Laboratory Emergency Management Survey
Canadian Animal Health
Laboratorians Network
Calgary, ABJune 8th, 2010
Maria Spinato, DVM DVSc MBAVahab Farzan, DVM VMIS PhD
Roadmap:
• Background of lab emergency management
• Objectives of emergency preparedness survey
• Survey design and participants
• Selected results:
Successful preparations for laboratory emergencies
Challenges and opportunities for enhanced preparedness
Canadian Animal Health Surveillance Network
CAHSN established ~ 2006
network of federal, provincial and university animal health diagnostic labs
linked to Canadian Public Health Lab Network
key outputs of CAHSN:
surveillance and early warning system for animal disease threats
rapid diagnosis in regional lab, confirmed by central reference lab
surge capacity to provide a rapid response and post-outbreak recovery surveillance testing
http://www.inspection.gc.ca/english/anima/surv/cahsnrcsze.shtml
Canadian Animal Health Surveillance Network
Network interoperability based upon:
standardized protocols, equipment and reagents
training and certification of technical analysts (PCR, ELISA)
implementation of Quality Assurance (QA) program
upgrading of biocontainment facilities: CL2+ (FAD)
http://www.inspection.gc.ca/english/anima/surv/cahsnrcsze.shtml
US National Animal Health Laboratory Network
NAHLN formed in 2002 by APHIS/CSREES/AAVLD to provide lab support of routine and emergency animal disease diagnosis:
enhance lab emergency preparedness
respond to FAD and toxicological emergencies, bioterrorism events
protect human health by decreasing risk of zoonotic diseases
network of 62 labs (2010)http://www.www.aphis.usda.gov/animal_health/nahln
Laboratory Emergency Management Survey
Survey objectives:
investigate and provide a benchmark of the current emergency preparedness status of CAHSN university and provincial labs
generate a checklist that can be used to assist in developing a lab emergency response plan
Laboratory Emergency Management Survey
Survey questions based upon guidelines developed by the Emergency Preparedness Workgroup of the American Association of Veterinary Laboratory Diagnosticians (AAVLD, 2003)
52 questions, LimeSurvey electronic format
Invited participants were the 10 provincial/university labs most likely to be responding to FAD outbreak (CAHSN)
CAHSN Laboratories
Dr. Grant MaxieMexico City
Plum Island, NY
Ames, IA
St. John’s
CharlottetownTruro
Fredericton
St-Hyacinthe
Guelph
WinnipegSaskatoon
Edmonton
Abbotsford
CAHSN legend:■ Partner Laboratories CFIA Laboratories
Which agencies fund or partially fund the diagnostic laboratory?
Does the laboratory retain fee revenue?
Operational reliance upon fee-for-service revenue has implications for business continuity and long-term financial viability post-emergency
Does the lab have a QA Officer?
Lab accreditation or certification
5 labs ISO/IEC 170252 labs AAVLD5 labs other:
- CFIA- working towards 17025
Quality Assurance and Accreditation
Does the lab have SOPs for:
Quality Assurance: Standard Operating Procedures
Does the lab have a BiosafetyOfficer?
Containment testing facilities:
Level 2 – 10 labsLevel 2+ (FAD) – 7 labsLevel 3 – 2 labs
Containment Facilities and Biosafety
How does the lab dispose of large carcasses that are level 3 or FAD pathogen suspects?
Is the LIMS linked or accessible toother data management systems?
LIMS able to sort outbreak samplesubset?
Yes – 6 labsNo – 4 labs
Laboratory Information Management System
Method of tracking samplesbetween lab sections?
Method of tracking samplesreferred out to another lab?
Laboratory Information Management System
Does the lab have an emergency response plan?
Does your province have a currentForeign Animal DiseaseEmergency Support (FADES) plan?
Does the FADES plan clearlydefine the roles and responsibilitiesof the lab and lab staff?
Emergency Response Plans
Who has access to specimenreception and administrativeoffices?
Who has access to testinglaboratories?
(Maintenance and custodial staff: supervised? biosafety training?)
Laboratory Access
Emergency Contact Information?
How would the lab manage surge testing demand during an outbreak?
Human Resources – Surge Capacity
How would the lab manage business continuity (routine testing) during an outbreak?
Human Resources – Business Continuity
Unionized staff categories?
Directors/Managers – 30%Supervisors/Sections Heads – 60%Technical – 100%Administrative – 90%
Pre-existing labour agreements topermit overtime, reassignment orhiring of contractors during anemergency?
No – 60%Yes – 40%
Human Resources
0
5000
10000
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25000
Jan Feb Mar Apr May Jun Jul AugDr. Grant Maxie
California 2002-2003 Exotic NewcastleDisease Outbreak – Surge Testing Demand
Have standing purchase ordersbeen negotiated with majorsuppliers to permit rapid delivery ofessential consumables andreagents?
