Biological hazards in clinical
laboratories
Riesgos biológicos
en laboratorios clínicos
Diego Armando Flores-Pilco
Universidad Regional Autónoma de Los Andes. UNIANDES,
Ambato – Ecuador
https://orcid.org/0000-0001-6180-4334
ABSTRACT
The
objective of this research is to analyze the biological risks in clinical
laboratories in the city of Ambato - Ecuador. A descriptive type of research
was developed. The biological risk found in laboratories that handle dangerous
samples such as viruses and bacteria, must have all the protective measures to
avoid the contagion of laboratorians, it is necessary to identify the best
protocol for the care of the professional starting from biosafety standards and
especially the transport, handling and storage of the sample, thus avoiding a
large percentage of the level of contagion by exposure. These are the
microorganisms that were found in the areas of the different private clinical
laboratories in the city of Ambato, caused by the handling of biological
agents, and these can cause serious diseases such as HIV, Hepatitis A,
Hepatitis B, Tuberculosis, different Pneumonias, Influenza and Covid-19.
Descriptors: working
conditions; occupational
safety; safety
measures. (Source: UNESCO Thesaurus).
RESUMEN
La investigación tiene por objetivo analizar los riesgos biológicos en
laboratorios clínicos de la ciudad de Ambato – Ecuador. Se desarrolló una
investigación de tipo descriptiva. El riesgo biológico encontrado en los
laboratorios que manejan muestras peligrosas como virus y bacterias, deben
contar con todas las medidas de protección, para evitar el contagio de los
laboratoristas, es necesario identificar cual es el mejor protocolo para el
cuidado del profesional partiendo desde normas de bioseguridad y sobre todo el
transporte, manejo y almacenaje de la muestra, evitando así en un gran
porcentaje el nivel de contagio por exposición. Estos son los microorganismos
que se encontraron en las áreas de los distintos laboratorios clínicos privados
de la ciudad de Ambato, causados por la manipulación de agentes biológicos, y
estos nos pueden causar enfermedades graves como VIH, Hepatitis A, Hepatitis B,
Tuberculosis, distintas Neumonías, Influenza y Covid-19.
Descriptores: condiciones de trabajo; seguridad en el trabajo;
medida de seguridad. (Fuente:
Tesauro UNESCO).
Research articles
section
INTRODUCTION
Clinical laboratories consist of the following
areas; sample collection, hematology, biochemistry, immunology, uro analysis, coprology, coagulation, microbiology (Patel, et
al. 2016). Workers when handling biological fluids are exposed to various
risks, so that failure to comply with preventive measures and biosafety
standards can lead to the acquisition of various diseases (Bentrón,
2020). That is why the value of recognizing biological hazards in clinical
laboratories, in their process or study area (Loh, et al. 2020), while
(Wang, et al. 2020), indicate that current infection prevention
strategies in clinical laboratories, are based on lessons learned from severe
acute respiratory syndrome, expert judgments and related regulations.
In order to determine the most common biological
risks to which health personnel are exposed in the clinical laboratory area and
to establish measures to avoid future accidents and possible illnesses or
diseases (Pérez-Díaz, et al. 2020), resulting in the application of the
BIOGAVAL method, useful for the detection of risk factors associated with
biological risk.
Due to the above; the research aims to analyze the
biological risks in clinical laboratories in the city of Ambato - Ecuador.
METHOD
A descriptive research with a non-experimental
design was developed, describing the situation in which health professionals
are exposed to biological elements during their working day in clinical
laboratories.
The study population consisted of five (05) clinical
laboratories with Biosafety level type 2, for a total of 20 people working in
the different institutions.
The data collection technique used was the
survey through the application of the Biogaval neo
2018 method, proposed by the Valencia Institute of Safety and Health at Work
(INVASSAT).
The information collected was processed using
descriptive statistics with the support of the SPSS V25 statistical program.
RESULTS
These are the microorganisms that were found in the areas of the
different private clinical laboratories in the city of Ambato, caused by the
handling of biological agents, and these can cause serious diseases such as
HIV, Hepatitis A, Hepatitis B, Tuberculosis, different Pneumonias, Influenza
and Covid-19.
The classification of biological agents describes that most of the
biological agents are within the scores 2 and 3 that represent little probable
and probable, and with a score of 4 of high risk level are the influenza virus
and the SARS-CoV-2 virus, since both cause severe diseases in humans if they
are not treated.
The routes of transmission, it is observed that the SARS-CoV-2 virus is
the most transmissible by having 3 routes of transmission, direct, indirect and
airborne, together with the influenza virus that have a score 4, with two
routes of transmission, so it is essential to recognize the direct and airborne
routes of transmission are the main causes for catching the virus.
By the level of transmissibility we have as main the SARS-CoV-2 virus,
as it has a high level to be transmitted both by direct, indirect and airborne
transmission, it was a new disease worldwide, so much that infected several
people during the pandemic and a high level of mortality was observed, so it is
very striking that laboratory workers are very exposed, so it is necessary to
strengthen biosecurity measures in them.
