Table 3 Biocontainment and mitigation regulations for Rickettsia and Orientia spp
Laboratory studies | ||||
|---|---|---|---|---|
Country | Regulations | Activity | Low-risk | Enhanced-risk |
USA | BMBL 6th ed [35] | Clinical | “BSL-2 practices and facilities are recommended for nonpropagative laboratory procedures with inactivated samples, including serological and fluorescent antibody procedures, nucleic acid amplification, and for the staining of impression smears after fixation.” | “BSL-3 practices and containment equipment are recommended for activities involving culture propagation or specimen preparation and propagation of clinical isolates known to contain or potentially containing Rickettsia spp. pathogenic to humans.” “Laboratory work with Rickettsia spp. may be conducted in a BSL-2 facility with enhanced special practices including strict access control, competency, and adherence to BSL-3 practices. Laboratories should be locked and access to non-essential personnel should be prohibited. BSL-3 practices include, but are not limited to, appropriate personal protective equipment (e.g., rear-closing gowns, gloves, eye protection, and respiratory protection such as N95 respirators or PAPRs), use of BSCs when handling any open container with potentially infectious material, and primary containment, such as sealed centrifuge rotors and other means of containment outside the BSC. Disruption of infected cells or yolk sacs should be accomplished within the BSC using an enclosed chamber to minimize the potential for aerosols. If eggs are used for propagation, the site of inoculation should be sealed with an appropriate sealant prior to transfer to an incubator. BSL-2 facilities with BSL-3 practices are recommended for all manipulations of known or potentially infectious materials, including the necropsy of experimentally infected animals and trituration of their tissues, and inoculation, incubation, and harvesting of embryonated eggs or cell cultures. Use of sharps should be minimized. When use of sharps is necessary, they should be disposed of and decontaminated appropriately. All contaminated materials should be effectively decontaminated before removal from the laboratory. If transport to an autoclave is necessary, materials should be double-bagged.” |
Research | “Several species including R. montanensis, R. rhipicephali, R. bellii, R. amblyommatis, and R. canadensis are not known to cause human disease and may be handled under BSL-2 conditions. New species are frequently described and should be evaluated for appropriate containment on a case-by-case basis.” | As per clinical activity | ||
Canada | PSDS [10] | RMSF | “Containment Level 3 facilities, equipment, and operational practices for work involving infected or potentially infected material, including necropsy of infected animals, arthropods, inoculation, incubation and harvesting of embryonated eggs or tissue cultures. Personnel entering the laboratory should remove street clothing and jewellery, and change into dedicated laboratory clothing and shoes, or don full coverage protective clothing (i.e., completely covering all street clothing). Additional protection may be worn over laboratory clothing when infectious materials are directly handled, such as solid-front gowns with tight fitting wrists, gloves, and respiratory protection. Eye protection must be used where there is a known or potential risk of exposure to splashes. All activities with infectious material should be conducted in a biological safety cabinet (BSC) or other appropriate primary containment device in combination with personal protective equipment. Centrifugation of infected materials must be carried out in closed containers placed in sealed safety cups, or in rotors that are loaded or unloaded in a biological safety cabinet. The use of needles, syringes, and other sharp objects should be strictly limited. Open wounds, cuts, scratches, and grazes should be covered with waterproof dressings. Additional precautions should be considered with work involving animals or large-scale activities” | |
UK | ACDP [37] | Clinical | “There may be other circumstances or types of work involving biological agents not specified in the list or Annex 1 where full containment measures may not be appropriate. A specific example is work where, although there is a strong indication or likelihood that certain Hazard Group 3 agents might be present, the work will not lead to an increase in the risk of exposure to the agent. For example, blood-borne viruses (BBVs) are unlikely to infect by an airborne route during diagnostic procedures not involving propagation or concentration of the virus (eg haematology), testing of blood donations or transfusion, serology and drug assays. Providing appropriate precautions are taken, not all the stated CL3 measures may be required.” | |
Research | As per clinical activity | As per clinical activity | ||
Australia | AS/NZS 2243.3.2010 [38] | Clinical | “The risk group classifications listed in Table 3.1 to 3.7 are appropriate for small-scale laboratory operations with microorganisms of Risk Groups 2 and 3” | “Where larger volumes or very high concentrations of the microorganisms are to be handled, the risk of infection or inadvertent release from containment can be higher and additional precautions or an increase in physical containment level may be appropriate” |
Research | As per clinical activity | As per research activity | ||
Thailand | Pathogens and Animals Toxins Act 2015 [41] | Clinical | Routine diagnostic laboratory processing within hospital laboratories can be performed in BSL-2 laboratories with strict adherence to Good Laboratory Practice guidelines. | Culturing with the aim of producing large amounts of bacteria should be performed in BSL3 laboratories or equivalent safety level (BSL2 enhanced) |
Research | As per clinical activity | As per research activity |