How to choose a suit for a BSL4 laboratory

Elegir el traje apropiado para un laboratorio BSL4 es de vital importancia para crear un ambiente de trabajo seguir dentro de las instalaciones. El traje debe de proveer protección para quien lo usa y ser compatible con la infraestructura en las instalaciones, además de proporcionar cierto grado de confort. En este artículos los autores desarrollaron un programa de pruebas para comparar los diferentes modelos de traje y garantizar que los trajes elegidos puedan ser utilizados bajo condiciones específicas.
REFERENCIA:
Kümin D, Krebs C & Wick P. How to choose a suit for a BSL4 laboratory- The approach taken at Spiez Laboratory.  Applied Biosafety 2011. Vol. 16, No. 2, p94-102

Intervención de laboratorios y bancos de sangre en situaciones de desastre

ISBN 92 75 32380 1
OPS/HSP/HSE/08-2001

Las situaciones de emergencia o desastre requieren de una respuesta rápida y oportuna por parte de los servicios de salud. Desde hace varios años, la Organización Panamericana de la Salud ha venido promoviendo el desarrollo de acciones para reducir la vulnerabilidad del sector salud y fortalecer los programas de preparativos ante emergencias y desastres.

Desastres recientes ocurridos en Centroamérica como los huracanes Mitch y George en 1998 o el terremoto de El Salvador en 2001, alertaron sobre la necesidad de integrar a los laboratorios de salud pública, laboratorios clínicos y bancos de sangre dentro de los planes de contingencia sectorial de salud, revelando tres áreas prioritarias de intervención:
• La confirmación diagnóstica de las enfermedades transmisibles de alta mortalidad.
• La disponibilidad de exámenes básicos para el manejo de heridos.
• La provisión oportuna de sangre segura.
La presente guía pretende sensibilizar y orientar a las autoridades de salud, directores y técnicos de laboratorios y bancos de sangre en la identificación de responsabilidades y funciones de estos servicios ante situaciones de desastres, basándose en prioridades, necesidades y capacidad de respuesta inmediata local. La incorporación de actividades de mitigación y reducción de vulnerabilidad, rehabilitación y reorganización de los servicios en los planes de contingencia permitirá una mejor respuesta de los servicios de salud posterior a los desastres.
REFERENCIA:
Intervención de laboratorios y bancos de sangre en situaciones de desastre

StarTalkRadio: Zombie Apocalypse (Part 1)

PART 1: There’s no escaping the Zombie Apocalypse when Neil deGrasse Tyson interviews Max Brooks, author of World War Z and the world’s leading “authority” on these nonexistent killers.
45 mins.

Evaluation of the Operator Protection Factors Offered by Positive Pressure Air Suit

Laboratories throughout the world that perform work with Risk Group 4 Pathogens generally adopt one of two approaches within BSL-4 environments: either the use of positive pressure air-fed suits or using Class III microbiological safety cabinets and isolators for animal work. Within the UK at present, all laboratories working with Risk Group 4 agents adopt the use of Class III microbiological safety cabinet lines and isolators. Operator protection factors for the use of microbiological safety cabinets and isolators are available however; there is limited published data on the operator protection factors afforded by the use of positive pressure suits. This study evaluated the operator protection factors provided by positive pressure air suits against a realistic airborne microbiological challenge. The suits were tested, both intact and with their integrity compromised, on an animated mannequin within a stainless steel exposure chamber. The suits gave operator protection in all tests with an intact suit and with a cut in the leg. When compromised by a cut in the glove, a very small ingress of the challenge was seen as far as the wrist. This is likely to be due to the low airflow in the gloves of the suit. In all cases no microbiological penetration of the respiratory tract was observed. These data provide evidence on which to base safety protocols for use of positive pressure suits within high containment laboratorios.
REFERENCE

Jackie A. Steward * and Mark S. Lever. Evaluation of the Operator Protection Factors Offered by Positive Pressure Air Suits against Airborne Microbiological Challenge.

Viruses. 2012 August; 4(8): 1202–1211. PMCID: PMC3446757

EMERGENCIAS: Prácticas Sanitarias para Jeringas Desechables

Vacunación

La mayoría de los programas de inmunización en las Américas usan jeringas desechables para poner vacunas. Durante desastres naturales, como el causado por el huracán Mitch, todo el personal de salud (voluntarios internacionales y personal nacional) deben asegurarse que las guías de la OPS/OMS se sigan, para garantizar el uso sanitario del equipo de inyección desechable y que el equipo apropiado esté disponible para recoger y eliminar las jeringas y agujas contaminadas. Esto aplica especialmente cuando los métodos normales de operación no pueden ser seguidos, ya sea porque la recolección de desechos médicos ha sido interrumpida, o porque las instalaciones donde deben ser destruidos de la manera apropiada no funcionan.

