Assessment of biosafety precautions in Khartoum state diagnostic laboratories, Sudan

Biosafety precautions
BACKGROUND: This study was conducted to evaluate the biosafety precautions that applied by diagnostic laboratories in Khartoum state, 2009.
METHODS: A total number of 190 laboratories were surveyed about their compliance with standard biosafety precautions. These laboratories included 51 (27%) laboratories from government, 75 (39%) from private sectors and 64 (34%) laboratories belong to organization providing health care services.
RESULTS: The study found that 32 (16.8%) of laboratories appointed biosafety officers. Only, ten (5.2%) participated in training about response to fire emergency, and 28 (14.7%) reported the laboratory accident occurred during work. 45 (23.7%) laboratories had a written standard operation procedures (SOPs), and 35 (18.4%) had written procedures for the lean-up of spills. Moreover, biosafety cabinet was found in 11 (5.8%) laboratories, autoclave in 28 (14.7%) and incinerator in only two (1.1%) laboratories. Sharp disposable containers were found in 84 (44.2%). Fire alarm system was found in 2 (1.1%) laboratories, fire extinguisher in 39 (20.5%) laboratories, and fire emergency exit found in 14 (7.4%) laboratories. Furthermore, 19 (10%) laboratories had a hepatitis B virus vaccination programme, 5 (6.2%) applied BCG vaccine, and 2 (1.1%0) vaccinated the staff against influenza.
CONCLUSION: The study concluded that the standards biosafety precautions adopted by the diagnostic laboratories in Khartoum state was very low. Further, the laboratory personnel awareness towards biosafety principles implementation was very low too.

Elduma AH. Assessment of biosafety precautions in Khartoum state diagnostic laboratories, Sudan. Pan Afr Med J. 2012;11:19. Epub 2012 Feb 3. PubMed PMID:
22514753; PubMed Central PMCID: PMC3325057.

Effectiveness of shoe covers for bioexclusion within an animal facility

Black-light examination of the floor
after the completion of study 1.
The personal protective equipment (PPE) required for entry into rodent barrier rooms often includes a hair bonnet, face mask, disposable gown, gloves, and shoe covers. Traditionally, shoe covers have been considered essential PPE for maintaining a 'clean' animal room. The introduction of microisolation caging and ventilated rack housing prompted us to reevaluate the contribution of shoe covers to bioexclusion. Contamination powder that fluoresces under black light was to track particle dispersal on the floor and personnel. The test mouse room contained a ventilated microisolation rack and biosafety cabinet. Powder was applied directly inside or outside the animal room doorway. PPE with or without shoe covers was donned outside of the animal room doorway and discarded on exiting. Participants either were scanned on entry into the room for the presence of florescence or asked to complete a simulated standard animal room activity while wearing full PPE. Animal rooms were scanned for florescence after exit of participants. All participants donning shoe covers fluoresced in multiple areas, primarily on gloves and gowns. Shoe covers had no effect on the spread of powder in normal traffic patterns, with no powder detected within caging. Powder also was used to determine the distance substances could be carried on the floor from building entry points. Results indicate that shoe covers do not improve (and actually may compromise) bioexclusion. Donning of shoe covers offers a potential for contamination of personnel from contact with shoe bottoms.

Hickman-Davis JM, Nicolaus ML, Petty JM, Harrison DM, Bergdall VK.
Effectiveness of shoe covers for bioexclusion within an animal facility. J Am
Assoc Lab Anim Sci. 2012 Mar;51(2):181-8. PubMed PMID: 22776118; PubMed Central
PMCID: PMC3314521.

Efficacy of hand rubs with a low alcohol concentration

BACKGROUND: Some national hospital hygiene societies in Europe such as the French society for hospital hygiene (SFHH) have positive lists of disinfectants. Few hand disinfectants with a rather low concentration of ethanol are listed by one society as effective for hygienic hand disinfection with 3 mL in 30 s including a virucidal activity in 30 s or 60 s, but published data allow having doubts. We have therefore evaluated the efficacy of three commonly used hand disinfectants according to EN 1500 and EN 14476.
METHODS: Products 1 (Aniosgel 85 NPC) and 2 (Aniosrub 85 NPC) were based on 70% ethanol, product 3 (ClinoGel derma+) on 60% ethanol and 15% isopropanol (all w/w). They were tested in 3 laboratories according to EN 1500. Three mL were applied for 30 s and compared to the reference treatment of 2 x 3 mL applications of isopropanol 60% (v/v), on hands artificially contaminated with Escherichia coli. Each laboratory used a cross-over design against the reference alcohol with 15 or 20 volunteers. The virucidal activity of the products was evaluated (EN 14476) in one laboratory against adenovirus and poliovirus in different concentrations (80%, 90%, 97%), with different organic loads (none; clean conditions; phosphate-buffered saline) for up to 3 min.
RESULTS: Product 1 revealed a mean log10-reduction of 3.87 +/- 0.79 (laboratory 1) and 4.38 +/- 0.87 (laboratory 2) which was significantly lower compared to the reference procedure (4.62 +/- 0.89 and 5.00 +/- 0.87). In laboratory 3 product 1 was inferior to the reference disinfection (4.06 +/- 0.86 versus 4.99 +/- 0.90). Product 2 revealed similar results. Product 3 fulfilled the requirements in one laboratory but failed in the two other. None of the three products was able to reduce viral infectivity of both adenovirus and poliovirus by 4 log10 steps in 3 min according to EN 14476.
CONCLUSIONS: Efficacy data mentioned in a positive list published by a society for hospital hygiene should still be regarded with caution if they quite obviously contradict published data on the same or similar products.

