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Laboratory staff should take care of themselves to protect against the potentially hazardous effects of LAIs. Any part of the body that is accidentally cut or penetrated while removing or handling an infectious microorganism can become a source of infection. Therefore, great care should be taken to avoid cutaneous injuries. Careful and aseptic technique in handling specimens should be followed. Frequent handwashing and the use of disposable, single-use, or autoclavable gloves are essential to maintaining a clean work area and reducing the number of infections. Because noncompliance with these protocols or practicing poor aseptic technique can result in outbreaks of infection (26,109), laboratories must have an effective program in place to enforce aseptic technique. A program to monitor and maintain aseptic technique should be in place in every laboratory, and the risks of violating aseptic technique should be clearly documented and communicated to all laboratory staff.
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The biosafety levels of classification are principally based on the likelihood of an infectious agent causing disease in the laboratory setting (1). High-risk pathogens include viruses, such as hepatitis B virus, hepatitis C virus, and human immunodeficiency virus; parasites such as cysticercus; bacteria such as Mycobacterium tuberculosis, Bacillus anthracis, and Clostridium botulinum; and protozoa, such as Plasmodium falciparum, malaria (204). Pathogens that are unlikely to be used in laboratory settings include such agents as Cryptococcus neoformans, leishmania, and Brucella (204). These bioterrorism-related pathogens have been used in military, bioterrorism, and research laboratories because of the availability of agents that can be grown in pure culture and because of the effectiveness of these organisms as weapons of mass destruction. Biosafety level 1 (BSL-1) can also be used for engineering works that can disrupt the host or environment (205), and engineered biocontainment laboratories should be designed to prevent the escape of agents under the control of the site operators (205). BSL-3 and BSL-4 are used with biological agents that are easy to culture, are of low infectious potential, and can be applied to a wide variety of research techniques (205). BSL-2 or BSL-3 are used for animal or human tissue culture (206), BSL-4 may be used for laboratory animals, and BSL-2 or BSL-3 may be used for volunteer studies (206). In addition, strict adherence to established policies and procedures is critical to the prevention of laboratory-acquired infections. Proper biosafety and biocontainment practices must be carefully considered for all levels, including the type and power of microscope, the type of material handled, room size, and ventilation (207). Although diagnostic electron microscopy may be performed in an autoclave facility, autoclave decontamination of the laboratory is a separate and integral part of the laboratory safety program (208). Other physical and chemical disinfectants (e.g., alcohol-based) should be kept in accordance with recommendations of the manufacturer for virus and bacteria (208).