Chapter 10: Incident Response

Personnel Exposures

Exposure to an infectious agent, which includes recombinant or synthetic nucleic acid molecules, generally does not constitute an emergency in the same sense that a severe physical injury does. In the absence of physical injury, the emphasis when responding to an exposure incident involving a biological agent is on decontamination of affected persons to minimize the likelihood of infection and the spread of contamination. In some cases, the effectiveness of post-exposure prophylactic measures decreases significantly with time; therefore, it is recommended that a medical evaluation be obtained as soon as possible following all exposure incidents.

First Aid for Personnel Exposures

Percutaneous Inoculation

Wash affected area thoroughly using soap and water. Use of chemical disinfectants to treat the affected area is generally not recommended and can produce skin irritation that could increase the likelihood of infection.

Skin Exposure

Wash affected area using soap and water. Use of chemical disinfectants or abrasives to treat or clean the affected area is generally not recommended and can increase the likelihood of infection.

Eye and Mucous Membrane (Nose and Mouth) Exposure

Rinse affected areas thoroughly with water using an eye wash, sink faucet, or other means. It is recommended that eyes be rinsed for a minimum of 10 minutes. If ingestion or contact with the mouth or oral cavity occurs, the mouth should be rinsed thoroughly several times using water or antiseptic mouthwash if available.

Inhalation

If inhalation of infectious aerosols is suspected, decontaminate potentially exposed areas as described above.

Personnel Exposure Response Procedure

  1. Alert others in the immediate area that an exposure incident has occurred and ask for assistance as needed.
  2. Perform first aid as described above. Remove contaminated clothing as required to allow thorough removal of potential contamination and to prevent spread of contamination.
    1. If a large area of skin was exposed, shower and wash hair if a personnel shower is available in the immediate area. If a shower is not available, don “cover-up” clothing to cover all affected areas (including hair) as required to prevent spread of contamination.
  3. Seek medical evaluation as described below.

Seeking Medical Evaluation

Personnel who are employed by the University of Nevada, Reno (for example, faculty, staff, graduate research or teaching assistants) or are formally designated volunteers are covered by Workers’ Compensation. Employees who experience an occupational injury or exposure to a biological agent or chemical should go to one of the below facilities for medical evaluation and treatment.

Students with no employee status who are exposed to a biological agent or chemical, or injured, can seek medical attention at the Student Health Clinic or the medical facility of their choice. The medical facility should be called for guidance on decontamination, entrance to the facility, etc., prior to transport of the affected person. Students with no employee status are responsible for payment of any healthcare costs.

Reno

Occupational Health Clinic (within Patient Centered Family Medicine on the UNR campus)
101 East Stadium Way,
Reno, NV 89557
(775) 784-1100
Monday- Friday, 8 a.m.- 5 p.m.

Concentra Medical Centers
6410 South Virginia Street
Reno, NV 89511
(775) 322-5757
Hours: Monday- Friday, 8 a.m.-6 p.m.
Saturday, 8:00 am to 2:00 pm

ARC Health & Wellness Centers
2205 Glendale Avenue
Suite 131
Sparks, NV 89431
(775) 331-3361
Hours: Monday-Friday, 8 a.m.-5 p.m.

Nevada Occupational Health Clinic
3488 Goni Road
Suite 141
Carson City, NV 89706
(775) 887-5030
Hours: Monday-Friday 7:30 a.m.-5 p.m.

For life threatening injuries or treatment outside of Urgent Care facility business hours:

St. Mary’s Hospital
235 W. 6 th St.
Reno, NV 89503
(775) 770-3800

Las Vegas

Concentra Medical Center
3900 Paradise Rd., Suite V
Las Vegas, NV 89169
(702) 369-0560
Monday-Friday, 7 a.m.-6 p.m.

Concentra Medical Center
5850 S. Polaris Rd., #100
Las Vegas, NV 89118
(702) 739-9957
Open 24 hours, 7 days a week

Note: Other medical facilities can also be used as response time or available medical expertise dictates. Information for all authorized occupational health clinics is available through the BCN Worker's Compensation website.

