There is a new “pox” on lab safety- monkeypox. Like the most recent novel virus (COVID-19), the unknowns about the monkeypox virus is creating new safety concerns for laboratorians, and it is time now to nip unnecessary fears in the bud. That is done through preparation and education.
There are many questions that have arisen. How easily can this virus be transmitted? How should samples be handled or packaged for transport? Will staff illnesses create a critical lab staffing shortage? How should waste be treated? It is vital that lab leaders and safety professionals answer these questions for staff and relay as much information as possible to allay unnecessary fears.
One of the most important areas of focus for laboratorians potentially working with monkeypox patient samples is to continue to utilize Standard Precautions. As always, all specimens in the lab setting need to be treated as if infectious. When handling standard clinical specimens (blood, body fluids, etc.) from suspected monkeypox patients, no extra safety precautions or PPE should be necessary in the lab according to the CDC. The quantity of pox virus likely to be in clinical specimens is low, although procedures that generate aerosols should always be avoided or performed inside of a biological safety cabinet (BSC).
Laboratory staff should also be trained to package and ship Category B specimens. The current West African strain (clade) of monkeypox in the U.S. is not considered Category A under the Hazardous Materials Regulations (HMR), so monkeypox swab specimens for virus testing should be shipped similarly to other clinical specimens. Use the packaging kit and follow the instructions from the receiving testing lab.
There are also concerns about the spread of the monkeypox virus among employees in the laboratory. If there is an infected employee, they should be using PPE when working in the department. The monkeypox virus is only spread by close physical contact, direct contact with the infectious rash, scabs, or body fluids, and touching items (such as clothing or linens) that previously touched the infectious rash or body fluids. If there was contact with contaminated PPE or if an employee had prolonged face-to-face contact with an infected co-worker, that should be reported. The CDC states that monkeypox can spread from the time symptoms start until the rash has fully healed and a fresh layer of skin has formed. The illness typically lasts 2-4 weeks. People who do not have monkeypox symptoms cannot spread the virus to others. Direct any concerns to the employee health practitioners.
Handling monkeypox waste is another consideration for laboratories. Normally, the waste associated with monkeypox virus is considered a Category A waste (waste contaminated with a known highly infectious substance). However, waste from patients infected with the current West African strain of monkeypox is considered exempt from the category A Infectious Substance Regulations according to the Department of Transportation. It can be managed as regulated medical waste. Soiled laundry, including lab coats, should never be shaken or handled in manner that may disperse infectious particles. Laundry should be contained (bagged) at the point of use. Organizations should contact their local public health authority for more information if needed.
As time moves on, new threats will continue to emerge, and they will create safety questions for laboratorians. As always, staff should stay vigilant, pay attention to the work they do every day to avoid injuries and exposures when handling any specimens. Communicate with the hospital departments and clients to ensure proper specimen transport of clinical and diagnostic (swab) specimens. Handling laboratory specimens has never been more serious- the use of Standard Precautions and safe work practices will keep employees safe through this outbreak, and for whatever comes next.