INFECTION CONTROL
Isolation is not recommended for tu- laremia patients, given the lack of hu- man-to-human transmission. In hos- pitals, standard precautions101 are recommended by the working group for treatment of patients with tularemia.
Microbiology laboratory personnel
should be alerted when tularemia is clinically suspected. Routine diagnos- tic procedures can be performed in bio- logical safety level 2 (BSL-2) condi- tions. Examination of cultures in which F tularensis is suspected should be car- ried out in a biological safety cabinet. Manipulation of cultures and other ac- tivities involving infectious materials with a potential for aerosol or droplet production (centrifuging, grinding, vig-
orous shaking, growing cultures in volume, animal studies) require BSL-3 conditions.102 When F tularensis is pre- sumptively identified in a routine BSL-2 clinical laboratory (level A), speci- mens should be forwarded to a BSL-3 laboratory (level B) (eg, a state public health laboratory) for confirmation of agent and other studies, such as anti- microbial susceptibility testing.11 Bod- ies of patients who die of tularemia should be handled using standard pre- cautions. Autopsy procedures likely to cause aerosols, such as bone sawing, should be avoided. Clothing or linens contaminated with body fluids of pa- tients infected with F tularensis should be disinfected per standard precau- tions protocols.101
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