating Fumes, the; 7 dele and glutaraldehyde oe aldehydes en Foe diate aldehyde) are generally not used a8 su - Glutaraldehyde, which is sporicidal (kills ced for shorter pet syn living tissue (Skin) 1 or disinfecrants vA serial endosporess Bacterial sistant followed by oped viruses (C cceoorganis™ the most asporul exative (900 find enveloped Scanned By Scanner Appendospores) in 3.10 10 hours, is sed for medical equipment such as bronchoscopes, because ie does not corrode lenses, ein the presence of organic material, has also been wsed forthe surface steriliza tion of surgical instruments, ‘The use of glutaraldehyde or eraceti acd is called cold sterilization, PUQuaterary ammonium compounds are used to ds ‘meal, or eubber, Peracetic acid, effec fect bench tops or other surfaces in the laboratory. However, gross contamination with organic materials, such as blood, may inactivate heavy metals or quater yy ammonium com pounds, thus limiting their utility, They are most often used fn noncritical surfaces such as floors, furniture, and walls, Finally, phenolics, such as the common laboratory dls fectant Amphyl (Reckitt Benckiser, Parsippany, NJ), are de rivatives of carbolic acid (phenol), the addition of detergent results in a product that cleans and disinfects at the same time, and at concentrations of 2% to 5%, these products ate used for cleaning bench tops. Antiseptics Inaddition to decontamination of inanimate objects or su faces, personal laboratory safety and preparation of patients for invasive procedures require the use of an antiseptic. A variety of antiseptics are used to prepare a patients skin for blood draws or other invasive procedures. lodine is prepared cither as a tincture with alcohol or as an iodophor coupled to a neutral polymer (@-, povidone-iodine). Both iodine compounds are widely used antseptics. In fact, 70% eth- alcohol, followed by an iodophor, is the most common ‘compound used for skin disinfection before drawing blood specimens for culture or surgery Because mercury i toxic tothe environment, heavy met als containing mercury are no longer recommended. An eye drop solution containing 1% silver nieate was placed in the «yes of newborns ro prevent infections with Neisenia gonor- rhoeae. Silver nitrate however, is no longer manufactured in the United States. The current chemical treatment is ether an ointment containing erythromycin or povidone iodide ‘The most important point to remember when work ing with biocides, antseptics or disinfectants is to prepare 4 working solution of the compound exactly according to the manufacturer's package insert. Many individuals believe that if the manufacturer says to dilute 1:200, they will get 8 stronger product if they diluce it 1:10. However, the ratio of water to active ingredient may be critical, and if sufficient water is not added, the chemical for surface disinfection may not be effective Chemical Safety In 1987, OSHA published the Hazard Communication Standard, which provides for cerain institutional educ tional practices to ensure that all aboratory personnel have + thorough working knowledge of the hazards ofthe chemi «als with which they work. This standard has also been called the employee right wo know.” Ie man ates that all hazardous chemicals in the wo place be identified and clearly marked CHAPTER 4. Laboratory Safety with a National Wire Protection Association (NFPA) label statin gen (cause of can er), mutayen (cause of mutations in deoxyribonucleic acid [DNA| or ribonucleic acid [RNA}), or teratagen (cause of birth defects), and the hazaed class, for example, corrosive the health risks, stch as care (harmful to mucous membranes, skin, eyes, oF tissues), pot- sonous, flammable, or oxidizing (Figure 4-2) Fach laboratory should have a chemical hygiene plan that includes guidelines on proper labeling of chemi cal containers, manufacturers al safety data sheets (MSDS%), and the writien chemical safety raining, and retraining programs, Hazardous chemicals must be inven toried annually, In addition, laborories are required 10 maintain a file of every chemical they use and a correspond- ing MSDS. ‘The manufacturer provides the MSDS for every hazardous chemical some manufacturers ao provide letters for nonhazardous chemicals, such as saline, so that these can bye included with the other