Just recently, our university's Biosafety Committee told the faculty that we must discontinue certain laboratory exercises. The long list includes human blood, blood products, body fluids (cerebrospinal, synovial, pleural, pericardial, peritoneal, and amniotic fluids, saliva, and urine), contaminated needles, pathological wastes, microbiological wastes, and unfixed human tissues and organs.
We think that this decision, based on safety reasons that we can appreciate, is wrong. To quote our previously published article: "We feel human body fluids cannot be replaced in the teaching of physiology and can still be used effectively with minimal exposure risks if simple precautions are followed."1
The Ellis and Sanborn labs have been using body fluids in teaching biology and physiology since 1970 and 1984, respectively, and to our knowledge, we have never compromised a student, or anyone else, by using authentic blood, urine, or saliva. We understand the issues and we always err on the side of caution. In our estimation, the need to expose our undergraduate students (those planning on careers in the allied health fields, nursing, and other medically related disciplines) to realistic situations outweighs the risks of omitting these important procedures.
We use student blood samples and purchase human blood samples, which have been screened for major antigens, for determining ABO blood groups, staining for differential counts, calculating hematocrits, quantifying hemoglobin values spectrophotometrically, as well as other important clinical determinations. Under these new practices, when are students going to have time to be exposed to the practices they will face when they leave the university setting?
Out of curiosity, we decided to see if colleagues in other institutions were in the same predicament. We sent out about 20 E-mails, and the majority of those who replied said they are not allowed to use human tissue, urine, or blood in their labs. At Furman University, for example, human blood and urine is being phased out. "[A chair] claimed that human blood and urine pose too many problems with the possibility of infectious diseases," wrote one respondent. At Eastern Illinois University, staff still can use blood and urine, but this respondent didn't know for how much longer. "I know people are being careful but in my opinion, this is getting ridiculous. Soon, students would be forced to learn everything from simulation games!"
Perhaps some of the larger research universities still use blood and urine in their undergraduate life science laboratories. Because they have more research-oriented faculty, the importance of using such fluids in the lab may be better appreciated.
We understand that there could be an economic side to the issue; the lab must be properly prepared when body fluids are used: students need gowns, gloves, and protective eyewear; moreover, the lab requires an elaborate disposal system. At smaller institutions, the nature of liability may be a more significant issue.
Using these materials requires a written infection-control plan to identify and document tasks and procedures where occupational exposures may take place; steps taken to minimize or eliminate employee exposure also are required. At Barry University, a concern for housekeeping personnel cleaning the lab was raised, but these individuals clean the restrooms and already should be trained in proper procedures.
The current alternatives, synthetic blood, urine, and saliva, do not teach any valuable lessons about risks. Moreover, observing an agglutination reacting using synthetics is a distant second to the real antigen-antibody reaction. The reactions viewed appear to be similar to that of gelatin changing from the sol to gel phase after mixing. What ever happened to the urine sediment analysis?
Perhaps many of the exposure problems in the health-specified arenas are related to an improper understanding of the basics in dealing with the very protocols that students will face in their jobs. OSHA (Occupational Safety & Health Administration) regulations address the broader issues, but they do not provide guidelines for using such fluids in college and university teaching laboratories.
Requiring students to practice precautions in undergraduate laboratories while they are being exposed to potential pathogens provides a foundation for building a career in the health sciences. Returning graduated students tell us that they learned the most in these labs. Perhaps the risks of not knowing, early in one's career, present a greater hazard than identifying those risks and addressing them at the start.
Allen F. Sanborn, professor, and Gilbert E. Ellis, assistant professor, teach physiology at Barry University School of Natural and Health Sciences, Miami Shores, Fla.