Upon arrival at the medical facility, report the incident as work-related. The affected employee will be asked to complete a C-4 form (Employee’s Claim for Compensation/Report of Initial Treatment). After returning to work, the affected employee must complete a C-1 form (Notice of Injury or Occupational Disease Incident Report). Contact the Workers’ Compensation Office at (775) 784-4394 if there are any questions regarding reporting or filing of a Workers’ Compensation claim.

Transport of Exposed Personnel

In the event of a personnel exposure or injury, University employees that are aware of the incident are expected to take action to arrange the transport of affected personnel to a medical facility; however, University employees are not required to actually transport injured or exposed personnel. Due to potential for spread of infectious contamination and worsening of the affected person’s medical condition during transport, it is generally recommended that exposed or injured persons be transported by ambulance. Other transport options include transport by a University employee when requested by the affected person and agreed to by the transporting employee (preferably using a university-owned vehicle), and self-transport when the injured person is judged to be able to do so safely (however, self-transport is not recommended if other options are available).

Biohazardous Spill Cleanup

Spills of biohazardous agents, which include recombinant and synthetic nucleic acid molecules, do not all represent the same risk to personnel or the environment, making each spill somewhat unique. Nevertheless, preplanning of spill response will lower the risk of cleaning up a spill and will increase the likelihood that the spill is handled appropriately. Laboratory supervisors should prepare their laboratory for typical spill scenarios expected in the laboratory. Laboratory workers should be informed of the hazards of the biological agents used in the laboratory, the risk associated with the agents during spill scenarios, how to safely cleanup spills involving the agents, and proper disposal of cleanup materials.

Each laboratory area should have spill cleanup materials available to respond to the largest spill anticipated for that area. It is recommended that as a minimum, the following spill cleanup materials be available in the laboratory:

  • Gloves - thick chemical resistant gloves or double pair of thin, nitrile gloves recommended
  • Safety Goggles - face shield is strongly recommended to avoid splashes to the nose and mouth
  • Lab coat or smock to protect clothing and body
  • Absorbent pads
  • Disinfectant appropriate for the agents used in the laboratory
  • Forceps or other devices to pick up contaminated material (especially sharps)
  • Sharps disposal container
  • Autoclavable biohazard bags

The chemical spill kits distributed by EH&S to laboratories contain thick nitrile gloves, absorbent pads, and forceps. Additional items needed for cleanup of biological agents can be added to your chemical spill kit in order to customize it for your laboratory.

Biological Agent Spill Cleanup Procedures

There are several factors that must be considered when assessing the risk that a spill represents. These factors include:

  • Volume and concentration of the spilled material
  • The infectious dose of the spilled material and routes of transmission
  • Location of the spill
  • Degree of aerosolization of the agent resulting from the spill
  • Susceptibility of the spilled material to disinfection
  • Nature of the affected surface(s) and its ability to “hide” organisms from disinfection
  • Immune status of immediate personnel

As with any spill scenario (biological, chemical, or radiological) the safety of personnel is the most important consideration. Cleanup is to begin only after it is determined that the personnel who will clean up the spill have appropriate knowledge, training, and equipment.

The following are general spill cleanup procedures that are appropriate for most spill scenarios involving biological agents, including recombinant and synthetic nucleic acid molecules; however, the appropriate response to any spill is based on an assessment of the risk associated with that particular situation.

The following guidance is intended for spills of BSL-1 and BSL-2 agents. Spill response for BSL-3 agents is provided by the facility-specific procedures developed for each BSL-3 laboratory.

