Surveillance of laboratory exposures to human pathogens and toxins: Canada 2018.

BACKGROUND: The Laboratory Incident Notification Canada (LINC) surveillance system monitors laboratory incidents reported under the Human Pathogens and Toxins Act. The year 2018 marks the third complete year of data. OBJECTIVE: To describe the laboratory exposure and laboratory-acquired infection incidents that occurred in Canada in 2018 compared to previous years, and then by sector, human pathogens and toxins involved, number of affected persons, incident type and root causes. METHODS: Laboratory incidents that occurred in 2018 were reported through the LINC system. The number of laboratory incidents, people exposed and laboratory-acquired infections were compared to previous years, then the incidents were analyzed by sector, human pathogen or toxin involved, the type of incident, people exposed, route of exposure and root causes. Microsoft Excel 2016 was used for descriptive analysis. RESULTS: In 2018, there were 89 exposure incidents to human pathogens and 235 people were exposed. There were five suspected and one confirmed laboratory-acquired infections. This was approximately twice the number of exposure incidents that were reported in 2017 (n=44) and 2016 (n=46). The highest number of exposure incidents occurred in the academic and hospital sectors, and the ratio of incidence to licences was the lowest in the private sector. The majority of incidents (n=50; 56%) involved Risk Group 2 human pathogens that were manipulated in a Containment Level 2 laboratory. Most exposures were related to sharps or procedures and the most common people exposed were laboratory technicians. Human interaction and standard operating procedures were the leading root causes. CONCLUSION: Although overall the annual incidence of laboratory exposures in Canada remains relatively low, the incidence was higher in 2018 than in previous years. Whether this is a true increase in incidence or an increase in reporting is not known at this time as baseline estimates are still being established.

Surveillance of laboratory exposures to human pathogens and toxins: Canada 2017.

BACKGROUND: Under Canada's Human Pathogens and Toxins Act and Human Pathogens and Toxins Regulations, the Public Health Agency of Canada (PHAC) is mandated with monitoring laboratory incident notifications through the Laboratory Incident Notification Canada (LINC) surveillance system. The year 2017 marks the second complete year of data. OBJECTIVE: To describe the laboratory exposure and laboratory-acquired infection incidents that occurred in Canada in 2017 by sector, human pathogens and toxins involved, number of affected persons, incident type and root causes. METHODS: The incidents included in the analysis occurred between January 1 and December 31, 2017. They were reported by laboratories with active licences to PHAC through the LINC surveillance system. Microsoft Excel 2010 was used for basic descriptive statistics. RESULTS: A total of 44 exposure and laboratory-acquired infection incidents were reported to the LINC in 2017. Compared by sector and their respective shares of licences, the number of incidents was highest in the academic and hospital sectors compared with government laboratories and private industry. Altogether 118 people were exposed for an average of 2.7 people per incident (range of 1-29). There were no reports of secondary exposure. Six exposure incidents (14%) led to "suspected" (n=5) or confirmed (n=1) cases of laboratory-acquired infection. Although overall, risk group (RG)2 human pathogens and toxins were involved in the majority of incidents (n=23; 52%), Francisella tularensis (n=4; 9%) and Coccidioides immitis (n=3; 7%) were the most frequently involved in reported exposure incidents. These two pathogens are both RG3 and security-sensitive biological agents (SSBAs). An average of 2.3 root causes were identified per incident (n=101). Problems with standard operating procedures (SOPs) and human error were the two most common causes. CONCLUSION: The incidence of laboratory exposure incidents was relatively low in 2017. The most common route of exposure was through inhalation and the most common root causes were problems with SOPs and human error. Since this is a new surveillance system, baseline estimates are still being established.

Misidentification of Risk Group 3/Security Sensitive Biological Agents by MALDI-TOF MS in Canada: November 2015-October 2017.

