20.2 Emergencies and Packaging/Transportation of Specimens

20.2 Emergencies and Packaging/Transportation of Specimens

Quick Answer: Needlestick: wash with soap and water, report immediately, occupational health for source evaluation, baseline labs, and indicated PEP. Mucous-membrane splash: eyewash for 15 minutes, then the same occupational-health path. Fire: RACE to get people out, PASS to use an extinguisher. Most diagnostic specimens ship as UN 3373 Biological Substance, Category B in triple packaging. Cultures of certain high-risk pathogens are Category A (UN 2814). Follow current DOT/IATA/CDC rules. Do not mailbox a possible select-agent culture.

Official outline IV.C lists emergency procedures and packaging and transportation of specimens and microorganisms beside the prevention content in 20.1. This section is the first minutes of an exposure or a fire, and how a specimen legally leaves the building. Select-agent colony rule-out and LRN tiers live in 13.2–13.3; here the exam wants the exposure algorithm and the Category A versus Category B distinction, not a memorized packing cartoon.

Needlesticks and other percutaneous exposures

A needlestick, scalpel cut, or broken-tube puncture is an occupational exposure until proven otherwise. Immediate actions, in order:

1. Wash the site with soap and water. Do not squeeze the wound to bleed it out. Do not irrigate with bleach, phenol, or culture disinfectant—those damage tissue and do not improve bloodborne-pathogen outcomes.
2. Report at once to the supervisor and occupational health. Waiting until the end of the shift loses the HIV-PEP window (start as soon as possible, ideally within 2 hours).
3. Source-patient evaluation, with consent and according to facility policy: HIV antigen/antibody, HBV surface antigen (and other HBV markers as indicated), and HCV RNA or HCV antibody with RNA confirmation. Microbiology must not just test leftover blood outside the occupational-health protocol.
4. Exposed-employee baseline labs: HIV, HBV if immunity is not documented, and HCV. Prior HBV vaccine with a documented anti-HBs of at least 10 mIU/mL is considered immune; if unvaccinated or a nonresponder, HBIG and/or vaccine are considered.
5. Post-exposure prophylaxis: HIV PEP is a multi-drug antiretroviral regimen when the source is HIV-positive or unknown and the injury is significant. HCV has no recommended PEP; early diagnosis and treatment of infection is the strategy. Tetanus immunization is considered for dirty punctures.

Document the device, the procedure, whether a safety-engineered sharp was in use, and whether the exposure was preventable. That record feeds the exposure-control-plan review required in 20.1; it is not optional paperwork.

Splashes to mucous membranes and intact skin

Blood or culture fluid in the eyes, nose, or mouth is a mucous-membrane exposure.

• Get to the eyewash (or face wash) and flush for 15 minutes. Hold the eyelids open. Remove contact lenses during the flush so trapped fluid is not held against the cornea.
• Then report and follow the same occupational-health, source, baseline, and PEP pathway as a needlestick.

An eyewash must be reachable within about 10 seconds of the hazard, unobstructed, and activated weekly as a function check. A later rinse at the hand sink is not 15 minutes of eyewash. Intact-skin blood contact is washed with soap and water; it is generally lower risk than a puncture or mucosal splash, but it is still reported if the skin was chapped or the volume was large. Phenol or formalin on skin is a chemical emergency: follow the SDS (20.1), not the BBP algorithm alone.

Fire: RACE and PASS

Laboratories store ethanol, acid-alcohol, and paper. Know two acronyms:

• RACE — Rescue people in immediate danger, Alarm (pull the station, call the operator), Contain (close doors and the BSC sash), Extinguish if the fire is small or Evacuate if it is not. Rescue and alarm come before heroics with an extinguisher.
• PASS — Pull the pin, Aim at the base of the fire, Squeeze the handle, Sweep side to side.

Match extinguisher class to fuel: Class A (ordinary combustibles), B (flammable liquids—stain solvents), C (energized electrical—centrifuges, incubators), D (combustible metals, rare on the micro bench), K (kitchen oils). A typical ABC dry-chemical extinguisher covers most bench fires. Do not use water on a solvent or electrical fire. If the BSC is on fire, follow facility SOP; do not pour water into a burning cabinet of solvents. Know two exits. Do not use elevators. Meet at the designated assembly point so a headcount can occur.

Chemical and biologic spills in the emergency frame

A small biologic spill on the bench: cover with disinfectant-soaked towels, allow the contact time on the disinfectant label (often 10–20 minutes for freshly prepared 1:10 bleach on a nonporous surface), then dispose as biohazard waste. A spill inside a centrifuge waits for aerosols to settle (typically 30 minutes) and is opened in a BSC (20.1). A large spill or a spill of a BSL-3 culture: stop traffic, secure the room, and call the safety officer—do not mop concentrated TB broth across the floor.

A chemical spill starts with the SDS, not with bleach-by-habit. Use the spill kit matched to acids, bases, or organics. Evacuate if fumes are strong. Report.

Packaging and transportation: Category B versus Category A

Specimens and cultures that leave the laboratory are dangerous goods when they contain, or are reasonably expected to contain, infectious substances. U.S. ground shipment follows DOT; air shipment follows IATA; select-agent movement follows CDC/USDA (Federal Select Agent Program) in addition to transport rules. The exam will not ask you to reproduce a packing diagram. It will ask you to classify and to follow current DOT/IATA/CDC instructions rather than invent a package.

Biological Substance, Category B (UN 3373) is how most diagnostic specimens travel: blood tubes, urine, swabs, stool, tissue for routine culture, and most clinical samples whose pathogens are not in cultured, high-risk form. The proper shipping name is Biological Substance, Category B. Mark the outer package with the UN 3373 diamond.

Infectious Substance, Category A (UN 2814) is an infectious substance transported in a form that can cause permanent disability, life-threatening, or fatal disease in otherwise healthy humans or animals when exposure occurs. Cultures of certain high-risk pathogens—for example M. tuberculosis, B. anthracis, Y. pestis, F. tularensis, and cultured viral hemorrhagic fever agents—are the usual Category A microbiology examples. UN 2814 is the human-pathogen number; UN 2900 is used when the substance affects animals only. Patient specimens of unknown etiology are usually still Category B; growing the organism in culture is often what upgrades the classification. When in doubt, especially for a rule-out select agent, stop and ask public health (13.3) instead of guessing a UN number.

Triple packaging is required for both categories; Category A has stricter performance testing, labeling, and shipper-training requirements:

Dry ice, if used, is UN 1845, Class 9; the package must vent CO2 and the net dry-ice mass must be marked. Do not seal dry ice in an airtight can. Overpack markings must remain visible.

Shipper training is mandatory for anyone who classifies or packs infectious substances. A bench tech who tapes a plate into a biohazard bag and hands it to an untrained courier has not packaged a Category A culture.

Do not mail a possible select-agent culture as ordinary mail

A mailbox, a stamped envelope, interoffice paper mail, or the routine send-out bag on the next truck is not an acceptable path for a possible select-agent or Category A culture. Chapter 13.3 is explicit: call the LRN reference laboratory before packing; use a trained courier and the packaging they specify. Brucella deregulation (final rule published December 17, 2024, effective January 16, 2025) changed Federal Select Agent Program paperwork, not the prohibition on casual mailing of a highly infectious isolate. International and air shipments can change documentation; the M answer is current DOT/IATA/CDC rules, not a remembered packing cartoon from an old textbook.