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2. Health-care workers should practise hand hygiene before and after any direct contact
with patients. 3.
Personnel should also comply to the immunization policy of the hospital. Generally health-care workers should be immune to measles, mumps, rubella, varicella and
influenza. 4.
Personnel with active upper respiratory infection should avoid attending to patients.
6.9.7 Visitors
1. Written policies for visitors should be documented and made available.
2. Restriction to visitor numbers to two per patient at any one time is recommended.
Visitors are requested to practice hand hygiene before any contact with patient and should not sit on patient’s bed.
3. Children under 12 years are not allowed.
4. Visitors who have communicable infections e.g. upper respiratory tract infections,
recent exposure to communicable infections, active shingles, recent vaccination within 6 weeks should not be permitted.
6.9.8 Surveillance cultures
1. Routine bacteria and fungal cultures of asymptomatic patients, environment,
equipment and devices are not recommended. 2.
Colonization with MRSA may be eradicated with 0.2 chlorhexidine or mupirocin. This may be indicated during outbreaks.
3. An outbreak e.g. twofold or greater increase in aspergillus infections during any 6
month period may suggest a lapse in infection control procedures and attention to environment or ventilation should be carefully evaluated.
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6.10.1 General Principles
In this topic, references are made to the relative hazards of infective microorganisms by risk group WHO Risk Groups 1, 2, 3 and 4. This risk group classification is to be used for
laboratory work only. This risk group classification is to be used for laboratory work only. Table 1 describes the risk groups.
Table 1. Classification of infective microorganisms by risk group
• Laboratory facilities are designated as Biosafety Level 1 basic, Biosafety Level 2
basic, Biosafety Level 3 containment, Biosafety Level 4 maximum containment. •
Biosafety level designations are based on a composite of the design features, construction, containment facilities, equipment, practices and operational procedures
required for working with agents from the various risk groups. •
The assignment of an agent to a biosafety level for laboratory work must be based on a risk assessment. Such an assessment will take the risk group as well as other
factors into consideration in establishing the appropriate biosafety level. •
Table 2 summarizes the facility requirements at the four biosafety levels. A microorganism that is unlikely to cause human
or animal disease. A pathogen that can cause human or animal
disease but is unlikely to be a serious hazard to laboratory workers, the community, livestock or
the environment. Laboratory exposures may cause serious infection, but effective treatment
and preventive measures are available and the risk of spread of infection is limited.
A pathogen that usually causes serious human or animal disease but does not ordinarily spread
from one infected individual to another. Effective treatment and preventive measures are available
A pathogen that usually causes serious human or animal disease and that can be readily
transmitted from one individual to another, directly or indirectly. Effective treatment and preventive
measures are not usually available.
1 2
3
4
no or low individual and community risk
moderate individual risk, low community
risk
high individual risk, low community risk
high individual and community risk
Group Risk
Type of infective organism
6.10 Laboratory
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Biosafety Level . 1
2 3
4 Isolation
a
of laboratory No
No Yes
Yes Room sealable for decontamination
No No
Yes Yes
Ventilation: - Inward airflow
No Desirable
Yes Yes
- controlled ventilation system No
Desirable Yes
Yes - HEPA-filtered air exhaust
No No
YesNo
b
Yes Double-door entry
No No
Yes Yes
Airlock No
No No
No Airlock with shower
No No
No Yes
Anteroom No
No Yes
- Anteroom with shower
No No
YesNo
c
No Effluent treatment
No No
YesNo
c
Yes Autoclave:
- on site No
Desirable Yes
Yes - in laboratory room
No No
Desirable Yes
- double-ended No
No Desirable
Yes Biological safety cabinet
No Desirable
Yes Yes
Personnel safety monitoring capability
d
No No
Desirable Yes
Table 2. Summary of biosafety level requirement
a Environmental and functional isolation from general traffic
b Dependent on location of exhaust see chapter 4
c Dependent on agent s used in the laboratory
d For example. Window, closed-circuit television, two-way communication
Thus, the assignment of a biosafety level takes into consideration the organism pathogenic agent used, the facilities available, and the equipment practices and procedures required to
conduct work safely in the laboratory.
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6.10.2 Guidance And Recommendations
Diagnostic and health-care laboratories public health, clinical or hospital-based must all be designed for Biosafety Level 2 or above. As no laboratory has complete control over the
specimen it receives, laboratory workers may be exposed to “high risk group” organisms. Therefore, standard precautions should always be adopted and practiced, as well as to
promote good i.e. safe microbiological techniques GMT.
6.10.3 Code of Practice
This code is a listing of the most essential laboratory practices and procedures that are basic to GMT. Each laboratory should adopt a safety or operation manual that identifies
known and potential hazards, and specifies practices and procedures to eliminate or minimize such hazards. The most important concepts are listed below.
6.10.3.1 Access
1. The international biohazard warning symbol and sign must be displayed on the doors of the rooms where microorganisms of Risk Group 2 or higher risk
groups are handled. Table 1 2. Only authorized persons should be allowed to enter the laboratory working
areas. 3. Laboratory doors should be kept closed.
