Operational Handbooks

In addition to the hazards described in Chapter 4 for TB laboratories classified as moderate risk, and the general risks that are addressed by the biosafety measures described in Chapter 2, laboratories classified as high-risk (or containment) also face the following challenges, all of which increase risks:

The term TB-containment laboratory refers to a facility that has the minimum design features necessary to safely manipulate TB cultures. This type of facility may or may not meet all of the requirements of a Biosafety Level 3 laboratory as described in WHO’s Laboratory biosafety manual.² All laboratory facilities must comply with local and national regulations.

In addition to the general risks that are addressed by the biosafety measures described in Chapter 2 (such as unauthorized persons in the laboratory, mouth pipetting, cluttered work stations, improper waste disposal), the TB laboratory classified as moderate risk also faces the following challenges, all of which increase risks:

The recommendations in this chapter are the minimum requirements needed to limit or reduce risks of infection in laboratories carrying out specific procedures that are considered to have a moderate risk of spreading TB. Additional measures may be deemed necessary following a site-specific risk assessment.

In addition to the general risks that are addressed by the biosafety measures described in Chapter 2, the low-risk TB laboratory may also face the following challenges, all of which increase risks:

• bench spaces may be used improperly;
• specimen containers may leak;
• specimens manipulated carelessly may lead to subsequent aerosolization;
• specimens may be shaken vigorously;
• ventilation or illumination may be poor. 

The recommendations in this chapter are the minimum requirements needed to limit or reduce risks of infection in laboratories carrying out specific procedures that are considered to have a low risk of spreading TB. Additional measures may be deemed necessary following a site-specific risk assessment.

All positive TB cultures must be autoclaved before disposal. An autoclave should be available close to or in the laboratory where TB culture is performed.

All contaminated (that is, potentially infectious) materials except sharps should be placed in disposable plastic bags before being transported for incineration. If possible, materials from TB laboratories should not be discarded in a landfill even after decontamination.

Broken slides and used slides must be disposed of in a sharps container. Containers for sharps disposal must be puncture-proof, have a fitted lid, and must not be filled to capacity. When they are three quarters full, they should be placed in containers for infectious waste and incinerated. Containers for sharps disposal must not be discarded in a landfill unless they have been incinerated or autoclaved. Used slides must not be reused.

A system for identifying and separating infectious materials and their containers should be adopted. Categories may include:

• uncontaminated (non-infectious) waste that can be reused, recycled or disposed of in the same way as general household waste;
• contaminated (infectious) sharps, such as broken glass, syringes and slides;
• contaminated infectious material to be disposed of by burying, incinerating or autoclaving.

The killing action of disinfectants depends on the population of organisms to be killed, the concentration used, the duration of contact, and the presence of organic debris.

Proprietary disinfectants recommended as suitable for use in TB laboratories are those containing phenols, chlorine or alcohol. These are usually selected depending on the material to be disinfected.

Phenol