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BIOSAFETY TRAINING Tina Preseau* & Rita ToussaintArchambault *Office of Risk Management Human Resources - Occupational Health Disability & Leave COURSE OUTLINE Introduction Laboratory Associated Infections Blood-borne Pathogens Classification of Biohazards Infection/Biohazard Control BIOSAFETY Spill Response Biomedical Waste Regulations INTRODUCTION WHAT IS A BIOHAZARD? A potential hazard to humans, animals or the environment caused by a biological organism, or by material produced by such an organism Examples: Viruses, bacteria, fungi, and parasites and their product. Blood and body fluids, as well as tissues from humans and animals. Transformed cell lines and certain types of nucleic acids . WHAT IS BIOSAFETY? Measures employed when handling biohazardous materials to avoid infecting oneself, others or the environment. Achieved through; Administrative Controls Engineering Controls Personal Protective Equipment Practices and Procedures WHAT IS BIOSECURITY? Measures employed to protect biohazardous materials, or critical relevant information, against theft or diversion by those who intend to pursue intentional misuse. Achieved through; Physical barriers Psychological barriers Monitoring Activities Personnel Clearance WHO ARE THE STAKEHOLDERS? INTERNALLY EXTERNALLY Vice-President (Research) Committees University Services (ORM, HR, PRS, PS) Deans, Chairs, Principal Investigators, Employees, Students Manager of Biological Containment Suite Public Health Agency of Canada Canadian Food Inspection Agency Environment Canada Transport Canada Ontario Ministry of Labour Emergency Response Personnel Suppliers & Contractors Community KEY SERVICES Office of Risk Management Training Interface with Regulatory Bodies Biosafety Program certifications training procedures inspections contingency planning accident/incident follow-up KEY SERVICES HR (Occupational Health, Disability and Leave) Medical surveillance Immunizations Medical Follow-up Interface with Workplace Safety and Insurance Board WHY ARE WE CONCERNED? Potential for acquiring a laboratory-associated infection (LAI) Contamination of the environment Contamination of research Public perception LABORATORY ASSOCIATED INFECTIONS LABORATORY ASSOCIATED INFECTIONS Infection Source Susceptible Host Immune system Vaccination status Age Cultures and stocks Research animals Specimens Items contaminated with above Route of Transmission Percutaneous inoculation Inhalation of aerosols Contact of mucous membranes Ingestion LAIS Only 20% causative or defined event 80% of which are caused by human factors 20% are caused by equipment failure Top 4 accidents resulting in infection Spillages & splashes Needle and syringe Sharp object, broken glass Bite or scratch from animals or ectoparasites http://www.weizmann.ac.il/safety/bio2.html LAIS WHO WHAT WHERE WHEN HOW Researcher SARS Taiwan December 2003 Microbiologist West Nile Virus United States August 2002 Laceration Laboratory Worker Meningococcal Disease United States 2000 Aerosol? Laboratory worker Vaccinia virus United States 2004 Many ways BLOOD-BORNE PATHOGENS BLOODBORNE PATHOGENS (BBP) Sources Blood Semen Vaginal Secretions Other Bodily Fluids Cerebrospinal Amniotic Synovial Tissue Cultures Organ Cultures Infected Experimental Animals RISK OF EXPOSURE Pathogen involved Type of body fluid Route of exposure Duration of exposure Volume of blood involved in exposure Concentration of virus at time of exposure PPE worn SPECIFIC EXAMPLES OF BBPS Hepatitis B Hepatitis C HIV ISSUES TO CONSIDER Symptoms Mode of transmission Incubation period Survival outside host Communicability Immunization Prophylaxis / Treatment IF AN EXPOSURE OCCURS Initiate first aid Notify your supervisor / designated person Report to hospital emergency department or University’s Health Services Report incident to OHDL Occupational Health, Disability and Leave Office telephone ext. 1472 http://www.rh.uottawa.ca/00_main/index_f.asp UNIVERSAL PRECAUTIONS Minimum standard of practice for preventing the transmission of BBP includes: Education Hand washing Wearing protective barriers Use safe work practices If samples cannot be guaranteed noninfective …… treat as infectious! BIOHAZARD CLASSIFICATION BIOHAZARD CLASSIFICATION Conventional Agents Recombinant DNA Tissue Culture Animal Work Anatomical Specimens Unconventional Agents Class D, division 3 of WHMIS (Poisonous and Infectious Material - Biohazardous Infectious Material) BIOHAZARD CLASSIFICATION Organisms are categorized into a group base on the particular characteristics of each organism, such as Pathogenicity Infectious dose Mode of transmission Host Range Availability of effective preventive measures Availability of effective treatment BIOHAZARD CLASSIFICATION Organisms are categorized base on the measures required for handling each organism safely