Biological Risk Engineering Handbook: Infection Control and Decontamination - Chapter 1 docx

Biological Risk Engineering Handbook Infection Control and Decontamination Biological Risk Engineering Handbook Infection Control and Decontamination Martha J. Boss, CIH, CSP Dennis W. Day, CIH, CSP Edited by LEWIS PUBLISHERS A CRC Press Company Boca Raton London New York Washington, D.C. Cover micrograph courtesy of Janice Carr, Centers for Disease Control and Prevention. This book contains information obtained from authentic and highly regarded sources. Reprinted material is quoted with permission, and sources are indicated. A wide variety of references are listed. Reasonable efforts have been made to publish reliable data and information, but the author and the publisher cannot assume responsibility for the validity of all materials or for the consequences of their use. 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Sanitary engineering. 5. Industrial microbiology. I. Boss, Martha J. II. Day, Dennis W. III. Industrial hygiene series (Boca Raton, Fla.) QR48 .B487 2002 620.8′6 dc21 2002073064 CIP Preface Biological Risk Engineering — Infection Control and Decontamination provides a compendium of biological risk management information. Biological risk is of concern to us all. The biological risks we face vary and include biological contamination within our environment and, more personally, biological risk to ourselves through disease or the potential for disease. This book deals with a subset of biological risk agents defined as bacteria, molds, yeasts, viruses, and prions. The term biologicals refers to these agents. Of these, the viruses and prions are not currently defined as independent life forms, and the extent to which these agents exhibit the characteristics of organic life are still being debated. The intent of this compendium of information is to foster risk management decisions. In times of strength, we can manage many risks for ourselves and for those around us. As homeland security and other risk-management agendas are addressed politically, increasing emphasis will be placed on codifying biohazard management protocols. The biological risk regulatory process is expected to progress in a manner similar to the chemical risk regulations developed under Superfund. In fact, Superfund was always intended to include uncontrolled infectious substances. The authors of biological risk management regulations face a daunting challenge in that biohazardous agents, unlike chemicals, can reproduce. As with most complex subjects, not all the authors included here or in the future will agree on everything. These differences were put aside to provide interdisciplinary discussions that hopefully will lead to sensible risk-management decisions. This text’s authors are bacteriologists, biologists, industrial hygienists, environmental scientists, microbiologists, engineers, nurses, sanitarians, tox - icologists, and safety professionals. All authors used their personal time and offered their profes- sional opinions to shape the research and writing that resulted in this book. Whether they are in the public or private sector, one goal remained preeminent — to provide information to enhance the effectiveness of biological risk management and control. Elizabeth Buckrucker, a reviewer, is a Project Manager for the Kansas City District Army Corps of Engineers, working in the Environmental Program branch. Elizabeth began her career in the U.S. Army and currently works as a civilian on environmental projects, including the U.S. Food and Drug Administration (FDA) Laboratory Decommissioning Program. In that capacity, Elizabeth met Dennis and Martha. Along with Donald Demers, current Chief of the FDA Safety Staff, and Renee Dufault, who is a Lieutenant Commander in the Public Health Service, they formulated the basic concepts for this book during their hours away from duty. Biological Risk Engineering — Infection Control and Decontamination begins in Chapter 1 with a basic microbiological dictionary with emphasis on fungi and bacteria. Viruses and prions are also discussed. Illustrations of basic morphology and the appearance of mold cultures are provided. Chapters 2 and 3 provide sampling and laboratory procedural descriptions. For biological contaminant sampling (molds, bacteria, viruses), coordination between the sampling teams and the ultimate receiving laboratory is essential. We then shift gears in Chapters 4 and 5 to