• The Employee Health Program
• Risks
  1. Zoonotic risks to Pregnant Women
  2. Toxoplasmosis
  3. Q Fever
  4. Herpesvirus simiae
  5. Tuberculosis
  6. Allergy
• General Animal Bite Management
  • Bites received from dogs or cats
  • Bites received from wild animals
  • Nonhuman Primate Bites, Scratches and Mucous Membrane Secretion Exposures
  • Bites received from rats and mice
• The Employee Health Services
• Report of Injuries
• Personal Hygiene
• Protective Clothing/Equipment

The Employee Health Program

The employee health program is composed of several components, all of which are critical to maintain a safe environment for personnel working with or around laboratory animals. The program involves understanding hazards and minimizing risks utilizing correct personal hygiene techniques, provision of protective clothing/equipment and utilizing the services of the Emory Healthcare/Employee Health Services (EHS).

All personnel working with animals must participate in this educational and risk assessment program. This program is designed to prevent unnecessary occupational hazards in the work environment, including the potential risks which are incurred due to contact with laboratory animals. The EHS is located in the Emory University Hospital (EUH) (404-686-7941)

Risks

There are several types of risks that are incurred when personnel work with laboratory animals. Animal bites/scratches can be reduced by utilizing appropriate techniques when manipulating animals, animal tissues and animal caging. Protective clothing/devices augment the use of appropriate techniques.

Individuals who are employed by Emory in health or research related positions with potential occupational exposure to communicable and vaccine preventable diseases must provide documentation of previous immunization or be tested for immunity within 10 days of employment. Occupational Health and Safety Administration (OSHA) law requires that new employees who are hired into positions in which they may have bloodborne pathogen exposure must be offered the Hepatitis B Virus (HBV) Immunization within ten business days of the date they start working. See Emory University's Immunization Policy for more information.

Exposure to animals may induce the development of allergies to animal dander or excretions. Individuals who develop allergies are at risk for the development of asthma and should immediately consult EHS. The development of allergies can be minimized by reducing ones exposure to dander and excretions by utilizing protective clothing and gloves when handling animals, using specified equipment as trained, and minimizing exposure to airborne dusts, dander, cautery fumes, etc..

Diseases transmitted from animals to man (i.e. zoonotic diseases) also represent a risk to personnel. Though not common, these diseases can have significant health consequences when contracted by personnel. There are numerous zoonotic diseases, however the potential for exposure has been decreased by the use of commercial animal vendors that have eliminated zoonotic diseases from their colonies. In general laboratory animals have the potential for harboring zoonotic diseases. Personnel wearing protective clothing/handwear and who wash their hands after exposure to animals will substantially reduce the potential for transmission. Other preventive measures are to not eat while in the animal facility, not applying makeup, or placing contact lenses. Eating in animal use areas is prohibited unless personnel are in the break room or in administrative areas. Proper sharps management practices should be followed. All personnel should discard used sharps (needles, scalpels) immediately after use. Recapping needles or the improper disposal of scalpels presents a hazard to the user and other personnel in the facility. Mouth pipetting of hazardous materials should be replaced with manually operated devices.

Staff who are immunocompromised (from any cause including: HIV, steroids, chemotherapy, post transplant, certain arthritis medications etc.) may be at increased risk of acquiring  opportunistic zoonotic infection and are strongly encouraged to discuss that risk with their treating physician or can discuss with EHS.

Zoonotic risks to pregnant women

The animal vivarium can be a source of several zoonotic diseases that represent a threat to the pregnant employee. A pregnant employee or an employee planning to get pregnant should consult with EHS prior to exposure to laboratory animals.

Toxoplasmosis

Toxoplasmosis is a parasitic disease associated predominantly with cats and caused by a microscopic parasite called Toxoplasma gondii. Toxoplasmosis has been found in virtually all warm-blooded animals including most pets, livestock, and human beings. Nearly one-third of all adults in the U.S. and in Europe have antibodies to Toxoplasma, which means they have been exposed to this parasite. Individuals become infected by eating raw meat or, through poor hygiene, accidentally ingesting the oocyst (egg) that is excreted in cat feces. Ingestion of the oocyst from cat feces is the primary hazard to personnel working in laboratory animal facilities. Since it takes one day for the oocyst to become infective after fecal excretion, daily routine cage sanitation greatly decreases the chance of transmission. Persons that are pregnant, immunocompromised or those that are concerned about toxoplasmosis are encouraged to contact EHS for consultation.

The American Veterinary Medical Association provides a brochure on "What You Should Know About Toxoplasmosis". The Center for Disease Control also has brochures on "Toxoplasmosis: An Important Message for Women" and "Toxoplasmosis: An Important Message for Cat Owners".

