The Idaho Bureau of Laboratories and Emergency ... - Webs
Transcript of The Idaho Bureau of Laboratories and Emergency ... - Webs
The Idaho Bureau of Laboratories and
Emergency Preparedness
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Michael Stevenson, Ph.D.IBL Emergency Preparedness Section Manager
208-334-2235 x269
October 24, 2013
“I wish you’d learn to put the lid on your petri dish,Harry! We came here today with just four kids butnow it looks like we’ve got several million!!”
Objectives• Overview of the Idaho Bureau of Laboratories (IBL)
• Overview of the Laboratory Response Network (LRN)
• Overview of the Select Agent Program
• Emergency Preparedness testing at IBL
• How IBL can assist with infection control
3NO FOOD OR DRINK
WEAR PROTECTIVE
CLOTHING
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The Idaho Bureau of LaboratoriesAs Idaho’s state public health laboratory, IBL provides laboratory services to support the programs within the Department of Health and Welfare, Idaho’s seven Public Health Districts, and other state agencies.
Training• Continuing medical education
seminars and telelectures• Formal presentations at
conferences• State Training Coordinator
Inspection• Clinical and environmental
laboratories• X-ray and mammography units• Air quality monitoring stations
Testing• Communicable disease agents in
clinical specimens• Contaminants or adulterants in
water, food, and soils• Biological and chemical threats
Outreach• Maintenance of Idaho Sentinel
Laboratory Network (ISLN)• Publication/presentation of
applied public health research• Development/validation of new
analytical methods
IBL Statistics• 20,000 square feet laboratory space
• Approximately 40 full-time employees
• ~ 60,000 samples per year• 72% Microbiology
• 26% Environmental
• 2% Emergency Preparedness
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IBL Program OrganizationBureau Chief
Business Operations
Administration
Data
Management
Facilities
Shipping & Receiving
Emergency Preparedness
Biological
Threat (LRN-B)
Chemical
Threat (LRN-C)
Food Testing
Environmental Analysis
Air Quality
Certification
Inorganics
Microbiology
Organics
Laboratory Improvement
Clinical Labs
X-Ray
Microbiology
Bacteriology
Molecular Epidemiology
Myco-bacteriology
Virology-Serology
QA/QC
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Christopher L. Ball, Ph.D., HCLD (ABB)
Emergency Preparedness Section• Michael Stevenson, Ph.D. – Scientist 4, Section Manager• Justin Grant, B.S. – Scientist 2, Chemist• Wendy Loumeau, B.S. – Health Education Specialist, STC• Dan Rousselle, B.A. – Scientist 3, Chemist• Robert Voermans, B.S. – Scientist 3, Microbiologist
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First Responders Post Office BiohazardDetection System (BDS)
Incident
Unknown powders, anthrax threat letters
Evidence
Biosafety Level 3(BSL3) Laboratory
Testing
Conventional methodsB. anthracis culture
Rapid methodsReal-time PCR
Anatomy of a Biological Terrorism EventBoise Fire
Department, HazMat Region IV
Idaho 101st Civil Support Team
FBI
IBL Emergency Preparedness
Section
LRN protocols
The Laboratory Response Network
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Level 3 Level 2 Level 1 CDC
LRN-B LRN-C
CDC, Atlanta, GA
The Laboratory Response Network• The LRN was established by the Department of Health and
Human Services’ CDC in accordance with Presidential Decision Directive 39, which outlined national anti-terrorism policies and assigned specific missions to federal departments and agencies.
• The LRN became operational in August 1999 through a collaborative effort involving LRN founding partners, CDC, FBI and APHL.
• The LRN is the premier system for identifying, testing and characterizing potential agents of bio- and chemical threats.