Spills Inside Biological Safety Cabinets

  1. Wear laboratory coat (disposable recommended), safety glasses, and gloves (appropriate for the >biological agent and the chemical disinfectant) during cleanup.
  2. Allow the biological safety cabinet to run continually during cleanup.
  3. Surround the affected spill area with absorbent material to prevent spread of the spill.
  4. Cover the spill with absorbent material and gently apply disinfectant appropriate for the biological agent in sufficient quantity to saturate the absorbent material. Alcohol or other flammable liquids are not recommended. Allow a minimum of 20 minutes contact time (or as directed by manufacturer’s instructions) and then place absorbent material into a biohazardous waste bag. Allow 30 minutes of contact time if the spill involves a pathogenic spore-forming agent. If practical, use tongs to handle absorbent material to avoid contact with gloved hands.
  5. Thoroughly apply disinfectant to the area that was under the absorbent material and allow contact time as practical (20 minutes or as directed by disinfectant manufacturer). Wipe the walls and work surface of the BSC, and any equipment in the cabinet with disinfectant-soaked towels.
  6. Place contaminated items in an appropriate container (biohazard waste bag, sharps container,
  7. or autoclavable pan with lid for reusable items) for autoclaving.
  8. Thoroughly wipe non-autoclavable items with an appropriate disinfectant before removing from the BSC. When possible, allow items to have a minimum of 20 minutes contact time with disinfectant (or as directed by manufacturer’s instructions) to ensure disinfection.
  9. Remove protective clothing and place in a biohazard waste bag for autoclaving.
  10. Thoroughly wash hands, forearms, and face with soap and water.
  11. Allow BSC to run for a minimum of 5 minutes before resuming work in the cabinet or shutting the cabinet off.

Spills In the Laboratory, Outside the Biological Safety Cabinet

  1. If a BSL-1 agent (or less than 100 ml of a BSL-2 agent) is spilled, proceed to step 4.
  2. The specification of 100 ml is a guideline. In some cases, a smaller spill volume of a BSL-2 agent may justify a more conservative response, including evacuation of the lab as described in step 2. Each laboratory should conduct their own risk assessment and develop a laboratory-specific SOP as appropriate.
  3. If the spill involves greater than 100 ml of a BSL-2 agent, immediately evacuate all personnel from the affected area. Wait for aerosol to settle (usually a minimum of 30 minutes) before entering the spill area. Exception: If the laboratory is not under negative pressure, cleanup should begin as soon as possible to minimize the spread of aerosols.
  4. Notify EH&S at 327-5040 (24 hour contact number) as soon as possible for assistance with the cleanup. Consult with the laboratory supervisor (as available) and EH&S to determine the most appropriate spill response. If it is determined that laboratory personnel can safely clean up the spill, proceed as indicated below.
  5. Remove any contaminated clothing and place in a biohazard waste bag for autoclaving, and wash all areas affected by skin contact with soap and water. Notify the BSO of all personnel contamination incidents.
  6. Wear a long-sleeved gown or lab coat (disposable recommended), safety glasses (face shield also recommended), and gloves (appropriate for biological agent and disinfectant). Shoe covers can be worn if available to help prevent contamination of shoes and to facilitate contamination control.
  7. Place absorbent pads over the spill (to absorb liquid), then gently add disinfectant in sufficient quantity to saturate the absorbent pads.
  8. Allow a minimum of 20 minutes contact time (or as directed by manufacturer’s directions) with the disinfectant and then place absorbent material into a biohazardous waste bag. Allow a minimum of 30 minutes contact time if the spill involves a pathogenic spore-forming agent. If practical, use tongs to handle absorbent material to avoid contact with gloved hands.
  9. Thoroughly apply disinfectant to the area that was under the absorbent material and allow contact time as practical (20 minutes or as directed by disinfectant manufacturer). Collect absorbent material in a biohazardous waste bag for autoclaving.
  10. Wipe down all equipment, tools, etc. that might be contaminated with disinfectant and allow contact time with disinfectant as practical. If the agent was spilled on the floor, it is generally recommended that the entire floor be mopped with disinfectant.
  11. Place contaminated items in an appropriate container (biohazard waste bag, sharps container, or autoclavable pan with lid for reusable items) for autoclaving.
  12. Remove protective clothing and place in a biohazard waste bag for autoclaving.
  13. Thoroughly wash hands, forearms, and face with soap and water. It is recommended that cleanup personnel shower as soon as possible.

