Fatal infection in lab worker remains a mystery
Case underscores threat to lab workers
No specific infection control breach has been identified in the death earlier this year of a 25-year-old research laboratory associate at the VA Medical Center in San Francisco. Richard Din was working on a project to develop a vaccine against Neisseria meningitides serogroup B, the very pathogen that was found in his blood upon autopsy
Soon after he came home from work one day last spring, Din complained of headache, fever and chills. He developed a rash and lost consciousness in the car on the way to the hospital. He died about 17 hours after his first symptoms appeared.
"There's no evidence that he did anything outside of laboratory routine practice," says Harry Lampiris, MD, chief of infectious disease at the San Francisco VA Medical Center. "At the end of the day, it's a mystery. He had only been working in the lab for about six months. We tried hard to get to the question of whether he did something to increase his risk. He didn't disclose anything to friends, coworkers didn't observe anything."
The medical center undertook a review of "all the potential microbiologically transmissible agents that we work with in all our research laboratories," he says.
The hospital also beefed up its lab safety and training. Lab workers should be aware of the signs and symptoms of early infection with an organism such as N. meningitides and should seek antibiotic prophylaxis if there's an exposure, he says.
Clinical laboratories operate under the standard of "universal precautions. Any specimen could be high risk," Lampiris says.
Reporting of exposures, incidents such as spills, and near-misses is important to maintaining a culture of safety, he says. "Laboratory safety is everyone's responsibility. If there's any kind of breach, lab employees [should] feel they can report it to the [principle investigator] with no risk of recrimination," Lampiris says.
A continuing risk
The meningitis case highlights the serious risks that face lab workers in both clinical and research labs. In a 2005 report, researchers from the Centers for Disease Control and Prevention in Atlanta identified six cases of laboratory-acquired meningitis, with a fatality rate significantly higher than for community acquired cases.1 Other deadly organisms also transmitted to workers in a lab include plague (Yersinia pestis) and Brucella.2,3
No one knows the actual number of laboratory-acquired infections — or lab exposures — because there is no national reporting system. A Biosafety Blue Ribbon Panel of experts representing all laboratory disciplines advised CDC to create a surveillance system and to promote a "culture of safety" in the nation's diagnostic labs.4 In response to their concerns, the CDC and National Institutes of Health are working on an online, voluntary, non-punitive reporting system which may be available later next year.
"Working in the microbiology laboratory is inherently risky because we work with live, virulent infectious agents. We do that every day, 24 hours a day, and we do everything we can to protect our patients, ourselves, our coworkers and our families from [being exposed]," says Michael Miller, PhD, D(ABMM), former associate director for laboratory science at the CDC's National Center for Emerging and Zoonotic Infectious Diseases and now a private clinical microbiology laboratory consultant based in Dunwoody, GA.
Miller led a writing team of experts to produce the new "Guidelines for Safe Work Practices in Human and Animal Medical Diagnostic Laboratories." The document provides detailed information on analyzing hazards and reducing risk. "We think that these guidelines fill a gap that hasn't been filled for quite some time," he says.
References
- Sejvar JJ, Johnson D, Popovic T, et al. Assessing the risk of laboratory-acquired meningococcal disease. J Clin Microbiol 2005;43:4811–4814.
- Centers for Disease Control and Prevention. Fatal laboratory-acquired infection with an attenuated Yersinia pestis strain – Chicago, Illinois, 2009. MMWR 2011;60:201-205.
- CDC. Laboratory-acquired brucellosis – Indiana and Minnesota, 2006. MMWR 2008;57:39-42.
- Singh K. Laboratory-acquired infections. Clin Infect Dis2009;49:142-147.
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