All clinical specimens may contain potentially infectious materials. Take precautions when handling specimens suspected or confirmed positive for monkeypox. Timely communication between clinical and laboratory staff is essential to minimize the potential risk of laboratory transmission when handling and testing specimens from patients with possible monkeypox. Label specimens accordingly and alert the receiving laboratory to ensure that specimens are handled properly. Correct handling and storage of specimens during transportation are essential for accurate diagnostic testing. Show
General GuidanceMonkeypox is a member of the Orthopoxvirus genus within the Poxviridae family. Laboratory testing has indicated that the current outbreak is associated with Clade II of the monkeypox virus. Clade II of the monkeypox virus is not subject to select agent regulations 42 CFR § 73. The guidance below reflects solely the handling and processing of specimens with Clade II. According to Advisory Committee on Immunization Practices (ACIP) recommendations, employers should offer pre-exposure orthopoxvirus vaccination to workers. Two vaccines may be used to prevent monkeypox disease, JYNNEOS and ACAM2000. Individuals are considered fully vaccinated 14 days after the second dose of the JYNNEOS vaccine or four (4) weeks after the ACAM2000 vaccination. The Biosafety in Microbiological and Biomedical Laboratories (BMBL) 6th edition recommends vaccination for laboratorians who directly work with viral cultures or infected animals contaminated or infected with replication-competent orthopoxvirus (e.g., monkeypox), and both the BMBL and the ACIP recommend booster doses of JYNNEOS every 2 years and ACAM2000 every 3 years for persons at occupational risk for virulent replicating orthopoxviruses (e.g., monkeypox) and at least every 10 years for those at occupational risk for less virulent orthopoxviruses (e.g., cowpox and vaccinia virus). As with all procedures, laboratories should perform a site-specific and activity-specific risk assessment to identify and mitigate risks. Risk assessments and mitigation measures depend on:
Follow Bloodborne Pathogens—Worker protections against occupational exposure to infectious diseases | Occupational Safety and Health Administration (OSHA) when handling clinical specimens, all of which may contain infectious materials. Including hand hygiene and specific personal protective equipment (PPE) determined by the potential for exposure to blood, body fluids, and infectious material. PPE, such as laboratory coats or gowns, gloves, eye protection, respiratory protection, and face shield, can help protect the skin and mucous membranes of the eyes, nose, and mouth. Avoid procedures that could generate infectious aerosols. For more information, see:
Biosafety Considerations for Diagnostic TestingFacilities that process and test monkeypox lesion materials, including swabs of lesion surface and exudate, and lesion crusts, should have the necessary equipment, engineering controls, personal protective equipment, appropriate diagnostic assays, and properly trained personnel. If the appropriate safety equipment or protocols are unavailable, consider referring specimens to an equipped reference laboratory that meets the recommendation above.
For further details, see:
Routine Diagnostic TestingIf a patient is suspected or confirmed for monkeypox virus infection, testing to evaluate other illnesses on the clinical differential should continue while awaiting orthopoxvirus test results. Implement specific biosafety precautions depending on the specimen tested.