La OPS/OMS recomienda las normas siguientes:

• Las jeringas "autodestructibles" [a] son el tipo preferido de inyecciones desechables con el que se aplican vacunas y el material escogido para llevar a cabo campañas de inmunizaciones en gran cantidad de gente.
• Los trabajadores de la salud no deben rehusar las agujas.
• Las jeringas desechables usadas deben recolectarse en "Cajas de Seguridad", que son contenedores resistentes a perforaciones, diseñados para colectar equipo de inyecciones.
• Las "Cajas de Seguridad" o contenedores similares donde se recolectan equipo de inoculación contaminado, debe ser transportado con mucho cuidado a un sitio de incineración.
• Si no existen o no están en servicio las instalaciones o sitios para incineración, las "Cajas de Seguridad" se pueden quemar en una fosa o algo parecido, por ejemplo un barril metálico. Las agujas quemadas se pueden enterrar de una manera segura o eliminadas con otra basura.
• No cumplir con estas normas puede poner en riesgo la salud pública ya que el material de inoculación podría ser utilizado de nuevo exponiendo a la gente a enfermedades y a la muerte.
• Los trabajadores de la salud que rehusan agujas se arriesgan a contraer enfermedades infecciosas debido a pinchazos accidentales. El público podría pincharse accidentalmente si las agujas y jeringas no son destruidas de una manera apropiada.

Recuerde: toda inyección debe administrarse con una aguja y jeringa estéril.

a. Jeringas autodestructibles son jeringas desechables que contienen un mecanismo por el cual automáticamente no pueden ser rehusadas después de la primera vez.

REFERENCIA:
http://www.paho.org/disasters/index.php?option=com_content&task=view&id=555&Itemid=664

VIDEO: Problemas sanitarios durante el terremoto en México - 1985

Esta producción describe los problemas sanitarios y las actividades de socorro realizadas a raíz de los terremotos del 19 y 20 de septiembre de 1985 en México. El primer sismo, de magnitud 8,1 en la escala de Richer, dejó más de 10.000 muertos o desaparecidos y miles de heridos.

Efficacy of disinfectants against naturally occurring and artificially cultivated bacteria.

Abstract
Naturally occurring bacteria, is exist in nature, and is never cultivated on conventional culture medium. We evaluated the efficacy of disinfectants against naturally occurring bacteria in in-use cotton balls soaked in 0.02% benzalkonium chloride solution which had been used to disinfect the genital area by patients undergoing self-catheterization at home and the same bacteria subcultured on nutrient broth (artificially cultivated bacteria). The colony forming units (CFU) of naturally occurring bacteria such as Serratia marcescens, Alcaligenes xylosoxidans, and Burkholderia cepacia were not decreased after 48 h exposure to 0.025-0.1% benzalkonium chloride solution, but the same strains subcultured on nutrient broth were killed within only 10 min exposure to 0.025-0.1% benzalkonium chloride solution. In addition, the CFU of these three kinds of naturally occurring bacteria were not decreased after 48 h exposure to 0.02% chlorhexidine gluconate solution, but the same strains subcultured on nutrient broth were killed within 2 h exposure to chlorhexidine gluconate solution. The result showed that disinfectant efficacy differed markedly against naturally occurring and artificially cultivated bacteria. Therefore, it is preferable to use the naturally occurring bacteria not only artificially cultivated bacteria when examining disinfectant efficacy.

REFERENCE:
Suwa M, Oie S, Furukawa H. Efficacy of disinfectants against naturally occurring and artificially cultivated bacteria. Biol Pharm Bull. 2013;36(3):360-3. PubMed PMID: 23449324.

Communicable disease control in emergencies - A field manual

 

Publication details
Pages: 301
Pub. date: 2005
Language : English
ISBN  924154616 6
Download English

This manual is intended to help health professionals and public health coordinators working in emergency situations prevent, detect and control the major communicable diseases encountered by affected populations. Emergencies include complex emergencies and natural disasters (e.g. floods and earthquakes). The term “complex emergencies” has been coined to describe “situations of war or civil strife affecting large civilian populations with food shortages and population displacement, resulting in excess mortality and morbidity”.

In this manual, the generic term “emergencies” will be used to encompass all situations in which large populations are in need of urgent humanitarian relief. Following an emergency, the affected population is often displaced and temporarily resettled. They may be placed in camps or become dispersed among the local population (either in towns or in rural communities). People who are displaced across national borders are termed refugees whereas those who have been displaced within their country are called “internally displaced persons” (IDPs). Resettlement in camps may entail high population densities, inadequate shelter, poor water supplies and sanitation, and a lack of even basic health care. In these situations, there is an increased threat of communicable disease and a high risk of epidemics.

