NSF/ANSI Standard 49 Certification Testing of Biosafety Cabinets

NSF International maintains NSF/ANSI Standard 49 Class II (laminar flow) biosafety cabinetry and also certifies that biosafety cabinets conform to the requirements of the standard. More than 20 tests are required during initial qualification testing; of these, the biological challenge tests are the most critical to ensuring that the model tested will provide personnel, product, and cross contamination protection.

REFERENCE:
Maren H. Roush and Stephen C. Williams. NSF/ANSI Standard 49 Certification Testing of Biosafety Cabinets. JALA 2009;14:171–3

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Feasibility of establishing a BSL3 tuberculosis culture lab in a resource-limited setting

Background: Despite the recent innovations in tuberculosis (TB) and multi-drug resistant TB (MDR-TB) diagnosis, culture remains vital for difficult-to-diagnose patients, baseline and end-point determination for novel vaccines and drug trials. Herein, we share our experience of establishing a BSL-3 culture facility in Uganda as well as 3-years performance indicators and post-TB vaccine trials (pioneer) and funding experience of sustaining such a facility.
Methods: Between September 2008 and April 2009, the laboratory was set-up with financial support from external partners. After an initial procedure validation phase in parallel with the National TB Reference Laboratory (NTRL) and legal approvals, the laboratory registered for external quality assessment (EQA) from the NTRL, WHO, National Health Laboratories Services (NHLS), and the College of American Pathologists (CAP). The laboratory also instituted a functional quality management system (QMS). Pioneer funding ended in 2012 and the laboratory remained in self-sustainability mode.
Results: The laboratory achieved internationally acceptable standards in both structural and biosafety requirements. Of the 14 patient samples analyzed in the procedural validation phase, agreement for all tests with NTRL was 90% (P <0.01). It started full operations in October 2009 performing smear microscopy, culture, identification, and drug susceptibility testing (DST). The annual culture workload was 7,636, 10,242, and 2,712 inoculations for the years 2010, 2011, and 2012, respectively. Other performance indicators of TB culture laboratories were also monitored. Scores from EQA panels included smear microscopy >80% in all years from NTRL, CAP, and NHLS, and culture was 100% for CAP panels and above regional average scores for all years with NHLS. Quarterly DST scores from WHO-EQA ranged from 78% to 100% in 2010, 80% to 100% in 2011, and 90 to 100% in 2012.
Conclusions: From our experience, it is feasible to set-up a BSL-3 TB culture laboratory with acceptable quality performance standards in resource-limited countries. With the demonstrated quality of work, the laboratory attracted more research groups and post-pioneer funding, which helped to ensure sustainability. The high skilled experts in this research laboratory also continue to provide an excellent resource for the needed national discussion of the laboratory and quality management systems.
REFERENCIA:
Ssengooba, W., et al. Feasibility of establishing a biosafety level 3 tuberculosis culture laboratory of acceptable quality standards in a resource-limited setting: an experience from Uganda. Health Research Policy and Systems 2015, 13:4

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Control of #ebola virus disease - firestone district, Liberia, 2014

WSJ

On March 30, 2014, the Ministry of Health and Social Welfare (MOHSW) of Liberia alerted health officials at Firestone Liberia, Inc. (Firestone) of the first known case of Ebola virus disease (Ebola) inside the Firestone rubber tree plantation of Liberia. The patient, who was the wife of a Firestone employee, had cared for a family member with confirmed Ebola in Lofa County, the epicenter of the Ebola outbreak in Liberia during March-April 2014. To prevent a large outbreak among Firestone's 8,500 employees, their dependents, and the surrounding population, the company responded by 1) establishing an incident management system, 2) instituting procedures for the early recognition and isolation of Ebola patients, 3) enforcing adherence to standard Ebola infection control guidelines, and 4) providing differing levels of management for contacts depending on their exposure, including options for voluntary quarantine in the home or in dedicated facilities. In addition, Firestone created multidisciplinary teams to oversee the outbreak response, address case detection, manage cases in a dedicated unit, and reintegrate convalescent patients into the community. The company also created a robust risk communication, prevention, and social mobilization campaign to boost community awareness of Ebola and how to prevent transmission. During August 1-September 23, a period of intense Ebola transmission in the surrounding areas, 71 cases of Ebola were diagnosed among the approximately 80,000 Liberians for whom Firestone provides health care (cumulative incidence = 0.09%). Fifty-seven (80%) of the cases were laboratory confirmed; 39 (68%) of these cases were fatal. Aspects of Firestone's response appear to have minimized the spread of Ebola in the local population and might be successfully implemented elsewhere to limit the spread of Ebola and prevent transmission to health care workers (HCWs).

