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Biosafety Level Criteria and Requirements for Handling Specimens Suspected of Containing Mycobacterium tuberculosis

All specimens suspected of containing M. tuberculosis (including specimens processed for other microorganisms) should be handled in a biological safety cabinet (BSC). Appropriate personal protective equipment (PPE) must be used. At a minimum, this includes gloves and fluid-resistant laboratory coat or gown.
Non-aerosol-producing manipulations (eg, preparing direct smears for acid-fast staining when done in conjunction with training and periodic checking of competency) can be performed using biosafety level-2 (BSL-2) practices and procedures, containment equipment, and facilities.
BSL-3 practices, safety equipment, and facility design and construction are applicable to microbiology laboratories that work with indigenous or exotic agents with a potential for respiratory transmission, and which may cause serious and potentially lethal infection. If the laboratory is propagating and manipulating cultures for M. tuberculosis, BSL-3 practices, containment equipment, and facilities are required. Barriers include controlled access to the laboratory and ventilation requirements that minimize the release of infectious aerosols from the laboratory. Secondary barriers should include self-closing double-door access and negative airflow into the laboratory. Exhausted air must not be recirculated.
Work surfaces must be decontaminated, using the laboratory-approved disinfectant, upon completion of procedures, immediately following a spill, and at the end of the work shift, if the surface was recontaminated since the last cleaning. Laboratory equipment should be routinely decontaminated.
Hands must be washed upon completion of work with potentially infectious materials and before leaving the laboratory.
These containment recommendations are from the CDC website:
Containment Recommendations
Most laboratories handling clinical specimens of suspected tuberculosis will not know if an extensively drug-resistant tuberculosis (XDR TB) strain is present until after testing is completed on the materials. Initially, BSL-2 practices and procedures, containment equipment, and facilities are required for non-aerosol-producing manipulations of clinical specimens such as preparation of acid-fast smears.2 All aerosol-generating activities must be conducted in a biological safety cabinet (BSC). Use of a slide-warming tray, rather than a flame, is recommended for fixation of slides. Liquefaction and concentration of sputa for acid-fast staining may be conducted safely on the open bench by first treating the specimen in a BSC with an equal volume of 5% sodium hypochlorite solution (undiluted household bleach) and waiting 15 minutes before processing.
If samples are being received from a known or highly suspected source of XDR TB, BSL-2 with full BSL-3 practices are highly recommended for manipulations of the clinical specimens, including additional personal protective equipment (PPE) and autoclaving of waste before leaving the laboratory (see 5th edition BMBL for full description of BSL-3 practices).


Reference: CDC website. Available at:
https://www.cdc.gov/tb/topic/laboratory/biosafetyguidance_xdrtb.htm. Accessed November 14, 2018.