Q fever

Q fever is a zoonotic disease associated primarily with sheep (and other ruminants). Q fever is a highly infectious rickettsial infection caused by Coxiella burnetii. Infection usually causes flu-like symptoms, and in some cases, these symptoms can be severe. Chronic endocarditis may develop, particularly in persons with preexisting valvular disease.

Transmission of the organism to man usually occurs from contact with the fluids and products associated with the birth of lambs from infected ewes.

The following recommendations are made to minimize the possibility of transmission from potentially infected animals to humans. Protective measures are most important when handling a ewe and the birth products at the time of parturition.

• Access to ruminant areas is restricted to persons whose presence is required for program or support needs.
• Protective clothing must be worn in the animal housing areas. This clothing should not be worn outside of the animal facilities.
• Potentially contaminated materials (such as syringes, needles) are to be placed in proper sharps containers.
• Disposable gloves should be worn when handling laboratory animals or tissues.
• Equipment should be decontaminated.
• A spray bottle of chemical sterilant is near the animal room door to spray the bottom of footwear upon exiting the room.

Herpesvirus simiae (B virus)

Non-human primates (macaques, rhesus, cynomolgus and possibly others) can transmit herpesvirus simiae (B virus) through bites, scratches, lacerations or needle sticks that penetrate the skin, and secretions (feces, urine, saliva or mucus) splashed into the mucous membranes (mouth, eye, inside nose) of humans. This virus, a close relative of the herpes simplex virus found in humans, is enzootic in these non-human primates. Symptomatic infection of humans from handling non-human primates is rare, however, the consequences of symptomatic infection are severe and potentially fatal. One case of infection being spread from person to person has been reported. A protocol for management of a potential exposure is available in all animal care facilities housing macaques and should be followed in the event of a non-human primate bite, scratch or secretion splash from the non-human primate to the human's mucous membranes.

Tuberculosis

The tuberculosis bacterium can be transmitted from animals to humans and humans to animals. Personnel working with non-human primates must be evaluated by EHS, which will include annual TB testing to monitor for exposure. Yerkes requires TB testing every 6 months for all individuals with access to Yerkes facilities.

Allergy

Exposure to animals may induce the development of allergies to animals from animal dander or excretions. Individuals who develop allergies are at risk for the development of asthma and should immediately consult EHS.

Manifestations of laboratory animal allergy include dermaititis, urticaria, conjunctivitis, rhinitis, and asthma. Risk factors for development of occupational allergy include family history of allergies, history of seasonal allergy, and smoking. Animal bites, airborne bedding dust, cautery fumes and other respiratory exposures are the major sources of symptoms. Exposures should be decreased through exhaust ventilation, work practices, protecting street clothes from contamination through the use of protective outerwear, and gloves. HEPA filter respirators or masks may be considered as means of preventing allergy in the work place.

General Animal Bite Management:

Bites or scratches received by University personnel should immediately be washed with soap and water for 15 minutes. Wounds should be referred to the Employee Health Services (EHS; 6-7941), EUH Emergency Room (2-7100) or to a personal physician.

The supervisor/lab director should be informed as soon as possible after cleansing the wound. The supervisor/lab director should:

• Assist in obtaining medical attention.
• Assure that a incident report is completed and submitted on the Environmental Health & Safety website http://www.ehso.emory.edu/

Bites received from dogs or cats:

The animal should be identified as a rabies suspect and isolated by animal resources personnel.

If death of a rabies suspect occurs, identification should be confirmed, and the animal refrigerated in cold storage. A University Veterinarian should be contacted immediately for completion of paperwork and initiation of procedures to have the deceased animal checked for rabies.

Nonhuman Primate Bites, Scratches and Mucous Membrane Secretion Exposures

Non-human primates (macaques, rhesus, cynomolgus and possibly others) can transmit herpesvirus simiae (B virus) through bites or scratches that penetrate the skin, and secretions (feces, urine, saliva or mucus) splashed into the mucous membranes (mouth, eye, inside nose) of humans. This potentially fatal virus, a close relative of the herpes simplex virus found in humans, is enzootic in these non-human primates. Bites and scratches transmit other viruses and bacteria as well. The following protocol is available in all animal care facilities housing macaques and should be followed in the event of a non-human primate bite, scratch or secretion splash from the non-human primate to the human's mucous membranes.

In order to prevent Macaque bites/scratches chemical restraint is required before handling any primate. Physically active macaques should not be handled by investigative personnel at any time. It is also important to utilize protective clothing and wear hand protection when in primate housing areas.