REFERENCE:
Reaves EJ, et al. Control of ebola virus disease - firestone district, Liberia, 2014. MMWR Morb Mortal Wkly Rep. 2014 Oct 24;63(42):959-65.
NEWS:
How Firestone Liberia’s unique approaches helped stem the spread of the ebola virus
Liberian Rubber Farm Becomes Sanctuary Against Ebola
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Cluster of #ebola cases among liberian and u.s. Health care workers in an ebola treatment unit and adjacent hospital - Liberia, 2014

aljazeera

The ongoing Ebola virus disease (Ebola) epidemic in West Africa, like previous Ebola outbreaks, has been characterized by amplification in health care settings and increased risk for health care workers (HCWs), who often do not have access to appropriate personal protective equipment. In many locations, Ebola treatment units (ETUs) have been established to optimize care of patients with Ebola while maintaining infection control procedures to prevent transmission of Ebola virus. These ETUs are considered essential to containment of the epidemic. In July 2014, CDC assisted the Ministry of Health and Social Welfare of Liberia in investigating a cluster of five Ebola cases among HCWs who became ill while working in an ETU, an adjacent general hospital, or both. No common source of exposure or chain of transmission was identified. However, multiple opportunities existed for transmission of Ebola virus to HCWs, including exposure to patients with undetected Ebola in the hospital, inadequate use of personal protective equipment during cleaning and disinfection of environmental surfaces in the hospital, and potential transmission from an ill HCW to another HCW. No evidence was found of a previously unrecognized mode of transmission. Prevention recommendations included reinforcement of existing infection control guidance for both ETUs and general medical care settings, including measures to prevent cross-transmission in co-located facilities

REFERENCE:
Forrester JD et al. Cluster of Ebola Cases Among Liberian and U.S. Health Care Workers in an Ebola Treatment Unit and Adjacent Hospital — Liberia, 2014. MMWR Morb Mortal Wkly Rep. 2014 Oct 17;63(41):925-9.
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People, planet and profits: the case for greening operating rooms

Green Healthcare

Over the past 40 years, the health care industry has undergone radical changes in the types of products it uses and its waste disposal practices. In the 1980s, concerns about the spread of blood-borne diseases prompted a shift from reusable to single-use devices, resulting in increases in waste production.
The most recent environmental data on health care in Canada show that in 2008 the sector generated about 1.46% of Canada’s total greenhouse gas emissions and in 2001 was a source of 1% of total solid waste. Canadian hospital activities were the second most energy-intensive activity in the commercial and institutional sector in 2008, consuming the equivalent annual energy of 440 000 Canadian homes. In 2007, US health care facilities contributed 8% of total greenhouse gas emissions, disposed of more than 4 billion pounds (1 lb = 0.45 kg) of waste and were the second-largest contributor to landfills after the food industry.
Few Canadian hospitals have published their ecological footprints (a calculation of the bioproductive land and water required to sustain a population). However, in 2001, Lions Gate Hospital in Vancouver, British Columbia, reported a footprint of 2841 hectares (ha) or 719 times its actual area. In 2006, London Health Sciences Centre in London, Ontario, reported a footprint of 63 074 global hectares or about 384 times its actual area.
It is ironic that our efforts in hospitals to improve the health of patients contribute detrimentally to the health of the ecosystem. In 2009, the World Health Organization emphasized that hospitals have responsibilities in making health care more sustainable.
REFERENCE:
Kagoma Y, et al. People, planet and profits: the case for greening operating rooms. CMAJ. Nov 20, 2012; 184(17): 1905–1911.
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Evaluation of transmission risks associated with in vivo replication of several high containment pathogens in a biosafety level 4 laboratory #EBOLA

