Reviewer in MLSP111 (Finals) PDF

Reviewer in MLSP111 (Finals)  Changes in the normal microbiota (antibiotic use) Lesson 1: Disease, Disease Transmission, and Epidemiology Infection...

Reviewer in MLSP111 (Finals)  Changes in the normal microbiota (antibiotic use) Lesson 1: Disease, Disease Transmission, and Epidemiology Infection  When contaminating organism evades body’s external defenses and multiplies in the host  Most infections are eliminated by the bodies defenses Disease  Infections may lead to disease  Results when normal body functions are altered Infectious Disease Symptoms and Signs Symbiotic Relationships Between Microbes and Symptoms Their Hosts  Subjective characteristics of disease felt only by the patient Normal Microbiota in Hosts  Organisms that colonize the body’s surfaces Examples: without normally causing disease  Headache  Fever Two Types 1. Resident microbiota - inhabit or reside on a Signs specific area  Objective manifestations of disease 2. Transient microbiota - pass through the observed or measured by others body then they are excreted from the body Examples: Examples:  Fever  Skin - staphylococcus  Nasal obstruction  Colon - escherichia  High blood pressure  Oral cavity - viridans streptococci  Female reproductive organ - lactobacillus Asymptomatic acidophilus  Infections that lack symptoms but may still have signs of infection and can be Acquisition Of Normal Microbiota transmitted  Development in uterus is free of microorganisms Classification of Infectious Diseases  Microbiota begin to develop during birthing process Terms Used To Classify Infectious Disease  Much of your resident microbiota is established during first month of life  Acute disease (rapid onset, short period of time ex. (Common cold), 4 weeks How Normal Microbiota Become Opportunistic  Subacute - more than 4 weeks but less than Pathogens 12 weeks  Chronic disease (develop slowly, continual Opportunistic Pathogens or recurrent ex. Hepatitis C, TB), more than  Normal microbiota that cause disease under 12 weeks certain circumstances  Latent disease (pathogen remains inactive for a long period of time before becoming Conditions That Provide Opportunities For active ex. shingles) Pathogens  Introduction of normal microbiota into unusual site in body (cuts and abrasions)  Immune suppression (radiation therapy) 1 The Stages of Infectious Disease b. Carrier - harbors the pathogen but have no signs and symptoms  Many infectious diseases have five stages following infection i. incubatory carrier – transmits the pathogen during the incubation period 1. Incubation period (time between infection ii. convalescent carrier – transmit and first symptoms and signs of disease) pathogen during convalescence or recovery 2. Prodromal period (short time, mild period symptoms) iii. active carriers – completely 3. Illness (severe stage, signs and symptoms recovered from disease but continue to most evident) harbor the pathogen indefinitely (e.g. HIV & 4. Decline (gradual decline of signs and TB) symptoms as body returns to normal due to iv. passive carriers – carry the pathogen without immune response or drug treatment) ever having the disease (e.g. hepatitis b) 5. Convalescence (patient recovers no signs or symptoms) 2. Animal Reservoir  Patient can be infectious at any stage of Zoonoses disease depending on the causative agent  Infectious diseases that humans acquire from animal sources Routes: a. Direct contact – with infected animal or with domestic pet waste b. Inhalation – from contaminated hides, fur, feathers c. Ingestion – contaminated food and water; consumption of infected animal products d. Injection of the pathogen – insect vector 3. Inanimate (Non-Living) Reservoir Epidemiology  example: air, soil, food, milk, water, and  Frequency and distribution of disease fomites Factors That Contribute To The Spread Of Fomites Disease  contaminated materials 1. virulence of pathogen  e.g. clothing, bedding, urinals/bedpans, 2. susceptibility of the population eating and drinking utensils 3. lack of immunization 4. inadequate sanitation procedures Air 5. mode of transmission of the pathogen  contaminated by dust, smoke, and respiratory secretions of humans A. Reservoirs Of Infections expelled into the air by breathing, blowing, sneezing, and coughing Reservoir  Any site where the pathogen can multiply or B. Mode of Disease Transmission merely survive until it is transferred to the host 1. Contact Transmission  spread of an agent of disease by direct, 1. Human Reservoir indirect or droplet transmission  principal living reservoir of human disease because many human pathogens are a. Direct Contact Transmission specie-specific  person to person transmission of an agent by physical contact (source to susceptible a. Direct Transmission - with signs and symptoms host) of disease and transmit the disease  no intermediate host involved i.e. touching, kissing, sexual intercourse 2 b. Indirect Contact Transmission  Respiratory tract is the most common site of  from source to a non-living object to a entry susceptible host  Entry is through the nose, mouth, or eyes c. Droplet Transmission  Gastrointestinal tract may be route of entry  Microbe spread in droplet nuclei that travels  Must survive the acidic pH of the only a short distance ( 1 meter from into tissues beneath the skin or mucous the reservoir to host membranes  Hypodermic needles 3. Vector Transmission  Thorns, nails, etc..  Animals that carry pathogens from one host to another The Movement of Pathogens Out of a Reservoir: Portal of Exit Control of Epidemic Disease  Pathogens leave host through portals of exit 1. Report cases of communicable diseases to  Many portals of exit are the same as portals proper agencies of entry 2. Public education  Pathogens often leave hosts in materials the 3. Identification and elimination of reservoirs body secretes or excretes of infection 4. Isolated disease person 5. Participate in immunization program 6. Help to treat sick person Movement Of a Pathogen Into a Host Portals of Entry  Sites through which pathogens enter the body Four Major Pathways 1. Skin  Outer layer of dead skin cells acts as a barrier to pathogens  Some pathogens can enter through openings Vector Transmission or cuts  Others burrow into or digest outer layers of a. Biological Vector skin  An organism transmits and serves as host.  Vector involved in life cycle of pathogen 2. Mucous membranes  Line the body cavities that are open to the environment 3 Example: Example:  Malaria: Part of life cycle of protozoan,  Plague in U.S. Plasmodium, occurs inside the Anopheles mosquito 2. Endemic  A native disease that prevails continuously in b. Mechanical Vector a geographic region  Vector transmits disease causing organism  Endemic disease can lead to epidemic through mechanical contact  Regular cases occurrence in area Example: Example:  Trachoma (Blindness): Chlamydia  Dengue trachomatis carried on feet of fly from  Common cold infected person's eye to eye of new host  Influenza Epidemiology 3. Outbreak  Epidemiology focuses on the effect of a  Implies a cluster of cases occurring during a pathogen in a population brief period of time and attacking a specific  The study of where and when diseases occur population, usually food borne and how they are transmitted in a population. Example:  Seventy-seven people sick and one died in a Why is this field important? salmonella outbreak caused by  Earth’s population is becoming over contaminated ground turkey: Centers for populated. Disease Control 2011  Humans are relying more on mass food production and distribution 4. Epidemic  Travel to other countries very readily.  