Culturing Specimens for Monkeypox VirusCulture-based testing for monkeypox virus should not be performed as a routine diagnostic procedure in clinical or diagnostic laboratories. Refer to the Biosafety in Microbiological and Biomedical Laboratories (BMBL), 6th edition, Section IV—Laboratory Biosafety Level Criteria BSL-3, and Section VIII-E Viral Agents. Clinical Pathology, Molecular Testing, and Analysis of Bacterial or Mycotic CulturesPerform the following procedures in a Biosafety Level 2 (BSL-2) laboratory facility following standard and special practices, safety equipment, and facility specifications recommended for BSL-21:
1 Unless the viral cultures are being done with lesion specimens awaiting orthopoxvirus test confirmation. Refer to the Biosafety in Microbiological and Biomedical Laboratories (BMBL), 6th edition, Section IV—Laboratory Biosafety Level Criteria BSL-3, and Section VIII-E Viral Agents, when performing culturing of lesion specimens for diagnostic purposes other than monkeypox virus from an individual suspected of having monkeypox. Environmental TestingAt this time, the National Wastewater Surveillance System team recommends that untreated wastewater samples be pasteurized (60°C for 1 hour) before processing if they are suspected of containing monkeypox. This is due to the potential exposure of laboratory personnel during untreated wastewater processing. Procedures with a High Likelihood of Generating AerosolsLaboratory exposures to poxviruses occur primarily through needle-stick injuries, direct contact with the specimen, or aerosols that laboratory procedures may generate. Conduct procedures with a high likelihood of generating aerosols (e.g., vortexing or sonication) in a certified Class II BSC. Use additional precautions to create a barrier between the specimen and personnel. These additional precautions can include centrifuge safety cups, sealed centrifuge rotors, and additional PPE to reduce the risk of exposure to laboratory personnel. Perform site-specific and activity-specific biosafety risk assessments to identify and mitigate risks and to determine if your situation warrants additional biosafety precautions. Situations that may warrant additional biosafety precautions include high testing volumes, pneumatic tube systems use, and automated testing platforms (e.g., laboratory robotic platforms, etc.). If testing a lesion specimen from a suspected monkeypox patient, CDC recommends that laboratory personnel perform complete viral inactivation before putting the specimen on any automated platform or placing the platform within a Class II BSC, if available, to perform the work. If laboratory personnel cannot perform procedures that may generate aerosols in a BSC, acceptable methods of respiratory protection include NIOSH-approved respirators with N95 filters or higher. N95 filtering facepiece respirators provide the minimum level of respiratory protection. Facilities may consider using higher levels of respiratory protection, particularly if personnel cannot be correctly fitted to tight-fitting respirator models. These higher levels may include using loose-fitting NIOSH-approved powered air-purifying respirators equipped with particulate filters. DecontaminationPerform routine cleaning and disinfection procedures using an EPA-registered, hospital-grade disinfectant with emerging viral pathogens claim. Products with Emerging Viral Pathogens claims may be found on EPA’s List Q. Follow the manufacturer’s directions for concentration, contact time, and care and handling. Reevaluate current protocols for cleaning, use of PPE, patient placement, and hand hygiene; see Standard Precautions | Section IV. For example, high-touch surfaces such as patients waiting rooms and equipment present a higher probability of contamination in the work area and should be disinfected frequently. Increase the number of available cleaning supplies, distribute them throughout the laboratory and waiting areas, and encourage staff to clean surfaces and equipment frequently. Reusable PPE should be cleaned and disinfected according to manufacturer instructions because not all disinfectants are compatible, and some may degrade the PPE. Laboratory Waste ManagementDispose of sharps in appropriate puncture-resistant containers to autoclave as infectious waste. All cultures, stocks, residual specimens, and monkeypox virus waste should be decontaminated before on-site disposal using an approved method, such as autoclaving. Materials decontaminated outside the immediate laboratory should be placed in a durable, leak-proof container and closed for transport from the laboratory. Follow local, regional, state, national, and international regulations for waste disposal. State and local waste disposal regulations vary; for more information, see:
Select Agent RegulationsLaboratory testing has indicated that the current outbreak is associated with Clade II of the monkeypox virus. Clade II of the monkeypox virus is not subject to select agent regulations (42 CFR § 73). Monitoring Healthcare Workers Exposed to Monkeypox VirusInfection Control: Healthcare Settings Guidelines for monitoring healthcare workers who have unprotected exposures to patients with monkeypox or laboratory specimens from these patients Monkeypox and Smallpox Vaccine Guidance At which point during a patients venipuncture process should a medical assistant label the blood specimen tube?At which point during a venipuncture process should a medical assistant label the blood specimen tube? The medical assistant should label the blood specimen tubes after the venipuncture procedure is completed, but prior to the patient being discharged.
Which of the following actions should the Assistant take to ensure proper specimen processing?Which of the following actions should the assistant take to ensure proper specimen processing? Verify that the requisition form has been completed.
How should an MA label a tube that contains a capillary sample?Included on the label should be at least the first and last name of the patient, the medical record or identification number, the date and time of collection, initials of the person collecting the specimen, and any other information required by the collecting facility.
Which of the following veins is the preferred vein for routine phlebotomy?Of these, the median cubital vein is usually the vein of choice for phlebotomy: It is typically more stable (less likely to roll), it lies more superficially, and the skin overlying it is less sensitive than the skin overlying the other veins. Antecubital veins, right arm.
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