Course Objectives Illustrate science and profession of biosafety Examine the application of biosafety in various settings Provide a foundation in the principles of biohazard containment and control
Course Syllabus Lectures –1 st half of course Tours –Building HVAC system, cooling tower –Biohazard containment facility –Animal facility tour –Guest speakers Bioaerosol or project sampling location –Selected by student teams
Course Syllabus Projects –Risk assessment exercise (major) –Regulatory Policy comparison (minor) –Bioaerosol/env. micro sampling (major – team) –Facility commissioning exercise (minor – team) Completed by group in class session –Point/counterpoint challenge (major – team) Final Exam (major) –Open book(s), open notes and handouts
Texts Biosafety: Principles and Practices, 4 th Ed. CDC/NIH Biosafety in Microbiological and Biomedical Laboratories, 5th Ed. NIH Guidelines for Research Involving Recombinant DNA Molecules (April 2002) Handouts (hard copies, , or online) Previous coursework or experience in Micro or Molecular Biology?
Students Introductions Student Interests –What do YOU hope to get out of the class? Course Goals!!
Biosafety The consistent application of safety measures to minimize or prevent exposure to the person handling the agent, lab and building occupants, the community and the environment. –Key Safety Measures: good microbiological work practices safety and containment equipment facility design consideration
Biohazard Biohazard n (1967): a biological agent or condition (as an infectious organism or insecure laboratory conditions) that constitutes a hazard to man or his environment; also a hazard posed by such an agent or condition. Websters 9th New Collegiate Dictionary, Miriam- Webster Inc. Publishers, Springfield, MA USA, 1985
Biohazard Settings/Biosafety Applications Research, including: –human & animal pathogens, select agents (bioterrorism) –toxins of biological origin –rDNA research, Human Gene Transfer, plants, animals, large scale –shipping, transport, import, export, permits –training (BBP, TB, infection control, shipping, Biosafety, BSL-3, work practices, BSCs) –field work, work abroad (feral animal, insects, arthropods)
Biohazard Settings/Biosafety Applications Clinical/Hospital Settings (helping sick people) –micro labs, in- and out-patient facilities, infirmaries –infection control, standard precautions, airborne precautions (TB, measles, varicella, flu) –social workers, divinity and law school volunteers, students
Biohazard Settings/Biosafety Applications Buildings/IAQ –fungi, SBS, cooling towers, HVAC, floods, leaks, allergens Emergency Response –police, fire, plant maintenance personnel, public health officials –biohazard spills, exposures, incident review Environmental Issues –mosquito control program, anthrax sampling (mailrooms) –food sanitation Other –clean air device monitoring (biosafety cabinets, other hoods) –facility design, renovation, construction, and commissioning
Biohazard Settings/Biosafety Applications Cruise ships, airplanes, trains, buses, other crowded conditions Homeless shelters, prisons, schools Farms, agricultural settings (zoonotic agents) Hunting (gutting/dressing wildlife) Bioterrorism (local area response) Production of medical products, vaccines, drugs, biologics Outbreak investigations, war, refugee camps Other???
OEHS Biosafety We dont make the jobs you do….. We make the jobs you do safer.