First Aid for Macaque bites/scratches

• Scrub and soak the area immediately for 15 minutes if it is a skin wound. Eye splashes should be irrigated for a full 15 minutes, with 0.9% sodium chloride (normal saline) if available or tap water. For skin wounds, Dakin's solution (buffered 0.5% sodium hypochlorite) or 9 parts water and one part household bleach should be used. Scrubbing the area is most important and use of hot, soapy water immediately is preferred to waiting until the appropriate solution is found. Saturated sponges should be used for scrubbing and universal precautions (gloves, eye protection, masks and lab coat or apron) should be used by anyone aiding the bite victim in scrubbing. A clean, dry dressing should be applied and the individual should report to the EUH Emergency Room. It is important to notify either the emergency room staff or the EHS Staff that there is a potential for Herpes B exposure. This will determine the care that you receive.
• The exposed individual should then proceed to the Emergency Room or EHS for further care.
• The injury should be reported to the animal facility supervisor and/or the Animal Resources Veterinarian as soon as possible. The supervisor will call EHS or the EUH Emergency Room to alert the area the individual is on the way and to insure care can be provided. If initial treatment is provided by the EUH Emergency Room the EHS should still be notified as soon as possible since follow-up blood samples and or cultures, if required, will be performed by them.
• The Division of Animal Resources should also be notified as soon as possible after receiving treatment, in order to provide for testing of the offending non-human primate. This is very important since the test results from the offending non-human primate will determine the future therapy of the injured employee.

Signs and symptoms of viral infection include the following: numbness, tingling, burning, weakness, pain, blister-like lesions, fever, chills, muscles aches, headaches lasting over 24 hours, unsteadiness when walking, double vision, intense itching, shortness of breath, feeling poorly or personality change. Development of any of the symptoms should be reported immediately to either EHS or the Emergency Room.

Bites received from rats and mice

Bites received from rats and mice should be managed as described under General Bite Management. Rodents that have been purchased from commercial vendors by the Division of Animal Resources or raised within University facilities do not represent a rabies threat.

The Employee Health Services:

Program may vary, depending on exposures or concerns of animal workers:

• Medical and Work History
• Physical Examination as indicated
• A PPD skin test annually for non-human primate exposure.
• Diphtheria-tetanus booster as needed.
• Appropriate additional vaccines as indicated.
• Q-fever titer levels drawn yearly for sheep exposure.
• Serum for frozen banking drawn once as a baseline is indicated.
• Toxoplasmosis titers drawn yearly on women working with cats.
• Spirometry for any people with allergic symptoms.
• Annual audiometry if indicated.

Report of Injuries

All injuries should be reported to your supervisor even if medical treatment is not required.

The individual receiving an on the job injury must complete a Emory Incident Report in order to be eligible for Workmen's Compensation. This includes animal bites or any other injury which occurs on the job.

For any employee to receive Workmen's Compensation in the form of payment for medical treatment and/or loss of time, a Emory Incident Report must be filled out and sent along with the employee for treatment. Any breakdown in this procedure could well cause an employee to lose Workmen's Compensation Benefits or be delayed in receiving them. This includes animal bites or any other injury occurring on the job.

If medical treatment is required the employee can receive treatment in the EUH Emergency Room, from EHS, or from his personal physician

Acute emergencies should be treated in the EUH Emergency Room by dialing "911" while on campus and asking for Emergency Service. The individual should only be moved by medical authorities unless a delay in movement may prove to be detrimental to the individual.

If accidents/injuries occur during non-regular working hours, treatment can be obtained from the EUH Emergency Room. A Emory Incident Report must be submitted on the first regular working day after the incident.

If the incident is due to an animal bite refer to General Animal Bite Management.

Personal Hygiene

Hand washing, which is the most effective practice of personal hygiene to reduce the potential of exposure to infectious material, should be performed after the start of the work day, upon leaving for breaks , meals, or restrooms, when returning to work, after the handling of any live animal or animal tissue, and after handling any other potential source of contamination. All animals are to be regarded as infected with pathogens which are contagious to humans.

Eating and drinking are prohibited in animal quarters and other areas where laboratory animals or hazardous agents are utilized. Eating and drinking within the laboratory animal facility is only permitted in administrative office space and in employee break rooms. Smoking is prohibited in all University facilities.

Protective Clothing/Equipment

DAR provides protective clothing for animal care personnel which is laundered by the institution. Animal care personnel are required to wear protective clothing while at work and are expected to change protective clothing as often as necessary to maintain a clean appearance and prevent contamination (microbiological, chemical or radiological) of other areas of the facility. Likewise, laboratory personnel should wear laboratory coats when working with animals. Protective clothing should be changed as appropriate to minimize cross contamination between species or activities in different animal rooms within the facility. Protective clothing should not to be worn outside of laboratory animal facilities or laboratories unless it is necessary to perform assigned duties.

Personnel working with non human primates are also required to wear surgical type face masks and goggles/glasses (or full face shields), and shoe covers which are available in all NHP facilities. Gloves (vinyl/latex) should always be worn when handling primates or equipment contaminated by primates.