The Idaho Bureau of Laboratories and Emergency Preparedness - - PowerPoint PPT Presentation

▶
the idaho bureau of laboratories and emergency
SMART_READER_LITE
LIVE PREVIEW

The Idaho Bureau of Laboratories and Emergency Preparedness - - PowerPoint PPT Presentation

Nov 30, 2022 321 likes •757 views

The Idaho Bureau of Laboratories and Emergency Preparedness Michael Stevenson, Ph.D. IBL Emergency Preparedness Section Manager stevensm@dhw.idaho.gov 208-334-2235 x269 1 October 24, 2013 I wish youd learn to put the lid on your

slide-1
SLIDE 1

The Idaho Bureau of Laboratories and Emergency Preparedness

1

Michael Stevenson, Ph.D.

IBL Emergency Preparedness Section Manager stevensm@dhw.idaho.gov 208-334-2235 x269

October 24, 2013

slide-2
SLIDE 2

“I wish you’d learn to put the lid on your petri dish, Harry! We came here today with just four kids but now it looks like we’ve got several million!!”

slide-3
SLIDE 3

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

3

NO FOOD OR DRINK

WEAR PROTECTIVE CLOTHING

slide-4
SLIDE 4

4

The Idaho Bureau of Laboratories

As 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

slide-5
SLIDE 5

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

5

slide-6
SLIDE 6

IBL Program Organization

Bureau 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

6

Christopher L. Ball, Ph.D., HCLD (ABB)

slide-7
SLIDE 7

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

7

slide-8
SLIDE 8

8

First Responders Post Office Biohazard Detection System (BDS)

Incident

Unknown powders, anthrax threat letters

Evidence

Biosafety Level 3 (BSL3) Laboratory

Testing

Conventional methods

  • B. anthracis culture

Rapid methods Real-time PCR

Anatomy of a Biological Terrorism Event

Boise Fire Department, HazMat Region IV Idaho 101st Civil Support Team FBI IBL Emergency Preparedness Section LRN protocols

slide-9
SLIDE 9

The Laboratory Response Network

9

Level 3 Level 2 Level 1

CDC

LRN-B LRN-C

CDC, Atlanta, GA

slide-10
SLIDE 10

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.

10

slide-11
SLIDE 11

11

  • Typically hospital/clinical

laboratories - voluntary

  • Broadly, all laboratories

analyzing or referring specimens that may contain microbial agents

  • r toxins
  • Rule out or refer to

nearest LRN Reference Laboratory if potential select agent

Laboratory Response Network for Biological Threats (LRN-B)

slide-12
SLIDE 12

12 Idaho Sentinel Laboratory Network

in the seven Public Health Districts

slide-13
SLIDE 13

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 lab

Biosafety Level-3 laboratory Registered Select Agent entity 13

slide-14
SLIDE 14

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”

14

slide-15
SLIDE 15

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.

15

Select Agents

Cutaneous anthrax Bubonic plague Tularemia

slide-16
SLIDE 16

16

Select Agents

Anthrax Plague Brucellosis Tularemia

Environmental Threats:

Threat letter

Terrorism:

slide-17
SLIDE 17

17

www.selectagents.gov

Code of Federal Regulations (CFR) Title 42 – Public Health Part 73 – Select Agents and Toxins

  • Centers for Disease Control and Prevention (CDC), Division
  • f Select Agents and Toxins (DSAT)
  • Animal and Plant Health Inspection Services (APHIS),

Agricultural Select Agent Program

Select Agent Program

slide-18
SLIDE 18
  • 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

18

Select Agent Program

slide-19
SLIDE 19

Bacterial Select Agents

  • Bacillus anthracis
  • Botulinum neurotoxin producing

species of Clostridium

  • Brucella abortus
  • Brucella melitensis
  • Brucella suis
  • Burkholderia mallei
  • Burkholderia pseudomallei
  • Coxiella burnetii
  • Francisella tularensis
  • Rickettsia prowazekii
  • Yersinia pestis

19

Burkholderia pseudomallei Brucella

slide-20
SLIDE 20

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

20 Ebola virus Monkeypox virus

slide-21
SLIDE 21

Toxin Select Agents

  • Abrin
  • Botulinum neurotoxins
  • Conotoxins
  • Ricin
  • Staphylococcal enterotoxins
  • T-2 toxin
  • Tetrodotoxin

21 Rosary peas abrin Castor beans ricin

slide-22
SLIDE 22

Laboratory Response Network for Chemical Threats (LRN-C)

22

Level 3

62 labs

  • Work with hospitals/labs
  • Comprehensive CT

response plan

  • Competency in SCPaS

Level 2

46 labs

  • Level 3 activities
  • Proficient in CT analyses

(e.g. cyanide, VOC)

  • Surge capacity lab

Level 1

10 labs

  • Level 2 activities
  • Proficient in more CT

analyses (e.g. mustards)

  • Conduct CDC research

CDC

Analytical Capability

slide-23
SLIDE 23

23

Level 2 Labs Level 3 Labs Level 1 Labs

Level 3

American Samoa Chicago Guam Micronesia Los Angeles Marshall Is.

