To PAPR or not to PAPR?

The present outbreak of Ebola has health care professionals seeking guidance on isolation precautions for routine care and aerosol-generating procedures (AGPs). The most recent guidelines state that during AGPs, health care professionals should wear respiratory protection at least as protective as a National Institute for Occupational Safety and Health-certified fit tested N95 filtering face piece respirator or higher; for example, a powered air-purifying respirator (PAPR). The present review discusses the advantages and disadvantages of using a PAPR versus an N95 mask, and relates the experience of the Jewish General Hospital (Montreal, Quebec) of PAPR policy implementation. Training programs on proper donning and doffing of personal protective equipment and quality control systems need to be in place. Respiratory therapists are frontline during AGPs and need to be active in the decision making of the type of equipment chosen to protect them.

REFERENCE:
Roberts V. To PAPR or not to PAPR? Can J Respir Ther. 2014 Fall;50(3):87-90. Review.
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Health worker #Ebola infections in Guinea, Liberia and Sierra Leone

This preliminary report summarizes the impact of the Ebola epidemic on the health workforce of Guinea, Liberia and Sierra Leone. It investigates the determinants of infection and describes safe practices put in place to protect health workers during the epidemic. The report covers the period from 1 January 2014 to 31 March 2015 and is presents findings from the 815 confirmed and probable cases for whom individual case reports were available.

The Ebola epidemic has taken a heavy toll on the already scarce health workforce. Among the health workers for whom final outcome is known, two-thirds of those infected died. Preliminary analysis shows that, depending on their occupation in the health service, health workers are between 21 and 32 times more likely to be infected with Ebola than people in the general adult population. With higher risks of exposure in caring for others, health workers were disproportionately impacted and traumatised by Ebola.

Health worker infections can be prevented. WHO and partners have worked with ministries of health, partners, managers and health workers to put in place infection prevention control (IPC) and occupational health and safety (OHS) strategies and supplies to prevent health worker infections and improve patient safety. Health worker protection and support must be at the core of emergency response, preparedness and efforts to build a resilient health system. Cementing this lesson learnt into practice can be a lasting tribute to health workers.

REFERENCE:
Health worker #Ebola infections in Guinea, Liberia and Sierra Leone
Number of pages: 16.  Publication date: May 2015.  Languages: English
WHO reference number: WHO/EVD/SDS/REPORT/2015.1

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Genetic Analysis of a Sarcoma Accidentally Transplanted from a Patient to a Surgeon #LAIs

Modern concepts of cancer immunology originated from the classic observations by Jensen, Loeb, Tyzzer, and Little in the early years of the 20th century of the rejection of transplanted allogeneic tumors and the acceptance of syngeneic tumors. Despite this law of transplantation, there are several clinical examples of the accidental transplantation of a malignant tumor or tumor cells into a healthy recipient. We describe the accidental transplantation of a malignant sarcoma from a patient to a surgeon. Using molecular methods, we showed that the sarcomas in the unrelated patient and surgeon were genetically identical.

REFERENCE:
Gärtner HV, Seidl C, Luckenbach C, Schumm G, Seifried E, Ritter H, Bültmann B. Genetic analysis of a sarcoma accidentally transplanted from a patient to a surgeon. N Engl J Med. 1996 Nov 14;335(20):1494-6.
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Reduced Efficiency of Chlorine Disinfection of Naegleria fowleri in a Drinking Water Distribution Biofilm