Biosafety: Historical Perspective (Seymour Block) Homer (Odyssey XXII)- burned sulfur for fumigation, 800BC Hippocrates- involvement of fomes/fomites in disease process, 4th century BC Bible –move campsites daily, care of wastes, strict dietary/cleanliness –rules/regulations regarding lepers (ISOLATION) –burn or boil clothing and equipment Aristotle - advised Alexander the Great (boil water, bury excreta)
Biosafety: Historical Perspective (Seymour Block) Susruta (Hindu physician)- cleaning/fumigation of OR before and after operations, 500 AD Great plagues- burn victims clothes, burned bodies on 10 foot poles, unique PPE worn by physicians (perfume in beak), full body coverage, Middle Ages Girolamo Fracastoro- referred to seeds or germs of disease. Identified 3 sources of contagion (contact, fomites, air) Venice Magistry of Health- fumigated cargo and mail from ships, 1438
Biosafety: Historical Perspective (Seymour Block) Leeuwenhoek- studied effect of chemicals on little animals under microscope, 1676 Cotton Mather- 1st in America to vaccinate against smallpox (with smallpox, Jenner used Cowpox), 1720 James Lind- hygiene as sea (disinfection, filtration of water, cleaning and ventilation of sick bay, special clothes for physicians), 1757 Nicholas Appert- Canning method for food preservation, 1810 John Pringle- sanitary trench disposal of waste in warfare
Biosafety: Historical Perspective (Seymour Block) Oliver Wendell Holmes (1843), Ignaz Semmelweis (1847) Identified spread of puerperal fever to patients from medical staff. Introduced hand washing to thwart spread. Agostino Bassi (lawyer)- suggested use of germicides, patient isolation, and decontamination of clothes and excreta (1835) Louis Pasteur- Flame sterilization of surgical tools, heat sterilization of bandages before use on wounds, risk assessment enters forefront with his quote Chance favors the prepared mind. (1880s)
Biosafety: Historical Perspective (Seymour Block) Joseph Lister- antiseptic use on open wounds (phenol), poured directly into wounds, lowered infection rate from %, (1860s s) Robert Koch- sterile technique, pure culture, use of solid media, tested over 70 disinfectants, (1881) Dakin- 0.5% hypochlorite used to disinfect wounds in WWI WWII-1st war with less deaths from disease than from battle wounds (disinfectants in common use)
Pertinent Biosafety Events Flu pandemic Discovery of antibiotics 1930s - present - Biowarfare research continues (Japans Unit 731, many other examples before and after) 1930s- U.S. Malaria Control Division (later CDC&P) 1940s- Invention of Electron Microscope –Can now see viruses! 1950s -present- Viral Hemorrhagic Fever outbreaks Marburg virus outbreak in lab development of Biohazard Symbol Lassa Fever LAIs at Yale OSHA, EPA created (OSHA General Duty Clause)
Pertinent Biosafety Events Classification of Etiologic Agents on Basis of Hazard (Biosafety Levels 1 - 4) NIH rDNA Guidelines Ebola outbreak Smallpox LAI, England Laboratory Safety Monograph (NIH) Anthrax release from military research lab, Sverdlosk, Russia (>60 deaths) CDC/NIH Biosafety handbook, WHO text st HIV cases reported
Pertinent Biosafety Events EPA Medical Waste Requirements needles/syringes found on beaches on east coast, Medical Waste Tracking Act established resurgence of TB cases, MDR-TB observed OSHA Bloodborne Pathogens Standard st Human Gene Transfer trial initiated (ADA) Hantavirus outbreak, Southwest USA Publication of Richard Prestons, The Hot Zone Sabia LAI, Yale Hendra virus, Australia/Avian flu, Hong Kong Mad Cow Disease (BSE)
Pertinent Biosafety Events Influenza A Virus (H5N1) in poultry, Hong Kong West Nile Virus, 1st time ever in U.S st HGT death, UPenn OTC Protocol Nipah Virus, Malaysia (high mortality rate) Anthrax letters shipped via US Mail HGT Trials suspended after 2nd case of leukemia caused by integration of defective retroviral vector in host chromosome SARS Virus 2004 – Bird Flu (H5N1) concerns return 2004 – SARS LAIs, Tularemia LAIs (BU)
Pertinent Biosafety Events 2004 – TB Infections, Washington State (associated w/ Madison Aerosol Chamber) – Occular Vaccinia, Pennsylvania (route of exposure unknown) – Vaccinia infection from needlestick, Connecticut (animal research experiment) 2006 – Brucella infections – Texas A&M (associated w/ Madison Aerosol Chamber). 3 additional seroconversions to C. burnetii identified – Significant non-compliance w/ Select Agent Regulations identified at Texas A&M (SA Research shut down) – U.S. Federal hearings on oversight of BSL3 and BSL4 laboratories.
