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FactSheet Preventing and Managing Laboratory Worker Exposure to

Zika virus is primarily spread by the bites of infected mosquitoes. However, workers in biomedical laboratories working with the virus are also at risk of . This guidance provides employers and workers with information to prevent and manage occupational exposure to Zika virus. The guidance may be updated as more information becomes available.

How Laboratory Exposures Occur The Zika virus has been found to spread through Quick Facts exposure to blood, semen and vaginal fluid. • Zika can produce not only mild symptoms, Researchers are continuing to investigate but also serious birth abnormalities. whether other materials also spread the virus. • Sharps injuries are among the most likely However, Zika virus has been detected by sources of laboratory worker exposure to in many other human body fluids, Zika virus. including urine, amniotic fluid, breast milk, • Zika virus exposures can be effectively , cerebrospinal fluid, aqueous humor (fluid controlled by following existing biosafety in the eyeball between the cornea and lens) guidelines and OSHA standards. and cervical mucous. Zika virus has also been • Generally, work with samples of Zika virus detected on swabs of the nasopharynx. can be done at 2. Limit access to active work areas and conduct For laboratory workers, the most likely sources -generating procedures in biosafety of exposure to Zika virus include: cabinets or other containment devices. • Punctures and cuts from needlesticks and • Workers should always report exposure other contaminated, sharp objects. incidents, including sharps injuries, to their • Compromised skin with cuts, abrasions or supervisor. Ensure exposed workers receive that contacts contaminated materials. prompt medical attention. Workers may also be exposed to the Zika virus through: • The eyes, nose and mouth. This may occur Employers must identify and comply with by splashes or sprays of infectious liquids or standards and regulations requiring control of droplets from laboratory samples, accidentally workers’ Zika virus exposure, when applicable touching the face with contaminated gloves or (e.g., OSHA’s Bloodborne (BBP) when handling contaminated waste. standard (29 CFR 1910.1030)). In all cases, • Bites of infected mosquitoes being studied in employers should assess and control their the laboratory, particularly if such mosquitoes workers’ Zika virus exposure risk, consider are not properly contained. relevant advisory documents, and review new • Contact with blood or other body fluids of information as it becomes available, including infected being studied in the laboratory. from the Centers for Disease Control and Prevention (CDC). Preventing Worker Exposures Laboratory Risk Assessments Employers and workers in laboratories should Perform a risk assessment of the work follow required and recommended infection environment when introducing new tasks and as prevention and biosafety practices to minimize part of developing safety precautions. the . Determine whether work with certain specimens or procedures, such as those that could create Follow standard biosafety practices for , require higher levels of laboratory work involving pathogens or other precautions. • Controls in place in laboratories that routinely work with potentially infectious Consider the risk and reproductive effects of Zika samples can also protect workers from virus infection for workers who are or may become exposure to Zika virus. pregnant and for workers with sexual partners • Use universal precautions, as required who are or may become pregnant. Zika virus can by OSHA’s Bloodborne Pathogens (BBP) be spread between sexual partners or from a standard (29 CFR 1910.1030). pregnant woman to her fetus. Zika virus infection •Always work at the appropriate biosafety is a cause of serious birth defects, including level (BSL) for the tasks being performed: microcephaly: www.cdc.gov/zika/pregnancy. www.cdc.gov/biosafety/publications/bmbl5. For Zika virus, most work, including related Prevention studies, can be done at BSL-2 and Whenever workers have occupational exposure ABSL-2. to human blood, body fluids or other potentially • Follow arthropod containment guidelines for infectious materials (OPIM), employers must studies involving live, infected arthropods comply with OSHA’s Bloodborne Pathogens (e.g., mosquitoes): www.astmh.org/ (BBP) standard (29 CFR 1910.1030). Among subgroups/acme. Work at arthropod other requirements, employers whose workers containment level (ACL)-2 in areas where have occupational exposure, as defined in the Zika virus is established in the resident standard, must implement universal precautions: mosquito population; otherwise, ACL-3. www.osha.gov/SLTC/bloodbornepathogens/​ • Conduct experiments involving worker_protections.html. recombinant or synthetic Zika virus nucleic Laboratory employers also must comply with acids in accordance with NIH guidelines: OSHA’s personal protective equipment (PPE) www.osp. od.nih.gov/biotechnology/nih- standards (29 CFR 1910 Subpart I), including guidelines. the Respiratory Protection standard (29 CFR • Consult CDC’s Zika-specific guidance: www. 1910.134), and other applicable OSHA and State cdc.gov/zika/laboratories/lab-safety. html. Plan requirements for protecting workers from that may be present in the laboratory. Proper hand consists of scrubbing with The BBP standard requires the use of soap and water for at least 15 seconds. When engineering and work practice controls to hands are visibly soiled, always wash with soap eliminate or minimize employee exposure and water. If soap and water are not available, (29 CFR 1910.1030(d)(2)). For example, where use an alcohol-based hand rub containing at the BBP standard applies, employers must least 60 percent alcohol, but then wash with 1 ensure that workers immediately perform proper soap and water as soon as possible. hand hygiene after any contact with blood Where the BBP standard applies, employers and OPIM, as as promptly after removing must also consider and use safer devices, gloves or other PPE (29 CFR 1910.1030(d)(2)). such as specially engineered sharps designed The BBP standard also requires that employers to minimize exposure risk, wherever ensure that workers immediately flush mucous possible (see www.osha.gov/OshDoc/ membranes with copious clean water after any data_BloodborneFacts/bbfact02.pdf). OSHA contact with blood or OPIM (29 CFR 1910.1030(d) recommends using safer devices even if no (2)). Eyes should be flushed with saline or a specific OSHA standard applies. sterile irrigant. If requested by a worker who is pregnant or may Immediately report any possible exposures to become pregnant, or whose sexual partner is a supervisor. pregnant or may become pregnant, consider OSHA recommends using engineering controls, reassigning the worker to tasks that reduce or following safe work practices, performing proper eliminate the risk of exposure to Zika virus. hand hygiene and flushing mucous membranes (after contact with blood or OPIM) even if no 1) U.S. Department of Health and Human Services, Centers specific OSHA standard applies. for Disease Control and Prevention, “Show Me the – When & How to Use .” While there is no evidence of Zika virus their health and safety concerns and their risk of through aerosol exposure, it is transmitting the virus to others. If the exposure best to minimize the risk. Always use biosafety falls under the BBP standard (29 CFR 1910.1030), cabinets for activities that generate potentially employers must provide this confidential infectious aerosols.2 counseling.

