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发表于 2014-8-20 14:31:15
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病理科做完尖锐湿疣检查的病理组织的切块，用蜡封着，有传染性吗？这种尖锐湿疣的蜡块应该怎么处理？
组织标本经福尔马林固定石蜡包埋后切片染色观察和免疫组化检测，是医疗机构病理诊断常规操作。据美国CDC资料，虽然绝大多数固定后标本中蛋白经福尔马林变性而没有传染性，但阮病毒、结核分枝杆菌和克雅氏病毒仍可从包埋材料中传播，而具有感染性。即使是充分包埋，也存在感染风险。所以固定后的蜡块并不是完全安全的。包埋不充分或不完全，导致的感染性风险更大。
尖锐湿疣主要是以性传播感染人乳头瘤病毒（HPV）所致增生性损害。所以蜡块的传染性基本可以不考虑。
组织蜡块做为患者病历的一部分，是不能做医疗废物丢弃的。需要编号专室存档，以备疾病复核与科研教学使用。
据我了解，国外已经开始重视包埋后组织蜡块的生物安全问题。目前我国还没有一家医院对此引起重视而采取相关预防措施。建议根据询证依据，对有经空气传播感染性病原体存在的蜡块，置拉扣透明塑袋中保存，贴“生物危害”外标识。提醒再取用人员采取相关防护措施。并保护存贮环境。
我在论坛内有相关介绍，请参考http://oc.gkteach.cn/thread-129066-2-1.html。文献资料见下：
Fixed tissue — Fix tissue in 10% formalin in a concentration 10 times the volume of tissue to ensure effective fixation and to reduce potential of infectious contamination. However, the viability of infectious organisms is dependent on a host of variables that have not been clearly identified, and fixed tissue has been shown to remain infectious (78). M. tuberculosis has been transmitted from fixed specimens as well as grown from fixed specimens, and CJD is not inhibited by the routine concentration of formalin. Grossing stations where formalin-fixed specimens are cut are designed for decreasing the fumes of formaldehyde but are not BSCs (2,57,83–85). Formalin-fixed specimens must be handled with gloves.--Transmissibility of the prion is retained in formalin-fixed paraffin blocks .FROM《Guidelines for Safe Work Practices in Human and Animal Medical Diagnostic Laboratories 2012 CDC and BBRP》。
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楼主: dearhang