Affecting an unusually large number of  Leads to higher incidence, number of new individuals within given region or cases of a disease in a population) population  Prevalence, the total number of cases, new  Epidemic may lead to pandemic and already existing in a population  Unusually high number of cases in area  Occurrence of an infectious disease can be Example: classified in terms of geographic distribution  H1N1 was epidemic in US in 2009 and frequency. 5. Pandemic  A disease affecting an increased proportion of the population over a wide geographic area, most often worldwide  A global epidemic Example:  AIDS  COVID-19 Epidemiology of Infectious Diseases Hospital Epidemiology: Nosocomial Infections Control Of Nosocomial Infections  Disinfection, good housekeeping, bathing, 1. Sporadic sterile procedures, and HAND WASHING!  A few cases randomly distributed  Hand washing is the most effective way to geographically reduce nosocomial infections  Occasional occurrence  CDC reports that on average, health care workers wash their hands before interacting with patients only 40% of the time. 4 Factors That Influence Nosocomial Infections breathing, ingested through swallowing, or absorbed through breaks in the skin. 1. Presence of microorganisms in hospital environment Biohazard Symbol 2. Immunocompromised patients  Biological hazards, also known as 3. Transmission of pathogens between staff biohazards, refer to biological substances and patients and among patients that pose a threat to the health of living organisms, primarily that of humans. The  Infection can result from any one of these biohazard symbol was developed in 1966 by factors but usually it is a product of all three Charles Baldwin, an environmental-health engineer working for the Dow Chemical Lesson 2: Biosafety & Biosecurity Company on the containment products  It is used in the labeling of biological Biosafety materials that carry a significant health risk,  Biosafety describes the containment including viral samples and used principles, technologies and practices that hypodermic needles. In unicode, the are implemented to prevent the biohazard symbol is U+2623. unintentional exposure to Biological agents and toxins or their accidental release.  Biosafety is defined as, “The discipline addressing the safe handling and containment of infectious microorganisms and hazardous biological materials”. The practice of safe handling of pathogenic micro-organisms and their toxins in the biological laboratory is accomplished  There are four circles within the symbol, through the application of containment signifying the chain of infection. principles and the risk assessment. a. Agent: The type of microorganism, that Biosecurity causes infection or hazardous condition.  Describes protection, control and b. Host: The organism in which the accountability for valuable biological microorganism Infect. The new host must be materials within laboratories, in order to susceptible. prevent their loss, theft, misuse, diversion of, c. Source: The host from which the unauthorized access or intentional release microorganism originate. The carrier host whether or not the biorisks is acceptable. might not show symptoms. d. Transmission: The means of transmission, Biohazard mostly direct or indirect. Some routes of  A biohazard, also known as a biological transmission include air, insect, direct hazard, is a biological substance that poses a contact and contaminated surfaces. threat to human and animal health. Classification Examples Of Biohazards Include:  Bio hazardous agents are classified for  Human or animal blood transportation by UN Number:  Human or animal waste and body fluids  Deceased animals 1. Category A, UN 2814  Human remains  Infectious substance, affecting humans: An  Used drug needles infectious substance in a form capable of  Medical waste (used syringes and bandages) causing permanent disability or  Rotting food life-threatening or fatal disease in otherwise healthy humans or animals when exposure  All of these substances can harbor bacteria to it occurs. (like E. Coli) and viruses (like Hepatitis and HIV) that can cause disease in humans and 2. Category A, UN 2900 animals. Biohazards may enter the body and  Infectious substance, affecting animals (only): cause damage if they are inhaled through An infectious substance that is not in a form generally capable of causing permanent 5  disability or life-threatening or fatal  Hantaviruses disease in otherwise healthy humans and  tuberculosis typhus animals when exposure to themselves  Rift Valley fever occurs.  Rocky Mountain spotted fever yellow fever  malarIa 3. Category B, UN 3373  Biological substance transported for 4. Biohazard Level 4: Viruses that cause severe to diagnostic or investigative purposes. fatal disease in humans, and for which vaccines or other treatments are not available. 4. Regulated Medical Waste, UN 3291  Waste or reusable material derived from Examples: medical treatment of an animal or  Bolivian hemorrhagic fever human, or from biomedical research,  Marburg virus which includes the production and testing.  Ebola virus  Lassa fever virus Levels of Biohazard  Crimean–Congo hemorrhagic fever  other hemorrhagic diseases and rishibola. 1. Biohazard Level 1: Bacteria and viruses  Variola virus (smallpox) is an agent that is including Bacillus subtilis, canine hepatitis, worked with at BSL-4 despite the existence Escherichi a coli, varicella (chicken pox), of a vaccine, as it has been eradicated. When as well as some cell cultures and non-infectious dealing with biological hazards at this level bacteria. At this level precautions against the the use of a positive pressure personnel suit, biohazardous materials in question are minimal, with a segregated air supply, is mandatory. most likely involving gloves and some sort of facial protection. Brief History Of Biosafety  In the mid- to late 1800’s, the science of 2. Biohazard Level 2: Bacteria and viruses that microbiology had advan the point that the cause only mild disease to humans, or causative bacterial agent of common are difficult to contract via aerosol in a lab diseasess tuberculosis, diphtheria and setting cholera were identified using postulates.  Following close behind this initial work in Examples: the culture and purificat bacterial pathogens,  Hepatitis A, B, and C, LAIs were first reported. In the early- to  some influenza A strains, mid-1 wooden and steel boxes were  Lyme disease, designed to prevent work-relate however it  salmonella, took many more years for the discipline of  mumps, biosaf develop. Biological Safety was  measles, pioneered at the U. S. Army Biol Research  scrapie, Laboratories in Fort Detrick Maryland led by  dengue fever, the effo Arnold G. Wedum, Director of  HIV. Industrial Health and Safety and the of modern biological safety. Dr. Wedum was  Routine diagnostic work with clinical one of the original pi of the first Biological specimens can be done safely at Biosafety Safety Conference and was central in the Level 2, using Biosafety Level 2 practices and formation of the American Biological Safety procedures. Association (ABSA).  April 18, 1955 - first unofficial meeting at 3. Biohazard Level 3: Bacteria and viruses that Camp Detrick (now Fort Detrick) and can cause severe to fatal disease in humans, but involved members of the military for which vaccines or other treatments exist. representing Camp Detrick, Pine Bluff Arsenal, Arkansas (PBA), and Examples: Dugway Proving Grounds, Utah (DPG).  Anthrax  In those days, the offensive BW program of  West Nile virus the United States was in full swing: the  Venezuelan equine encephalitis opening keynote address was “The Role of  SARS virus, Safety in the Biological Warfare Effort.”  