MSDSs. ‘The MSDSs include information on the nature ofthe chemical, the precautions to take ifthe chemical is spilled, and disposal recommenda- tions. ‘The sections in the typical MSDS include + Substance name + Name, address, and telephone number of manufacturer + Hazardous ingredients ‘+ Physical and chemical properties Fire and explosion daca Toxicity Health effects and firs aid Stability and reactivity Shipping daca Spill, leak, and disposal procedures Personal protective equipment Handling and storage NOTICE. CHEMICAL HAZARD Figure 4-2. Natona Fre Protection Associaton camond cathy werricalhazid,Tis inrmation ean be custied (a sho NO {er oprop alcoho) by applying tho appropat sl ose poles ter narnbor to the carson color ove! ana. Coxe) Lb Sooty Sy na, Wesson) Scanned By Scanner AppGeneral Pics with the location and Employers should become furs MSDS Biles in the Tree aere wo lok in she event ofan emergeney : nds (igure 4-3) ae prosded in the lbortor co pee inlitan of ox furs, Fame hoods protect sean chemical odor by exhausting air tothe ouside, but they are not HEA lered eo rap Fa seen Te portant 10 remember that a BSC (discussed Trin the cpt) noc a Fume hood. "Work with toxic or noxious chemicals should always be performed while wearing nite loves, in 2 fume hood ot Iie wearing fume mask. Spl shouldbe cleaned up us ing fame mask, gloves, impervious (impenetrable vo mois- ‘ute apron, and goals. Acid andallaline,fammable, and raiacive spl ts are avaiable to asi in rendering any ‘hema pil bares n of porary 20 that they Fire Safety Fest an ingen’ cmponen of be bre sey pagan ah idan equed open ee sin ps har a xen hpi Re Renee ears eit incase fie, Fie del com ret Fire ils conducted quartet or now wha main dear ofbstructio Pending on local laws, ensure that ll personel mrows nica atow through the found in most laboratories so that pe ‘Mbout which extinguisher co reach fo type Cestingishes, which contin fumes are also used, because this type of extinguisher docs 2, Activate the fire alarm. 3. Contain (smother) the fire, if feasible (close fire doors) Electrical Safety Hetil cords should be checked egulaly fr fying regularly for fraying a replaced when necessary. All plugs should be the dre tron, poundel ope. All sockets shouldbe checked f+ Clecrical grounding and leakage atleast annually. No ext son drshouldbewsed in helaborsory Handling of Compressed Gases cone 8 otindes (CO, anaerobic gas mine Sourain presutized gases and muse be propery handled a! secured. When ad must be properly handled a! ropeetls cesulking in loss of life and. destruction © Property. Therefore ga tan fe and destruct Cre Ft sould be propery ain! Scanned By Scanner Appper- h for vcher does nrder | the 13) gand hree- d for cure) dand ye be- on of ained . The alled, li reneatothe Glinders should be transported chained to special dollies (igure 4-4, 8). Biosafety Individuals are exposed in various ways to health care~ associated infections transporting specimens and in public areas such a elevators or cafeterias, by: ‘+ Rubbing the eyes or nose with contaminated hands * Inaling acrosols produced during centrifugation, mix- ing wich a vorce, oF spills of liquid culeures * Accidentally ingesting microorganisms by putting pens or fingers in che mouth Receiving percutaneous inoculation (ie. through punc- ture from an accidental needle stick) ‘Manipulating or opening bacterial cultures in liquid me- dia or on plates, crating potentially hazardous aerosols, outside of a biosaery hood Falure o wash hands upon leaving the restroom or other public areas before entering the laboratory Risks from 2 microbiology laboratory may extend adjacent laboratories and to the familie of those who work in the microbiology laboratory. For example, Blaser and ie noted that 5 of 31 individuals who contracted oid fever from proficiency testing specimens did not ork ina microbiology abort. Two pens were fimy members of a microbiologist who had worked with Salmo- nella enterica serotype Typhi; rwo were students whose af {Sean ss was inthe laboratory where she organism had =n caltured that morning, and one worked in an adjacent shemisy laboratory ’ cHapren 4 Laboratory Safety B, Ges cyinder chained in 8 doy dung varspartation In the clinical microbiology laboratory, shigellosis, sal- monelloss, uberculosis, brucellosis, and