APPENDIX C:  UNIVERSAL PRECAUTIONS/BIOSAFETY LEVEL 2 PRACTICES

Universal Precautions are suitable for activity (patient care and laboratory) involving human source material. Biosafety Level 2 (BSL 2) represents the laboratory safety level that corresponds to Universal Precautions.

It is important to understand that at these levels we are dealing with research, diagnostic or production activities thought to pose little or minimal hazards to workers.  To date, these procedures and practices have been considered sufficient to protect the work force.

The control of potential biohazards at the BL-2 level is provided by use of standard microbiological practices with the addition of personnel protective equipment (lab coat and gloves).  The following are procedures to be used with BL-2 containment requirements.

All specimens of blood or body fluids should be placed into a well-constructed container with a secure leakproof  lid.

Avoid contaminating the outside of the container or the requisition slip.

All persons processing laboratory specimens should wear gloves.  Gloves should be changed and hands washed if the gloves are crossly contaminated or damaged and after completion of specimen processing.

Take care to minimize the formation of droplets, spatters, splashes. and spills of  blood or  body fluids. Class 2 Biological Safety Cabinets should be used whenever  there is a high potential to produce droplets or aerosols of infectious materials.  This  includes blending, sonicating, vigorous mixing (vortexing), and homogenization. Biological safety cabinets are not needed for other routine work. Other primary   containment devices (e.g., centrifuge safety cups) should be used when manipulating cultured or concentrated infectious organisms outside a biological safety cabinet.

Mouth pipetting must not be done. Mechanical pipetting devices must be for all liquids in the laboratory.

Laboratory work surfaces should be decontaminated after a spill of blood or body fluid and at the completion of work

Contaminated material used in laboratory tests may be decontaminated in the laboratory before disposal (e.g., by autoclaving.  Material which is to be decontaminated at a site away from the laboratory, should be handled according to institutional policy.  It  should be placed in a leakproof, rigid biohazard container,  which is sealed before being removed from the laboratory.  If the outside of the container is contaminated, it should be enclosed in a second clean external container.

Contaminated clothing should be processed according to institutional policy.

Laboratory equipment should be cleaned and decontaminated prior to being repaired or transported to the manufacturer.

All persons should wash their hands after leaving the laboratory.  Protective clothing should be removed before leaving the laboratory.                        

Barrier Protection should be routinely used to prevent skin and mucous membrane contamination with blood, body fluids containing visible blood, or other body fluids to which universal precautions apply. Barrier protection should be used with all tissues. The type of barrier protection used should be appropriate for the type of procedure being performed and the type of exposure anticipated.

Gloves.  OSHA and CDC propose that gloves be worn when there is potential or hand skin contact with blood, other potentially  infectious material, or surfaces contaminated with these materials.  Gloves should be worn when:

• Performing routine laboratory work with blood, potentially infectious body fluids, and tissues.
• Touching mucous membranes and non-intact skin of patients.
• Handling items (potentially) contaminated with blood or body fluids, including specimen containers, laboratory instruments, counter tops, etc.
• Gloves should be changed immediately if contamination is visible.

Since all clinical specimens are to  be treated as infectious, laboratory workers should follow Biosafety Level 2 (BSL-2) practices when handling clinical specimens, blood, body fluids, or tissues.

BSL-2 procedures and practices incorporate Universal Precautions

Laboratory space should be sufficient to minimize crowding, which may contribute to laboratory accidents.

Laboratory surfaces, counters, and floors should be made of impervious materials to facilitate disinfection.

Good laboratory practices should be followed and eating, drinking, and smoking should not be permitted in the laboratory.  Direct and indirect hand-to-face contact should be avoided.

Adequate and conveniently located biohazard containers for disposal of contaminated materials should be provided.

Adequate decontaminating containers for reusable supplies should be provided.

Written decontamination, disinfection, and sterilization protocols should be developed for processing reusable supplies, laboratory equipment, laboratory waste, machine effluent, and environmental surfaces.  OSHA requires that written protocols be developed and enforced.

Facilities for hand washing should be provided in each laboratory area.  These should be separate from those used for washing equipment or for waste disposal.

Only authorized personnel should be allowed in the laboratory. Casual visitors should not be admitted.  Non laboratory personnel should be closely supervised and should use appropriate protective measures to ensure that they do not cause a hazard to themselves or to the laboratory staff.

Monitoring compliance is a major responsibility of both the staff and management of the laboratory.  The necessary educational, monitoring, and remedial programs should be defined, documented in writing, and rigorously enforced.  The cooperation of the institutional quality assurance program should be enlisted.

Signs and Labels

Implementing universal precautions eliminates the need for using specific warning labels on

specimens obtained from patients infected with HBV or HIV.  Whether warning labels are used or not, all specimens should be treated as if infectious and capable of transmitting serious infection. In addition, each work area must keep an Emergency Notification Sign posted on the entry doors This sign lists the names of persons who should be contacted in the event of any emergency

involving the work site.  While this Emergency Notification Sign may not specifically include a place for off hours telephone, please include these numbers whenever possible. Be sure that persons whose names appear on the list have telephone numbers in the telephone directory or list the telephone beside the name.  Be sure that the room number and supervisor's name are filled in at the top.  Review information at least annually and redate on bottom  left corner.                      

The use of radioactive or chemically hazardous substances in the work area also require special signs.

Signs which prohibit smoking, eating, drinking, etc. are to be posted in areas where work is conducted.

Eye protection is required in all areas where there is a splash potential to the eye.Safety glasses for visitors must also be available.                      

Signs indicating the location of fire blankets, safety showers, fire extinguisher, and other safety devices are also required.                          

Entrances to laboratories, storage areas, and associated facilities must have signs as necessary to warn other researchers, visitors, emergency personnel, custodians, etc. of radiaoactive, biological, or chemical hazards which may be present.