MERS coronavirus, 6  Beginning in 1957, the yearly meetings  Photo-publisher Robert Stevens, age 63, was began to include non- classified hospitalized with the diagnosis of meningitis sessions to broaden the reach of and subsequently died on October 5, 2001. the Association; representatives of the  The autopsy showed that the death was USDA were regular attendees through this caused by symptoms that had the “transition period.” characteristics of an anthrax infection,  There were striking changes in the meetings confirming a bacteriological in 1964-1965: the NIH and CDC joined for inoculation. Stevens reported the first the first time, along with a number of other signs of illness arose on September relevant federal agencies 27, 2001 during a business trip in  All classified information was removed North Carolina. Researchers established that accompanied by a concerted effort to his death was the first incident with the lung declassify safety studies and release them for form of anthrax in the USA since 1976. public knowledge and advantage.  By 1966, the attendees included universities, private laboratories, hospitals, and industry. Gradually, federal regulations began to appear.  In 1973, the impact of new OSHA regulations was analyzed and debated at the ASBA meeting; interestingly, there was a range of responses to the new regulations:  In 1974, the United States Postal Service and Department of Transportation introduced regulations for shipping of etiologic agents (microorganisms and toxins that cause disease in humans)  New safety programs and trainings were introduced.  The designation of 4 levels of biosafety originated in the mid-1970s, and the safety requirements for research with recombinant  DNA were hotly debated. A survey of the Organizations ABSA meetings in the 1980s reveals increased focus on individual agents or 1. BioRisk Association of Philippines (BRAP) groups ofagents and coordination of 2. World Health Organization (WHO) international safety issues. ABSA now 3. American Biological Safety Association (ABSA) represents biosafety professionals in 20 4. Center for Disease Control (CDC) countries, and reflects the organic nature of 5. National Institute of Health (NIH) the topic: biosafetyis a fast-moving field 6. Occupational Safety and Health with constant research into and reevaluation Administration (OSHA) of its tenets as threat perception change 7. International Federation of Biosafety and technologies advance Associations (IFBA) The Anthrax Attacks Principles of Biosafety  Anthrax is a disease caused by Bacillus anthracis, a germ that lives in soil. Many To protect: people know about it from the 2001  the patient bioterror attacks. In the attacks, someone  yourself purposely spread anthrax through the U.S.  the environment mail. This killed five people and made 22 sick.  The first documented incident of illness associated with the circulation of anthrax was registered on October 2, 2001 in Florida. 7  Risk Group Classification 1. Risk Group 1  Unlikely to cause animal or human disease  Non pathogenic agent 2. Risk Group 2  Pathogenic for humans Unlikely a serious hazard  Treatment and preventive measures available  Limited risk of spread of infection Example:  CDC, Yersinia pestis laboratory 3. Risk Group 3  Pathogenic, cause serious disease  Effective treatment and preventive measures usually available  Little person-to-person spread Example:  Laboratory in Lyon France 4. Risk Group 4  Lethal, pathogenic agent Readily Triple Packages transmittable  Category B infectious substances may be  direct, indirect shipped in "602" packages, as long as the  Effective treatment and preventive measures correct marking and labelling is provided on not usually available the outer package  Category A infectious substances cannot be Example: shipped in "650" packages  National Institute for Infectious Diseases, Rome, Italy Relation To Risk Groups To Biosafety Levels, Practices And Equipment Biosafety Containment Levels  Biosafety levels  Level 1& 2: basic laboratories  Level 3: containment laboratories  Level 4: high containment laboratories  Each level associated with appropriate  Equipment, practices, work procedures  Diagnostic and health-care laboratories must be biosafety level 2 or above 8 Biosafety Levels 8. Storing human foods or drinks anywhere in the laboratory working areas is prohibited. 9. Protective laboratory clothing that has been used in the laboratory must not be stored in the same lockers or cupboards as street clothing. Procedures 1. Pipetting by mouth must be strictly forbidden. 2. Materials must not be placed in the mouth. Labels must not be licked. 3. All technical procedures should be performed in a way that minimizes the formation of aerosols and droplets. 4. The use of hypodermic needles and syringes Access should be limited. They must not be used as substitutes for pipetting devices or for any 1. The international biohazard warning symbol purpose other than parenteral injection or and sign (Figure 1) must be displayed on the aspiration of fluids from laboratory animals. doors of the rooms where microorganisms of 5. All spills, accidents and overt or potential Risk Group 2 or higher risk groups are handled. exposures to infectious materials must be 2. Only authorized persons should be allowed to reported to the laboratory supervisor. A written enter the laboratory working areas. record of such accidents and incidents should be 3. Laboratory doors should be kept closed. maintained. 4. Children should not be authorized or allowed 6. A written procedure for the clean-up of all to enter laboratory working areas. spills must be developed and followed. 5. Access to animal houses should be specially 7. Contaminated liquids must be decontaminated authorized. (chemically or physically) before discharge to the 6. No animals should be admitted other than sanitary sewer. An effluent treatment system may those involved in the work of the laboratory. be required, depending on the risk assessment for the agent(s) being handled. Personal Protection 8. Written documents that are expected to be removed from the laboratory need to be 1. Laboratory coveralls, gowns or uniforms must protected from contamination while in the be worn at all times for work in the laboratory. laboratory. 2. Appropriate gloves must be worn for all procedures that may involve direct or accidental Laboratory Working Areas contact with blood, body fluids and other potentially infectious materials or infected 1. The laboratory should be kept neat, clean and animals. After use, gloves should be removed free of materials that are not pertinent to the aseptically and hands must then be washed. work. 3. Personnel must wash their hands after 2. Work surfaces must be decontaminated after handling infectious materials and animals, and any spill of potentially dangerous material and at before they leave the laboratory working areas. the end of the working day. 4. Safety glasses, face shields (visors) or other 3. All contaminated materials, specimens and protective devices must be worn when it is cultures must be decontaminated before disposal necessary to protect the eyes and face from or cleaning for reuse. splashes, impacting objects and sources of 4. Packing and transportation must follow artificial ultraviolet radiation. applicable national and/or international 5. It is prohibited to wear protective regulations. laboratory clothing outside the laboratory, 5. When windows can be opened, they should e.g. in canteens, coffee rooms, offices, libraries, be fitted with arthropod-proof screens. staff rooms and toilets. 6. Open-toed footwear must not be worn in Biosafety Management laboratories. 7. Eating, drinking, smoking, applying cosmetics 1. It is the responsibility of the laboratory director and handling contact lenses is prohibited in the (the person who has immediate responsibility for laboratory working areas. 