1

Biosafety and Infectious Control in Laboratoriesความปลอดภัยทางชีวภาพ และ การควบคุมการตดิเช้ือในห้องปฏิบัตกิาร

Anek Kaewpan, MT MPHBiosafety Officer

Strengthening Laboratory Capacity Program (SLCP)Thailand MOPH – U.S. CDC Collaboration (TUC)

Purpose• Understand principles of laboratory

biosafety which will lead to IC• Be able to apply biosafety for infectious

control in laboratories

Definitions• Infectious control

Measures aim to ensure the protection of those who might be vulnerable to acquiring an infection both in the general community and while receiving care due to health problems, in a range of settings (WHO)

• Infectious agentAn organism (virus, rickettsia, bacteria, fungus, protozoan or helminthes) that is capable of producing infection or infectious disease

2

• BiosafetyReduce or minimize or eliminate accidental exposure of individuals and environment to potentially hazardous biological agents

“protect people from dangerous pathogens”

• BiosecurityThe protection of pathogens, toxin, and sensitive information from loss theft and subsequent misuse

“protect pathogens from dangerous people”

Infectious Control PrinciplesAll body fluids are potentially infectious

– blood and blood-tinged fluids including open-wounds– stool – urine – vomit – respiratory secretions – saliva – semen / vaginal secretions – breast milk – other body fluids (e.g. pericardial and synovial fluids)

Chain of

Infection

BacteriaVirus

FungusParasite

Human specimen(blood, urine, stool, CSF, etc.)

Cultures(isolates, QC strains)

Animal specimen

Skin injury InhalationIngestion

Mucous membrane

Lab peopleJanitorVisitor

Environment

In Laboratory

3

• Minimize exposure to potentially infectious body fluids

• Infection control measures designed to “break the chain” of transmission

*Risk assessment- PPE, equipment- procedure- staff training

Standard precaution- hand hygiene- respiratory hygiene

Vaccination

Principles of Biosafety• A biosafety program involves the containment

of potentially harmful biological agents.• Containment

- safe methods - facilities- equipment

• Reduce or eliminate exposure of laboratory workers, other persons, and the outside environment to potentially hazardous agents.

What Does Risk Assessment Do?

• The agent's biological and physical natures,• The sources likely to harbor the agent,• Host susceptibility,• The procedures that may disseminate the agent, and• The best method to effectively

4

Engineering Controls(WHO Lab Biosafety Manual. 3rd Ed.)

Risk Grp Lab Type BSL Practices Safety Equipment /

Facilities

1 Basic teaching, research (Bacillus subtillis, Lactobacillus)

1 GMT None. Open bench work

2Primary health services, diagnostic services, research(E. coli, Influenza , Dengue)

2

GMT + protective clothing, biohazard sign

Open bench plus BSC for potential aerosols

3 Special diagnostic services, research(Brucella, Coxiella, JE, HIV)

3 BSL2 + special clothing, controlled access, directional airflow

BSC and/or other primary devices for all activities

4 Dangerous pathogen units (Ebola, Marburg)

4 BSL3 + airlock entry, shower exit, special waste disposal

Class III BSC, or pos. pressure suites +class II BSCs; double ended autoclave (through the wall filtered air)

Tools of Lab Infectious Control

Laboratory infection control

Biosafety

Tool

Standard precaution- hand hygiene- PPE- respiratory hygiene

Vaccination

Standard Precautions• Hand hygiene

– Hand washing – Selection of detergent

• PPE – Selection – Donning / doffing

• Respiratory hygiene– Fit testing

5

Hand Hygiene Duration of entire procedure 40-60 seconds

What is PPE?

