UK DoH Advice On Dangerous Pathogens
UK DoH Advice On Dangerous Pathogens
UK DoH Advice On Dangerous Pathogens
Work in
cytogenetics
laboratories
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Supplement to ACDP guidance on protection against blood-borne infections in the workplace: HIV and hepatitis
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Supplement to ACDP guidance on protection against blood-borne infections in the workplace: HIV and hepatitis
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Supplement to ACDP guidance on protection against blood-borne infections in the workplace: HIV and hepatitis
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Supplement to ACDP guidance on protection against blood-borne infections in the workplace: HIV and hepatitis
15. For emphasis, the earlier recommendations are (in part) reproduced
below.
Anyone responsible for taking and/or despatching
specimens or other potentially hazardous material for
laboratory examination has duties under the Health and
Safety at Work etc. Act (HSWA) and the COSHH
Regulations to conduct the work safely. One specific
requirement (covered by Section 3 of the HSWA) is to
convey knowledge of known or suspected hazards to those
who need to handle any material that is sent for
examination, and this may be achieved by inclusion of
clinical details on the request form which accompanies
the specimen. Such information however is confidential
and should not be readable by persons handling the
specimen while it is still contained in its packaging.
Use of some form of danger of infection label; (e.g. a
yellow biohazard sticker) is appropriate for labelling
specimens known or suspected to come from individuals
with BBV infections. The specimen container should be
labelled on the outside and be clearly visible. The
accompanying paperwork should also be appropriately
labelled. It is good practice for those requesting tests to
provide as much information as is relevant, consistent
with maintaining patient confidentiality, with any request
for a laboratory investigation.
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Supplement to ACDP guidance on protection against blood-borne infections in the workplace: HIV and hepatitis
APPENDIX
ASSESSMENT OF RISK OF PROPAGATION OF HIV IN TISSUE CULTURE IN
CYTOGENETIC LABORATORIES
RISK ASSESSMENTS FOR INDIVIDUAL SAMPLE-TYPE CULTURES
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Supplement to ACDP guidance on protection against blood-borne infections in the workplace: HIV and hepatitis
cells which, although of poor quality, can be used to diagnose many of the
common cytogenetic abnormalities. Direct preparations do not require
culturing, although sometimes the tissue may be placed in an incubator
overnight prior to processing. CVS however are also usually cultured to
improve diagnostic accuracy. Cells derived from the mesenchyme core of
the villus are cultured in a way similar to amniocytes. A CVS sample
needs to be manually processed on receipt, in order to remove any
maternal decidua or clotted blood adhering to the villus. This is achieved
most effectively by the use of sharp needles.
Risk assessment
There is no evidence that CVS cultures
support the production of HIV. While any associated macrophages
may be infected with HIV, these cells do not grow well under
routine culture conditions.
However, the initial sample, particularly if contaminated with
blood from a patient infected with HIV, could present a risk during
processing. There is epidemiological evidence to show that the risk
from percutaneous injury with a hollow bore needle is greater than
with a solid needle. For example, needlestick injuries in health care
workers, involving hypodermic syringes, are associated with a
greater risk of HIV transmission than injuries in surgeons using
suture needles. In addition, there is experimental evidence to show
that there is a significantly greater wiping effect (90%) through
wearing disposable latex gloves in percutaneous injuries involving
solid needles compared with hollow bore needles. This reinforces
the need to wear disposable protective gloves when handling and
processing samples, and to avoid the use of sharps wherever
possible. When the use of sharps is essential, particular care must
be taken, and solid needles should be used for dissection rather
than syringe needles.
In HIV high risk cases, the use of plastic pipettes should also be
considered for manipulating the specimen, where the condition of
the sample allows it. Great care should also be exercised in
handling glass coverslips when in situ culture techniques are
employed.
5. Solid tissue samples: Tissue biopsies and post mortem samples are
grown for cytogenetic, biochemical and molecular analysis from a variety
of sources, and also stored as cell lines. Common samples used in
diagnostics include tissues from early products of conception, fetal tissues
(e.g. skin, fascia lata, pericardium, muscle, amnion, chorion etc.), and skin
biopsies from neonates, children and adults. Cells are often in culture for
3-4 weeks.
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Supplement to ACDP guidance on protection against blood-borne infections in the workplace: HIV and hepatitis
Risk assessment
There is no evidence that fibroblast
cultures support the sustained production of HIV. Whilst
Langerhans cells in skin samples may contain HIV, the cells do not
grow well under routine culture conditions. The associated
keratinocytes are unlikely to be susceptible. However, the initial
sample, particularly if contaminated with blood from an HIVinfected patient, could present a risk during processing. As with
CVS samples, when the use of sharps is essential, particular care
must be exercised in their handling and disposal.
6. Marrow samples: Diagnosis and prognosis of leukaemia patients is
assisted by cytogenetic analysis of marrow cells. Although some analysis is
done on direct preparations, where culturing time is limited by the action
time of the spindle inhibitor, colcemid, most laboratories use a range of
culture times from overnight to 48 hours incubation, and occasionally as
long as 72 hours. In some lymphoid disorders, a B-cell mitogen may be
used. Leukaemia patients may be immunosuppressed, increasing chances
of infection. Adult T-cell leukaemia may, rarely, be caused by HTLV1, but
the prevalence of HTLV1 infection in the UK is thought to be very low.
Risk assessment
It is very unlikely that there would be any
significant production of HIV in the culture regimens normally
employed with marrow samples.
7. Solid tumour samples: Samples from patients with other forms of
cancer are increasingly being analysed using cytogenetic techniques.
Although some malignant tissue, such as lymphomas, contain
spontaneously dividing cells, long-term cell culture of 10-60 days is also
necessary in most cases.
Risk assessment
It is most unlikely that cultures established
from solid tumours would be a productive source of HIV. Shortterm cultures established from lymphomas present no significant
risk. However, a separate risk assessment should be made in each
case that may potentially involve permissive cells. Immortalised cell
lines derived from lymphoid cells should probably be subject to the
same containment conditions as lymphoblastoid cell lines, and
handled at CL2+. In samples from patients presenting with
lymphadenopathy, the possibility of HIV, or HTLV1 infection
being the cause should be considered.
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Supplement to ACDP guidance on protection against blood-borne infections in the workplace: HIV and hepatitis