9 the laboratory) to ensure the development and long-term storage space, conveniently located adoption of a biosafety management plan and a outside the laboratory working areas, should also safety or operations manual. be provided. 2. The laboratory supervisor (reporting to the 7. Space and facilities should be provided for the laboratory director) should ensure that regular safe handling and storage of solvents, radioactive training in laboratory safety is provided. materials, and compressed and liquefied gases. 3. Personnel should be advised of special hazards, 8. Facilities for storing outer garments and and required to read the safety or operations personal items should be provided outside the manual and follow standard practices and laboratory working areas. procedures. The laboratory supervisor should 9. Facilities for eating and drinking and for rest make sure that all personnel understand these. A should be provided outside the laboratory copy of the safety or operations manual should working areas. be available in the laboratory. 10. Hand-washing basins, with running water if 4. There should be an arthropod and rodent possible, should be provided in each laboratory control programme. room, preferably near the exit door. 5. Appropriate medical evaluation, surveillance 11. Doors should have vision panels, appropriate and treatment should be provided for all fire ratings, and preferably be selfclosing. personnel in case of need, and adequate medical 12. At Biosafety Level 2, an autoclave or other records should be maintained. means of decontamination should be available in appropriate proximity to the laboratory. Laboratory Design and Facilities 13. Safety systems should cover fire, electrical emergencies, emergency shower and eyewash  In designing a laboratory and assigning facilities. certain types of work to it, special attention 14. First-aid areas or rooms suitably equipped should be paid to conditions that are known and readily accessible should be available to pose safety problems. These include: 15. In the planning of new facilities, consideration should be given to the provision of mechanical 1. Formation of aerosols ventilation systems that provide an inward flow 2.Work with large volumes and/or high of air without recirculation. If there is no concentrations of microorganisms mechanical ventilation, windows should be able 3. Overcrowding and too much equipment to be opened and should be fitted with 4. Infestation with rodents and arthropods arthropod-proof screens. 5. Unauthorized entrance 16. A dependable supply of good quality water is 6. Workflow: use of specific samples and reagents essential. There should be no cross connections between sources of laboratory and Design Features drinking-water supplies. An antibackflow device should be fitted to protect the public water 1. Ample space must be provided for the safe system. conduct of laboratory work and for cleaning and 17. There should be a reliable and adequate maintenance. electricity supply and emergency lighting to 2. Walls, ceilings and floors should be smooth, permit safe exit. A stand-by generator is desirable easy to clean, impermeable to liquids and for the support of essential equipment, such as resistant to the chemicals and disinfectants incubators, biological safety cabinets, freezers, normally used in the laboratory. Floors should etc., and for the ventilation of animal cages. be slip-resistant. 18. There should be a reliable and adequate 3. Bench tops should be impervious to water and supply of gas. Good maintenance of the resistant to disinfectants, acids, alkalis, organic installation is mandatory. solvents and moderate heat. 4. Illumination should be adequate for all Laboratory Equipment activities. Undesirable reflections and glare should be avoided. 1. Designed to prevent or limit contact between 5. Laboratory furniture should be sturdy. Open the operator and the infectious material spaces between and under benches, cabinets and 2. Constructed of materials that are impermeable equipment should be accessible for cleaning. to liquids, resistant to corrosion and meet 6. Storage space must be adequate to hold structural requirements supplies for immediate use and thus prevent 3. Fabricated to be free of burrs, sharp edges and clutter on bench tops and in aisles. Additional unguarded moving parts 10 4. Designed, constructed and installed to 4. Screw-capped tubes and bottles. facilitate simple operation and provide for ease 5. Autoclaves or other appropriate means to of maintenance, cleaning, decontamination and decontaminate infectious materials. certification testing; glassware and other 6. Plastic disposable Pasteur pipettes, whenever breakable materials should be avoided, available, to avoid glass. whenever possible 7. Equipment such as autoclaves and biological safety cabinets must be validated with appropriate methods before being taken into use. Recertification should take place at regular intervals, according to the manufacturer’s instruction Biosafety Level 3 Biosafety Level 2  Same as biosafety level 1  Access  Personal protection  Procedures  Laboratory working areas  Biosafety management  Laboratory design and facilities Essential Biosafety Equipment  Design features  The containment laboratory – Biosafety Essential Biosafety Equipment Level 3 is designed and provided for work with Risk Group 3 microorganisms and with 1. Pipetting aids – to avoid mouth pipetting. large volumes or high concentrations of Many different designs are available.  Risk Group 2 microorganisms that pose an 2. Biological safety cabinets, to be used increased risk of aerosol spread. Biosafety whenever:  Level 3 containment requires the  infectious materials are handled; such strengthening of the operational and materials may be centrifuged in the open safety programmes over and above those laboratory if sealed centrifuge safety cups for basic laboratories – Biosafety Levels 1 are used and if they are loaded and and unloaded in a biological safety cabinet  The guidelines given in this chapter are  there is an increased risk of airborne presented in the form of additions to those infection for basic laboratories – Biosafety Levels 1  procedures with a high potential for and 2, which must therefore be applied producing aerosols are used; these may before those specific for the include centrifugation, grinding, blending, containment laboratory – Biosafety Level 3. vigorous shaking or mixing, sonic disruption, The major additions and changes are in: opening of containers of infectious materials whose internal pressure may be different 1. Code of practice from the ambient pressure, intranasal 2. Laboratory design and facilities inoculation of animals, and harvesting of 3. Health and medical surveillance. infectious tissues from animals and eggs. 3. Plastic disposable transfer loops. Alternatively, Code of Practice electric transfer loop incinerators may be used  The code of practice for basic laboratories – inside the biological safety cabinet to reduce Biosafety Levels 1 and 2 applies except aerosol production. where modified as follows. 11 1. The international biohazard warning symbol Openings through these surfaces (e.g. for service and sign displayed on laboratory access doors pipes) should be sealed to facilitate must identify the biosafety level and the name of decontamination of the room(s). the laboratory supervisor who controls access, 4. The laboratory room must be sealable for and indicate any special conditions for entry into decontamination. Air-ducting systems must be the area, e.g. immunization. constructed to permit gaseous decontamination. 