interpretation issues associated with toxicological studies and ultimately risk assessment. Risk assessment quantitation had been more thoroughly developed for chemical risk, and the authors hope this volume will provide further impetus for synergistic studies related to risk assessment and management of biohazardous agents. Because one of the exposure routes is inhalation, Chapter 6 deals with ventilation design. Should disruption occur in ventilation equipment or other building structures, maintenance will be required. Good design principles will ensure that maintenance can be safely and easily accomplished. Thus, it is emphasized in both Chapters 6 and 7 that correct design and ongoing maintenance using interdisciplinary expertise are essential. Special requirements apply to laboratories, healthcare facilities, and other areas where immuno- compromised patients may be exposed. Chapters 8 and 9, on infection control and medical settings, © 2003 by CRC Press LLC discuss these special requirements and current methods to reduce biological risk. The lead author for these chapters is Renee Dufault, who is a Lieutenant Commander in the Public Health Service. In response to concerns voiced by local hospitals about excessive fines for improperly regulated medical waste disposal in the District of Columbia (DC), Renee began working with the DC Hospital Association (DCHA) to improve disposal practices, as biohazardous waste was ending up at the DC waste transfer station. In coordination with a friend at the National Institutes of Health (NIH), Renee distributed regulated medical waste stream surveys at 22% of the district’s hospitals. None of the hospitals surveyed provided the comprehensive training required by existing laws and regulations (OSHA, EPA, DOT) for waste handlers, including those who performed basic house - keeping services. Renee discovered that these housekeepers, who clean and disinfect all the patient care areas including isolation rooms, have a higher incidence of occupationally acquired tubercu - losis than do nurses. Renee then researched nosocomial infections and was shocked by both the findings and lack of current and accurate data. With support from the EPA, the FDA, and especially the DCHA, Renee developed and presented the Environmental Services Professional Training Course, which will soon be available on the Internet. Renee’s friend and colleague, Rita Smith, who is Georgetown Washington University Hospital’s Infection Control Director, helped write a section on hospital infection prevention and control for Chapter 9. Ed Rau, another friend and colleague from the NIH, contributed the information on prions found in Chapter 8. Decontamination and assessment are addressed in Chapter 10, which provides basic information and a sample of specifications, including statements or scopes of work that can be used as guidelines in developing specifications or purchase orders. Site-specific considerations will always take pre - cedence over any general guidance, and professionals must be consulted to provide site-specific interpretation and required design documents. Chapter 11, which discusses Legionella and cooling towers, is essentially a case study demonstrating how design, maintenance, and decontamination can be integrated into a seamless process. Chapter 12 presents biocides given the various general chemical or physical alterations that constitute a biocidal (life-killing) effect. While biocide use is rarely the sole answer to mitigating biological risk, biocide usage remains an alternative. Chapter 13, on laws and regulations, discusses current regulations, patent utility requirements, and insurance processes. In particular, biocides and their approval are discussed. Chapter 14, on tuberculosis, is essentially a case study that compares OSHA and CDC guidelines. Both the CDC guidelines and current OSHA rule making will ulti - mately result in an OSHA regulation to control occupational exposure to tuberculosis. Finally, Chapter 15 presents security both from the standpoint of homeland security given current U.S. requirements, and from an individual laboratory perspective. To put this book in perspective time-wise, Martha’s father, Eugene Johnson, wrote his master’s degree research paper in the 1950s on sanitation in the South Dakota schools. During that decade, the United States awakened to the prospect of controlling polio, even though the newly discovered virus was yet to be understood. Now, some 