Kampf G, Ostermeyer C, Werner HP, Suchomel M. Efficacy of hand rubs with a lowalcohol concentration listed as effective by a national hospital hygiene society in Europe. Antimicrob Resist Infect Control. 2013 Jun 12;2(1):19. [Epub ahead of 
print] PubMed PMID: 23759059; PubMed Central PMCID: PMC3689097.

WHO: Flip Chart Safe Hospital

How could we call on a community, a school, or a rural health center to be partners and participants in the promotion of Hospitals Safe from Disasters? This flip chart gives us that opportunity. It has an entertaining format and design, and it teaches by using simple and direct language. Each illustrated sheet presents only the most important ideas; pictures are accompanied by short, simple text written in a font that is easy to read.
It was conceived and developed as an informational, motivational, and educational tool that could communicate the strategic importance of safe health facilities, whether large hospitals in urban areas or small health posts serving urban and rural populations. The flip chart can be used to work with a variety of audiences, including children and teenagers, persons associated with health services, users of health services, media and education sectors, authorities from different levels and sectors, including regional and local authorities, and the community at large.
The three objectives–to inform, motivate, and educate–are achieved by inviting reflection on the “stories” that are presented. A story is presented on each page of the flip chart. Through individual or collective reflection about the images, new stories, behavior, lessons, and conclusions will emerge that will enhance the potential and scope of the material.
The flip chart can be “guided use” teaching, where the person leading the session suggests that the audience perform certain activities such as: discuss these stories as a group and compare different versions from the discussion process and propose conclusions and lessons learned from each of the stories. For “open use” teaching, sheets from the flip chart can be placed in locations throughout the community, such as waiting rooms and clinics of health facilities, shops and supermarkets, places where people stand in line (city hall and other public institutions, banks, utility payment windows, etc.), and educational facilities. With open use, there is the potential for collective reaction to messages on each sheet, as well as individual reflection. Having the media use the sheets as newspaper inserts is a good use of the material.

Comparative efficacy evaluation of disinfectants routinely used in hospital practice: India

AIM: The aim of this study was to evaluate and compare practically achieved disinfection efficacy of some locally available disinfectants on surfaces and infectious microbiological hospital waste.
MATERIALS AND METHODS: Seven disinfectants were tested at concentrations recommended by manufacturers on rough and smooth surfaces that were contaminated experimentally by locally circulating isolates of methicillin-resistant Staphylococcus aureus, multidrug-resistant Acinetobacter baumannii, Klebsiella pneumoniae, Enterobacter aerogenes, Pseudomonas aeruginosa strains, standard isolate of Salmonella typhi and Candida albicans. Reduction in microbial counts before and after surface disinfection was expressed as log reduction. A very heavy microbial waste load was simulated by immersing culture plates with heavy microbial growth in disinfectants. Daily, a sample of disinfectant was taken and subjected to in-use test.
RESULTS: The highest average log reduction of test microbes on the rough surface was given by DesNet (5.05) and Bacillocid special (5.02). A comparable average log reduction of test microbes on a smooth steel surface was noted (5.68, 5.67, 5.50) for Lysol, Bacillocid sp. and DesNet, respectively. In the discard jars, Bacillocid special worked satisfactorily for 4 days, DesNet for 3 days and Hi-giene Germitol for 1 day. The remainder of the disinfectants failed in the in-use test on Day 1. Phenolics, although widely used in our settings, may not be as good surface disinfectants as newer formulations like DesNet and Bacillocid special.
CONCLUSIONS: Newer quaternary ammonium compounds and aldehyde formulations were found to be the best disinfectants for disinfection of heavy contamination.
KEYWORDS: Disinfectant, evaluation, hospital practice

Singh M, Sharma R, Gupta PK, Rana JK, Sharma M, Taneja N. Comparative efficacyevaluation of disinfectants routinely used in hospital practice: India. Indian J 
Crit Care Med. 2012 Jul;16(3):123-9. doi: 10.4103/0972-5229.102067. PubMed PMID: 
23188950; PubMed Central PMCID: PMC3506067

