Despite
the processing of several thousand diagnostic specimens from patients
with SARS-CoV disease in routine clinical laboratories around the world,
to date there have been no reported clusters of SARS-CoV disease among
laboratory workers. To date, the only confirmed episode of SARS-CoV
transmission to a laboratory worker occurred in a research laboratory.
The risk of transmission to laboratory personnel is most likely during
specimen processing and handling of virus cultures.
A. Specimen Collection and Handling
Objective: Safely
collect and handle specimens from SARS patients to prevent transmission
of SARS-CoV.
Activities
- Healthcare
workers who collect specimens from SARS patients should wear PPE
as appropriate for Standard, Contact, and AII Precautions.
- Standard
facility procedures for specimen collection and transport to the
clinical laboratory should be followed.
- All
specimens should be appropriately contained (bagged if necessary)
and have a completed laboratory requisition slip attached. Information
on the requisition slip should indicate that the patient is or could
be infected with SARS-CoV. Laboratory personnel should be alerted
to the possibility of SARS-CoV to ensure safe handling procedures.
B. Laboratory Procedures
Objective: Safely
process SARS-CoV specimens to prevent transmission.
Activities
- Biosafety
levels 2 and 3, according to specimen type, are recommended for processing
SARS-CoV specimens. The specifics of these recommendations are provided
in Supplement F.
C. Postmortem Handling of Human Remains Objective: Safely handle human remains during autopsy
procedures to prevent transmission of SARS-CoV.
Activities
In general, safety procedures for human remains infected with SARS-CoV
should be consistent with those used for any autopsy procedure. However,
additional respiratory protection is needed during an autopsy procedure
that generates aerosols (e.g., use of oscillating saws).
Personal protective equipment (PPE)
- Wear
standard autopsy PPE, including a scrub suit worn under an impervious
gown or apron, eye protection (i.e., goggle, face shield), double surgical
gloves with an interposed layer of cut-proof synthetic mesh gloves,
surgical mask or respirator, and shoe covers.
- Add
respiratory protection if aerosols might be generated. This includes
N-95 or N-100 disposable particulate respirators or PAPR. Autopsy personnel
who cannot wear a disposable particulate respirator because of facial
hair or other fit limitations should wear a loose-fitting (i.e., helmeted
or hooded) PAPR.
- Remove
PPE before leaving the autopsy suite and disposed in accordance with
facility policies and procedures.
Engineering controls
- Whenever
possible, perform autopsies on human remains infected with SARS-CoV
in autopsy settings that have adequate air-handling system. This includes
a minimum of 6 (old construction) to 12 (new construction) ACH, negative
pressure relative to adjacent areas as per recommendations for AIIRs,
and direct exhaust of air to the outside or passed through a HEPA filter
if air is recirculated. Exhaust systems around the autopsy table should
direct air (and aerosols) away from healthcare workers performing the
procedure (e.g., exhaust downward).
- Use
containment devices whenever possible. Use biosafety cabinets for the
handling and examination of smaller specimens. When available, use
vacuum shrouds for oscillating saws to contain aerosols and reduce
the volume released into the ambient air environment.
Prevention of percutaneous injuries
- Follow
standard safety procedures for preventing percutaneous injuries during
autopsy.
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