2. Laboratory protective clothing must be of the 5. Windows must be closed, sealed and type with solid-front or wrap-around gowns, break-resistant. scrub suits, coveralls, head covering and, where 6. A hand-washing station with hands-free appropriate, shoe covers or dedicated shoes. controls should be provided near each exit door. Front-buttoned standard laboratory coats are 7. There must be a controlled ventilation system unsuitable, as are sleeves that do not fully that maintains a directional airflow into the cover the forearms laboratory room. A visual monitoring device with or without alarm(s) should be installed so  Laboratory protective clothing must not that staff can at all times ensure that proper be worn outside the laboratory, and it directional airflow into the laboratory room is must be decontaminated before it is maintained. laundered. The removal of street clothing 8. The building ventilation system must be so and change into dedicated laboratory constructed that air from the containment clothing may be warranted when working laboratory – Biosafety Level 3 is not recirculated with certain agents (e.g. agricultural or to other areas within the building. Air may be zoonotic agents). high-efficiency particulate air (HEPA) filtered, reconditioned and recirculated within that 3. Open manipulations of all potentially laboratory. When exhaust air from the infectious material must be conducted within a laboratory (other than from biological safety biological safety cabinet or other cabinets) is discharged to the outside of the primary containment device building, it must be dispersed away from 4. Respiratory protective equipment may occupied buildings and air intakes. Depending on be necessary for some laboratory the agents in use, this air may be discharged procedures or working with animals infected through HEPA filters. A heating, ventilation and with certain pathogens air-conditioning (HVAC) control system may be installed to prevent sustained positive Laboratory Design and Facilities pressurization of the laboratory. Consideration should be given to the installation of audible or  The laboratory design and facilities for basic clearly visible alarms to notify personnel of laboratories – Biosafety Levels 1 and 2 apply HVAC system failure. except where modified as follows: 4. The Containment Laboratory – Biosafety Level 1. The laboratory must be separated from the areas that are open to unrestricted traffic flow 9. All HEPA filters must be installed in a manner within the building. Additional separation may that permits gaseous decontamination and be achieved by placing the laboratory at the testing. blind end of a corridor, or constructing a 10. Biological safety cabinets should be sited partition and door or access through an away from walking areas and out of crosscurrents anteroom (e.g. a double-door entry or basic from doors and ventilation systems (see Chapter laboratory – Biosafety Level 2), describing a 10). specific area designed to maintain the pressure 11. The exhaust air from Class I or Class II differential between the laboratory and its biological safety cabinets which will have been adjacent space. The anteroom should have passed through HEPA filters, must be discharged facilities for separating clean and dirty clothing in such a way as to avoid interference with the air and a shower may also be necessary. balance of the cabinet or the building exhaust 2. Anteroom doors may be self-closing and system. interlocking so that only one door is open at a 12. An autoclave for the decontamination of time. A break-through panel may be provided for contaminated waste material should be available emergency exit use. in the containment laboratory. If infectious waste 3. Surfaces of walls, floors and ceilings should be has to be removed from the containment water-resistant and easy to clean. 12 laboratory for decontamination and disposal, it important if working in a Biosafety Level 4 suit must be transported in sealed, unbreakable and facility. leakproof containers according to national or 2. A complete change of clothing and shoes is international regulations, as appropriate. required prior to entering and upon exiting the 13. Backflow-precaution devices must be fitted to laboratory. the water supply. Vacuum lines should be 3. Personnel must be trained in emergency protected with liquid disinfectant traps and HEPA extraction procedures in the event of personnel filters, or their equivalent. Alternative vacuum injury or illness. pumps should also be properly protected with 4. A method of communication for routine and traps and filters. emergency contacts must 14. The containment laboratory – Biosafety Level be established between personnel working 3 facility design and operational procedures within the maximum containment laboratory – should be documented. Biosafety Level 4 and support personnel outside the laboratory Laboratory Equipment Laboratory Design and Facilities  The principles for the selection of laboratory equipment, including biological safety  The features of a containment laboratory – cabinets are the same as for the basic Biosafety Level 3 also apply to a maximum laboratory – Biosafety Level 2. containment laboratory – Biosafety Level 4  However, at Biosafety Level 3, with the addition of the following. manipulation of all potentially infectious material must be conducted within a 1. Primary containment. An efficient primary biological safety cabinet or other primary containment system must be in place, consisting containment device. Consideration should of one or a combination of the following: be given to equipment such as centrifuges,  Class III cabinet laboratory. Passage through which will need additional containment a minimum of two doors prior to entering accessories, for example, safety buckets or the rooms containing the Class III biological containment rotors. safety cabinet(s) (cabinet room) is required.  Some centrifuges and other equipment, such In this laboratory configuration the Class III as cell-sorting instruments for use with biological safety cabinet provides the infected cells, may need additional local primary containment. exhaust ventilation with HEPA filtration for  A personnel shower with inner and outer efficient containment changing rooms is necessary. Supplies and materials that are not brought into the The Maximum Containment Laboratory – cabinet room through the changing area are Biosafety Level 4 introduced through a double-door autoclave or fumigation chamber. Once the  The maximum containment laboratory – outer door is securely closed, staff inside the Biosafety Level 4 is designed for work with laboratory can open the inner door to Risk Group 4 microorganisms. Before such a retrieve the materials. The doors of the laboratory is constructed and put into autoclave or fumigation chamber are operation, intensive consultations should be interlocked in such a way that the outer held with institutions that have had door cannot open unless the autoclave has experience of operating a similar facility. been operated through a sterilization cycle Operational maximum containment or the fumigation chamber has been laboratories – Biosafety Level 4 should be decontaminated under the control of national or other  Suit laboratory. A protective suit laboratory appropriate health authorities. with self-contained breathing apparatus differs significantly in design and facility Code of Practice requirements from a Biosafety Level 4 laboratory with Class III biological safety  The code of practice for Biosafety Level 3 cabinets. The rooms in the protective suit applies except where modified as follows: laboratory are arranged so as to direct personnel through the changing and 1. The two-person rule should apply, whereby no decontamination areas prior to entering individual ever works alone. This is particularly areas where infectious materials are 13  manipulated. A suit decontamination monitored. Airflow in the supply and shower must be provided and used by exhaust components of the ventilating personnel leaving the containment system must be monitored, and an laboratory area. A separate personnel appropriate system of controls must be used shower with inner and outer changing to prevent pressurization of the suit rooms is also provided. laboratory.  