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• Typically hospital/clinical laboratories - voluntary
• Broadly, all laboratories analyzing or referring specimens that may contain microbial agents or toxins
• Rule out or refer to nearest LRN Reference Laboratory if potential select agent
Laboratory Response Network for Biological Threats (LRN-B)
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Idaho Sentinel Laboratory Networkin the seven Public Health Districts
LRN-B Reference Laboratories • Typically are public health
laboratories
• Receive isolates from Sentinel Laboratories for confirmation
• Perform conventional and rapid molecular biological agent testing
• Process environmental samples
• Receive mandatory LRN proficiency test samples
• IBL is Idaho’s LRN-B reference labBiosafety Level-3 laboratory
Registered Select Agent entity13
LRN-B National Reference Laboratories
• CDC (Atlanta)
• USAMRIID (Frederick, MD)
• Have highest biosafety level(BSL4) to work with highly dangerous/infectious agents (smallpox, Ebola)
• Have advanced methods to further characterize isolates of biological agents, i.e. “microbial forensics”
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Under United States law, select agents are bacteria, toxins, viruses, or fungi which have been declared by the U.S. Department of Health and Human Services or by the U.S. Department of Agriculture to have the potential to pose a severe threat to public health and safety.
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Select Agents
Cutaneous anthraxBubonic plague
Tularemia
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Select Agents
Anthrax
Plague
Brucellosis
Tularemia
Environmental Threats:
Threat letter
Terrorism:
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www.selectagents.gov
Code of Federal Regulations (CFR)Title 42 – Public HealthPart 73 – Select Agents and Toxins
• Centers for Disease Control and Prevention (CDC), Division of Select Agents and Toxins (DSAT)
• Animal and Plant Health Inspection Services (APHIS), Agricultural Select Agent Program
Select Agent Program
• The Select Agent Program is administered by CDC and APHIS, and regulates laboratories that may possess, use, or transfer select agents within the United States.
• The Select Agent Program was established to satisfy requirements of the USA PATRIOT Act and the Public Health Security and Bioterrorism Preparedness and Response Act of 2002, which were enacted in the wake of the September 11, 2001 attacks and the subsequent 2001 anthrax attacks.
• IBL is a registered entity with the Select Agent Program.
• www.selectagents.gov
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Select Agent Program
Bacterial Select Agents• Bacillus anthracis
• Botulinum neurotoxin producingspecies of Clostridium
• Brucella abortus
• Brucella melitensis
• Brucella suis
• Burkholderia mallei
• Burkholderia pseudomallei
• Coxiella burnetii
• Francisella tularensis
• Rickettsia prowazekii
• Yersinia pestis
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Burkholderia pseudomallei
Brucella
Viral Select Agents• Crimean-Congo haemorrhagic fever virus
• Eastern Equine Encephalitis virus
• Ebola virus
• Lassa fever virus
• Monkeypox virus
• South American Haemorrhagic Fever viruses
• Tick-borne encephalitis complex (flavi) viruses
• Variola major virus (Smallpox virus)
• Nipah Virus
• Rift Valley Fever Virus
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Ebola virus
Monkeypox virus
Toxin Select Agents
• Abrin
• Botulinum neurotoxins
• Conotoxins
• Ricin
• Staphylococcal enterotoxins
• T-2 toxin
• Tetrodotoxin
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Rosary peas abrin
Castor beans ricin
Laboratory Response Network for Chemical Threats (LRN-C)
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Level 362 labs• Work with hospitals/labs• Comprehensive CTresponse plan
• Competency in SCPaS
Level 246 labs• Level 3 activities• Proficient in CT analyses(e.g. cyanide, VOC)
• Surge capacity lab
Level 110 labs• Level 2 activities• Proficient in more CTanalyses (e.g. mustards)
• Conduct CDC research
CDC
Analytical Capability
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Level 2 Labs