in a laboratory setting, such as Engineering Requirements Operational Requirements Technical Requirements Physical Requirements CONVENTIONAL AGENTS Risk Group Individual Risk Community Risk Containment Level 1 Low Low Level 1 E.coli, B. subtilis, S. aureus, Trichoderma reesei Level 2 Streptococcus & Salmonella spp, Measles, Adenoviruses, Hepatitis A, B & C, Influenza Level 3 Bacillus anthracis, Mycobacterium tuberculosis, HIV, Yellow fever virus Level 4 Lassa virus, Ebola virus, Marburg virus Unlikely to cause disease in healthy workers or animals 2 Moderate Limited Rarely cause serious human or animal disease 3 High Low May cause serious disease 4 High High Likely to cause very serious disease Examples RECOMBINANT DNA Genetic Engineering = in vitro incorporation of genetic material from one cell into another In Canada the level of risk depends on source of DNA, vector and host. The Office of Risk Management will assist the investigator in this determination. TISSUE CULTURE Have the potential to contain pathogenic organisms In general; Human & non-human primate, and mycoplasma-containing cell lines Level 2 Others Level 1 A detailed risk assessment should be undertaken when using a new cell line. ANIMAL WORK Animals can harbour infectious organisms (naturally or introduced) Level dependent on type of work being conducted. Special Animal Care training is required for all personnel working with animals. All work involving animal use must receive prior approval from the Animal Care Committee ANATOMICAL SPECIMENS All specimens should be considered infectious due to potential presence of infectious agents Important to consider the type of specimen blood, organs, tissues Spinal sample, brain tissue From infectious patient In general Level 2 but it depends on the nature of the work. UNCONVENTIONAL PATHOGENS TSE prion diseases; lethal neurodegenerative conditions transmissible Creutzfeld-Jakob disease, Variant C-J Disease, Mad Cow Disease, Scrapie, Chronic Wasting Disease Resistant to destruction by procedures that normally inactivate viruses. Contact ORM to assess requirements (containment, procedures, waste disposal, etc.) WHERE CAN WE FIND THESE? Biology Earth Sciences Bio-Engineering University Engineering Human Kinetics Civil Chemical Chemistry Medicine/ Nursing INFECTION/BIOHAZARD CONTROL INFECTION/BIOHAZARD CONTROL Administrative Controls Engineering Controls Personal Protective Equipment Practices and Procedures ADMINISTRATIVE CONTROLS Program based, information and methods to minimize risk of exposure: Risk assessment Medical Surveillance Training/Education Resources Inspections Signs & Labeling ADMINISTRATIVE CONTROLS Risk Assessment Will determine type of containment, procedures, and safety equipment required Responsibility of users, additional assistance is available from the ORM Consider areas such as; experimental design, procedures to be employed and personal experience/knowledge, etc. Know and understand the various characteristics of the agent(s) you are working with. (Material Safety Data Sheets and suppliers or manufacturers) ADMINISTRATIVE CONTROLS Medical Surveillance Training & Education WHMIS Lab specific policies and procedures Biosafety training Resources ORM web site, Biosafety page Faculty web sites Biosafety Manual Training Videos ADMINISTRATIVE CONTROLS Inspections Routine self-inspections Biosafety Inspection Checklist available on-line In addition, ORM, EHSOs and OH&S will inspect labs to ensure compliance with regulations/ guidelines and provide feedback. ADMINISTRATIVE CONTROLS Signs & Labeling Biohazard warning signs must be posted on doors to rooms where biohazardous materials are used. Biohazard labels should be placed on containers, equipment and storage units used with biological agents. ENGINEERING CONTROLS Technology based, reduce or eliminate exposure to hazards by changes at the source of the hazard. Containment: Types: Primary and Secondary Containment levels PRIMARY CONTAINMENT First line of defence. Ensures protection of personnel and immediate environment from exposure to the infectious agent. ‘Protective envelope’ that encapsulates the infectious agent or animal. Petrie dish, vial, stoppered bottle…. Biological safety cabinets, glove boxes and animal caging equipment, etc. Effectiveness of control is based on the integrity of the containment. SECONDARY CONTAINMENT Protects the environment external to the laboratory from exposure Includes facility design and operational practices CONTAINMENT LEVEL 1 Basic laboratory Requires no special design features Biosafety cabinets are not required and work may be performed on the open bench. CONTAINMENT LEVEL 2 Clinical, diagnostic, research and teaching facilities with level 2 agents. Requires a class I or class II biological safety cabinet if any potential for aerosol or splash exists. An emergency plan for handling