BACKGROUND: Matrix-Assisted Laser Desorption/Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS) is a technology increasingly used in diagnostic identification of microorganisms. However, anecdotal evidence suggests that this technology is associated with misidentification of Risk Group 3 (RG3)/Security Sensitive Biological Agents (SSBA) resulting in exposure risks to laboratory personnel. OBJECTIVE: To investigate and characterize incidents related to the use of MALDI-TOF MS in Canada between November 6, 2015, and October 10, 2017. METHODS: Cases were identified from laboratory incident reports in the national Laboratory Incident Notification Canada (LINC) surveillance system. Eligible cases referred directly to MALDI-TOF MS or one of three RG3/SSBA organisms, Brucella species, Francisella tularensis and Burkholderia pseudomallei. A questionnaire was developed to identify potential risk factors leading to the exposure. Reporters from organizations with selected incidents were interviewed using the questionnaire. Data were entered into an Excel spreadsheet and standard descriptive statistical analysis performed to assess common characteristics and identify possible risk factors. RESULTS: There were eight eligible incidents and a total of 39 laboratory workers were exposed to RG3/SSBA organisms. In five (out of eight) of the incidents, the reporters indicated that their device was equipped with both clinical and research reference libraries. For six incidents where reporters knew the type of library used, only the clinical library was employed at the time of the incident even though both libraries were available in five of these incidents. In all eight cases, the exposure occurred during the sample preparation stage with analyses performed on an open bench and directly from the specimen. And in all eight cases, patient specimens were received without information regarding potential risk. CONCLUSION: This first national study characterizing the nature and extent of laboratory incidents involving RG3/SSBA that are related to the use of MALDI-TOF MS identifies risk factors and provides baseline data that can inform mitigation strategies.

Surveillance of laboratory exposures to human pathogens and toxins: Canada 2016.

BACKGROUND: Canada recently enacted legislation to authorize the collection of data on laboratory incidents involving a biological agent. This is done by the Public Health Agency of Canada (PHAC) as part of a comprehensive national program that protects Canadians from the health and safety risks posed by human and terrestrial animal pathogens and toxins. OBJECTIVE: To describe the first year of data on laboratory exposure incidents and/or laboratory-acquired infections in Canada since the Human Pathogens and Toxins Regulations came into effect. METHODS: Incidents that occurred between January 1 and December 31, 2016 were self-reported by federally-regulated parties across Canada using a standardized form from the Laboratory Incident Notification Canada (LINC) surveillance system. Exposure incidents were described by sector, frequency of occurrence, timeliness of reporting, number of affected persons, human pathogens and toxins involved, causes and corrective actions taken. Microsoft Excel 2010 was used for basic descriptive analyses. RESULTS: In 2016, 46 exposure incidents were reported by holders of 835 active licences in Canada representing 1,352 physical areas approved for work involving a biological agent, for an overall incidence of 3.4%. The number of incidents was highest in the academic (n=16; 34.8%) and hospital (n=12; 26.1%) sectors, while the number of reported incidents was relatively low in the private industry sector. An average of four to five incidents occurred each month; the month of September presented as an outlier with 10 incidents.​: A total of 100 people were exposed, with no reports of secondary exposure. Four incidents led to suspected (n=3) or confirmed (n=1) cases of laboratory-acquired infection. Most incidents involved pathogens classified at a risk group 2 level that were manipulated in a containment level 2 laboratory (91.3%). Over 22 different species of human pathogens and toxins were implicated, with bacteria the most frequent (34.8%), followed by viruses (26.1%). Eleven (23.9%) incidents involved a security sensitive biologic agent. Procedure breaches (n=15) and sharps-related incidents (n=14) were the most common antecedents to an exposure. In 10 (21.7%) cases, inadvertent possession (i.e., isolation of an unexpected biological agent during routine work) played a role. Possible improvements to standard operating procedures were cited in 71.7% of incidents. Improvements were also indicated for communication (26.1%) and management (23.9%). CONCLUSIONS: The Laboratory Incident Notification Canada is one of the first surveillance systems in the world to gather comprehensive data on laboratory incidents involving human pathogens and toxins. Exposure incidents reported in the first year were relatively rare, occurring in less than 4% of containment zones within laboratory settings.