Sanitizer Efficacy against Murine Norovirus on Stainless Steel Surfaces

Abstract
Human noroviruses are major etiologic agents of epidemic gastroenteritis. Outbreaks are often accompanied by contamination of environmental surfaces, but since these viruses cannot be routinely propagated in laboratory cultures, their response to surface disinfectants is predicted by using surrogates, such as murine norovirus 1 (MNV-1). This study compared the virucidal efficacies of various liquid treatments (three sanitizer liquids, 5% levulinic acid plus 2% SDS [LEV/SDS], 200 ppm chlorine, and an isopropanol-based quaternary ammonium compound [Alpet D2], and two control liquids, sterile tap water and sterile tap water plus 2% SDS) when delivered to MNV-1-inoculated stainless steel surfaces by conventional hydraulic or air-assisted, induction-charged (AAIC) electrostatic spraying or by wiping with impregnated towelettes. For the spray treatments, LEV/SDS proved effective when applied with hydraulic and AAIC electrostatic spraying, providing virus reductions of 2.71 and 1.66 log PFU/ml, respectively. Alpet D2 provided a 2.23-log PFU/ml reduction with hydraulic spraying, outperforming chlorine (1.16-log PFU/ml reduction). Chlorine and LEV/SDS were equally effective as wipes, reducing the viral load by 7.05 log PFU/ml. Controls reduced the viral load by <1 log with spraying applications and by >3 log PFU/ml with wiping. Results indicated that both sanitizer type and application methods should be carefully considered when choosing a surface disinfectant to best prevent and control environmental contamination by noroviruses.
REFERENCE:

Bolton SL, Kotwal G, Harrison MA, Law SE, Harrison JA, Cannon JL. Sanitizerefficacy against murine norovirus, a surrogate for human norovirus, on stainless steel surfaces when using three application methods. Appl Environ Microbiol. 2013
Feb;79(4):1368-77. doi: 10.1128/AEM.02843-12. Epub 2012 Dec 21. PubMed PMID:
23263949; PubMed Central PMCID: PMC3568589.

WHO: Emergency Response Framework

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WHO’s Member States face a broad range of emergencies resulting from various hazards and differing in scale, complexity and international consequences. These  emergencies can have extensive political, economic, social and public health impacts,  with potential long-term consequences sometimes persisting for years after the  emergency. They may be caused by natural disasters, conflict, disease outbreaks, food contamination, or chemical or radio-nuclear spills, among other hazards. They can undermine decades of social development and hard-earned health gains, damage hospitals and other health infrastructure, weaken health systems and slow progress towards the Millennium Development Goals (MDGs). Preparing for and responding effectively to such emergencies are among the most pressing challenges facing the international community.

REFERENCE:
WHO: Emergency Response Framework. ISBN 978 92 4 150497 3

Guidelines for Infection Control in Dental Health-Care Settings

This report consolidates previous recommendations and adds new ones for infection control in dental settings. Recommendations are provided regarding 1) educating and protecting dental health-care personnel; 2) preventing transmission of bloodborne pathogens; 3) hand hygiene; 4) personal protective equipment; 5) contact dermatitis and latex hypersensitivity; 6) sterilization and disinfection of patient-care items; 7) environmental infection control; 8) dental unit waterlines, biofilm, and water quality; and 9) special considerations (e.g., dental handpieces and other devices, radiology, parenteral medications, oral surgical procedures, and dental laboratories). These recommendations were developed in collaboration with and after review by authorities on infection control from CDC and other public agencies, academia, and private and professional organizations.
REFERENCE:
Guidelines for Infection Control in Dental Health-Care Settings, 2003. MMWR, December 19, 2003:52(RR-17).
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Recommendations on the Transport of Dangerous Goods, Model Regulation. Book UNECE 2013

Published:July 2013
ST/SG/AC.10/1/Rev.18
Complete set of two volumes
Sales No. 13.VIII.1
ISBN 978-92-1-139146-6
Price: US$ 155
Languages: E, F
(A, C, R forthcoming)
UNECE.ORG

These recommendations have been developed in the light of technical progress, the advent of new substances and materials, the exigencies of modern transport systems and, above all, the requirement to ensure the safety of people, property and the environment. They are addressed to governments and international organisations concerned with the regulation of the transport of dangerous goods. The Model Regulations cover the classification of dangerous goods, their listing, the use, construction, testing and approval of packagings and portable tanks, as well as consignment procedures such as marking, labelling, placarding and documentation.
This eighteenth revised edition contains various new and revised provisions concerning, inter alia, classification of solid oxidizing substances; transport of adsorbed gases; lithium batteries (including damaged or defective lithium batteries, lithium batteries for disposal or recycling); asymmetric capacitors; discarded packagings; ammonium nitrate and radioactive material; testing of gas cartridges and fuel cell cartridges; marking of bundles of cylinders; and the applicability of ISO standards to the manufacture of new pressure receptacles or service equipment.
UNECE: United Nations Economic Commision for Europe
Versión 2009 en Español