  • N. Mariana Is.

New York City Palau Puerto Rico US Virgin Islands

Level 2

District of Columbia

2004

LRN-C Laboratories

slide-24
SLIDE 24

24

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)
slide-25
SLIDE 25

25

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

slide-26
SLIDE 26

Emergency Preparedness Testing

26

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

slide-27
SLIDE 27

27

How IBL Can Assist with Infection Control

http://www.cdc.gov/phpr/zombies.htm “If you are generally well equipped to deal with a zombie apocalypse you will be prepared for a hurricane, pandemic, earthquake, or terrorist attack.”

slide-28
SLIDE 28

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.

slide-29
SLIDE 29

29 Center for Infectious Disease Research and Policy www.cidrap.umn.edu/

slide-30
SLIDE 30

30

www.cdc.gov/salmonella/pdf/CDC_LAI_Prevention_Poster_012313_508.pdf

Infection Control: Scientist POV

proper biosafety practices, training

slide-31
SLIDE 31

31

Standard Microbiological Practices: DO NOT’s

Unauthorized entry Mouth pipetting Eating, drinking, smoking, applying cosmetics, handling contact lenses Poor housekeeping

slide-32
SLIDE 32

32 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

slide-33
SLIDE 33

33

IBL Biosafety Level PPE

NO LAB WORK LOW RISK HI GH RI SK

PAPR or N/P-100

LOW RI SK HI GH RI SK

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
slide-34
SLIDE 34

34

Instructions for Shipping Blood/Urine Samples

Centers for Disease Control and Prevention Attn: Lt. Ernest McGahee 4770 Buford Hwy/Building 110 Loading Dock Atlanta, GA 30341 (770) 488-7579

sample box with adsorbent pad

UN 3373 label (blood and urine)

seal lid on; return address shipping manifest in bag sample, cushioning, more coolant line with coolant adsorbent pad in shipper box seal with evidence tape and initial place in white envelope wrap box in pad; tape; seal into bag seal with evidence tape and initial

blood

initials half off tape urine dry ice blood ice packs

Class 9/UN 1845 label (for dry ice only)

FedEx to CDC or IBL

Idaho Bureau of Laboratories Attn: CT Lab Coordinator 2220 Old Penitentiary Rd Boise, ID 83712 (208) 334-2235

urine

slide-35
SLIDE 35

35

  • 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 with these agents.

  • Notify supervisor and/or seek medical care.

Fever Watch

slide-36
SLIDE 36

36

If working with a slow-growing, Gram negative, coccobacillus bacteria, move work into a biosafety cabinet.

Infection Control: Scientist POV

slide-37
SLIDE 37

37

Look-alike Organisms

Select 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

slide-38
SLIDE 38

38

Automated ID Systems: Mis-Identification

Most automated systems carry an inherent risk for the production

  • f infectious aerosols.

Using these systems with a potential biothreat agent is not recommended.

Example: Yersinia pestis may key out instead as Shigella, H2S-negative Salmonella, Acinetobacter, or Y. pseudotuberculosis.

slide-39
SLIDE 39

39

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.

slide-40
SLIDE 40

40 Description

Idaho Bureau of Laboratories (IBL) will conduct a workshop that provides an overview of the sentinel laboratory’s role in the presumptive identification of agents of biological threat. Participants will review the Laboratory Response Network (LRN) and sentinel laboratory protocols for ruling

  • ut suspect agents. Laboratory demonstrations will outline

the microbiology of these agents to recognize the culture, staining, and biochemical characteristics.

Registration

Register online at www.keysurvey.com/f/542874/2603/ Please register by October 29th.

Sentinel Laboratory

Biothreat Preparedness Workshop

November 5, 2013

9:00 am - 5:00 pm

Idaho Bureau of Laboratories 2220 Old Penitentiary Road Boise, ID 83712 208-334-2235 www.statelab.idaho.gov

Contact Wendy Loumeau with questions Phone: 208-334-2235 x 258 Fax: 208-334-4067 Email: Loumeauw@dhw.idaho.gov

slide-41
SLIDE 41

41

slide-42
SLIDE 42

42

Emergency Preparedness Section

Michael Stevenson, x269, stevensm@dhw.idaho.gov Justin Grant, x252, grantj@dhw.idaho.gov Wendy Loumeau, x258, loumeauw@dhw.idaho.gov Dan Rousselle, x270, rousseld@dhw.idaho.gov Robert Voermans, x255, voermanr@dhw.idaho.gov

Idaho Bureau of Laboratories

2220 Old Penitentiary Rd Boise, ID 83712 208-334-2235 www.statelab.idaho.gov

Questions? Thank you!