Naegleria fowleri associated with biofilm and biological demand water (organic matter suspended in water that consumes disinfectants) sourced from operational drinking water distribution systems (DWDSs) had significantly increased resistance to chlorine disinfection. N. fowleri survived intermittent chlorine dosing of 0.6 mg/L for 7 days in a mixed biofilm from field and laboratory-cultured Escherichia coli strains. However, N. fowleri associated with an attached drinking water distribution biofilm survived more than 30 times (20 mg/L for 3 h) the recommended concentration of chlorine for drinking water. N. fowleri showed considerably more resistance to chlorine when associated with a real field biofilm compared to the mixed laboratory biofilm. This increased resistance is likely due to not only the consumption of disinfectants by the biofilm and the reduced disinfectant penetration into the biofilm but also the composition and microbial community of the biofilm itself. The increased diversity of the field biofilm community likely increased N. fowleri's resistance to chlorine disinfection compared to that of the laboratory-cultured biofilm. Previous research has been conducted in only laboratory scale models of DWDSs and laboratory-cultured biofilms. To the best of our knowledge, this is the first study demonstrating how N. fowleri can persist in a field drinking water distribution biofilm despite chlorination.

REFERENCE:
Miller HC, Wylie J, Dejean G, Kaksonen A, Sutton D, Braun K, Puzon G. Reduced efficiency of chlorine disinfection of Naegleria fowleri in drinking water distribution biofilm. Environ Sci Technol. 2015 Aug 19.
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WHO Guidelines for Containment of Poliovirus Following Type-Specific #Polio Eradication

In 1988, the World Health Assembly of the World Health Organization (WHO) resolved to eradicate polio worldwide. Among the three wild poliovirus (WPV) types (type 1, type 2, and type 3), WPV type 2 (WPV2) has been eliminated in the wild since 1999, and WPV type 3 (WPV3) has not been reported since 2012. In 2015, only Afghanistan and Pakistan have reported WPV transmission. On May 25, 2015, all WHO Member States endorsed World Health Assembly resolution 68.3 on full implementation of the Polio Eradication and Endgame Strategic Plan 2013-2018 (the Endgame Plan), and with it, the third Global Action Plan to minimize poliovirus facility-associated risk (GAPIII). All WHO Member States have committed to implementing appropriate containment of WPV2 in essential laboratory and vaccine production facilities* by the end of 2015 and of type 2 oral poliovirus vaccine (OPV2) within 3 months of global withdrawal of OPV2, which is planned for April 2016. This report summarizes critical steps for essential laboratory and vaccine production facilities that intend to retain materials confirmed to contain or potentially containing type-specific WPV, vaccine-derived poliovirus (VDPV), or OPV/Sabin viruses, and steps for nonessential facilities† that process specimens that contain or might contain polioviruses. National authorities will need to certify that the essential facilities they host meet the containment requirements described in GAPIII. After certification of WPV eradication, the use of all OPV will cease; final containment of all polioviruses after polio eradication and OPV cessation will minimize the risk for reintroduction of poliovirus into a polio-free world.

REFERENCE:
Previsani N, Tangermann RH, Tallis G, Jafari HS. World Health Organization Guidelines for Containment of Poliovirus Following Type-Specific Polio Eradication - Worldwide, 2015. MMWR Morb Mortal Wkly Rep. 2015 Aug 28;64(33):913-7.

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MERS-CoV in Upper Respiratory Tract and Lungs of Dromedary Camels, Saudi Arabia, 2013-2014

To assess the temporal dynamics of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in dromedary camels, specimens were collected at 1-2 month intervals from 2 independent groups of animals during April 2013-May 2014 in Al-Ahsa Province, Saudi Arabia, and tested for MERS-CoV RNA by reverse transcription PCR. Of 96 live camels, 28 (29.2%) nasal swab samples were positive; of 91 camel carcasses, 56 (61.5%) lung tissue samples were positive. Positive samples were more commonly found among young animals (<4 years of age) than adults (>4 years of age). The proportions of positive samples varied by month for both groups; detection peaked during November 2013 and January 2014 and declined in March and May 2014. These findings further our understanding of MERS-CoV infection in dromedary camels and may help inform intervention strategies to reduce zoonotic infections.

 REFERENCE: 

Khalafalla AI, Lu X, Al-Mubarak AI, Dalab AH, Al-Busadah KA, Erdman DD. MERS-CoV in Upper Respiratory Tract and Lungs of Dromedary Camels, Saudi Arabia, 2013-2014. Emerg Infect Dis. 2015 Jul;21(7):1153-8. 