spills must be developed. Access should be controlled. CONTAINMENT LEVEL 3 Specialized design and construction primary barriers to protect the individual secondary barriers to protect the environment All staff must undergo special training on the agents being used, PPE, equipment, waste management as well as practices and procedures above and beyond the scope of this course. CONTAINMENT LEVEL 4 Only one level 4 facility in Canada (Canadian Centre for Human and Animal Health in Winnipeg, Man.) Design specifications are extremely stringent, worker is completely isolated from infectious material. BIOLOGICAL SAFETY CABINETS Effective means of primary physical containment for biological agents, especially when aerosols are generated. HEPA filters remove particles (min 0.3 microns) with 99.97% efficiency. There are 3 main classes of cabinets (I, II, III) which provide various levels of protection. BIOLOGICAL SAFETY CABINETS Biological Safety Cabinet Laminar flow hoods HEPA filtered laminar air flow Exhaust Personnel, environment & product protection Vertical or horizontal laminar flow HEPA filtered air (intake only) Product protection only VS WORKING SAFELY IN A BSC Before using the cabinet: Ensure BSC is certified Turn off UV lamp; turn on fluorescent lamp Disinfect work surfaces with appropriate disinfectant Place essential items inside cabinet Allow the blower to run for 5-10 min before work WORKING SAFELY IN A BSC While using the cabinet: Ensure material and equipment is placed near the back of the hood, especially aerosol-generating equipment. Do not block any vents Use techniques that reduce splatter and aerosols. General work flow should be from clean to contaminated areas Minimize movement so as not to impede air flow Open flame in BSC’s is controversial WORKING SAFELY IN A BSC WORKING SAFELY IN A BSC After using the cabinet: Leave blower on at least 5 minutes to purge cabinet Remove and decontaminate equipment and materials Disinfect cabinet surfaces Turn off blower and fluorescent lamp, turn on UV lamp WORKING SAFELY IN A BSC Maintenance: Before and after each use - Work surfaces wiped down Weekly - UV lamp should be wiped clean Monthly - All vertical surfaces wiped down Annually- UV lamp intensity verified - Decontamination with formaldehyde gas (ORM) - Certification (ORM) PERSONAL PROTECTIVE EQUIPMENT (PPE) PPE can become an important line of defence (last line of defense) Responsibility of both the user and the supervisor to ensure that PPE is worn PPE Criteria for consideration Routes of exposure that need to be blocked Degree of protection offered Ease of use Only effective if correctly selected, fitted, used and cared for, and the individual is trained Ensure PPE is removed before leaving the lab PPE Footwear Closed toed shoes should always be worn. Booties are worn in some higher containment labs and animal facilities. Lab Coats/Gowns Long-sleeved, knee length with snaps Elastic cuffs Back-closing gowns Periodic cleaning required PPE Gloves Latex, nitrile & vinyl for work with biological agents. Exam gloves should not be reused, change frequently. Utility gloves can be disinfected and reused if they show no sign of degradation. Consider tensile characteristics, length of cuff. Double gloving. ORM can provide assistance finding an alternative for people with allergies. PPE Eye & Face Protection Goggles, safety glasses to protect the eyes Full face shield to protect facial skin. Respirators Only personnel who have been fit-tested and trained should wear respirators. PRACTICES AND PROCEDURES General Safety Guidelines Good Microbiological Practice Handwashing Suspicious Packages Specific Procedures Centrifuges Needles & Syringes and other sharps Pipettes Blenders, Grinders, Sonicators & Lyophilizers Inoculation Loops Cryostats GENERAL LABORATORY SAFETY GUIDELINES Mostly common sense, but you must understand the hazards you face in the laboratory and be adequately trained to deal with them. Basic must be known for all labs. b i o s a f e t y GOOD MICROBIOLOGICAL PRACTICE (GMP) Basic code of practice that should be applied to all types of work involving microorganisms. Objectives: prevent contamination of laboratory workers and the environment prevent contamination of the experiment/samples Application of aseptic technique, minimization of aerosols, contamination control, personal protection, emergency response HANDWASHING One of the single effective means of preventing infections if done properly and frequently When to wash? Before starting any manipulations Before leaving the lab When hands are obviously soiled Before and after completing any task in a BSC Every time gloves are removed Before contact with one’s face or mouth At the end of the day SUSPICIOUS PACKAGES Unopened Do not open and do not shake Place in secondary container or cover Inform others of the situation Clear the room