50 years later, we can identify some bacteria based on their viral phage loading and are just beginning to understand prions and the impact of bacteria and viruses on cancer initiation. As time goes by we increasingly realize the vulnerability of our world, such as how quickly a viral or bacterial pandemic can envelop the Earth. Yet, despite this understanding, we continually forget the simplest of lessons. In the days since the 1950s, running water and indoor bathrooms have become commonplace in the continental United States. Yet, in Alaska in the heart of oil country, children still awaken each morning and carry honey pots to the local landfill. The raw sewage is no longer burned (to protect the air?) and the raw sewage is not treated (too expensive to build aboveground plumbing systems and waste treatment facilities?). The sewage flows to the nearby waters, marshes, and streams and the honey pot plastic bags float in the air like junkyard birds. An epidemic waiting to happen? The answers to this and other questions are complicated, with politics, science, and the many facets of human existence commingled. The recent anthrax scare, the HIV pandemic, and the © 2003 by CRC Press LLC potential use of biological weapons are all high-profile issues that have their basis in a simple understanding: The world is alive, and the life forms compete. To guard humanity, we must protect and understand our world, and these efforts must be continual, rather than being initiated once a biohazardous agent is out of control. In the words of a wise man, the time to fix your roof is when the sun is shining. Martha J. Boss Dennis W. Day © 2003 by CRC Press LLC About the Editors Martha J. Boss is a practicing industrial hygienist and safety engineer living in Omaha, Nebraska and various airports throughout the United States. Many years ago, Martha won the Army Science award at the Des Moines, Iowa science fair. As fate would have it, Martha eventually worked for the Army and through the auspices of EPA grants was trained in industrial hygiene. All of this surprised Martha because she had intended to teach high school science and had prepared herself for that endeavor with a B.A. in biological education (University of Northern Iowa) and later a B.S. in biology (University of Nebraska). During Desert Storm, Martha was tasked under the War Powers Act to assist in the preparation of a western Army base to be used to house and train special forces. Shortly thereafter, Martha was trained in what was then known as the U.S. Army Defense Ammunition Center and School, Technical Chemical Surety Materiel Course, AMMO-M-8. This course was offered to instruct personnel working at depots and arsenals on some of the issues associated with chemical warfare materiels. Martha then began an interdisciplinary set of assignments with her fellow Army industrial hygienists and engineers to assess chemical, biological, radioactive, and chemical warfare sites and to find solutions to the problems associated with them. The Army continued her training at such institutions as Johns Hopkins, Harvard, and other top centers through the nation. After 5 years of traveling throughout the country to various very scary places, Martha decided to settle down in a regional engineering firm. After a couple of years, Martha realized she did not want to settle down and joined a national engineering firm where she is employed to this day. Martha is a Principal Toxicologist for URS Corporation and continues her practice as a Certified Industrial Hygienist and Certified Safety Professional (Safety Engineer). Martha is a member of the NEER (Nonlethal Environmental evaluation and Remediation Center), a Diplomat of the American Academy of Industrial Hygiene, serves as an Editorial Advisory Board Member for Stevens Publishing, and is a member of the American Industrial Hygiene Association. Dennis W. Day is a practicing industrial hygienist and safety engineer living in Omaha, NE and various airports throughout the United States. Dennis began his career as a forester. For several years, he traveled through the forests of the East and South cruising timber. Then he decided to become a high school science teacher. Dennis used his B.S. in forestry (University of Missouri) to enable him to pursue additional studies in chemistry and biology (Creighton University) and become a professional teacher. After teaching for awhile Dennis was persuaded to join the Army Safety Office and ultimately