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Probable Crimean-Congo hemorrhagic fever virus transmission occurred after aerosol-generating medical procedures in Russia: nosocomial cluster

We report here a fatal case of laboratory confirmed Crimean-Congo hemorrhagic fever (CCHF), which caused nosocomial infection in eight health care workers (HCWs), who had provided medical care for the patient. All the HCWs survived. The report demonstrates that airborne transmission of CCHF is a real risk, at least when the CCHF patient is in a ventilator. During performance of any aerosol-generating medical procedures for any CCHF patient airborne precautions should always be added to standard precautions, in particular, airway protective N95 mask or equivalent standard, eye protection, single airborne precaution room, or a well-ventilated setting.
REFERENCE:
Pshenichnaya NY, Nenadskaya SA. Probable Crimean-Congo hemorrhagic fever virus transmission occurred after aerosol-generating medical procedures in Russia: nosocomial cluster. Int J Infect Dis. 2015 Apr;33:120-2.
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Transmisión de arbovirus (flavivirus) sin necesidad de vectores biológicos

Hay que recordar que quienes trabajan con virus como dengue, virus del Oeste del Nilo, fiebre amarilla pueden adquirir la infección en el laboratorio, SIN necesidad de vectores biológicos.



http://www.researchgate.net/publication/228656801_Non-vector_transmission_of_dengue_and_other_mosquito-borne_flaviviruses

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BSL-3 Laboratory Practices in the United States: Comparison of Select Agent and Non–Select Agent Facilities

New construction of biosafety level 3 (BSL-3) laboratories in the United States has increased in the past decade to facilitate research on potential bioterrorism agents. The Centers for Disease Control and Prevention inspect BSL-3 facilities and review commissioning documentation, but no single agency has oversight over all BSL-3 facilities. This article explores the extent to which standard operating procedures in US BSL-3 facilities vary between laboratories with select agent or non–select agent status. Comparisons are made for the following variables: personnel training, decontamination, personal protective equipment (PPE), medical surveillance, security access, laboratory structure and maintenance, funding, and pest management. Facilities working with select agents had more complex training programs and decontamination procedures than non–select agent facilities. Personnel working in select agent laboratories were likely to use powered air purifying respirators, while non–select agent laboratories primarily used N95 respirators. More rigorous medical surveillance was carried out in select agent workers (although not required by the select agent program) and a higher level of restrictive access to laboratories was found. Most select agent and non–select agent laboratories reported adequate structural integrity in facilities; however, differences were observed in personnel perception of funding for repairs. Pest management was carried out by select agent personnel more frequently than non–select agent personnel. Our findings support the need to promote high quality biosafety training and standard operating procedures in both select agent and non–select agent laboratories to improve occupational health and safety.

REFERENCE:
Richards, Stephanie L., Victoria C. Pompei, and Alice Anderson. “BSL-3 Laboratory Practices in the United States: Comparison of Select Agent and Non–Select Agent Facilities.” Biosecurity and Bioterrorism : Biodefense Strategy, Practice, and Science 12.1 (2014): 1–7. PMC. Web. 30 July 2015. -----------------------------------------------------------
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Pathogen transfer and high variability in pathogen removal by detergent wipes

BACKGROUND:
The rise in health care-associated infections has placed a greater emphasis on cleaning and disinfection practices. The majority of policies advocate using detergent-based products for routine cleaning, with detergent wipes increasingly being used; however, there is no information about their ability to remove and subsequently transfer pathogens in practice.
METHODS: Seven detergent wipes were tested for their ability to remove and transfer Staphylococcus aureus, Acinetobacter baumannii, and Clostridium difficile spores using the 3-stage wipe protocol.
RESULTS: The ability of the detergent wipes to remove S aureus, A baumannii, and C difficile spores from a stainless steel surface ranged from 1.50 log10 (range, 0.24-3.25), 3.51 log10 (range, 3.01-3.81), and 0.96 log10 (range, 0.26-1.44), respectively, following a 10-second wiping time. All wipes repeatedly transferred significant amounts of bacteria/spores over 3 consecutive surfaces, although the percentage of total microorganisms transferred from the wipes after wiping was low for a number of products.
CONCLUSIONS: Detergent-based wipe products have 2 major drawbacks: their variability in removing microbial bioburden from inanimate surfaces and a propensity to transfer pathogens between surfaces. The use of additional complementary measures such as combined detergent/disinfectant-based products and/or antimicrobial surfaces need to be considered for appropriate infection control and prevention.