and section off the area All individuals who may have come into contact with the material must wash their hands Call Protection Services and wait for their arrival List all the individuals present in the room or area when the package arrived. Give this list to Protection Services for followup SUSPICIOUS PACKAGES Opened Contents Intact Do not manipulate contents further Cover the package Inform others of the situation Clear the room and section off the area All individuals who may have come into contact with the material must wash their hands Call Protection Services and wait for their arrival List all the individuals present in the room or area when the package arrived. Give this list to Protection Services for followup SUSPICIOUS PACKAGES Contents not intact (spilled) Do not try to clean up the spill Gently cover the spill Inform others of the situation All individuals who may have come into contact with the material must wash their hands Call Protection Services Remove heavily contaminated clothing (place in bag) and shower using soap and water List all the individuals present in the room or area when the package arrived. Give this list to Protection Services for followup SAFE USE OF CENTRIFUGES Before use Stress lines? Overfilled? Balanced? Caps or stoppers properly in place? Run conditions achieved? Use sealable buckets (safety cups) or sealed rotors After run Centrifuge completely stopped? Spills or leaks? Allow aerosols to settle (30 min) or open in a BSC. NEEDLES AND SYRINGES Avoid use whenever possible Use a BSC for all operations with infectious material Fill syringes carefully Shield needles when withdrawing from stoppers Do not bend, shear or recap needles. Dispose of all used needles/syringes in yellow sharps containers PIPETTES Mouth pipetting is prohibited. Never force fluids out. To avoid splashes, allow discharge to run down dispense the receiving container wall. Never mix material by suction and expulsion. Reusable pipettes should be placed horizontally in a disinfectant filled pan. BLENDERS, GRINDERS, SONICATORS, AND LYOPHILIZERS • Operate in a BSC whenever possible. Allow aerosols to settle for 5 minutes before opening. • Safety Blender Do not use glass blender jars Decontaminate immediately after use • Lyophilizers Use glassware designed for vacuum work, ensure there is no damage before using All surfaces should be disinfected after use Use vapour traps whenever possible INOCULATION LOOPS Sterilization in an open flame may create aerosols which may contain viable microorganisms. Use a shielded electric incinerator Shorter handles minimize vibrations Disposable plastic loops are good alternatives CRYOSTATS Wear gloves during preparation of frozen sections and heavy gloves when accessing the cryostat. Decontaminate frequently (100 or 70% Ethanol) SPILL RESPONSE SPILLS Spill response will vary depending on: What was spilled? How much was spilled? Where was the spill? What is the potential for release to the environment? Spills should be cleaned up immediately (unless an aerosol was generated), to ensure proper decontamination. Ensure appropriate PPE is worn and clean-up equipment is readily available. SPILLS-GENERAL CLEAN-UP Cover spill area with absorbent material Soak the spill area with an appropriate disinfectant (i.e. 10% bleach) Pour disinfectant from the outside of the absorbent material towards the inside Ensure any broken glass is picked up (with forceps!) and placed in a sharps container Leave on for 20 to 30 minutes Wipe up with absorbent material Waste should be disposed in appropriate biohazard bags and where possible autoclaved SPILLS-SPECIAL CASES Within a Centrifuge Within a BSC Open Areas (lab, during transport) The spill response plan template is available at (http://www.uottawa.ca/services/ehss/SPILLRESPONSEPLAN.p df) SPILLS All users of biological materials should be familiar with the spill clean-up procedures. All spills are to be reported ASAP to the lab supervisor and ORM. Additional assistance is available from: ORM x 5892 Your departmental safety officer ERT x 5411 (through Protection Services) BIOMEDICAL WASTE DECONTAMINATION, DISINFECTION, AND STERILIZATION Decontamination: Free of contamination, the destruction of microorganisms to a lower level such that it removes danger of infection to individuals. Sterilization: The complete destruction of all viable microorganisms. Disinfection: Use of agents (physical or chemical) to destroy harmful organisms on inanimate objects (not necessarily all organisms) DECONTAMINATION: PHYSICAL Heat: Autoclaving (most practical and recommended) Incineration (for disposal of sharps and tissues) Irradiation: UV light (wavelength of 253 nm is germicidal) Gamma (disrupts DNA and RNA) Filtration HEPA (biological safety cabinets, ventilation) AUTOCLAVES Items that CAN be autoclaved: Cultures and stocks of infectious material