Laboratory exposure to Coccidioides: lessons learnt in a non-endemic country
Coccidioides is a primary pathogenic fungus, which infects humans through highly infectious arthroconidia, causing substantial morbidity including life-threatening disseminated infections. Due to the low infectious dose, laboratory personnel might become infected during diagnostic procedures. Accordingly, coccidioidomycosis is reported as the most frequent laboratory-acquired systemic mycosis worldwide. This risk is aggravated in nonendemic countries, where the diagnosis may not be suspected. We report on an inadvertent exposure of 44 persons to Coccidioides posadasii in a clinical microbiology laboratory in Chile, the measures of containment after rapid diagnosis with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, and the lessons learnt in a non-endemic setting.
Floor and environmental contamination during glove disposal
Background: Evidence suggests that doffing and possibly disposal of used personal protective equipment (PPE) can lead to environmental contamination. Aim: To ascertain the potential for site and floor contamination when medical gloves are inappropriately disposed. Methods: Fifteen healthcare workers (HCWs) disposed of gloves inoculated with bacteriophage and a chemical dye into a wastebasket, located 1.22 m away. Following each trial, designated sample areas were visually inspected with a blacklight for fluorescent dye stains and swabbed with a 3M Letheen Broth sponge to quantify the bacteriophage. Findings: The area closest to the participant (<0.30 m) had the highest bacteriophage concentrations (geomean: 6.9 103 pfu/100 cm2 ; range: 8.07 to 3.93 107 pfu/100 cm2 ). Bacteriophage concentrations were significantly higher (P < 0.05) in areas 0.61 m compared to >0.61 m from the HCWs. Although the farthest distances (1.22e1.52 m) resulted in 14% bacteriophage- and 4% fluorescent dye-positive occurrences, there was no significant difference (P ¼ 0.069) between the tracers. The bacteriophage and chemical dye indicate highest environmental contamination nearest the HCWs and both tracers could be appropriate for PPE disposal training. Conclusion: HCWs use gloves every workday and potentially could contaminate surrounding surfaces and floors, during improper disposal practices. Therefore, proper disposal techniques are required to minimize pathogen transmission by establishing industry-wide policies, adequate training, and education to HCWs.