REFERENCE:
Ramm L, et al. Pathogen transfer and highvariability in pathogen removal by detergent wipes. Am J Infect Control. 2015 Jul 1;43(7):724-8.
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Worker Health and Safety Practices in Research Facilities Using Nonhuman Primates, North America

Since 1975, federal quarantine regulations have restricted nonhuman primate importation to scientific, educational, or exhibition purposes to limit risks for disease introduction. Infectious diseases resulting from importation of nonhuman primates need to be prevented to ensure that colonies of these animals are available for research and to protect persons working with them from exposure to established and emerging zoonotic diseases.

REFERENCE:
Emily W. Lankau. Worker Health and Safety Practices in Research Facilities Using Nonhuman Primates, North America. Emerg Infect Dis. 2014 Sep; 20(9): 1589–1590. 
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Debate on MERS-CoV respiratory precautions: surgical mask or N95 respirators?

Since the emergence of Middle East respiratory syndrome coronavirus (MERS-CoV) in mid-2012, there has been controversy over the respiratory precaution recommendations in different guidelines from various international bodies. Our understanding of MERS-CoV is still evolving. Current recommendations on infection control practices are heavily influenced by the lessons learnt from severe acute respiratory syndrome. A debate on respiratory precautions for MERS-CoV was organised by Infection Control Association (Singapore) and the Society of Infectious Disease (Singapore). We herein discuss and present the evidence for surgical masks for the protection of healthcare workers from MERS-CoV.

REFERENCE:

Chung SJ, Ling ML, Seto WH, Ang BS, Tambyah PA. Debate on MERS-CoV respiratory precautions: surgical mask or N95 respirators? Singapore Med J. 2014
Jun;55(6):294-7.

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Guidelines for safe work practices in human and animal medical diagnostic laboratories. Recommendations of a CDC-convened, Biosafety Blue Ribbon Panel.

Prevention of injuries and occupational infections in U.S. laboratories has been a concern for many years. CDC and the National Institutes of Health addressed the topic in their publication Biosafety in Microbiological and Biomedical Laboratories, now in its 5th edition (BMBL-5). BMBL-5, however, was not designed to address the day-to-day operations of diagnostic laboratories in human and animal medicine. In 2008, CDC convened a Blue Ribbon Panel of laboratory representatives from a variety of agencies, laboratory organizations, and facilities to review laboratory biosafety in diagnostic laboratories. The members of this panel recommended that biosafety guidelines be developed to address the unique operational needs of the diagnostic laboratory community and that they be science based and made available broadly. These guidelines promote a culture of safety and include recommendations that supplement BMBL-5 by addressing the unique needs of the diagnostic laboratory. They are not requirements but recommendations that represent current science and sound judgment that can foster a safe working environment for all laboratorians. Throughout these guidelines, quality laboratory science is reinforced by a common-sense approach to biosafety in day-to-day activities. Because many of the same diagnostic techniques are used in human and animal diagnostic laboratories, the text is presented with this in mind. All functions of the human and animal diagnostic laboratory--microbiology, chemistry, hematology, and pathology with autopsy and necropsy guidance--are addressed. A specific section for veterinary diagnostic laboratories addresses the veterinary issues not shared by other human laboratory departments. Recommendations for all laboratories include use of Class IIA2 biological safety cabinets that are inspected annually; frequent hand washing; use of appropriate disinfectants, including 1:10 dilutions of household bleach; dependence on risk assessments for many activities; development of written safety protocols that address the risks of chemicals in the laboratory; the need for negative airflow into the laboratory; areas of the laboratory in which use of gloves is optional or is recommended; and the national need for a central site for surveillance and nonpunitive reporting of laboratory incidents/exposures, injuries, and infections.

