Prepare and Protect

Safer Behaviors in Laboratories and Clinical Containment Settings

Sean G. Kaufman

• Publisher: ASM Press
• Year: 2020
• Print ISBN: 9781683670148
• eBook ISBN: 9781683673569
• Edition: 1
• Topic: Biological Sciences
• Subtopic: Science Research & Methodology
• Index: Biological Sciences

Biological safety is a critical requirement when working with or around infectious disease agents. To prevent exposures and keep staff and patients safe, laboratories and health care facilities rely on personal protective equipment, standard operating procedures (SOPs), and engineering controls. In an instant, however, a single inappropriate human behavior can negate any of these safeguards.

This reference provides an important call to action for anyone who relies on safety plans to consider carefully the humans who must follow those plans. Written by an expert in behavioral biosafety training, Prepare and Protect offers a common-sense program for addressing and reducing the risk factors of human behavior. Learn how to

• Examine the safety culture of your organization and its approach to risk
• Motivate the compliance, adherence to rules, and community thinking that keep everyone safe
• Evaluate, validate, and verify SOPs and staff competence
• Create safety plans and safety training programs that connect outcomes to behaviors
• Provide leadership that translates the containment philosophy from words to actions

The critical message of this book is illustrated and enriched by personal accounts from infectious disease pioneers, from lab safety directors and trainers to the researchers and health care workers directly affected by infectious hazards.

If your work involves pathogenic microbes—whether treating patients in a hospital emergency department or conducting research in a biosafety level 2 or higher laboratory—or overseeing those who do these jobs, this resource will teach you how to develop a culture of biosafety through behavior. If you are looking for online access to the latest clinical microbiology content, please visit www.wiley.com/learn/clinmicronow.

chapter 1
Infectious Disease Pioneers

Pi.o.neer (noun)

One that begins or helps develop something new and prepares a way for others to follow: one of the first to settle in a territory : an early settler

—Merriam-Webster Unabridged
(http://unabridged.merriam-webster.com)

In this book, you will meet Beth Griffin, a young woman working with non-human primates at Yerkes National Primate Research Center in Atlanta, Georgia; Linda Reese, described as the “lab mom,” verifying a dangerous sample at the Michigan Department of Health Laboratory; and Maybelline (last name unknown), a maternal delivery nurse in Liberia during the 2014 Ebola outbreak, praying as she struggles to live. These women were infectious disease pioneers who died doing their jobs.

You will also learn about Henry Mathews, a scientist at the Centers for Disease Control and Prevention (CDC), who became sick with hepatitis B while working on samples from Africa during the early days of the HIV crisis; Joshua Gurtler, a United States Department of Agriculture (USDA) scientist, who became sick with Escherichia coli O157:H7 while working to make food safer for the public; and Nina Pham, a Texas nurse treating an Ebola patient, who also became sick with Ebola. These individuals, now living with conditions that impact the rest of their lives, are infectious disease pioneers, too.

If you work in a clinical laboratory, research laboratory, ambulance, emergency room, intensive care unit, or isolation room, then you, too, are among the ranks of the infectious disease pioneers. You are on the frontline of emerging and reemerging infections, working directly with infectious pathogens and infected patients for the common good.

The pathogens are invisible. There are newly emerging and re-emerging pathogens that are changing and mutating constantly. Although we understand a great deal about pathogens and pathogenesis, there is even more that we do not know. Infectious disease pioneers are not only some of the first to encounter an unknown pathogen, they (you) may also have the earliest exposures and be among the first patients.

I think that this kind of work is heroic. Many don’t think of laboratory workers when the word “hero” is mentioned. Typically, that word conjures images of firefighters running toward flames to save lives, police officers providing security of mind and body, and members of the military standing guard. The value and heroism of these individuals are correctly recognized by society for the way in which they put their lives on the line for others. But what happens when these heroes get sick?

Imagine this scenario: One of these heroes wakes up at 2:00 a.m. with a high fever. She is greeted at the emergency room by a nurse who screens her, asks her questions, and guides her to a room. A doctor then visits her and orders blood to be drawn for testing. A clinical microbiologist, either in the hospital or at a nearby lab, receives the sample (along with thousands of other patient samples) to perform the ordered tests, and guides the nurses and doctors in their patient care. More than 24 hours later, everyone involved with the patient learns that she is infected with the severe acute respiratory syndrome virus (SARS). All these nurses, doctors, and laboratorians have unknowingly encountered a very dangerous pathogen just by doing their jobs. They are infectious disease pioneers.