Personnel who enter the suit area are  HEPA-filtered supply air must be provided required to don a one-piece, positively to the suit area, decontamination shower pressurized, HEPA-filtered, supplied-air suit. and decontamination airlocks or chambers. Air to the suit must be provided by a system Exhaust air from the suit laboratory must be that has a 100% redundant capability with passed through a series of two HEPA filters an independent source of air, for use in the prior to release outdoors. Alternatively, event of an emergency. Entry into the suit after double HEPA filtration, exhaust air may laboratory is through an airlock fitted with be recirculated, but only within the suit airtight doors. An appropriate warning laboratory. Under no circumstances shall the system for personnel working in the suit exhaust air from the Biosafety Level 4 suit laboratory must be provided for use in the laboratory be recirculated to other areas. event of mechanical system or air failure Extreme caution must be exercised if recirculation of air within the suit laboratory 2. Controlled access. The maximum containment is elected. laboratory – Biosafety Level 4 must be located in a separate building or in a clearly delineated zone 4. Decontamination of effluents. All effluents within a secure building. Entry and exit of from the suit area, decontamination chamber, personnel and supplies must be through an decontamination shower, or Class III biological airlock or pass-through system. On entering, safety cabinet must be decontaminated before personnel must put on a complete change of final discharge. Heat treatment is the preferred clothing; before leaving, they should shower method. before putting on their street clothing.  Effluents may also require correction to a  Controlled air system. Negative pressure neutral pH prior to discharge. Water from must be maintained in the facility. Both the personnel shower and toilet may be supply and exhaust air must be discharged directly to the sanitary sewer HEPA-filtered. without treatment.  Class III cabinet laboratory. The supply air to the Class III biological safety cabinet(s) may 5. Sterilization of waste and materials. A be drawn from within the room through a double-door, pass-through autoclave must be HEPA filter mounted on the cabinet or available in the laboratory area. Other methods supplied directly through the supply air of decontamination must be vailable for system. Exhaust air from the Class III equipment and items that cannot withstand biological safety cabinet must pass through steam sterilization. two HEPA filters prior to release outdoors. The cabinet must be operated at negative 6. Airlock entry ports for specimens, materials pressure to the surrounding laboratory at all and animals must be provided. times. A dedicated non-recirculating ventilating system for the cabinet laboratory 7. Emergency power and dedicated power is required. supply line(s) must be provided.  Suit laboratory. Dedicated room air supply and exhaust systems are required. The 8. Containment drain(s) must be installed. supply and exhaust components of the ventilating system are balanced to provide Types of Cabinet directional airflow within the suit area from the area of least hazard to the area(s) of 1. Fume Hood greatest potential hazard. Redundant  Removes toxic chemical (ducting exhaust fans are required to ensure that the sys./ductless) facility remains under negative pressure at  No HEPA filter -> not for biohazard agents all times. The differential pressures within the suit laboratory and between the suit laboratory and adjacentareas must be 14  the outside atmosphere, is HEPA-filtered to protect the environment. HEPA & ULPA Filter (HEPA: High Efficiency Particulate Air ULPA: Ultra Low Penetration Air) Important definitions:  HEPA: 99.99% - at 0.3 microns  ULPA: 99.999% - at 0.12 microns  Note: The “classical” definition of HEPA filter is 99.97% at 0.3 microns, but nowadays all BSC and LF in US use 99.99% at 0.3 m 2. Laminar Flow Cabinet (LFC)  Product protection (no personnel Particle Size Comparison protection)  Not for biohazard agents or chemical fumes 3. Biohazard Safety Cabinet (BSC)  Class I BSC: Personnel and Environment Protection  Class II & III BSC: Personnel, Product and Environment Protection  HEPA filters (not for chemical vapors) HEPA/ULPA Capability  Removes a broad range of airborne contaminants:  Fine dust  Smoke  Bacteria (typical size: 500 to 0.3 micron) Biological Safety Cabinets  Soot  BSCs provide effective primary containment  Pollen for work with infectious material or toxins  Radioactive particles when they are properly maintained and  Impurity ion -> can affect Integrated used in conjunction with good laboratory Circuit speed techniques Class I BSC Basic Principle  100% Exhaust  Personnel protection is provided through a  Inflow velocity 75 fpm continuous stream of inward air, known as minimum inflow, which helps prevent aerosols from  BSL 1 –3 Usage escaping through the front opening.  Personnel protection only  The exhaust air, which is exhausted into the  CDC/NIH recommends a glove- port surrounding containment zone or directly to panel for use with small amounts of radionuclides when exhausted 15  Typical uses today: Toxic powder weighing, necropsy  Maybe thimble/air gap or hard connected to a exhaust system when proper precautions are taken b. Class II Type A2  30% Exhaust, 70% Re-circulate  Negative pressure plenum  Inflow velocity 100 fpm minimum  BSL 1 –3 Usage  Personnel and Product protection  Minute amounts of volatile toxic chemicals and radionuclides if canopy/thimble exhausted  Typical uses today: Bacterial, Viral, Fungal, Parasitic, Arbor- viruses Class II Type B1 Class II BSC  70% Exhaust, 30% Re-circulate  Negative-pressure ventilated cabinet  Negative pressure plenum  Provides HEPA-filtered, recirculated airflow  Inflow velocity 100 fpm minimum within the cabinet  BSL 1 –3 Usage  Exhaust air is HEPA-filtered  Personnel and Product protection  Provides personnel and product protection  Minute amounts of volatile toxic chemicals  Types of Class II BSCs and radionuclides  Class II A: HEPA filtered air is  Must be hard connected with typical discharged into the room exhaust requirement being 300-500 CFM at  Class II B: HEPA filtered air is ϭ.Ϭ” w.g. discharged out of the room  Must have interlocked internal blower with audible and visual alarm for exhaust failure a. Class II Type A1  Typical uses today: Bacterial, Viral, Fungal,  30% Exhaust, 70% Re-circulate Parasitic, Arbor-viruses  Negative pressure plenum (Changed 2007)  Inflow velocity 75 fpm minimum  BSL 1 –3 Usage  Personnel and Product protection  Minute amounts of non-volatile toxic chemicals and radionuclides if canopy/thimble exhausted  Typical uses today: Bacterial, Viral, Fungal, Parasitic 16 Class II Type B2  BSL 4  100% Exhaust  Personnel and Product Protection  Negative pressure plenum  Small amounts of volatile toxic chemicals  Inflow velocity 100 fpm minimum and radionuclides  BSL 1 –3 Usage  Must be hard connected with typical  Personnel and Product protection exhaust requirement being 50-100 CFM at  Small amounts of volatile toxic chemicals 0.5 w.g. and radionuclides  Must have negative pressure alarm for  Must be hard connected with typical cabinet or exhaust failure exhaust requirement being 700-1,200 CFM  Typical uses today: Toxic Powders, BSL 4 at Ϯ.