the Omaha District engineering division. Dennis continued for ten years to work with various Army, EPA, and Department of Defense missions. His work included sites throughout the nation and in Europe. Dennis concentrated his efforts on streamlining site assessment protocols, community outreach with protective action plans for chemical warfare sites, and training industrial hygienists entering the Army work force. Dennis joined URS to develop an interdisciplinary industrial hygiene, safety, and engineering service to commercial and governmental clients. Dennis is the regional health and safety manager for URS Corporation and continues his practice as a certified industrial hygienist and certified safety professional (safety engineer). Dennis is a diplomate of the American Academy of Industrial Hygiene and a member of the American Conference of Governmental Industrial Hygienists, the American Industrial Hygiene Association, and the American Society of Safety Engineers. © 2003 by CRC Press LLC Contributors Harriet M. Amman, Ph.D., DABT Washington State Department of Health Olympia, Washington Marwan Bader, MD, CIH Oak Ridge National Laboratory Knoxville, Tennessee Martha J. Boss URS Corporation Omaha, Nebraska Dennis W. Day URS Corporation Omaha, Nebraska Renee Dufault, CHSP, CDR Food and Drug Administration Rockville, Maryland James D. Hollingshead, MHS, CIH URS Corporation Santa Ana, California Melanie Karst, Ph.D. URS Corporation Omaha, Nebraska Jerry King, D.A. Midwest Laboratories, Inc. Omaha, Nebraska R. Vincent Miller, Ph.D. Aerotech Labs Phoenix, Arizona Richard C. Pleus, Ph.D. Intertox Seattle, Washington Captain Edward Rau, MS, RS, CHSP, REM National Institutes of Health Rockville, Maryland Heriberto Robles, Ph.D., DABT URS Corporation Santa Ana, California Rita Smith, MSN, CIC George Washington University Hospital Takoma Park, Maryland Brian Wight, PE URS Corporation Des Moines, Iowa Chris Wrenn, BA RAE Systems Sunnyvale, California Review ers Elizabeth Buckrucker U.S. Army Corps of Engineers Kansas City, Missouri Donald Demers Food and Drug Administration Rockville, Maryland © 2003 by CRC Press LLC Acknowledgments We all extend a special thank you to Elizabeth Buckrucker, Donald Demers, Renee Dufault, and Richard Pleus. Elizabeth and Donald continually reviewed the developing work effort. Their efforts assisted the primary editors (Martha and Dennis) and each individual author. Similarly, Renee Dufault on the east coast and Richard Pleus on the west coast (United States) coordinated the work of various authors in their geographic regions. A thank you is also extended to Dee Chambers for illustrations and Bridget Boss for graphic design. Picture and illustration contributors include Deniese Chambers (URS), Karin Galligan (SKC, Inc.), Aerotech Laboratories, Neil Carlson (University of Minnesota), Centers for Disease Control and Prevention (CDCP), RAE Systems, Daniel Behler, (Biotest), and Peter Pratt (Bioscience International). Additional thanks to Melanie Edwards (ASHRAE) and Dan Woodbury (Environ - mental Building News). © 2003 by CRC Press LLC Contents CHAPTER 1 Micro Dictionary Dennis W. Day, Martha J. Boss, Jerry King, and Melanie Karst CHAPTER 2 Industrial Hygiene Sampling Dennis W. Day, Martha J. Boss, R. Vincent Miller, and Chris Wrenn CHAPTER 3 Biological Sampling and Lab Interpretation R. Vincent Miller and Martha J. Boss CHAPTER 4 Toxicology Richard C. Pleus, Harriet M. Ammann, R. Vincent Miller, and Heriberto Robles CHAPTER 5 Risk Assessment Harriet M. Ammann, R. Vincent Miller, Heriberto Robles, and Richard C. Pleus CHAPTER 6 Ventilation Systems Martha J. Boss and Dennis W. Day CHAPTER 7 Maintenance Martha J. Boss, Dennis W. Day, and Marwan Bader CHAPTER 8 General Infection Control Renee Dufault, Martha J. Boss, and Edward Rau CHAPTER 9 Medical Setting Infection Control Renee Dufault, Rita Smith, and Martha J. Boss CHAPTER 10 Decontamination and Assessment Brian Wight and Martha J. Boss CHAPTER 11 Legionella and Cooling Towers Martha J. Boss and Dennis W. Day CHAPTER 12 Biocides Martha J. Boss and Dennis W. Day © 2003 by CRC Press LLC [...].. .CHAPTER 13 Laws and Regulations James D Hollingshead and Martha J Boss CHAPTER 14 Proposed OSHA Tuberculosis Standard and CDC Guidance Comparison Martha J Boss and Dennis W Day CHAPTER 15 Security Martha J Boss and Dennis W Day © 2003 by CRC Press LLC CHAPTER 1 Micro Dictionary Dennis W Day, Martha J Boss, Jerry King, and Melanie Karst CONTENTS 1. 