Accidents. They happen, you know?

         Accidents happen in the laboratory. In fact, accidents happen in most, if not all, sectors of healthcare. Trust me, it's not fun dealing with them.

         I recall shadowing a phlebotomist during my internship and witnessed a needle stick. The patient we visited fought back against a blood draw and the person I shadowed got hit. Lucky for her, the needle had not entered the patient before that happened. But, safety precautions still took place in case of serious aftermath.

         That was also when I decided that I didn't like direct patient contact. So, I made every effort to make sure I stayed behind the scenes. Even then, things could go awry. Here's an instance of such incident.

         One of my coworkers, she was working with a routine culture sourced from a shoulder. Usually, this suggests it was some kind of wound. There were no other clinician notes in the entry, so she handled per protocol.

         On day three, she noticed a few small white colonies on the chocolate agar. She proceeded to identify them via the MALDI-TOF. Unfortunately, the machine could not offer any reasonable suggestions. So, she came to me and asked if I could try to run the biotyper again with the extraction method.

         Once again, the MALDI-TOF could not identify the organism. However, the biotyper did offer possible suggestions that time. They all came back as Francisella species. I put the culture under the safety hood and called my coworker over. I decided to perform a gram stain after heat fixing it under the hood. As expected, I saw something similar to this picture:

         My coworker grabbed our supervisor from his office and he came over. He immediately contacted the medical director and put him on the speaker phone. We explained what had happened and waited for his instructions. I was anxious because I didn't know if I could go home after my shift. To that, the medical director said to not worry.

Here's the rundown:

1. Tularemia is infectious, but not contagious from person to person. You can read more here.
2. Find out all personnel that had been in contact with the specimen. Those who handled it under the safety hood needed to not worry.
3. The medical director prescribed us prophylaxis as safety measure.
4. He told us to go home as normal, but watch for symptoms.

         Of course, I was definitely in the basement when I returned home. You could never be too careful. The next day, they identified the organism as Francisella tularensis. I went to the pharmacy at work and obtained ciprofloxacin. It did not cost me a cent as my employment covers for work-related incidents.

         Was that the end? No, not quite. While I was taking the antibiotic, I started to have unexplained back pains. I relayed it to the nurse practitioner who oversees employee health. He concluded that it might be one of the rare side effects of the drug. If you look at Mayo Clinic's breakdown, that is a thing. He switched me to doxycycline afterwards. I still got to keep the Cipro, though.

What went wrong?

1. The hospital of origin did not put enough information about the patient circumstances. Had we known it was a bite wound, we would have handled it with precautions.
2. The colonies were atypical of what we have seen in other cases.

         In the laboratory, we need as many clues as possible when given patient samples. It's not only for proper diagnosis, but also for personnel safety.

Bonus tidbit

         Francisella tularensis can be a weapon in bioterrorism due to its infectious nature. In fact, it's one of the four bioterror organisms we look out for in our lab.