Laboratory Acquired Infections (Harding & Byers) –Infections acquired through lab or lab related activities (symptomatic or asymptomatic) LAIs came with golden age of Microbiology –Typhoid1885 –Brucellosis1887 –Tetanus1893
LAIs (Harding & Byers) Total: 5, 346 LAIs 190 deaths –underreporting likely –many more sub-clinical infections? Percentage that knew route of exposure similar from , and from ! Name that percentage?
Secondary Infections (LAIs) (Harding & Byers) –The transfer of an occupationally acquired infection to another person outside of the work environment. Uncommon (8 reported ) (2) Brucella- sexual transmission (2) Salmonella- microbiologist prepared dinner for family (one death) (1) Leptospira interrogans- through breast milk (2) Bordetella pertussis- to family members (1) B-Virus – spouse of injured animal care worker
Laboratory Acquired Infection (LAI) Summaries PA Vaccinia LAI ocular infection (2004) –Route unknown Breach in aerosol containment/poor work practices –Failure to consistently wear gloves –Absence of face protection while working outside of primary containment –Failure to confine all procedures to biosafety cabinet –Inadequate decontamination of contaminated work surfaces –Possible hand to eye to contact during experiments –Lack of awareness of signs/symptoms of disease
Laboratory Acquired Infection (LAI) Summaries Vaccinia infection from needlestick (2005) –Inadequate oversight, training –Insufficient risk assessment, poor SOP utilized –Poor work practices Transport of needles by hand to sharps container outside of room Recap of contaminated needles by hand –Poor exposure response (delay in skin washing) –No report of exposure (State reportable infection!) –Secondary bacterial infection (required hospitalization)
Laboratory Acquired Infection (LAI) Summaries Texas A&M Brucella infection (2006) –Use of Madison Aerosol chamber Insufficient Risk Assessment for Agent and Operation Poor training of staff on use of chamber No secondary containment of device or animals removed from device (aerosols from hair of animals) –No recognition of signs/symptoms of Brucella infection –Untrained, unregistered researcher 3 Additional Q-Fever Infections (asymptomatic) unreported –No immediate report of Select Agent infections to CDC (10 month delay)
Laboratory Acquired Infection (LAI) Summaries BU Tularemia infections (2004) –3 cases – not identified by institution Discovered by personal physicians or ER No recognition of signs/symptoms of disease –Attenuated BSL2 (non Select Agent strain?) If rDNA – in violation of NIH Guidelines! –Lowering containment from BSL3 to BSL2 must be authorized by NIH OBA Inadequate risk assessment performed Inadequate containment, PPE, work practices –Some procedures conducted on open bench
Laboratory Acquired Infection (LAI) Summaries Monkey B-Virus Infection (fatal), Georgia, 1997 (Yerkes Regional Primate Center) –Ocular exposure during transport of non-human primate Insufficient training identified –No agent-specific training on hazards associated w/ NHPs –No emergency/exposure response training provided Insufficient personal protective equipment –No face protection provided Inadequate barrier (open cage) used for transport
Biosafety Profession Resources: –American Biological Safety Association –Centers for Disease Control & Prevention –National Institutes of Health –World Health Organization
Biosafety Profession Certified Biological Safety Professional (CBSP) - Exam Task List –Disinfection, decontamination, sterilization –Work practices and procedures –Risk assessment/hazard identification –Regulatory aspects, standards & guidelines –Program Management –Equipment Operation and Certification –Facility Design
Biosafety Profession Also requires knowledge of: –immunology, molecular biology, epidemiology –microbiology, cell biology –animal care and use, cell culture techniques –immunizations, risk management –aerobiology
Biosafety Profession Sources of information/training –ABSA Professional Development short courses offered at annual conference and spring seminar local chapters and affiliates of ABSA –Duke University MPH and DRPH degrees –NIH Biosafety Training Program (BSL3/BSL4) –Occ. Health/Public Health/Env. Health programs throughout U.S. and world –Short courses (Harvard SPH, Eagleson Institute, Canada, AIHA, ASM, APIC, NSC, CSHEMA, etc.) –Mentors (other biosafety officers, laboratorians, biosafety committee members, university courses (learning is ongoing!)