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Guidelines for
Preventing Splash Hazards

 

Exposure Prevention: Preventing worker exposure to biohazardous material is the best protection against infection. Reviews of injuries and biohazard exposures among workers exposed to nonhuman primates suggest that mucocutaneous contact with nonhuman primate body fluids is common; 16 (94%) of 17 contacts with primate body fluids in one survey involved ocular exposure (6,7). Each institution working with macaques should develop a written comprehensive personal protective equipment (PPE) program based on thorough hazard assessments of all work procedures, potential routes of exposure (e.g., bites, scratches, or mucosal exposures) and potential adverse health outcomes. This plan should clearly identify the PPE required for each task or working area and address training, inspection, maintenance, and periodic assessment of program effectiveness.

 

Previous recommendations for preventing B virus infections in humans advise presuming that all macaques are infected with B virus and protecting workers with a faceshield (or surgical mask and goggles or glasses) when handling uncaged active macaques (3,8). The incident described in this report indicates that proper eye protection also should be mandatory during activities such as entering areas containing macaques, conducting captures, and transporting caged macaques. Other activities where eye protection is necessary should be determined by the hazard assessment. All personnel who work in situations determined to be hazardous should wear eyewear conforming to established standards for eye and splash protection (9). Personal eyeglasses are not PPE.

Protective goggles designed for splash protection (available with antifog lenses for humid environments and in models that preserve peripheral vision) should be worn to protect the eyes against splash hazards in combination with a mask designed to protect other mucous membranes.

Faceshields are commonly considered secondary eye protectors that are worn in combination with protective goggles (9,10). Although previous guidelines indicate a faceshield may be sufficient, ocular exposures have occurred to workers wearing  faceshields, including to a worker who was wearing a combination surgical mask/faceshield while moving a macaque within cages. To minimize the potential for mucous membrane exposure, faceshields must prevent droplet splashes to the head from running down into the eyes and prevent mucous membrane exposure around the edges (sides, top, and bottom to below the chin) (10). Decisions to use faceshields as the sole means for preventing ocular exposure should only be made after full consideration of both the limitations of faceshields and regulatory (OSHA) considerations.

Exposure Management:  If exposure prevention fails, the adequacy and timeliness of wound or exposure decontamination procedures are critical factors determining the risk for infection. Institutions that house or conduct procedures involving nonhuman primates or potentially contaminated tissues should develop institution‑specific postexposure procedures (3,8). Such procedures would eliminate institutional barriers to patient access and ensure appropriate diagnostic testing and infection control.

 First, animal handlers should be instructed to cleanse immediately and thoroughly all bites, scratches, and/or mucosal surfaces or abraded skin exposed to macaque biologic materials and to report these exposures immediately (3).

Following an exposure to the eye, existing guidelines recommend immediately flushing the eye with water for at least 15 minutes (3).

  • Second, postexposure procedures also should provide potentially exposed workers with direct and rapid access to a local medical consultant knowledgeable about B virus and other biohazards associated with nonhuman primates. The employer should ensure that direct access to the knowledgeable consultant is available immediately following exposures and at any time the worker is concerned that potential occupational exposure to B virus may be relevant to worker symptoms.

  • Finally, postexposure procedures also should include routing diagnostic specimens to the B Virus Research and Resource Laboratory, now at Georgia State University in Atlanta.

  • These interim recommendations will be reviewed and may be revised or augmented following additional consideration by a working group convened by Office of Health and Safety, CDC.

 

References

  1. Fierer J, Bazely P, Braude AI. Herpes B virus encephalomyelitis presenting as ophthalmic zoster: a possible latent infection reactivated. Ann Intern Med 1973;79:225‑8.

  2. Weigler BJ. Biology of B virus in macaque and human hosts: a review. Clin Infect Dis 1992; 14:555‑67.

  3. Holmes GP, Chapman LE, Stewart JA, Straus SE, Hilliard JK, Davenport DS. Guidelines for the prevention and treatment of B‑virus infections in exposed persons. Clin Infect Dis 1995; 20:421‑39.

  4. Wells DL, Lipper SL, Hilliard JK, et al. Herpesvirus simiae contamination of primary rhesus monkey kidney cell cultures: CDC recommendations to minimize risks to laboratory personnel. Diagn Microbiol Infect Dis 1989;12:333‑5.

  5. CDC/National Institutes of Health. Biosafety in microbiological and biomedical laboratories. 3rd ed. Atlanta, Georgia: US Department of Health and Human Services, Public Health Service, CDC and the National Institutes of Health, May 1993; DHHS publication no. (CDC)93‑8395.

  6. Holmes GP, Hilliard JK, Klontz KC, et al. B virus (Herpesvirus simiae) infection in humans: epidemiologic investigation of a cluster. Ann Intern Med 1990;112:833‑9.

  7. Zakaria M, Lerche NW, Chomel BB, Kass PH. Accidental injuries associated with nonhuman primate exposure at two regional primate research centers (USA): 1988‑93. Lab Anim Sci 1996;46:298‑304.

  8. CDC. Guidelines for prevention of Herpesvirus simiae (B virus) infection in monkey handles. MMWR 1987;36:680‑2,687‑9.

  9. American National Standards Institute. Practice for occupational and educational eye and face protection, Z87‑1. Des Plaines, Illinois: American Society of Safety Engineers, 1989.

  10. Heinsohn P, Jacobs R, Concoby B. Biosafety reference manual. 2nd ed. Fairfax, Virginia: American Industrial Hygiene Association, 1995:79‑80.