Ϭ” w.g. Agents  Must have interlocked internal blower with audible and visual alarm for exhaust failure  Typical uses today: Bacterial, Viral, Fungal, Parasitic, Arbor-viruses, Prion, Cytotoxics Proper Use  Standard operating procedures (SOPs) to be followed by facility personnel is strongly recommended to encourage the proper and consistent use of a BSC by personnel to prevent exposures and the release of pathogens and toxins. Start-Up Considerations  Check that the sash is at the appropriate height. Adjust stool height so that the user’s underarms are level with the bottom of the sash.  Check the pressure gauges to verify that readings are within the acceptable range.  If present, test the airflow alarm and ensure it is switched to the "on" position.  Confirm inward airflow by holding a tissue at the middle of the edge of the sash to establish that it is drawn in.  Disinfect the interior surfaces with a disinfectant effective against the infectious material and toxins used in the laboratory, allowing an appropriate contact time.  If a corrosive disinfectant is used, the surface should be rinsed with water after disinfection.  Assemble all materials required for manipulation and load into the BSC.  Care should be taken not to overcrowd or block the front or rear grilles to prevent the Class III BSC appropriate airflow patterns from being  100% Exhaust Glove Box compromised.  Negative Pressure at Ϭ.5” w.g. minimum  When there is significant potential for  Double HEPA Filter Exhaust splatter or splashes to occur during 17  manipulations of infectious material or  Windows that open should be kept closed toxins, the work area should be lined with a when the BSC is in use. plastic-backed absorbent pad.  Place aerosol generating equipment (e.g., Completion of Work in the BSC vortex mixer, sonicator) towards the back of  Upon completion of work, allow sufficient the BSC, without blocking the rear grille. time for the air in the BSC to purge (i.e., pass  After loading material in the BSC, allow through the filter) before disrupting the air sufficient time for the air to purge and the curtain by removing hands or unloading airflow to stabilize before initiating work. material from the BSC.  This will be specified in the manufacturer's  The purge time will vary by model and can instructions, and is generally 3-5 minutes. be up to several minutes.  Close or cover all containers. Working in the BSC  Surface decontaminate items before  Perform operations as far to the rear of the removing them from the BSC. work area as reasonable.  Disinfect the interior surfaces of the BSC,  Ensure that elbows and arms do not rest on including sides, back, lights, and the grille or work surface. interior of the glass, with a disinfectant  Avoid excessive movement of hands and effective against the pathogens in arms through the front opening. Such use, allowing an appropriate contact time. movements disrupt the air curtain at the  If a corrosive disinfectant is used, front of the BSC, which can allow the surface should be rinsed with contaminants to enter or escape the BSC. water after disinfection to avoid  Arms should enter and exit the BSC slowly corrosion of the stainless steel surfaces. and perpendicular to the front opening.  Routinely remove the work surface and  Keep a bottle of an appropriate disinfectant disinfect the tray beneath it. in the BSC while work is performed to avoid  Routinely wipe the surface of the lights having to move hands outside of the BSC. within the BSC with a suitable cleaner or  Segregate non- contaminated ("clean") items disinfectant (e.g., ethanol). from contaminated ("dirty") items. Work should always flow from "clean" to "dirty" UV Lamps areas.  Germicidal UV lamps are not substitutes for  Material should be discarded in a waste proper cleaning of BSC workzone container located towards the rear of the  May cause performance degradation cabinet workspace. Do not discard materials  May compromise personnel safety when in containers outside of the cabinet. proper precautions are not taken  Decontaminate the surface of all objects in the BSC in the event of a spill. Lesson 3: Biorisk Management  The work area, including the inside surface of the window, should be decontaminated Biorisk while the BSC remains in operation.  Risk associated to biological toxins or  Natural gas and propane should not be used  infectious agents in a BSC; sustained open flames (e.g., Bunsen burner) in BSCs are prohibited. Source: On-demand open flames (e.g., touch-  Unintentional exposure to unauthorized plate microburners) are to be avoided as access they create turbulence in the BSC, disrupt  Accidental release or loss airflow patterns, and can damage the HEPA  Theft filter (BSC Matrix 4.6).  Misuse  Non-flame alternatives (e.g.,  Diversion microincinerator, or sterile disposable  Intentional unauthorized release of inoculation loops) should be used whenever biohazard possible.  Equipment creating air movement (e.g., Biorisk Management vacuum pumps, centrifuges) may affect the  Is the integration of biosafety and integrity of the airflow and should not biosecurity to manage risks when be used within the BSC. working with biological toxins and infectious agents. 18   A system or process to control safety and Introduction to Biosecurity Risk Assessment security risks associated with the handling or storage and disposal of To be comprehensive: biological agents and toxins in the laboratories and facilities. Laboratory Biosecurity Risk Assessment  should consider every asset, adversary AMP Model Components: and vulnerability in an institution and its component laboratories and units. A – Assessment M – Mitigation Introduction to Laboratory Risk Assessments P – Performance Biorisk Assessment Biorisk  allows a laboratory to determine the  Risk associated with biological materials relative level of risk its different activities  Biorisk = Biosafety + Biosecurity Risks pose, and helps guide risk mitigation decisions so these are targeted Biorisk Assessment to the most important risk.  Process of identifying the hazards and evaluating the risks associated with biological agents and toxins, taking into account the adequacy of any existing controls, and deciding whether or not the risks are acceptable Define: 1. Define the situation 2. Define the risk 3. Characterize the risk 4. Define if risk are acceptable or not Biorisk Mitigation  Actions and control measures that are put into place to reduce or eliminate the risks associated with biological agents and toxins Risk Biorisk Performance  Risk is the likelihood of an undesirable  Improving biorisk management by event happening, that involves a specific recording, measuring, and evaluating hazard or threat and has consequences. organizational actions and outcomes to  Risk = f (likelihood, consequences) reduce biorisk.  Risk is a function of both the Likelihood of something happening and Introduction to Laboratory Risk Assessments Consequences of that occurrence. Laboratory Biorisk Assessment  is an analytical procedure designed to characterize and evaluate safety and security risks in a laboratory. To be comprehensive: Biosafety Risk Assessment  should consider every activity and procedure conducted in a laboratory that involves infectious disease agents. 