Culture dishes and related devices Discarded live and attenuated vaccines Contaminated solid items (petrie dishes, eppendorf tips, pipettes, gloves, paper towels) AUTOCLAVES Items that CAN NOT be autoclaved: chemicals (flammables, oxidizers, phenols, acids, alkalides) chemotherapeutic or radioactive waste Bleach (or other chlorinated products) certain kinds of plastics sharps (not at the University of Ottawa) AUTOCLAVES Preparation of waste: Use only approved autoclave bags Do not overfill autoclave bags Separate material for re-use from that which will be disposed and dry from liquid material If outside of bag is contaminated, double bag All flasks containing biological material should be capped with aluminum foil Ensure items are labeled with contact information SAFE USE OF AUTOCLAVES Many autoclaves are now run by dedicated staff, however, if you are operating an autoclave; Learn how to use it! Ensure PPE is worn Recognize acceptable material and packaging Proper loading and unloading All users/operators must take the autoclave training DECONTAMINATION: CHEMICAL Generally for disinfection rather than sterilization Choice depends on; Type of material to be disinfected Organic load Chemical characteristics Most common are chlorine compounds and alcohols (broad range) WHAT TO USE FOR MY AGENT? Vegetative bacteria (E.coli, Viruses Enveloped (HIV, Herpes) Staph) 2% domestic bleach 75% Ethanol Quaternary ammonia 6% formulated Hydrogen peroxide Mycobacteria and fungi 10% domestic bleach 75% Ethanol Phenolic compounds 6% formulated Hydrogen peroxide Spore forming bacteria (Bacillus) 10% domestic bleach Gluteraldehyde Formaldehyde 6% formulated Hydrogen peroxide 2% domestic bleach 75% Ethanol Quaternary ammonia 6% formulated Hydrogen peroxide* Non enveloped (Hepatitis, Adenovirus) 10% domestic bleach 6% formulated Hydrogen peroxide* Gluteraldehyde Formaldehyde WASTE MANAGEMENT Discarded biological material from teaching, clinical and research laboratories and operations is biomedical waste. Biomedical waste includes but is not limited to; Animal waste Biological laboratory waste Human anatomical waste Human blood and body fluid waste Sharps WASTE MANAGEMENT All biological waste should be decontaminated prior to disposal (including level 1 agents). Treated waste is no longer considered ‘biomedical’ (i.e. microbiological waste, blood and bodily fluid waste) and can be disposed in the regular waste stream. Any waste that cannot be treated (i.e. sharps, carcasses, tissues and body parts) remains biomedical waste and must be incinerated off site. WASTE DISPOSAL Biomedical Waste (untreated) WASTE DISPOSAL Biomedical Waste (treated) compliance with * InSewer use by-laws With H2O 1:10 SPECIAL WASTE EtBr Toxins Recombinant DNA Contact ORM REGULATIONS KEY REGULATED ACTIVITIES Purchasing & Receiving of Biological Agents PHAC, CFIA, Environment Canada Inventory Records Transportation/Transfer Transport Canada- TDG All Agencies (provincial and federal) emphasize and expect Biosecurity PURCHASING Importation permits required by Public Health Agency Canada or CFIA for certain agents US restrictions Ensure you meet all criteria and have all pertinent documentation INVENTORY What material is presently being used and/or stored Location Expiry date Use log book for remaining amount MSDS’s Mandatory SHIPPING AND RECEIVING Transportation of Dangerous Goods Act: Class 6.2 of (Infectious Substances) PHAC/CFIA restrictions Ensure; Proper classification Proper packaging Proper labeling Proper documentation Import/Export Permits TRANSPORTATION OF DANGEROUS GOODS Pre-approved Authorized Individuals Lead time (International Regulations….) Appropriate Scheduling (Holidays, Weekends) Transportation within the building Between lab to lab Colleague to Colleague Between Institutions TRANSPORTATION Important Considerations: does material need to be transported at all packaging requirements means and route of transportation regulatory requirements Between lab transfers - 4 sided cart, sealed primary container, secondary container, low traffic route. Off Campus transfers – consult ORM THE BOTTOM LINE If you are not careful and diligent with biological agents you risk: Infecting yourself, others or the environment Contaminating your research Having Public Health Agency of Canada, Canadian Food Inspection Agency, Ministry of the Environment or Transport Canada after you CONCLUSIONS Biohazards - microorganisms, blood and body fluids, tissues and tissue culture Biosafety - ensuring that individuals and the environment are not infected Biosecurity - used in the context of protecting dangerous pathogens and toxins against intentional removal Everyone within the University community is responsible With proper knowledge, planning and care, a biological exposure is avoidable. BIOSAFETY WEBSITE http://www.uottawa.ca/services/ehss/biosafety.htm