Spills Inside a Centrifuge

  1. Clear the area of all personnel and allow aerosol to settle (usually a minimum of 30 minutes) before re-entering the area.
  2. Wear a laboratory coat (disposable recommended), safety glasses, and gloves during cleanup. If it is felt that the rotor or safety cups were breached, a N95 respirator, Powered Air-Purifying Respirator (PAPR), or other HEPA filtered respirator may be needed. Contact laboratory supervisor or EH&S for specific guidance.
  3. Transfer the centrifuge rotor to a biological safety cabinet for cleanup.
  4. Using an appropriate disinfectant, thoroughly disinfect the inside of the centrifuge, and the rotor.
  5. Discard cleanup materials and protective clothing as biohazardous waste.
  6. Thoroughly wash hands, forearms, and face with soap and water.

The following guidance is intended for spills of toxins.

Spill clean-up is only to be completed by personnel with documented training that are utilizing the proper personal protective equipment. The required PPE for cleaning up a toxin spill includes a laboratory coat or gown (disposable recommended), safety glasses, and two pairs of disposable nitrile gloves or thick chemical resistant gloves.

Liquid Spills

  1. Don the appropriate PPE.
  2. For chemical inactivation*, cover the spills with absorbent pads or towels and apply the appropriate chemical inactivating agent starting at the perimeter of the spill and working towards the center. Allow the prescribed contact time to ensure adequate deactivation of the biological toxin before clean-up.
  3. After the pads or towels have soaked for the required amount of time, remove and collect the absorbent pads as hazardous chemical waste.
  4. Use absorbent pads or towels to wipe the affected area a second time, followed by soap and water.
  5. Discard cleanup materials and protective clothing as hazardous chemical (biological toxin) spill waste. Label the decontaminated spill waste as “toxin spill waste” using the specific name if the toxin in use and submit to EH&S for disposal.
  6. Thoroughly wash hands, forearms, and face with soap and water.

Powder Spills inside of a fume hood/glove box/BSC or containment

  1. Don the appropriate PPE.
  2. For chemical inactivation*, gently cover the spills with moistened absorbent pads then apply the appropriate chemical inactivating agent starting at the perimeter of the spill and working towards the center. Allow the prescribed contact time to ensure adequate deactivation of the biological toxin before clean-up.
  3. After the pads or towels have soaked for the required amount of time, remove and collect the absorbent pads as hazardous chemical waste.
  4. Use moistened absorbent pads or towels to wipe the affected area a second time, followed by soap and water.
  5. Discard cleanup materials and protective clothing as as hazardous chemical (biological toxin) spill waste. Label the decontaminated spill waste as “toxin spill waste” using the specific name if the toxin in use and submit to EH&S for disposal.
  6. Thoroughly wash hands, forearms, and face with soap and water.

Powder Spills outside of a fume hood/glove box/BSC or approved containment

  1. Evacuate all personnel from the laboratory and restrict access; do not attempt to clean-up the spill.
  2. Notify EH&S as soon as possible by calling the 24 hour number (775-327-5040); tell them that a spill of a biological toxin has occurred in the lab area outside of containment, and you need assistance cleaning up the spill the toxin.

Spills of Biological Agents and Toxins Outside the Laboratory During Transport

  1. If infectious agent or biological toxin is released outside of the transport containment, immediately clear the area of all personnel and secure the area.
  2. Cleanup should be initiated as soon as possible to prevent spread of aerosol. Attempt cleanup only if appropriate cleanup materials and protective clothing are available.
  3. Notify EH&S at 327-5040 (24 hour contact number) as soon as possible for assistance with the cleanup.

Because it is impossible to prevent aerosolization when a spill occurs outside of the laboratory, the primary emphasis when transporting biological agents and toxins is on spill prevention.  All biological agents and toxins are to be transported from the laboratory inside an unbreakable, well-sealed, primary container containing absorbent material that is contained inside of a second unbreakable, well-sealed, secondary container.  Both the primary and secondary containers must be labeled with the universal biohazard symbol and the identity or biosafety level of the agent.  BSL-3/ risk group 3 agents or biological toxins must be transported using tertiary containment.