19 Factors That Affect Likelihood And/Or Assessing Consequences Consequences Level Descriptor Consequence – Agent Properties Description  Pathogenicity 1 Insignificant No injuries, low  Virulence financial loss  Host range Communicability 2 Minor First aid treatment,  Transmission on site release  Environmental Stability immediately contained Procedures 3 Moderate Medical treatment  PPE required, on site  Training release contained  SOPs with outside  Equipment used assistance, high financial loss Risk Assessment 4 Major Extensive injuries,  Involves team work loss of production  identify all the risks: capability, off site  5Ps release with no  Pathogen detrimental effects,  Procedures major financial loss  Personnel PE 5 Catastrophic Death, toxic release  Place off site with detrimental effect,  identify the specific hazard or threat huge financial loss  determine the consequences of an identified risk The AMP Model of Laboratory Biorisk  identify all the existing controls and any Management additional ones that need to be applied AMP Hazard, Threat, and Risk  Assessment, Mitigation, Performance 1. A hazard is an object that can cause harm Biorisk Management = AMP 2. A threat is a person who has intent Assessment Mitigation Performance and/or ability to cause harm to other ↑ ↑ ↑ people, animals, or the institution Risk Elimination or Control 3. A risk can be based on either a hazard identification substitution Assurance and/or a threat Hazard/threat Engineering Improvement identification controls Determining Likelihood of An Event Likelihood Administrative evaluation controls Level Descriptor Likelihood – Consequences Practices and Description evaluation procedures 1 Rare May occur only in Personal exceptional protective circumstances equipment 2 Unlikely Could occur at some time Risk Mitigation Control Measures 3 Possible Might occur at some time Elimination Removing the risk 4 Likely Will probably occur Substitution Substitution of a serious in most circumstances pathogen with one this is 5 Almost Expected to occur in much less pathogenic Certain most circumstances Controls: Physical changes to work Engineering stations, equipment, materials, production 20  facilities, or any other  Eye protection relevant aspect of the work  Gloves environment that reduce or  Face shields prevent exposure to hazards  Hair nets Administrative Policies, standards and  Ear plugs (when sonicating) guidelines  Protective clothing (gowns) Practices and Processes and activities  Footwear Procedures  Respiratory Protection PPE Devices worn by the worker to protect against hazards Safety Label/Sign Implementing Mitigation Measures  Ideally, you should first consider elimination or substitution  A combination of control measures should be used based on their effectiveness and your ability to implement them Advantages/Disadvantages A combination of different measures is needed to be effective Control Advantages Disadvantages Poster and Notice Measures Engineering Efficient, Cost, eliminates complexity hazard Significantly reduces the potential and the level of exposure to pathogens. Administrative Authority Indirect approach approach, addresses the human factor Practices and SOP based Training and Campaign Poster Porcedures (standardized supervision approach) requirements PPE Ease of use, Does not relative cost eliminate hazard: if PPE fails exposure happens, uncomfortable, limits ability Risk Mitigation Personal Protective Equipment (PPE)  Last control in the hierarchy of controls  Should be used with other controls.  However, in many laboratories it is the first control implemented, and sometimes the only control 21 Create Characters Performance Evaluation Management Systems Approach  Involves a systematic process intended to  This laboratory biorisk management achieve organizational objective and CWA is based on a management goals. system approach.  Model ensures that the implemented  This implies that identifying, mitigation are indeed reducing or understanding and managing a system eliminating risk of interrelated processes for a given objective, improves the organization’s effectiveness and efficiency. Application Of The Management Systems a) defining the system by identifying or developing the processes that affect a given objective; b) structuring the system to achieve the objective in the most effective manner; c) understanding the interdependencies among the processes of the system; d) continually improving the system through measurement and evaluation, and; e) establishing resource constraints prior to action. Effective Management System Approach  Should be built on the concept of continual improvement through a cycle of planning, implementing, reviewing and improving the processes and actions that an organization undertakes to meet goals. This is known as the PDCA (Plan-Do-Check-Act) principle: a) Plan: Planning, including identification of hazard and risk and establishing goals, b) Do: Implementing, including training and operational issues, c) Check: Checking, including monitoring and corrective action, d) Act: Reviewing, including process innovationand acting to make needed changes to the management system. 22  Challenges in Waste Management Practices 1. Policy/Government Agency  Poor regulative measures  Lack of green procurement policy 2. Institution/Administration  Lack of operational strategy  Lack of management commitment  Lack of adequate facilities  Lack of institutional arrangements  Financial constraints Lesson 4: Health Care Waste Management 3. Community/Society Waste Management  Waste picking and reusing  is a very important aspect for  Inadequate pressure from the societies biological/chemical safety because it has its own set of specialize procedures / steps to 4. Stakeholders/Employees be taken/ to ensure safety  Lack of Segregation practices  Different types of hazards i.e.heavy metals,  Reluctance to change and adoption organic solvents, and resins for chemical, envelop vs non envelop bacteria, viruses, Philippine Regulations on Waste Management prions for biologicals – need specific procedure for treatment and disposals 1. RA 6969 Toxic Substances and Hazardous  Not only the laboratory workers are and Nuclear Wastes - Control Act of 1990 involved in the process, the support staff 2. Presidential Decree No. 856 s 1975 - “The maintenance staff/ operators (who might Code of Sanitation of the Philippines” have the least training in handling hazardous 3. DOH DC # 156-C series of 1993 - “Provides substances) and the third-party contractors Guideline in Hospital Management” (whose credentials on giving the specific 4. RA 8749 - Clean Air Act of 1999 services needed should be verified). 5. RA 9003 - Ecological Solid Waste Management Act of 2001 Transmission Of Diseases: 6. RA 9275 - Clean Water Art of 2004 1. Direct contact 7. PD 1586 - Environmental Impact Statement 2. Disease vectors System Law Issues with Bio and Chemical Hazards: Human Waste Management System and Animal Health Environmental Degradation  Aesthetics: odor, growth of insects/pests  Ground water contamination  Eliminations of beneficial microorganism  Air pollution due to improper incineration 1. In-lab Hazard Reduction Lab Reduction and Segregation  Segregation at point of origin 23  Segregation of infectious waste with  Puncture proof container multiple hazards  Use of distinctive, clearly marked containers or plastic bags  Use of the universal biological hazard symbol As possible, separate…  pathology wastes from other medical wastes (OMW)  MW with hazardous chemicals or e. radioactive waste.  Radioactive waste  sharps waste from OMW  Lead Storage Containers  chemotherapy wastes from OMW 2. Waste Characterization DOH-Healthcare WM Guide f.  Non-infectious recyclables  Trash Bin/Plastic bags (bottles) a. 2. Waste Characterization  Non-infectious dry waste Unknown chemicals  Trash Bin/Plastic bags  Physical description  Water reactivity  Water solubility  pH  Ignitability (flammability)  Presence of oxidizers, halogens, radioactive, biohazardous, toxic constituents, PCBs, and high odor comp. b.  Non-infectious wet waste 3. Collection and Storage  Trash Bin/Plastic bags (foodstuff) 7-points for Academic institutions 1. Labeling standards 2. Facility/ container standards 3. Training requirements 4. Removal of unwanted chemicals 5. Hazardous waste determination 6. Laboratory cleanout 7. Prevention of emergencies and response c. 3. Collection and Storage  Infectious Pathologic waste Packaging Infectious Wastes  Plastic bag(double bagging)