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The page below is a sample from the LabCE course Tuberculosis Awareness for Health Care Workers. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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BSL-2 Enhanced

If M. tuberculosis is isolated in the microbiology laboratory and there is no BSL-3 laboratory available, work may proceed, if the following criteria are met. In this case, the BSL of the laboratory is considered "BSL-2 enhanced".
These criteria are stated in the Clinical and Laboratory Standards Institute (CLSI) guideline, M29-A4.
  • The laboratory director, in conjunction with institutional safety personnel have reviewed the risk and determined that "BSL-2 enhanced" practices are appropriate. If it is not determined to be appropriate, the organism must be sent to a BSL-3 reference laboratory for further work.
  • Additional practices and PPE must be used. These generally include:
    • Controlling access to the immediate area when work is being performed
    • Ensuring personnel are offered appropriate immunizations and are involved in a medical surveillance program
    • Ensuring personnel have appropriate training and demonstrate proficiency before handling increased risk agents
    • Wearing solid-front or wraparound gowns, respiratory protection, eye protection, and double gloves.
    • Performing all work within a certified biosafety cabinet (BSC)
    • Decontaminating all materials before removing them from the BSC
    • Decontaminating all waste before it leaves the facility
    • Decontaminating all reusable PPE (eg, powered air-purifying respirators, goggles)
    • Avoiding the use of sharps, such as glass, whenever possible
    • Decontaminating laboratory equipment and work surfaces routinely, and after spills, splashes, or other potential contamination
    • Ensuring that reporting and follow-up procedures are in place for emergencies and accidents

Reference: Clinical and Laboratory Standards Institute (CLSI). Protection of Laboratory Workers From Occupationally Acquired Infections; Approved Guideline. 4th ed. CLSI document M29-A4. CLSI. Wayne, PA: 2014.