Containment level 4 (CL4) laboratories studying biosafety level 4 viruses are under strict regulations to conduct nonhuman primate (NHP) studies in compliance of both animal welfare and biosafety requirements. NHPs housed in open-barred cages raise concerns about cross-contamination between animals, and accidental exposure of personnel to infectious materials. To address these concerns, two NHP experiments were performed. One examined the simultaneous infection of 6 groups of NHPs with 6 different viruses (Machupo, Junin, Rift Valley Fever, Crimean-Congo Hemorrhagic Fever, Nipah and Hendra viruses). Washing personnel between handling each NHP group, floor to ceiling biobubble with HEPA filter, and plexiglass between cages were employed for partial primary containment. The second experiment employed no primary containment around open barred cages with Ebola virus infected NHPs 0.3 meters from naïve NHPs. Viral antigen-specific ELISAs, qRT-PCR and TCID50 infectious assays were utilized to determine antibody levels and viral loads. No transmission of virus to neighbouring NHPs was observed suggesting limited containment protocols are sufficient for multi-viral CL4 experiments within one room. The results support the concept that Ebola virus infection is self-contained in NHPs infected intramuscularly, at least in the present experimental conditions, and is not transmitted to naïve NHPs via an airborne route.

REFERENCE:
Alimonti J, et al. Evaluation of transmission risks associated with in vivo replication of several high containment pathogens in a biosafety level 4 laboratory. Scientific Reports 4, Article number: 5824.
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ABSL-4 Aerobiology Biosafety and Technology...

Abstract
The overall threat of a viral pathogen to human populations is largely determined by the modus operandi and velocity of the pathogen that is transmitted among humans. Microorganisms that can spread by aerosol are considered a more challenging enemy than those that require direct body-to-body contact for transmission, due to the potential for infection of numerous people rather than a single individual. Additionally, disease containment is much more difficult to achieve for aerosolized viral pathogens than for pathogens that spread solely via direct person-to-person contact. Thus, aerobiology has become an increasingly necessary component for studying viral pathogens that are naturally or intentionally transmitted by aerosol. The goal of studying aerosol viral pathogens is to improve public health preparedness and medical countermeasure development. Here, we provide a brief overview of the animal biosafety level 4 Aerobiology Core at the NIH/NIAID Integrated Research Facility at Fort Detrick, Maryland, USA.
REFERENCE:
Lackemeyer MG, Kok-Mercado Fd, Wada J, Bollinger L, Kindrachuk J, Wahl-Jensen V, Kuhn JH, Jahrling PB. ABSL-4 Aerobiology Biosafety and Technology at the NIH/NIAID Integrated Research Facility at Fort Detrick. Viruses. 2014 Jan 7;6(1):137-50. doi: 10.3390/v6010137. PubMed PMID: 24402304.

Assessment of biosafety precautions in Khartoum state diagnostic laboratories, Sudan

Biosafety precautions

Abstract
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.

REFERENCE

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.

Abstract
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.

REFERENCE

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.

