Implementation of a biosafety software pop-up after two Brucella laboratory exposures

Abstract

Introduction

Brucellosis is rare in non-endemic countries where it mainly occurs as an imported or travel-related disease. In rare cases, Brucella species (spp.) are present in clinical specimens processed by clinical microbiology laboratories. These pathogens pose a risk to laboratory technicians, due to the high virulence, a low-infectious dose and ease of aerosol formation. Due to the low incidence in non-endemic countries, clinical samples are routinely processed on laboratory benches outside laminar flow cabinets. Recently, we have had three unexpected cases in which Brucella spp. were cultured at our clinical microbiology laboratory: one Brucella canis case and two Brucella melitenis cases. The B. canis and the first B. melitenis cases prompted the introduction of a biosafety software pop-up, which is presented in this paper.

Methods

Here, we describe the two B. melitensis cases and the introduction of a biosafety pop-up. The software pop-up parameters are a time-to-positivity (TTP) of more than 48 h, in an aerobic blood culture bottle, and a Gram stain appearance as Gram-negative bacteria. The software pop-up warns the technician through the laboratory information system (LIS) to further process the specimen in the Class 2 biological safety cabinet. To assess the number of false-positive pop-ups we can expect and resulting additional workload, we retrospectively analyzed laboratory data from the last seven years.

Results

The biosafety pop-up prevented laboratory exposure in the second B. melitensis case. Based on the retrospective analysis of laboratory data, we estimated the resulting additional workload of implementation of the biosafety pop-up to be less than one blood culture bottle per week on average to be processed in a Class 2 biological safety cabinet.

Conclusion

Our experience demonstrates that implementation of the biosafety software pop-up can reduce the risk of laboratory exposure to Brucella spp. This intervention provides a feasible approach even in a setting where Brucella spp. are normally only encountered every few years.