Tuberculosis acquired in laboratories and necropsy rooms

The resurgence of tuberculosis, and the increasing number of cases that are HIV-related and/or multidrug resistant, has renewed interest in the occupational hazards posed by tuberculosis to staff in laboratories and necropsy rooms. A search undertaken using Medline and Pre-Medline identified few comprehensive reviews: the last was published in 1982. Staff may acquire pulmonary infection by inhalation of aerosols and skin lesions through cuts and abrasions. Particular hazards for laboratory staff include specimen containers contaminated on the outside, unfixed sputum smears, and the generation of aerosols during examination procedures. Examination of patients with tuberculosis not diagnosed during life constitutes a particular risk to necropsy room staff. Staff of laboratories and necropsy rooms are estimated to be between 100 and 200 times more likely than the general public to develop tuberculosis. Training in good laboratory practice is the most important aspect of staff protection, especially in resource-poor countries where well-maintained safety cabinets are rarely available. This article summarises requirements and recommendations for safe handling of tuberculous material and the available guidelines for work in developed and resource-poor countries.