As for the influenza virus, we have a moderate level of transmissibility
since there is already immunization within the health scheme and treatment
established, recommended for this disease, therefore, it is transmitted quickly
but it is no longer fatal, then we have enteric diseases caused by Salmonella
Typhi and Shigella, which are not very transmissible but when infected, they
cause a moderate level of severity.
Regarding the probability of contact, a high
incidence of HIV, influenza virus, Staphylococcus aureus, and SARS-CoV-2 virus
is observed, these data were obtained according to the formula provided by the
BIOGAVAL method. According to the laboratories, the SARS-CoV-2 virus has the
highest incidence level, followed by the influenza virus, which shows that
these are two viruses that cause totally infectious diseases that affect
workers in a high level.
The health personnel studied presented 100%
vaccination for Hepatitis B and Varicella Zoster, since they are within the
vaccination schedule of our country, and the vaccine for Hepatitis B is
requested as an entry requirement for the positions in the health area, we have
90% vaccinated for influenza and COVID-19.
The risk would be exceeding the biological action
level in 4 biological agents such as HIV with a value of 9, Sars-Cov-2 Virus
with a value of 10, Influenza Virus with a value of 8 and Staphylococcus
Aureus, with a value of 9, for which immediate preventive actions should be taken,
acting on the time of exposure to the biological agent and the hygienic
measures adopted.
When observing a decrease in the level of biological
action, the most important thing is that in no laboratory studied were values
higher than 12 observed, i.e. it does not represent a situation of intolerable
risk.
DISCUSSION
The biological risk found in laboratories that handle dangerous samples
such as viruses and bacteria, must have all the protective measures to avoid
the contagion of laboratorians in the work area (Bentrón,
2020), so it is necessary to identify the best protocol for the care of the
professional starting from biosafety standards and especially the transport,
handling and storage of the sample, thus avoiding a large percentage of the
level of contagion by exposure.
Through the analysis of viruses and bacteria handled in private
laboratories in the city of Ambato, it was identified that the Acquired
Immunodeficiency Virus (HIV), Sars-Cov-2 virus, Influenza virus and
Staphylococcus Aureus, have a prevalence of infection, with values above and
equal to 8, which correspond to a level of biological action with high risk,
which means that laboratories should use all biosafety measures to avoid direct
contact with these pathogens (Lippi, et al. 2020).
Being important to take into account the vision of (Inal, et al.
2018), who expose the importance of organizing the workflow is an important
task of laboratory management. Recently, clinical laboratories have begun to
adopt methodologies such as Lean Six Sigma and some successful implementations
have been reported. In this order, (Wurtz, et al. 2016), indicate that
laboratory-acquired infections have been infrequent and even rare in recent
years, and human errors account for a very high percentage of cases. Today,
most of the risks from biohazards can be reduced through the use of appropriate
procedures and techniques, containment devices and facilities, and personnel
training.
Complementing the above; (Peng, et al. 2018),
expound that education and training of laboratory personnel are indispensable
to acquire adequate awareness to handle biohazardous materials according to
internationally recognized strategies. In addition, workshops should be
organized among laboratory workers to make them aware of the epidemiology,
pathogenicity, and human susceptibility of laboratory-acquired infections
(LAIs). Thus, various health-related threats resulting from biohazardous
materials can be reduced or minimized and controlled by proper implementation
of nationally and internationally certified protocols that include appropriate
microbiological practices, containment devices/appliances, satisfactory
facilities or resources, barrier protection, and specialized education and
training of laboratory personnel.
Likewise, the roles of the occupational physician
should be emphasized, especially for risk assessment, health and
clinical-epidemiological surveillance, with the need to monitor the second effectiveness
of preventive interventions, particularly for biosafety and biosecurity levels
in RL. It should be useful to increase the epidemiological surveillance
capacity of LAIs (Porru, et al. 2019).
CONCLUSION
The biological risk
found in laboratories that handle dangerous samples such as viruses and
bacteria, must have all the protective measures to avoid the infection of
laboratorians, it is necessary to identify the best protocol for the care of
the professional starting from biosafety standards and especially the
transport, handling and storage of the sample, thus avoiding a large percentage
of the level of exposure contagion. These are the microorganisms that were
found in the areas of the different private clinical laboratories in the city
of Ambato, caused by the handling of biological agents, and these can cause
serious diseases such as HIV, Hepatitis A, Hepatitis B, Tuberculosis, different
Pneumonias, Influenza and Covid-19.
FUNDING
Non-monetary
CONFLICT OF
INTEREST
There is no conflict of interest with persons
or institutions related to the research.
ACKNOWLEDGMENTS
Universidad Regional Autónoma de Los Andes.
UNIANDES, Ambato - Ecuador.
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