Level 3 Labs
Level 1 Labs
Level 3American SamoaChicagoGuamMicronesiaLos AngelesMarshall Is.N. Mariana Is.New York CityPalauPuerto RicoUS Virgin Islands
Level 2District ofColumbia
2004
LRN-C Laboratories
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Chemical Agents - Classes
• Pulmonary Agents: Chemicals that cause severe irritation/swelling of the respiratory tract• Phosgene (respiratory distress, choking)
• Chlorine, Chlorpicrin, Diphosgene
• Blood Agents: Poisons that affect the body by being absorbed into the blood • Hydrogen Cyanide (vertigo, tachycardia)
• Carbon Monoxide, Hydrogen Sulfide
• Biotoxins: Poisons that come from plants or animals• Ricin (respiratory distress, fever, coughing)
• Abrin, Strychnine
http://emergency.cdc.gov/chemical/
• Nerve Agents: Highly poisonous chemicals that work by preventing the nervous system from working properly• Sarin (diarrhea, miosis, bradycardia)
• Soman, Tabun, VX
• Vesicants: Chemicals that bliser the eyes, respirator tract, and skin on contact• Sulfur Mustard (itching, yellowish blisters)
• Nitrogen Mustard, Phosgene Oxime
• Industrial Chemicals: raw materials to convert into thousands of products• Metals (mercury, lead, arsenic, cadmium)
• Volatile Organic Compounds (VOCs)
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Chemical Threat Agents Tested at IBL
• Cyanide
• Toxic Metals(Cd, Hg, Pb)
• Volatile Organic Compounds(benzene, carbon tetrachloride, chloroform, 1,2-dichloroethane, ethylbenzene, styrene, tetrachloroethene, toluene, o-, m-and p-xylene)
• Abrine (abrin marker)
• Ricinine (ricin marker)
• HNPAA (explosive metabolite)
• Tetramine (rat poison)
• Metabolic Toxins(monochloroacetate, monofluoroacetate)
• Organophosphate Nerve Agents(sarin, soman, cyclohexylsarin, VX, Russian VX)
• Toxic Metals(As, Ba, Be, Cd, Pb, Tl, U)
BLOOD URINE
Emergency Preparedness Testing
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Proficiency Tests• LRN-B: swabs, powders, HEPA socks, sponges• LRN-C: blood, serum, urine, powders, liquids• Food Emergency Response Network (FERN)
• Arsenic in apple juice• Tetramine in beer• Yersinia pestis in hot dogs• Unknown agents in milk
Clinical• cultures, swabs, tissues• ticks, horse blood
Environmental• biothreat letters (3 sent to Boise government offices)• consumer products (arsenic in contact lens solution)• ultrafiltration of large volume water samples (Salmon River outbreak)
Food: posole soup, chicken, ice cream, fruit, peanut butter, salsa
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How IBL Can Assist with Infection Control
http://www.cdc.gov/phpr/zombies.htm
“If you are generally well equipped to deal with azombie apocalypse you will be prepared for ahurricane, pandemic, earthquake, or terrorist attack.”
28• Laboratory-Acquired Human Glanders [Burkholderia mallei] – Maryland,
2000. MMWR (2000), 49(24), 532-5.
Laboratory Acquired Infections (LAI)
• Laboratory-Acquired Brucellosis – Indiana and Minnesota, 2006. MMWR (2008), 57(02), 39-42.
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Center for Infectious Disease Research and Policy www.cidrap.umn.edu/
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www.cdc.gov/salmonella/pdf/CDC_LAI_Prevention_Poster_012313_508.pdf
Infection Control: Scientist POVproper biosafety practices, training
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Standard Microbiological Practices: DO NOT’s
Unauthorized entry
Mouth pipetting Eating, drinking, smoking, applying
cosmetics, handling contact lenses
Poor housekeeping
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Mechanical pipetting
Disinfect work areas
Vigorous hand washing with mild soap for
several seconds
Sharps containers
(10% bleach made fresh daily)
Standard Microbiological Practices: DO’s
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IBL Biosafety Level PPE
NO LAB WORK
LOW RISK
HIGH RISK
PAPR or N/P-100
LOW RISK
HIGH RISK
PAPR
Donning• don lab coat when entering lab• don gloves and safety glasses before working
Doffing• dispose of gloves in biohazard container• remove lab coat before leaving lab
Donning and Doffing procedures are given to authorized staff who work in the BSL-3 suite.
