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Safety of Laboratory Personnel �(Emerging infections and Epidemics) Uganda

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Otita Morgan

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Safety

  • A state in which hazards and conditions leading to harm are controlled in order to preserve the health and well-being of individuals and the community. 

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  • Safety assurance is based on the 
    1. Environment (physical, social, technological, political, economic and organizational) and on 
    2. Behaviour.

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Ref:Québec WHO Collaborating Centre for Safety Promotion and Injury Prevention, WHO Collaborating Centre on Community Safety Promotion, Karolinska Institutet, World Health Organisation, updated 2018. Safety and Safety Promotion: Conceptual and Operational Aspects, Québec.

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Biosafety and Biosecurity ���

Biosafety:

Application of safety precautions that reduce risk of exposure to a potentially infectious microbe and limit contamination to work environment and the community

(CDC; WHO Laboratory Biosafety manual 4th edition)

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Biosecurity:

Protection, control and accountability for valuable biological materials (VBM) to prevent their unauthorized access, loss, theft, misuse, diversion or release

ISO - ISO 35001:2019 - Biorisk management for laboratories and other related organisations

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Biorisk management

Biorisk : The probability or chance that a particular adverse event possibly leading to harm, will occur

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Biorisk = Biosafety + Biosecurity Risks

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Biorisk assessment : The process to identify pitfalls / risks and their potential consequences across the established quality assurance systems.

    • Very critical once a potential outbreak is suspected or confirmed

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Risk assessment framework

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Gather information �

  • Type of biological agent and its pathogenic characteristics
  • Route of transmission
  • Type and number of procedures to be carried out on specimens received by the laboratory,
  • Type of laboratory facilities and equipment available,
  • Human factors, for example, number and level of competence of the laboratory personnel,
  • Susceptibility of the biological agent to inactivation and disinfection procedures.

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Evaluation of risk

  • How exposure to the biological agent could occur,
  • How the biological agent could be released from the laboratory,
  • Likelihood of exposure or release occurring, and
  • Consequences of exposure or release.

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Risk Control Strategy

  • What resources are available for risk control measures,
  • What are the most appropriate risk control strategies for the available resources,
  • Whether enough resources are available to put in place and maintain the risk control measures, and
  • Whether the proposed risk control strategies are effective, sustainable for the course of the outbreak and achievable in the local context.

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Note: Implement risk control measures and monitor for effectiveness

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Public Health Events (PHEs)

Emerging infectious diseases are commonly defined as:

    • Outbreaks of previously unknown diseases 
    • Known diseases that are rapidly increasing in incidence or geographic range in the last 2 decades
    • Persistence of infectious diseases that cannot be controlled.

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Re-emerging diseases: Reappear after they have been on a significant decline as a result of

    • breakdown in public health measures for diseases that were once under control
    • new strains of known disease-causing organisms appear.

Note: Human behaviour affects re-emergence.

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https://www.hopkinsmedicine.org/health/conditions-and-diseases/emerging-infectious-diseases

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Examples of PHEs

Emerging diseases include

    • HIV infections
    • SARS
    • Lyme disease
    • Escherichia coli O157:H7 (E. coli)
    • Hantavirus
    • dengue fever
    • West Nile virus
    • Zika virus

Re-emerging diseases include

    • Malaria
    • Tuberculosis
    • Cholera
    • Pertussis
    • Influenza
    • pneumococcal disease
    • Gonorrhea
    • AMR pathogens (ESBL, VREs, MRSA, CROs)

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The Epidemiologic Triad

(http://www.med.uottawa.ca/SIM/data/Pub_Infectious_e.htm#epi_triad).

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Epidemic intelligence

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Safety precussors to consider prior to outbreak management engagement

    • Aetiology of disease
    • Case facility rate
    • Magnitude of outbreak
    • vaccination statusInfection or transmission rate (Ro)
    • Mode of transmission
    • Type of laboratory (Reference tetsing)
    • Medical surveillance of personnel
    • Biorisk assessment
    • Adherence to unversal safety precautions
    • Preservation aspects or Inactivation capabilites
    • Infrastructure
    • Specimen of choice

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