Biosecurity measures must be appropriate and not excessive

During the COVID-19 pandemic, the biosecurity risk assessments for nucleic acid testing were requested by health officials. However, other biosafety examinations and control reports were less often carried out for other laboratory tests. These biosafety risk assessments should be strengthened before testing samples from patients with COVID-19.

A study recently published in the American Journal of Infection ControlI, “Biosafety Risk Assessment and Risk Control of Clinical Laboratory in Designated Hospitals for COVID-19 Treatment in Chongquing, China”, discussed this topic and conclusions. During the COVID-19 pandemic, Chinese health authorities have adopted a series of effective measures, including nucleic acid testing of SARS-CoV-2 among large-scale populations, as well as prompt and timely diagnosis and treatment. of COVID-19, which has played a key role in controlling the epidemic in China.

Investigators found that “[t]The most important aspect of biosecurity risk assessment is to take appropriate but not excessive control measures for biosecurity risks against risks of different degrees of hazard, which can not only reduce the risk to a range acceptable, but also save resources and improve work efficiency,” the investigators wrote in the study. “For the same pathogenic microorganism tested in different testing activities, the degrees of biosafety risk existing in these testing activities are different, and they should be operated in laboratories with different biosafety levels. Therefore, it is inappropriate to unilaterally point out that the level of biosafety of the laboratory must be consistent with the level of danger of the pathogenic microorganisms tested in the laboratory.

At present, although many members of laboratory management emphasize biosafety assessment, management has ignored biosafety risk management after assessment. “Even if subsequent testing activities or pathogenic microorganisms exposed to laboratory personnel had changed, the biosecurity risk assessment was not restarted and the biosecurity risk control did not change accordingly. Biosecurity risk management is based on self-inspection and dynamic monitoring. investigators said.

The investigators determined that the residual risk after the implementation of the control measures was acceptable.

If clinical laboratory workers testing SARS-CoV-2 used a nucleic acid preservation solution containing viral inactivators, the biosafety risk in the process of detecting SARS-CoV-2 nucleic acid will be low. Since patients in China infected with SARS-CoV-2 are sent to designated hospitals for treatment except for the detection of SARS-CoV-2 nucleic acid, other laboratory tests such as bacterial culture can also be performed during the treatment of patients. However, investigators said that in addition to nucleic acid testing, the biosafety risks in testing these items for patients with COVID-19 could be overlooked. “Therefore, we have identified and assessed the risks in these detection processes and formulated appropriate, but not excessive, control measures for biosecurity risks, in order to improve work efficiency and prevent accidents related to biosecurity.”

Investigators identified a total of 32 risks in the following categories:

• Personal,
• Disinfectants,
• testing process,
• Biosafety Equipment,
• Facilities and environment,
• Waste after test,
• Emergency procedures.

The main risks included the following:

• A risk of infection of people or contamination of the environment due to a malfunction of the air flow or the filtration of the biological safety cabinet (ESB),
• A risk of contamination of the environment or infection of personnel resulting from incorrect selection of the concentration of laboratory disinfectants and failure to obtain the disinfectant effect,
• A risk of staff hands being contaminated with sample tubes, which are contaminated during sample collection during the sample receiving process,
• A risk of contamination of the environment or objects by contaminated hands when removed from the BSC during the process of operation in the BSC,
• Risk of specimen contamination of microscope objective and stage during microscopic examination of faecal specimens.

Biosafety risk monitoring includes monitoring changes in testing activity, pathogenic microorganisms involved, monitoring changes in the dose of pathogenic microorganisms used, sample types, and monitoring for risks not identified.

Finally, the investigators recommend that laboratory management annually review the adequacy of laboratory biosafety risk assessment and biosafety risk control, and promptly begin risk assessment, which is also part of risk management. risks.