Salmonella Outbreaks in Clinical and Teaching Laboratories Podcast

Bacterial culture grown on a blood agar plate.

AJ Troiano discusses the reasons behind the repeated outbreaks and what institutions and lab workers need to do to prevent them in the future.

Below is a summary of highlights from the podcast.

What is the greatest concern about the recent Salmonella outbreak announced by the CDC?
AJ Troiano: The biggest concern is that we can’t seem to learn anything from history and we keep repeating ourselves, almost every three years on the dot. In 2011, in 2014, and now currently in 2017 we have another Salmonella outbreak. Not foodborne related, which is a common occurrence. This time it’s happening over again in clinical and teaching microbiology laboratories.

It’s important to highlight that some of the people sickened from these outbreaks didn’t even work in a labs. They are family members of the people working in the laboratories. It’s happening unfortunately to some very vulnerable populations. Children less than one-year-old, and people as old as 87 getting sick from things that shouldn’t be happening. The whole idea of biological safety is protecting personnel, the community and the environment.

Why are we seeing a Salmonella outbreak, linked to unsafe lab practices, occurring every three years?
AJ Troiano: There is a false believe that it isn’t going to happen to you or at your institution. There are high profile, well-funded laboratories conducting extremely high containment level research where there have been instances, such as the CDC. That’s the reality.

Prevention of a lab-related Salmonella outbreak does not require a sophisticated or overly engineered solution. The solution is simple, it is basic lab safety principals that are being neglected. The CDC has linked the cause of these outbreaks to: not wearing gloves in labs, not wearing lab coats, not washing hands, cell phones, binders, and pens in labs that are then being brought outside the lab – and even home.

In the lab environment, who is at greatest risk for exposure to Salmonella?
AJ Troiano: Salmonella is ubiquitous in laboratories and used frequently. It’s tested for a lot, therefore even though it might not be a significant human pathogen in terms of the disease that it presents, the fact that it’s used so frequently presents a greater risk, and because it’s used across diverse settings.

Clinical lab scientists who have training and advanced degrees are going to be better suited to deal with it than a first or second year college student who doesn’t have the same amount of education or risk perception.

The reality is science does a very good job of quantifying risk, but people’s perceptions will determine what that risk is for themselves. So if you have somebody who’s worked in a laboratory for fifteen years, their risk of Salmonella will be different than a first or second year student working in a biology course, or just trying to finish out the end of the semester.

What controls are in-place on college and university campuses to minimize exposure? Where are the gaps?
AJ Troiano: It depends a lot on the campus, but usually there’s a basic training component for clinical lab science classes. The key is to integrate the training into the curriculum before students can actually conduct research with Salmonella. This is typically the policy.  Now, whether the policy is in-place, whether it is enforced, and whether the students are actually competent in the policy is a whole different discussion.

Resources like the CDC, BMBL, American Society for Microbiology and Association of Public Health Laboratories provide best practice guidelines. However, it’s not one size fits all. Institutions differ and they have to interpret and integrate the guidelines differently. Most institutions will have policies – even good policies. The real gap is that a lot of these institutions don’t have good compliance, or they don’t have good competency – and those are two very different things.

It’s one thing to be compliant with all of your safety plans, to go through all the training and get your students involved. It’s another thing to go back and then validate those plans and say, “Are we doing this effectively?” I think these are the challenges that aren’t being addressed.

How does an institution successfully integrate policies and training, and evaluate competency? 
AJ Troiano: The reality is you really have to integrate your environmental health and safety (EH&S) staff with the work that’s going on. That may mean your EH&S staff needs to have a more active and visible presence in the laboratory, this is a basic first step. The next step is leadership buy-in. It’s very hard for environmental health and safety staff to do their job if they don’t have leadership behind them.

Institutions should review their policies. Are the policies effective, do they need amending?  Then look at what lab procedures are being conducted. Maybe there are ways to modify the procedure to make it safer for the students and avoid this safety issue all together.