“specialized clothing or equipment worn by an employee for protection against infectious materials”

(Occupational Safety and Health Administration: OSHA)

Personal Protective Equipment

Kinds & Protection of PPE• Gloves – protect hands• Gowns/aprons – protect skin

and/or clothing• Masks and respirators– protect

mouth/nose – Respirators –protect respiratory tract from airborne infectious agents

• Goggles – protect eyes• Face shields – protect face,

mouth, nose, and eye

6

How to Select PPE• Type of exposure

– route or kind of infectious agent• Durability and appropriateness• Fit(size of each PPE)

Wearing PPE

• Gown first• Mask or respirator• Goggles or face shield• Gloves

*Combination of PPE will affect sequence –be practical

Removing PPE• Gloves• Face shield or goggles• Gown• Mask or respirator

7

Respiratory Hygiene

Wearing N95 Respirator

Fit Test

Vaccination

• HBV • TB• Rabies• Flu

8

Biosafety which will be lead to IC

Laboratory infectious controlBiosafety Tool

Laboratory Biosafety Manual• Biosafety guidelines

– risk assessments – BSL – facility commissioning & certification

• Biosecurity• Lab equipment

– BSC – Other safety equipment

• Good microbiology technique• Biotech, chemical, fire, electrical & training

International Biosafety Guidelines(WHO)

International Biosafety Guidelines(CDC)

BMBL (5th edition)

• Biological risk assessment• Principles of biosafety• BSL (including animal lab)• Occupational health• Agent summary statements

9

Biosafety Programs

• Risk assessment• PPE• Safety equipment• Disinfection• Packaging & transport• Waste management• Emergency plan e.g. spill or lab accident

Risk Assessment ProcessIdentify

hazardous agent

Identify hazardous procedure

Determine PPE, safety equipment

Evaluate staff

proficiency

Risk assessment

reviewing

Safety Equipment

• BSC

• Bucket centrifuge

• Autoclave

10

BSC and How its Working?

Centrifuge with bucket

Autoclave & Biological Indicators

11

Disinfection

• DisinfectionThe inactivation of disease-producing microorganisms.− Does not destroy bacterial spores. − Use on inanimate objects. − Usually involves chemicals, heat or UV.

• DecontaminationThe removal of disease-producing microorganisms to leave an item safe for further handling.

Definition

• Disinfectants Substances that are applied to non-living objects to destroymicroorganism that are living on the objects, not necessary to kill all forms of microorganisms. Not effective on bacterial spores.

• Antiseptics Chemicals that kill microorganism on living skin or mucous membrane.

Classification of Disinfectants

• Low level disinfectants– Phenolic compounds: Lysol®, Pine Sol®

– Quaternary ammonium compounds

• Intermediate level disinfectants– Alcohols: ethanol, isopropanol

– Hypochlorites: bleach

– Iodine compounds: povidone-iodine

– Biguanides: chlorhexidine

• High level disinfectants– Aldehydes: formaldehyde, glutaraldehyde

– Oxidizing agents: hydrogen peroxide

12

Fungi yeast

Disinfectant Level Affecting to Infectious gent

Vegetative bacteria

Enveloped viruses

Low level of disinfectants Medium level of

disinfectants

High level of disinfectants

A guide to selection and use of disinfectant , BCCDC

Non-enveloped

virus

Mycobacteria

Selection Criteria for Disinfectant• Microorganism• Degree of contamination • Amount of protein• Presence of organic matter • Best disinfectant• Concentration and quantity of disinfectant • Contact time and temperature• Toxicity to environment and relative safety to people • Cost

Infectious Packaging

13

UN3373 on Dry Ice

UN3373 BIOLOGICAL SUBSTANCE CATEGORY B

UN1845 DRY ICE

Net. QUANTITY ……….. KG

Shipper …………………………….………………………………………Consignee ………………………...………………………………………

Responsible person : nameTel ……….

Packaging- Example

Infectious Transportation

• Infectious• Pathological• Sharp• Pharmaceutical• Genotoxic or cytotoxic• Chemical, heavy metal• Pressurized container• Radioactive

Laboratory Waste

14

Waste Management-ProcessSegregation Packing Labeling

Handling & storageTransportDisposal

Emergency Plan

• Fire• Spills• Accidents• Needle sticks• Evacuation

Post exposure procedure for a needle stick or splash

− First aid− Report− Consent and initiation of prophylaxis− Baseline testing− Follow-up care− Documentation

15

• Spill kit and SOP should available in the lab– Evacuate area, alert personnel (let aerosol settle down)– Wear PPE and select appropriate disinfectant– Apply disinfectant and cover with paper towels – Contact time– Wipe and clean– Use tongs if broken glass is involved – sharps container

Minor Spills

Bad PracticesNot allowed in laboratory

Questions?

Contact Information

Email: hqg1@cdc.gov

Telephone: 02 591 4039 ext. 205