Worker Training Advise all workers with a suspected occupational OSHA’s BBP standard requires employers to exposure to Zika virus (i.e., for whom infection train workers as follows: initially when they are has not yet been ruled out through medical assigned to tasks where occupational exposure to evaluation) to: human blood or OPIM may take place, every year • Avoid mosquito bites for three weeks after the after that and whenever changes to a worker’s suspected exposure. job affect occupational exposures covered by the • Use condoms during sex or abstain from sex standard: 29 CFR 1910.1030(g)(2). Train workers with a pregnant partner for the duration of the who have potential exposure to Zika virus about: pregnancy or until Zika virus infection has been • How Zika virus spreads, their risks of ruled out, even if no symptoms of Zika are exposure, and signs and symptoms of Zika. present: www.cdc.gov/zika/pregnancy. • Adverse birth outcomes, including microcephaly • With a partner who is not yet pregnant, use and other problems in fetuses and infants, a condom during sex or abstain from sex caused by infection during pregnancy. for eight weeks, for exposed women, and • Protecting themselves by following rules and for six months, for exposed men, if planning procedures to reduce exposures. to conceive or until Zika virus infection is • Seeking medical evaluation after an exposure ruled out. Even couples who do not plan to incident and if signs or symptoms of Zika become pregnant should use a condom or develop. abstain from sex for the same periods to 3 • Any applicable requirements of the BBP standard minimize the risk of transmitting the virus. (29 CFR 1910.1030) or other OSHA standards. If Signs or Symptoms of Zika Develop More information about protecting workers If a worker develops signs and symptoms from occupational exposure to Zika is at: consistent with Zika within two weeks of www.‌osha.gov/zika. exposure, make available to the worker evaluation (or re-evaluation) by a healthcare provider. Exposure Incidents In most people, during the first 1-2 weeks of After a suspected exposure incident, it is crucial that infection, Zika virus can be detected in the blood workers perform proper hand hygiene and flushing and is capable of being spread from an infected of mucous membranes, as described above. person to a mosquito that feeds on that person. Post-Exposure Evaluation It also can be spread from an infected person to Laboratory employers should assess the other people through contact with the infected exposure incident to determine what happened person’s blood or body fluids. as well as the potential for infection. If the Laboratory Testing exposure falls under the BBP standard (29 CFR If laboratory testing is recommended or being 1910.1030), employers must comply with the considered, the healthcare provider should post-exposure evaluation and follow-up (as well obtain urine and serum (i.e., blood) samples as other) requirements in the standard. from the worker at baseline (i.e., immediately Refer workers with possible occupational exposure after the exposure incident). to a healthcare provider who can evaluate the A healthcare provider can confirm Zika virus worker and recommend appropriate testing for infection using baseline and follow-up tests. Zika and other BBP. Evaluating the results of baseline and follow-up Counseling tests in the context of other risk factors for Zika All exposed workers should receive confidential virus infection, such as geographic location, counseling from a healthcare provider to address local transmission and travel history, may help healthcare providers determine when and how

2) U.S. Department of Health and Human Services, “Biosafety in an infection occurred. Microbiological and Biomedical Laboratories (BMBL), 5th ed.”; Healthcare Infection Control Practices Advisory Committee, 3) U.S. Department of Health and Human Services, “Guideline for Precautions: Preventing Transmission Centers for Disease Control and Prevention, “Zika - Sexual of Infectious Agents in Healthcare Settings (2007).” Transmission & Prevention.” Once Zika virus infection has been ruled out, but providers and state, local, tribal and territorial no earlier than two weeks after exposure, no health departments should consult CDC further testing is recommended and additional guidelines for reporting information about precautions to prevent the transmission of Zika pregnant women and infants who are eligible virus from the exposed worker to others are no for the registry. The guidelines provide further longer required. Workers should make sure they information about who is eligible for the registry: receive Zika test results from their healthcare www.cdc.gov/zika/reporting/registry.html. provider even if they are feeling better. For More Information Confirmed Cases of Zika OSHA/NIOSH Zika guidance provides There is no specific treatment for Zika. CDC and information about signs and symptoms of Zika, OSHA advise infected individuals, including steps for preventing exposure, and other tips for workers, to: keeping workers healthy: www.osha.gov/zika • Get plenty of rest. CDC Zika website: www.cdc.gov/zika • Drink fluids to prevent dehydration. OSHA can provide extensive help through • Take such as acetaminophen to a variety of programs, including technical reduce and pain. assistance about effective safety and health • Do not take aspirin, ibuprofen, naproxen or programs, workplace consultations and training other non-steroidal anti-inflammatory drugs and education. without a healthcare provider’s approval. Under certain conditions, these can increase OSHA’s On-site Consultation Program offers free the risk of bleeding. and confidential advice to small and medium- • Talk to a healthcare provider before taking any sized businesses in all states across the country, other medications, including prescriptions, for with priority given to high- worksites. other medical conditions. On-site consultation services are separate from • To help prevent others from getting sick, avoid enforcement and do not result in penalties or mosquito bites during the first week of illness. citations. To locate the On-site Consultation Wear clothing that covers skin and use insect Program nearest you, visit www.osha.gov/ repellents to help prevent mosquito bites. consultation, or call 1-800-321-OSHA (6742).

CDC Reporting Guidelines for Healthcare Contact OSHA Providers and Health Departments For questions or to get information or advice, Zika virus disease is a nationally notifiable to report an emergency, fatality, inpatient condition. To facilitate diagnosis and mitigate hospitalization, amputation, or loss of an eye, or to risk of local transmission, state, local, tribal and file a confidential complaint, contact your nearest territorial health departments should consult OSHA office, visit www.osha.gov or call OSHA at CDC guidelines for reporting information about 1-800-321-OSHA (6742), TTY 1-877-889-5627. laboratory-confirmed and probable cases to CDC: www.cdc.gov/zika/public-health-partners. Workers’ Rights Under federal law, workers are entitled to working CDC established the U.S. Zika Pregnancy conditions that do not pose a risk of serious harm. Registry and is collaborating with state, local, tribal and territorial health departments to For more information on how to assure a safe collect information about pregnancy and infant and healthful workplace, see OSHA’s Workers outcomes following laboratory evidence of Zika page: www.osha.gov/workers. virus infection during pregnancy. Healthcare

This is one in a series of informational fact sheets highlighting OSHA programs, policies or standards. It does not impose any new compliance requirements. For a comprehensive list of compliance requirements of OSHA standards or regulations, refer to Title 29 of the Code of Federal Regulations. This information will be made available to sensory-impaired individuals upon request. The voice phone is (202) 693-1999; teletypewriter (TTY) number: (877) 889-5627.

DTSEM FS-3917 09/2017