Operational Handbooks

* In this population, diagnostic testing for TB with LF-LAM and other methods is usually considered early on. See WHO consolidated guidelines on tuberculosis, Module 3: Diagnosis – Rapid diagnostics for tuberculosis detection (12)

1. WHO handbook for guideline development. Geneva: World Health Organization, 2012.

2. Laboratory biosafety manual, 3rd edition. Geneva: World Health Organization, 2004 (WHO/CDS/CSR/LYO/2004.11). (Also available from http://www.who.int/csr/resources/publications/biosafety/en/Biosafety7.pdf.)

The laboratory manager is responsible for maintaining spill response kits. Two spill response kits should be prepared: one placed outside the containment laboratory and one placed inside the laboratory. The kits should include the items listed below.

Spill response kit:

Always use sealed centrifuge buckets, and load and unload them in a BSC. If breakage occurs during centrifuging, broken tubes must be discarded in a puncture-resistant container and disposed of immediately.

Decontaminate centrifuge buckets by soaking them in a suitable disinfectant. Do not use bleach to disinfect metal parts because it causes corrosion. Alternatively, buckets may be decontaminated by autoclaving.

When a spill of infectious material occurs within a BSC, a clean-up procedure should begin immediately, and the cabinet should continue to operate.

1. Place absorbent tissue over the spill area, and apply disinfectant solution liberally.

2. If the walls of the BSC have been splashed, clean with a layer of absorbent paper towel liberally soaked in disinfectant solution.

3. Leave affected areas covered with disinfectant for 30 minutes to 1 hour.

4. Carefully collect contaminated sharps material, and place in a puncture-resistant container for disposal.

A spill of infectious material outside a BSC is considered a major event. Spills of infectious liquid will generate infectious aerosols. Everyone should immediately vacate the affected laboratory area. The laboratory manager should be informed of the incident immediately, and staff must be prevented from re-entering the laboratory for at least 1 hour to allow aerosols to be removed through the laboratory’s ventilation system and allow time for heavier particles to settle.

The plan should provide operational procedures for:

A written emergency preparedness plan for dealing with laboratory incidents and accidents is a necessity in any facility that works with or stores M. tuberculosis isolates.

• Staff should remove their gloves and thoroughly wash their hands before removing respirators. Only the straps should be handled; staff should avoid touching the front of the respirator.

Staff who use respirators must be trained. They should be taught to: