Rule out & Refer

If a sentinel laboratory suspects an organism to be a hazardous (bioterrorism) pathogen, use the emergency pager number (402) 888-5588 where you will be given guidance to order testing and shipping to NPHL.

Do you have a suspected BT agent? Remember:

• All manipulation must be done in biosafety cabinet.
• Follow rule-out & refer procedures.
• Contact NPHL personnel by calling the emergency pager.
• Ship pure isolate to NPHL via an exclusive courier.
• Document courier transfer with NPHL courier by saving shipping documents for 2 years.
• Secure all potential BT organism and residual samples.
• Document personnel with access to agent.
• Document personnel who have worked outside of biosafety cabinet.

Rule out and Refer Guides for Potential Bioterrorism Organisms:

• NPHL Bench Guide for Hazardous Pathogens
• APHL Biothreat Agent Bench Cards for the Sentinel Laboratory
• Biothreat Agents Poster
• Nebraska Reportable Diseases Title 173 Regulations

Other References:

• NPHL Quick Reference Guide to Specimen Collection of Suspected Agents of Bioterrorism
• Checklist for Sentinel Clinical Laboratories
• Definition of LRN Sentinel Laboratory
• LRN Sentinel Level Clinical Laboratory Protocols

Do you have a confirmed BT agent?

• Follow directions from NPHL to destroy or transfer isolate and/or specimen.
• Perform a risk assessment review.
• If there is an exposure, document with APHIS/CDC Form 3: ADD. APHIS/CDC Form 3: Report of a Release/Loss/Theft | Forms | Federal Select Agent Program (selectagents.gov)
• Report any exposures to employee’s occupational health department and follow health department post-exposure prophylaxis.