hepatitis are com- monly acquired laboratory infections. Additional infections have been reported from agents such as Coxiella burnetii, Frahcisella tularensis, Trichophyton mentagrophytes, and Coc~ cidioides immitis, Viral agents transmitted through blood and body fluids also cause many health care-associated infections in non-microbiology laboratory workers and in health care workers in general. These include hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HV), and human immunodeficiency virus (HIV). Lab- ‘oratory-associated infection is not a new phenomenon, but data are based primarily on voluntary reporting, Therefore such incidents are widely underreported because of fears of repercussions associated with such events. Exposure Control Plan The laboratory direcor and supervisor are legally responsible focensuring tha an Exposure Cont Plan has becn imple mented and thatthe mandated safery guidelines ae followed The pln Mendes as thar are haardous employes and promotes employee safety through use of the following + Employee education and orientation Appropriate disposal of hazardous waste Standard (formerly Universal) Precautions Engineering controls and safe work practices, as well appropriate waste disposal and use of BSC Personal protective equipment (PPE), such as labora- ‘ory coats, shoe covers, gowns, gloves, and eye protection (gogeles, face shields) Scanned By Scanner Appcnical irob11097 Genera Princip cigating all accident # +A posexposre plan for nv plan eo prevent recuren and Orientation Employee Educatior : ~ Fach nsianon howl baves safer mane cmnaon shoul bavessfey mal ae wal ty fcr who knowl. Sd rel oe eat lborory mnel, The mechanical action 0! wr rds i ea he HBV cn ree rared with bacillus Calmerte-Guérin lh caressed nf vovide orientation £0 rsly been vc previoudy (BCG), the employer should offer employment, although follow-up annua fre no longer recommended by the CDC. Disposal of Hazardous Waste ‘Almaaconeainned wih porentalynfctout ages tne destin! bere dipon Tend Tiel prion of pen specimens, azn culture oc (Shuts of mieorpisns, and dapoble sharp instru ‘Seu ach sg rnp ide, gle abe sails tinge th nets ef commended ta ings with needs wrk cep inthe abort, sat’ mem fe ul be equed to subi capped syringes to the lent. lnfetows wane may be decotaninaed by se cf cnsoicer incinego yon of eer seu werent meds, Some state ole manips permit lod sem, ring fs, ad other body fds o cally pol ino a santaty sever, Infectious wate fem micrebaloylaborort usualy autodaved on ste In 1986, the EPA publ guide co hazardous wae ‘educion cine he rmount of hardous wate enced sed eased int theenvronment These regulation cl for defillowng +" Subse ad ingles haados chemicals when posible for ‘example, substituting ethyl acetate for ether in ova and Parasite concentrations, for trichrome sans + Developing procedures that use less of * Segregatng infectious wast (paper) cash and Hemo-de in place of xylene hazardous chemicals te from uncontaminated infectious waste Recently several alternative wa we deepen eaten machines ‘ount of waste buted in sy Hise H egw Pak, Hino) smbine mechanical shredding th chemical (sodium hypochle ‘tevehlrne dioxide, peracetic acid), thermal (moist hex re conizing radiation (microwaves, radio wave dy ea or jon, Mise state regulations for these uni fequite at least a sixfold reduction in vegetative bacteria, fungi, mycobacteria, and enveloped viruses and at least « four-fold reduction in bacterial spores. Tafecious waste (agar plates, plastic tubes, and reagent bottles) should be placed into two leak-proof, plastic bap for sturdiness (Figure 4-5); this is known as double bag: fing, Sharp objects, including pipettes, microscope slides Broken glass, glass tubes or bottles, scalpels, and needles, are placed in sharps containers (Figure 4-6), then autoclaved or incinerated. landfills. These systems 00 compacting of the waste wit Standard Precautions In 1987, the CDC published guidelines known as Univer sal Precautions to reduce the risk of HBV transmission in clinical laboratories and blood banks. In 1996, these safety recommendations became known as Standard Precau- tions. These precautions require that blood and body fluids Eom gr patient be treated as potentially infectious. The ls of Standard Precautions and safe laboratory