Biorisk assessment of medical diagnostic laboratories in Nigeria

BACKGROUND: The aim of this study was to assess public and private medical diagnostic laboratories in Nigeria for the presence of biosafety equipment, devices, and measures.
METHODS: A total of 80 diagnostic laboratories in biosafety level 3 were assessed for the presence of biosafety equipment, devices, and compliance rate with biosafety practices. A detailed questionnaire and checklist was used to obtain the relevant information from enlisted laboratories.
RESULTS: The results showed the presence of an isolated unit for microbiological work, leak-proof working benches, self-closing doors, emergency exits, fire extinguisher(s), autoclaves, and hand washing sinks in 21.3%, 71.3%, 15.0%, 1.3%, 11.3%, 82.5%, and 67.5%, respectively, of all laboratories surveyed. It was observed that public diagnostic laboratories were significantly more likely to have an isolated unit for microbiological work (p = 0.001), hand washing sink (p = 0.003), and an autoclave (p ≤ 0.001) than private ones. Routine use of hand gloves, biosafety cabinet, and a first aid box was observed in 35.0%, 20.0%, and 2.5%, respectively, of all laboratories examined. Written standard operating procedures, biosafety manuals, and biohazard signs on door entrances were observed in 6.3%, 1.3%, and 3.8%, respectively, of all audited laboratories. No biosafety officer(s) or records of previous spills, or injuries and accidents, were observed in all diagnostic laboratories studied.
CONCLUSION: In all laboratories (public and private) surveyed, marked deficiencies were observed in the area of administrative control responsible for implementing biosafety. Increased emphasis on provision of biosafety devices and compliance with standard codes of practices issued by relevant authorities is strongly advocated.
KEYWORDS: Nigeria, biosafety, diagnostic laboratories, occupational infection, risk

Oladeinde BH, Omoregie R, Odia I, Osakue EO, Imade OS. Biorisk assessment ofmedical diagnostic laboratories in Nigeria. Saf Health Work. 2013 Jun;4(2):100-4.
doi: 10.1016/ Epub 2013 Apr 25. PubMed PMID: 23961333.

A Literature Review of Laboratory-Acquired Brucellosis

Brucellosis is a bacterial zoonotic disease which has been associated with laboratory-acquired infections. No recent reviews have addressed the characteristics of laboratory-acquired brucellosis (LAB). English-language literature was reviewed to identify reports of laboratory exposures to Brucella spp. and LAB cases between 1982 and 2007. Evaluation of twenty-eight case reports identified 167 potentially exposed laboratory workers of which 71 had LAB. Nine reports were identified that summarized an additional 186 cases of LAB. Only 18 (11%) exposures were due to laboratory accidents, 147 (88%) exposures were due to aerosolization of organisms during routine identification activities and 2 (1%) exposures were unknown. Brucella melitensis was the causative agent for 80% (135/167) of the exposures. Workers with high risk exposures were 9.3 times more likely to develop LAB than workers with low risk exposures (95% CI, 3.0-38.6; P<0.0001); they were also 0.009 times as likely to develop LAB if they took antimicrobial PEP than those who did not take PEP (95% CI, 0-0.042; P<0.0001). Median incubation period in case and summary reports was eight weeks (range 1-40 weeks). Antimicrobial PEP is effective in preventing LAB. The incubation period may be used to identify appropriate serological and symptom surveillance timeframes for exposed laboratory workers.
Traxler RM, Lehman MW, Bosserman EA, Guerra MA, Smith TL. A Literature Review of Laboratory-Acquired Brucellosis. J Clin Microbiol. 2013 Jul 3. Pay-per-view

Biosafety Guidelines for Handling Microorganisms in the Teaching Laboratory: Development and Rationale

Teaching microbiology laboratory
The safe handling of microorganisms in the teaching laboratory is a top priority. However, in the absence of a standard set of biosafety guidelines tailored to the teaching laboratory, individual educators and institutions have been left to develop their own plans. This has resulted in a lack of consistency, and differing levels of biosafety practices across institutions. Influenced by the lack of clear guidelines and a recent outbreak of Salmonella infections that was traced back to teaching laboratory exposures, the Education Board of the American Society for Microbiology charged a task force to develop a uniform set of biosafety guidelines for working with microorganisms in the teaching laboratory. These guidelines represent best practices for safely handling microbes, based on the safety requirements found in the Centers for Disease Control and Prevention's (CDC's) Biosafety in Microbiological and Biomedical Laboratories (BMBL). Guidelines for safely handling microbes at both biosafety level 1 (BSL1) and biosafety level 2 (BSL2) were developed. The guidelines are brief by design for ease of use and are accompanied by an extensive appendix containing explanatory notes, sample documents, and additional resources. These guidelines provide educators with a clear and consistent way to safely work with microorganisms in the teaching laboratory.
Emmert EA; ASM Task Committee on Laboratory Biosafety. Biosafety guidelines for handling microorganisms in the teaching laboratory: development and rationale. J Microbiol Biol Educ. 2013 May 6;14(1):78-83.