Heating, Ventilation and Air Conditioning - Validation of System Cleaning Initiation Criteria under Real Conditions

The cleanliness of a ventilation system invariably affects the quality of the air that it distributes. However, it is difficult for building managers to assess the relevance of having their systems cleaned and to choose from among all the proposals from cleaning specialists because no objective method exists for evaluating the dustiness of systems. In the context of a previous project, the researchers developed a method for collecting surface dusts in heating, ventilation and air conditioning (HVAC) ducts and identified criteria for initiating cleaning. The method was validated in the laboratory and compared to those methods mentioned in the scientific literature [Association pour la prévention et l’étude de la contamination (ASPEC), of France, and the National Air Duct Cleaners Association (NADCA), of the United States]. They all proved feasible by using their corresponding cleaning initiation criterion.
In a new study, which this report describes, the same team validated the criteria for these methods in the ventilation systems of occupied non-industrial buildings. Once again, the results were conclusive. Building managers can now rely on the objective criteria of the offered methods, rather than basing themselves solely on visual inspection, which is subjective.

REFERENCIA
Heating, Ventilation and Air Conditioning - Validation of System Cleaning Initiation Criteria under Real Conditions.

Fundamentos de Ventilación e Ingeniería para Laboratorios de Bioseguridad

Invitación al Curso Pre-simposio:
"Fundamentos de Ventilación e Ingeniería para Laboratorios de Bioseguridad"
Impartido por el Ing. Juan Osorio, Director de Operaciones en World BioHazTec Corp.
Fecha:  Jueves 6 de junio de 2013. Horario 2 a 6 pm

Edificio Central de la Universidad de Guanajuato, Guanajuato.

Objetivos:
- Definir términos básicos y ecuaciones implicadas en la ventilación
- Explicar los componentes termodinámicos en un laboratorio de contención biológica
- Explicar los requerimientos de extracción para campanas de extracción de gases y cabinas de seguridad biológica
- Explicar los principios de control de la ventilación y flujo de aire
- Discutir los requerimientos de relación de presiones diferenciales

Inscripciones e información en
http://tinyurl.com/ny7h5lm

www.sibb.info
www.amexbio.org

Diseñador de laboratorios.

Resulta un día, el jefe mayor manda a llamar a un encargado de laboratorio. Tiene que entregar para mañana, el diseño de laboratorio de un área, para un presupuesto. El pobre encargado entra en pánico (por supuesto) y a duras penas se consigue una hoja, sin medidas, y hace un esquema de lo que quiere. Claro, no tenemos herramientas para hacer un dibujo medianamente explicativo, el AutoCad es impensable. Para acabarla de rematar, queremos meter todos los muebles y equipos en un lugar en el que simplemente no caben.
Pero les tengo una noticia! Existe un diseñador en línea, en el que de forma gratuita pueden hacer un esquema presentable! Es muy intuitivo, sólo arrastras el mueble, refrigerador, pared, puerta o silla que necesitas. Puedes modificar los tamaños, así que si un mueble no cabe, podrás darte cuenta. Pero si eres diseñador profesional, puedes hacer mas de un proyecto, pero te cobran el uso del software. Aunque no hay específicamente muebles de laboratorio, existen las "encimeras", los roperos y otros aditamentos que podemos modificar, no solo de posición, si no también en tamaño. Existen incluso símbolos de instalación eléctrica! Pero para que funcione deben recordar que las cosas tienen medidas, así que midan, los muebles, los equipos, las sillas, todo, y verán que se ahorran muchos dolores de cabeza.
Pruébenlo, se van a divertir!
http://floorplanner.com

@profvrr Visita NEIDL, un laboratorio #BSL4

Vincent Racaniello visit a las instalaciones del National Emerging Infectious Diseases Laboratories (NEIDL), que tiene laboratorios nivel 2, 3 y 4!, y que actualmente no se encuentra funcionando en su totalidad.Nos muestran las instalaciones desde adentro! Disfruténlo!
Formato: video 1 hr. Idioma: Inglés.