wot practices areas follows: ao * Do not ea, lip balm). Do not insert or remove contact lens Do not bite nails or chew on pens. De not mouth-pipen. : mit access to the laboratoy Assume all i Pathogens, Use appropriate bar maces eine barter precautions to prevent skin and al ines and mais, top or dropler formation oe rink, smoke, or apply cosmetics (including = FY to trained personnel only. Patients are infectious for all blood-borne ing wearing gloves at ion SES: BOWS, oF aprons if splash Scanned By Scanner AppA ae BET AE CHAPTER 4 Laboratory Safety a «Figure 4-6 Sharps containers, (Courtesy Lab Safety Supply, Janesville, Wisconsin) «+ Thoroughly wash hands and other skin surfaces after re- moving gloves and immediately after any contamination. «Take special care to prevent injuries with sharp objects such as needles and scalpels Standard Precautions should be followed for handling blood and body fluids, including all secreions and excre- tions submitted to the microbiology laboratory (e.g. serum, Semen, all sterile body fluids, saliva from dencal procedures, nd vaginal secretions). Standard Precautions applies +o blood and all body Aids, except sweat. Practice of Stan- dard Precautions by health care workers handling all patient material lessens the risks associated with such specimens. “Among the Standard Precautions, hand washing is one of the single most useful techniques to prevent the transmis- tion and acquisition of infection in a health care seting, Hand washing using running water with plain or antimi- ccobial soaps do not disrupt the normal microbiota but have demonsteated a reduction in transient microorganisms and viral agents. Studies have indicated that effective hand wash ing with plain soap versus antimicrobial products are both equally efficient and direcly correlates with the duration of the hand washing, All personnel should wash their hands with soap and water after removing gloves, after handling infectious material, and before leaving the laboratory area When hand washing is not available, waterless aleohol- based (60% ro 62%6) products provide a rapid and conve- iene means of controlling transmission of many organisms. However, aleohol-based products are not useful when hands are soiled or contaminated with other organic material such asblood and body fluids. Mouth: pipetting is striedy prohibited. Mechanical de- vices must be used for drawing all iquids into pipettes. Fat~ ing, drinking, and applying cosmetics are strictly forbidden in work areas. Food and drink must be stored in refrigera- tors in areas separate from the work area. In addition, i is good practice to store sera collected periodically from sll Feslth care workers so that, in the event of an accident, @ seroconversion (acquisition of antibodies to an infectious fagent) can be documented (see Chapter 9) “Al heath care workers should follow Standard Precau- tions whether working inside or outside the laboratory. ‘When collecting specimens outside the laboratory, individ- uals should follow these guidelines: ‘© Wear gloves and a laboratory coat. + Deal carefully with needles and lancets. 2 Discard sharps in an appropriate, puncture-resistant + Never recap needles by hand: if necessary, special safety devices are available. (Needles ae available with built-in safety devices to prevent accidental needle stick). Engineering Controls Laboratory Environment “The biohazard symbol should be prominently displayed on Jaboratory doors and any equipment (refrigerators, incuba~ tors, centifuges) that contains infectious material. The air- handling system of a microbiology laboratory should move air from lower to higher risk areas, never the reverse. Ideally, the microbiology laboratory should be under negative pres- sure,and ai should not be recirculated afer passing through. “The selected use of BSCs for procedures that generate infec- tious aerosols is critical to laboratory safety. Infectious disease, including the plague, tularemia, brucellosis, tuberculosis, and legionellosis, may be contracted through inhalation of infectious particles present in a droplet of liquid. Because blood isa primary specimen that may contain infectious vi- rus particles, subculturing blood culeures by puncturing the septum with a needle should be performed behind barrier Scanned By Scanner App