Donning• don lab coat when entering lab
Doffing• remove lab coat before leaving lab
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Instructions for Shipping Blood/Urine Samples
Centers for Disease Control and PreventionAttn: Lt. Ernest McGahee4770 Buford Hwy/Building 110 Loading DockAtlanta, GA 30341(770) 488-7579
sample box with adsorbent pad
UN 3373 label(blood and urine)
seal lid on; return addressshipping manifest in bag
sample, cushioning, more coolantline with coolantadsorbent pad in shipper boxseal with evidence tape and initial
place in white envelopewrap box in pad; tape; seal into bagseal with evidence tape and initial
blood
initials half off tape
urinedry ice
bloodice packs
Class 9/UN 1845 label(for dry ice only) FedEx to CDC or IBL
Idaho Bureau of LaboratoriesAttn: CT Lab Coordinator2220 Old Penitentiary RdBoise, ID 83712(208) 334-2235
urine
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• A “fever watch” is recommended for all laboratory personnel who have worked with select agents.
• Affected staff should be aware if they develop an unexplainable febrile illness or abnormal body temperatures within two weeks of working withthese agents.
• Notify supervisor and/or seek medical care.
Fever Watch
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If working with a slow-growing, Gram negative, coccobacillusbacteria, move work into a biosafety cabinet.
Infection Control: Scientist POV
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Look-alike OrganismsSelect Agent Organism Resembling Select Agent
Bacillus anthracis Could be disregarded as a lab contaminant
Brucella species Haemophilus influenza
Burkholderia mallei or B. pseudomallei Burkholderia cepacia
Francisella tularensis Actinobacillus species
Yersinia pestis Shigella species or Y. entercolitica
AVOID CONFUSION
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Automated ID Systems: Mis-Identification
Most automated systems carry an inherent risk for the productionof infectious aerosols. Using these systems with a potentialbiothreat agent is not recommended.
Example: Yersinia pestis may key out instead as Shigella, H2S-negative Salmonella, Acinetobacter, or Y. pseudotuberculosis.
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Automated ID Systems: Mis-Identification
Four different clinical laboratories attempted to identify the isolate. Three different commercial automated systems identified the organism as Acinetobacter lwoffii, Pseudomonas luteola, and Yersinia pseudotuberculosis, respectively. However, 25 days after specimen collection, the isolate was identified as Y. pestis … at the Spokane (Washington) Regional Health District Laboratory, prompting notification of the Oregon Health Authority.
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DescriptionIdaho Bureau of Laboratories (IBL) will conduct a workshopthat provides an overview of the sentinel laboratory’s rolein the presumptive identification of agents of biologicalthreat. Participants will review the Laboratory ResponseNetwork (LRN) and sentinel laboratory protocols for rulingout suspect agents. Laboratory demonstrations will outlinethe microbiology of these agents to recognize the culture,staining, and biochemical characteristics.
RegistrationRegister online at www.keysurvey.com/f/542874/2603/Please register by October 29th.
Sentinel Laboratory
Biothreat Preparedness Workshop
November 5, 20139:00 am - 5:00 pmIdaho Bureau of Laboratories2220 Old Penitentiary Road
Boise, ID 83712208-334-2235
www.statelab.idaho.gov
Contact Wendy Loumeau with questionsPhone: 208-334-2235 x 258Fax: 208-334-4067Email: [email protected]
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Emergency Preparedness SectionMichael Stevenson, x269, [email protected]
Justin Grant, x252, [email protected]
Wendy Loumeau, x258, [email protected]
Dan Rousselle, x270, [email protected]
Robert Voermans, x255, [email protected]
Idaho Bureau of Laboratories2220 Old Penitentiary Rd
Boise, ID 83712208-334-2235
www.statelab.idaho.gov
Questions? Thank you!