#ARTÍCULO: Impact of Regulations, Safety Considerations and Physical Limitations on Research Progress at Maximum Biocontainment

>>  COMPLETE TABLE  <<

Abstract:
We describe herein, limitations on research at biosafety level 4 (BSL-4) containment laboratories, with regard to biosecurity regulations, safety considerations, research space limitations, and physical constraints in executing experimental procedures. These limitations can severely impact the number of collaborations and size of research projects investigating microbial pathogens of biodefense concern. Acquisition, use, storage, and transfer of biological select agents and toxins (BSAT) are highly regulated due to their potential to pose a severe threat to public health and safety. All federal, state, city, and local regulations must be followed to obtain and maintain registration for the institution to conduct research involving BSAT. These include initial screening and continuous monitoring of personnel, controlled access to containment laboratories, accurate and current BSAT inventory records. Safety considerations are paramount in BSL-4 containment laboratories while considering the types of research tools, workflow and time required for conducting both in vivo and in vitro experiments in limited space. Required use of a positive-pressure encapsulating suit imposes tremendous physical limitations on the researcher. Successful mitigation of these constraints requires additional time, effort, good communication, and creative solutions. Test and evaluation of novel vaccines and therapeutics conducted under good laboratory practice (GLP) conditions for FDA approval are prioritized and frequently share the same physical space with important ongoing basic research studies. The possibilities and limitations of biomedical research involving microbial pathogens of biodefense concern in BSL-4 containment laboratories are explored in this review.
Referencia:
Shurtleff AC, et. al. Impact of Regulations, Safety Considerations and Physical Limitations on Research Progress at Maximum Biocontainment. Viruses. 2012 December; 4(12): 3932–3951.

Laboratorios de Bioseguridad Nivel 4 en Europa

Tabla 1. Instalaciones para diagnóstico e investigación en operación
en la Unión  Europea. Red Europea de Laboratorios de
Bioseguridad Nivel 4.

Un artículo publicado en Plos Pathogens, que habla acerca de la red de laboratorios BSL-4 europeo.  El artículo discute las características de la red y los laboratorios, así como las perspectivas y potenciales áreas de crecimiento. En esta red, se manejan microorganismos del grupo de riesgo 4, como son Arenaviridae, Bunyaviridae, Filoviridae, and Paramyxoviridae.


Referencia:
Nisii C., et al. Biosafety Level-4 Laboratories in Europe: Opportunities for Public Health, Diagnostics, and Research. PLoS Pathog 9(1): e1003105. doi:10.1371/journal.ppat.1003105

VIDEO: BSL3 inspection for select agents #biosecurity #CDC

Este video, en inglés, sirve con fines educativos para instituciones o individuos quienes poseen, almacenan o transfieren microorganismos controlados (Select Agents) y toxinas en Estados Unidos. Este video puede ser utilizado en programas de entrenamiento para personal o como herramienta para programas de entrenamiento. Puedes ver y descargar este y otros videos en: SelectAgents.Gov

BSL3 Inspection

Toxins Inspection

#WHO Laboratory Assesment Tool

El "Laboratory Assessment Tool.zip" ofrece una guía para evaluar laboratorios y sistemas nacionales. La audiencia blanco es cualquier persona que evalúa laboratorios: autoridades nacionales de salud, agencias multilaterales, organizaciones no gubernamentales (NGO´s), resposables de laboratorio, etc. Este documento describe los procesos generales para evaluar laboratorios y proporciona dos cuestionarios que ayudan a evaluar los sistemas de laboratorios nacionales (anexo 1) y laboratorios individuales (anexo 2). Los evaluadores pueden utilizar los cuestionarios tal y como se presentan o acondicionar los materiales disponibles para que cumplan con requerimientos locales o específicos y adecuarlos mejor al contexto de evaluación. Los cuestionarios se encuentran en formato PDF y pueden ser fácilmente impresos, y en archivos Excel que permiten calculos matemáticos automáticos de indicadores cuando se responde a las preguntas y el análisis de datos. Pueden descargar el Archivo ZIP o descargar los archivos individuales.
Publication details:
Number of pages: 35
Publication date: 2012
Languages: English
WHO reference number: WHO/HSE/GCR/LYO/2012.2