1 1. 2 1. 2 .1 1.2.2 1. 3 1. 4 1. 5 1. 6 1. 7 Biological. .. Environments 1. 7 .1 Absidia (Zygomycete) 1. 7.2 Acremonium (Ascomycete) © 2003 BY CRC PRESS LLC 1. 7.3 Alternaria (Ascomycete) 1. 7.4 Aspergillus (Ascomycete) 1. 7.5 Aureobasidium 1. 7.6 Bipolaris 1. 7.7 Botrytis 1. 7.8 Cephalosporium 1. 7.9 Chaetomium (Ascomycete) 1. 7 .10 Chrysosporium 1. 7 .11 Cladosporium 1. 7 .12 Coccidioides 1. 7 .13 Cryptococcus neoformans 1. 7 .14 Cunninghamella (Zygomycete) 1. 7 .15 Curvularia 1. 7 .16 Epicoccum... 1. 2 .11 Mycoplasmas 1. 2 .12 Gram-Positive Cocci 1. 2 .13 Mycobacteria 1. 2 .14 Nocardioforms 1. 2 .15 Gliding, Sheathed, and Budding and/ or Appendaged Bacteria Fungi 1. 3 .1 Typical Mold Life Story 1. 3.2 Thallus and Hyphae 1. 3.3 Mycelium Fungi Reproductive Structures 1. 4 .1 Asexual Spores 1. 4.2 Sexual Spores Fungi Phyla 1. 5 .1 Deuteromycota/Fungi Imperfecta 1. 5.2 Zygomycota/Conjugate Fungi 1. 5.3 Dikaryomycota... Formation 1. 2.3 Spirochetes 1. 2.4 Aerobic/Microaerophilic, Motile, Helical/Vibroid Gram-Negative Bacteria 1. 2.5 Gram-Negative Aerobic Rods and Cocci 1. 2.6 Facultatively Anaerobic Gram-Negative Rods 1. 2.7 Anaerobic, Gram-Negative, Straight, Curved, and Helical Rods 1. 2.8 Dissimilatory Sulfate- or Sulfur-Reducing Bacteria 1. 2.9 Anaerobic Gram-Negative Cocci 1. 2 .10 Rickettsias and Chlamydias 1. 2 .11 Mycoplasmas... Epicoccum 1. 7 .17 Eurotium 1. 7 .18 Fonsecea compacta 1. 7 .19 Fusarium 1. 7.20 Helminthosporium 1. 7. 21 Histoplasma (Ascomycete) 1. 7.22 Leptosphaeria (Ascomycete) 1. 7.23 Memnoniella 1. 7.24 Mucor 1. 7.25 Nigrospora 1. 7.26 Paecilomyces 1. 7.27 Penicillium (Ascomycete) 1. 7.28 Phoma 1. 7.29 Pithomyces (Fungi imperfecti) 1. 7.30 Rhinocladiella (Fungi imperfecti) 1. 7. 31 Rhizomucor (Zygomycete) 1. 7.32 Rhizopus 1. 7.33... produces flavacol, 4-hydroxymellein, neo-aspergillic acid, 1- octen-3-ol, 2-octen1-ol, penicillic acid, viomellein (liver and kidney toxin), and xanomegnin acid (liver and kidney toxin) A oryzae produces kojic acid, oryzacidin, 1- octen-3-ol, 3-octanone, 3-methylbutanol, cyclopiazonic acid (toxin), and B-nitropropionic acid (toxin) A oryzae is used in the production of enzymes, including amylase and amyloglucosidase... 1. 7.33 Rhodotorula 1. 7.34 Scendosporium 1. 7.35 Scopulariopsis 1. 7.36 Sporothrix 1. 7.37 Stachybotrys 1. 7.38 Stemphylium 1. 7.39 Sterile Fungi 1. 7.40 Streptomyces 1. 7. 41 Stysanus 1. 7.42 Torula 1. 7.43 Trichoderma 1. 7.44 Trichophyton 1. 7.45 Ulocladium 1. 7.46 Zygosporium 1. 8 Prions 1. 9 Viruses Bibliography Biological contaminants are defined in terms of taxonomic names, staining characteristics, and pathological... infections in immunocompromised hosts 1. 7 .15 Curvularia (See Figures 1. 29 and 1. 30 and Color Figures 16 and 17 .) Curvularia conidia are dark with lighter end cells, fusiform, bent with central cell enlarged, and three- to five-celled The conidiophores are brown and either simple or branched and bear the conidia apically Health effects include allergenic reactions, corneal infections, and mycetoma 1. 7 .16 ... phagocytic cells and enzymes that digest connective tissue and spread infection The enzymes lyse fibrin, thereby destroying the fibrous protein that is deposited in blood clots and normally would limit pathogen movement 1. 2 .12 .3 Endospore-Forming Gram-Positive Rods and Cocci These endospores are resistant to heat and many chemicals 1. 2 .12 .3 .1 Bacillus anthracis Bacillus anthracis is nonmotile and a facultative... Health and Safety, Minneapolis.) Figure 1. 24 Structures of Bipolaris (Courtesy of Deniese A Chambers.) Figure 1. 25 Botrytis structures; massed conidia graybrown (“bunch of grapes”) (Courtesy of Deniese A Chambers.) Figure 1. 26 Photomicrograph of Botrytis (Courtesy of University of Minnesota Environmental Health and Safety, Minneapolis.) 1. 7 .11 Cladosporium (See Figures 1. 27 and 1. 28 and Color Figure 15 .) . Biological Risk Engineering Handbook Infection Control and Decontamination Biological Risk Engineering Handbook Infection Control and Decontamination Martha J. Boss,. Mycoplasmas 1. 2 .12 Gram-Positive Cocci 1. 2 .13 Mycobacteria 1. 2 .14 Nocardioforms 1. 2 .15 Gliding, Sheathed, and Budding and/ or Appendaged Bacteria 1. 3 Fungi 1. 3 .1 Typical Mold Life Story 1. 3.2 Thallus and. 1. 7 .14 Cunninghamella (Zygomycete) 1. 7 .15 Curvularia 1. 7 .16 Epicoccum 1. 7 .17 Eurotium 1. 7 .18 Fonsecea compacta 1. 7 .19 Fusarium 1. 7.20 Helminthosporium 1. 7. 21 Histoplasma (Ascomycete) 1. 7.22