Emergency First Responder Respirator Thermal Characteristics: Workshop Proceedings

The purpose of this workshop was to identify performance needs and establish research priorities to address the thermal characteristics of respiratory equipment used by emergency first responders. The workshop provided a forum for representatives from the first responder community, self contained breathing apparatus (SCBA) and component manufacturers, and research and testing experts to discuss issues, technologies, and research associated with SCBA high temperature performance. The goals of the workshop were defined in two parts: 1) Clarify baseline information, including the current state-of-the-art, applicable fire service events, and current related research, and 2) Research planning, including identification of performance needs and short and long term research priorities. Presentations were given to explain the current SCBA and certification process, understand experience from actual fire service incidents, and review the current state of respirator research. After the presentations, the workshop divided into three working group sessions to discuss performance needs and research priorities in smaller groups. Suggested topics for discussion included: a) Current Equipment, b) Current Practice and Usage, c) Future Trends, d) Short Term Research Needs, e) Long Term Research Needs, and f) other issues. The results of the three smaller groups’ deliberations were discussed when the full workshop reconvened. The responses from each group were merged into a combination of issues that related to the use and performance of the lens of the SCBA. The primary concerns and research priorities were the characterization of the fire fighter environment, performance of current and new technology, development of representative and realistic testing, and improvements to fire fighter training on the limitations of protective equipment. A significant amount of discussion concentrated on the testing for NFPA certification, which currently contains limited thermal testing.
REFERENCE
NIOSH Emergency First Responder Respirator  Thermal Characteristics: Workshop Proceedings
National Institute of Standards and Technology Special Publication 1123
Natl. Inst. Stand. Technol. Spec. Publ. 1123, 52 pages (June 2011)

CLP Regulation and the transport of dangerous goods.

Abstract
Regulations concerning different modes of transport of dangerous goods are well harmonized at global level: they were then looked at as a model for developing Globally Harmonized System of Classification and Labelling of Chemicals (GHS), (on which CLP Regulations is based). Transport regulations do not cover some hazard classes, such as germ cell mutagenicity, carcinogenicity, reproductive toxicity, having been evaluated that such hazards are not relevant in transport because in general, in case of accident, no repeated and prolonged exposure takes place. Other differences with CLP Regulation are related to the use of "building block approach". Transport labels, which were used as a basis for GHS, can be used, instead of CLP pictograms, on packages during transport.

REFERENCE:

Benassai S. CLP Regulation and the transport of dangerous goods. Ann Ist Super
Sanita. 2011;47(2):153-6. doi: 10.4415/ANN_11_02_06. PubMed PMID: 21709384.

Manual de esterilización para centros de salud

Organización Panamericana de la Salud

“Manual de esterilización para centros de salud”

Washington, D.C.: OPS, © 2008

ISBN 978-92-75-32926-9

La Central de Esterilización juega un papel muy importante en la prevención de las infecciones adquiridas en el hospital, porque tales infecciones han sido asociadas con una desinfección inapropiada de objetos reusables incluyendo el equipo endoscópico, el equipo de cuidado respiratorio, transductores y equipos de hemodiálisis reusables. Recientemente, ha habido una controversia con respecto al reprocesamiento de dispositivos médicos caros (por ej. sondas sin lumen para electrofisiología cardíaca) etiquetados por el fabricante como de “uso único”. Si uno elige reusar un dispositivo descartable, la institución responsable debe demostrar que la Seguridad, efectividad e integridad del producto no ha sido comprometido en el proceso. 
El Servicio de Central de Esterilización tiene, además, la responsabilidad de recoger y recibir los objetos y equipos usados durante la atención del paciente, procesarlo, almacenarlo, y distribuirlo en todo el hospital.
Este manual ha sido elaborado con el propósito de informar al personal de salud acerca de los protocolos y procedimientos simples desarrollados para prevenir las infecciones nosocomiales dentro y desde la Central de Esterilización. Su publicación ha sido realizada por la Oficina Central de la Organización Panamericana de la Salud.
Las normas escritas en este manual orientan sobre los pasos a seguir en la limpieza, acondicionamiento, esterilización, almacenamiento y transporte del equipamiento hospitalario a fin de obtener un material estéril. Es muy importante estar consciente de esta información para proveer al paciente una práctica segura de atención de la salud.

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