Biocontainment in Gain-of-Function Infectious Disease Research

The discussion of H5N1 influenza virus gain-of-function research has focused chiefly on its risk-to-benefit ratio. Another key component of risk is the level of containment employed. Work is more expensive and less efficient when pursued at biosafety level 4 (BSL-4) than at BSL-3 or at BSL-3 as modified for work with agricultural pathogens (BSL-3-Ag). However, here too a risk-to-benefit ratio analysis is applicable. BSL-4 procedures mandate daily inspection of facilities and equipment, monitoring of personnel for signs and symptoms of disease, and logs of dates and times that personnel, equipment, supplies, and samples enter and exit containment. These measures are not required at BSL-3 or BSL-3-Ag. Given the implications of inadvertent or deliberate release of high-threat pathogens with pandemic potential, it is imperative that the World Health Organization establish strict criteria for biocontainment that can be fairly applied in the developing world, as well as in more economically developed countries.
Referencia
Lipkin WI. Biocontainment in Gain-of-Function Infectious Disease Research. MBio. 2012 Oct 9;3(5). pii: e00290-12. doi: 10.1128/mBio.00290-12. PMID: 23047747

EuroNHID Survey: Capabilities in 48 isolation facilities

BACKGROUND: Highly infectious diseases (HIDs) are defined as being transmissible from person to person, causing life-threatening illnesses and presenting a serious public health hazard. The sampling, handling and transport of specimens from patients with HIDs present specific bio-safety concerns.
FINDINGS: The European Network for HID project aimed to record, in a cross-sectional study, the infection control capabilities of referral centers for HIDs across Europe and assesses the level of achievement to previously published guidelines. In this paper, we report the current diagnostic capabilities and bio-safety measures applied to diagnostic procedures in these referral centers. Overall, 48 isolation facilities in 16 European countries were evaluated. Although 81% of these referral centers are located near a biosafety level 3 laboratory, 11% and 31% of them still performed their microbiological and routine diagnostic analyses, respectively, without bio-safety measures.
CONCLUSIONS: The discrepancies among the referral centers surveyed between the level of practices and the European Network of Infectious Diseases (EUNID) recommendations have multiple reasons of which the interest of the individuals in charge and the investment they put in preparedness to emerging outbreaks. Despite the fact that the less prepared centers can improve by just updating their practice and policies any support to help them to achieve an acceptable level of biosecurity is welcome.
PMID: 23009598
REFERENCE: Thiberville SD, et. al. Diagnostic issues and capabilities in 48 isolation facilities in 16 European countries: data from EuroNHID surveys. BMC Res Notes. 2012 Sep 25;5(1):527.

Establishing a laboratory network of influenza diagnosis in Indonesia

topnews.in

Abstract
Indonesia has been part of the global influenza surveillance since the establishment of a National Influenza Center (NIC) at the National Institute of Health Research and Development (NIHRD) by the Indonesian Ministry of Health in 1975. When the outbreak of avian influenza A (H5N1) occurred, the NIC and US Naval Medical Research Unit 2 were the only diagnostic laboratories equipped for etiology confirmation. The large geographical area of the Republic of Indonesia poses a real challenge to provide prompt and accurate diagnosis nationally. This was the main reason to establish a laboratory network for H5N1 diagnosis in Indonesia. Currently, 44 laboratories have been included in the network capable of performing polymerase chain reaction testing for influenza A. Diagnostic equipment and standard procedures of biosafety and biosecurity of handling specimens have been adopted largely from World Health Organization recommendations.
Reference:

Setiawaty V, Pangesti KN, Sampurno OD. Establishing a laboratory network of influenza diagnosis in Indonesia: an experience from the avian flu (H5N1) outbreak. Clin Epidemiol. 2012;4:209-12. Epub 2012 Aug 15.