Yes – 3 labs No – 7 labs
Has the lab identified fundingsources to pay for staff andconsumables during anemergency?
Yes – 4 labs No – 6 labs
Surge Testing Demands
Participation in FAD Test Exercises
Has the lab been involved in a realFAD or suspected FAD incident?
Yes – 6 labsNo – 4 labs
Was a post-incident “lessonslearned” session conducted?
Yes – 3 labsNo – 3 labs(N/A – 4 labs)
FAD Incidents and Lessons Learned Sessions
Lessons Learned - Critical Issues
Lab #1: communication, data handling
Lab #2: on-going communication needed between CFIA and
province during outbreak: inclusion in Emergency Operation Centre (EOC)
standardized submission forms and reporting formats for all FAD tests
increase # proficiency panels run by analysts pre-outbreak training for CFIA and lab staff re: sample
collection, labelling and packaging
Lab #3: enhanced communications between federal and provincial authorities
What does your lab need to effectively manage an emergency such as a FAD outbreak?
level 2+ lab facilities – 3 labs additional SOPs and ISO/IEC 17025 accreditation – 3 labs additional trained technical staff – 3 labs better LIMS and/or sample handling (bar coding) – 3 labs more FAD simulations, testing of emergency response
plan – 2 labs increased capacity for disposal of infected material – 1 lab lab would not manage the emergency situation; will
provide technical, specialized support as needed – 1 lab
Survey Summary:Successful Preparations for FAD Emergency
CAHSN has accelerated the training, certification and equipping of partner labs to meet the demand for surge testing
≥70% of labs have: Lab Emergency Response Plan Biosafety Officer, containment level 2+ (FAD) QA Officer, SOPs (sample tracking, decon/disinfection) Technical analysts certified for PCR and ELISA FAD tests
Survey Summary: Challenges and Opportunities for Enhanced Preparedness
Communications: interagency liaisons Improved data management Enhanced biosecurity (lab access, carcass disposal) Human resources management (labour relations, staffing
needs, overtime) Financial planning – who pays the bills? Suppliers Business continuity planning – managing routine diagnostic
cases during the outbreak Advanced training needs: ICS, FAD lab exercises
Emergency Preparedness – FAD Response
0
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25000
Jan Feb Mar Apr May Jun Jul Aug
Business Continuity
Lab Emergency Preparedness – All Hazards
How Basic Preparedness Prevented the Spread
of SARS in Vancouver in 2003
“Coordinated Response to SARS, Vancouver, Canada”
Skowronski, D. et al, Emerging Infectious Diseases, Vol. 12 (1), January 2006, 155-158
Skowronski, D.M. Emerging Infectious Diseases
Vancouver- Central public health coordination: BC
Centre for Disease Control (BCCDC)
- Periodic monitoring and electronic public health communication: Feb 2003 alert re atypical pneumonia China + H5N1 cases in Hong Kong
- Hospital A emergency room: recent infection control audit emphasizing barrier precautions with all acute respiratory infections (preparedness)
- Patient 0 from Hong Kong: admitted into negative-pressure isolation room with full respiratory precautions within 2 hr of arrival at hospital A
- Vancouver: 5 SARS cases, 0 deaths
Toronto- Decentralized local health boards, no
central public health agency
- Patient 0 (son of Hong Kong traveller): remained under general observation in emergency room for 18 hr.
- Placed in isolation after 21 hr
- Barrier precautions (droplet and contact) instituted 3 days after arrival
TO: 247 SARS cases, 43 deaths, $1 B
Skowronski, D.M et al, Emerging Infectious Diseases, Jan 2006
“Chance favors only the prepared mind”
Louis Pasteur, 1865
Thanks:Dr. Laura Rogers Newfoundland and LabradorDr. Darcy Shaw Prince Edward IslandDr. Grant Spearman Nova ScotiaDr. Jim Goltz New BrunswickDr. Lise Robert QuebecDr. Grant Maxie OntarioDr. Mark Swendrowski ManitobaMs. Marilyn Jonas SaskatchewanDr. Ole Sorensen AlbertaDr. Paul Kitching British Columbia
Ms. Joanne Sigfusson, Deputy Director, CAHSNDr. Grant Maxie, Director AHL, University of Guelph
Funded by University of Guelph/OMAFRA Emergency ManagementResearch Program
References:
Laboratory Exercises, Kris Clothier and Pat Blanchard, 2008 NAHLN Emergency Response Symposium, Greensboro, NC, USA
Suggested Laboratory Guidelines for Animal Health Emergency Management, AAVLD Emergency Preparedness Workgroup, November 2004,
Developing Laboratory Response Plans, Ron Wilson, NAHLN/AAVLD Laboratory Emergency Management Subcommittee Joint Symposium, October 2006, Minneapolis, MN.