REFERENCE:
Miller JM, et al.; Biosafety Blue Ribbon Panel; Centers for Disease Control and Prevention (CDC). Guidelines for safe work practices in human and animal medical diagnostic laboratories. Recommendations of a CDC-convened, Biosafety Blue Ribbon Panel. MMWR Surveill Summ. 2012 Jan 6;61 Suppl:1-102. Erratum in: MMWR Surveill Summ. 2012 Mar 30;61(12):214.
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Evaluation of a Disinfectant Wipe Intervention on Fomite-to-Finger Microbial Transfer

Inanimate surfaces, or fomites, can serve as routes of transmission of enteric and respiratory pathogens. No previous studies have evaluated the impact of surface disinfection on the level of pathogen transfer from fomites to fingers. Thus, the present study investigated the change in microbial transfer from contaminated fomites to fingers following disinfecting wipe use. Escherichia coli (108 to 109 CFU/ml), Staphylococcus aureus (109 CFU/ml), Bacillus thuringiensis spores (107 to 108 CFU/ml), and poliovirus 1 (108 PFU/ml) were seeded on ceramic tile, laminate, and granite in 10-μl drops and allowed to dry for 30 min at a relative humidity of 15 to 32%. The seeded fomites were treated with a disinfectant wipe and allowed to dry for an additional 10 min. Fomite-to-finger transfer trials were conducted to measure concentrations of transferred microorganisms on the fingers after the disinfectant wipe intervention. The mean log10 reduction of the test microorganisms on fomites by the disinfectant wipe treatment varied from 1.9 to 5.0, depending on the microorganism and the fomite. Microbial transfer from disinfectant-wipe-treated fomites was lower (up to <0.1% on average) than from nontreated surfaces (up to 36.3% on average, reported in our previous study) for all types of microorganisms and fomites. This is the first study quantifying microbial transfer from contaminated fomites to fingers after the use of disinfectant wipe intervention. The data generated in the present study can be used in quantitative microbial risk assessment models to predict the effect of disinfectant wipes in reducing microbial exposure.

REFERENCE:
Lopez, Gerardo U. et al. “Evaluation of a Disinfectant Wipe Intervention on Fomite-to-Finger Microbial Transfer.” Ed. D. W. Schaffner. Applied and Environmental Microbiology 80.10 (2014): 3113–3118. PMC. Web. 9 July 2015.

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Analysis of variation in total airborne bacteria concentration to assess the performance of biological safety cabinets in microbial laboratories

BACKGROUND: The purpose of this study was to compare the concentration of total airborne bacteria (TAB) in biosafety cabinets (BSCs) at universities and hospital microbial laboratories to assess the performance of BSCs.
METHODS: TAB was determined by using the single-stage Anderson sampler (BioStage Viable Cascade Impactor). The samples were obtained three times (with the BSC turned off and the shield open; with the BSC turned off and the shield closed; and with the BSC tuned on and operating) from the areas in front of 11 BSCs.
RESULTS: TAB concentrations of accredited and nonaccredited BSCs were determined. No significant differences were observed in the TAB concentrations of the accredited BSCs and the nonaccredited BSCs for the areas outside the BSCs in the laboratories (p > 0.05). TAB concentrations for the BSCs sampled with the shield open and the instrument turned off showed differences based on the sampling site outside the BSC in each laboratory.
CONCLUSION: These results imply that TAB concentration is not altered by the performance of the BSCs or TAB itself and/or concentration of TAB outside the BSC is not a good index of BSC performance.

REFERENCE:
Hwang SH, Park HH, Yoon CS. Analysis of variation in total airborne bacteria concentration to assess the performance of biological safety cabinets in microbial laboratories. Saf Health Work. 2014 Mar;5(1):23-6.
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