There are more heroes connected to this ecosystem. How do the clinical laboratorians know what tests to perform, how to interpret them, and what recommendations should be made to the health care staff? Identifying solutions to infectious diseases is the important role of research scientists working in research laboratories. They spend hours designing, performing, repeating, and analyzing experiments and encountering risks for the common good. Whether researching the elements of specific pathogens that threaten human, animal, and plant health, studying existing preventive measures and treatment protocols, or searching for new vaccines and medications, a research scientist is also an infectious disease pioneer.

Public health laboratory staff are infectious disease pioneers as well. As soon as health care workers and epidemiologists become aware of an outbreak, public health laboratory staff work to identify the culprit. Public health laboratories identify and distinguish community threats, determine whether they are natural or a form of bioterrorism, and monitor for emerging as well as existing public health threats. Public health laboratory staff are responsible for detecting and alerting other agencies and the public when something is wrong and when increased attention and assistance are needed.

I wrote this book to serve primarily those working in clinical, research, and public health laboratories, because these are the people I train globally. However, as I will discuss later, my time at Emory University Healthcare’s Ebola isolation unit gave me a unique perspective. I saw firsthand how beneficial the application of the biosafety principles and practices used in clinical and research labs could be for the treatment of sick patients by clinical care providers. With more than 1 million health care-associated illnesses and more than 100,000 deaths from these in the United States annually (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6245375/), it is clear why clinical care providers must add another component to their infection control practices.

Infectious disease pioneers from all of these arenas work together to improve and protect the lives of people around the world. Each contribution, whether in the clinic or in the clinical, research, or public health laboratory, is needed to complete the puzzle of global health. You may not find yourself on the front page of the newspapers (unless you make a mistake), but you certainly deserve to be there!

This book provides guidance for the everyday laboratorian as well as suggestions and guidelines for those in leadership and administrative roles. Most chapters feature a personal story from an infectious disease pioneer or someone close to them. Some stories are explorations or reflections of various career paths that infectious disease workers have taken, whereas others serve as cautionary tales that highlight the very serious risks these pioneers may face. In addition to providing education on safety considerations for those on the frontlines of the infectious disease battle, the book introduces some of the infectious disease pioneers I have had the privilege to know and work with over the years.

BIOSAFETY in the First Person

The Loss of Beth Griffin by Caryl Griffin

---

When I first heard Beth’s story, I was a new parent. My kids are now teenagers, getting ready to leave the house to start their own adult lives. I cannot imagine the pain Beth’s family went through when she was lost. However, Beth’s story did not end with her life. As far as I am concerned, she remains the heart of biosafety. Caryl continues to give her heart by telling Beth’s story in the hope of protecting people and ensuring that Beth’s tragedy never happens again.

---

In 1997, Beth Griffin was an artistic, intelligent, and compassionate young woman who worked as a research assistant at the Yerkes Primate Research Center studying hormonal influences on macaque behavior. Her exposure occurred while working within an outdoor compound containing 100 rhesus macaques. Beth was performing physicals on each of the monkeys during an annual roundup. During this process, the monkeys were brought out six at a time in a transport cage and then transferred one at a time to a squeeze cage where they were anesthetized to be examined safely.

The last monkey to be examined that day was frightened and refused to enter the squeeze cage. As Beth leaned toward the cage, attempting to coax the frightened monkey, the monkey jumped and flicked material with his tail from the bottom of the cage into Beth’s unprotected eye. It was not common practice at the time to wear goggles.

She removed brown material from her eye with a damp paper towel, and when she asked about washing her eye (she had not yet been trained in eye-wash station use, and this was also not common practice at the time), she was instructed to continue the examination of the monkey because “We all get splashes in the eye.” Forty-five minutes later, she rinsed her eye under the faucet in the ladies room with the help of the housekeeper. She was told that no incident report was necessary.

From the time of exposure, Beth was worried about the possibility of contracting the herpes B virus, which is endemic in macaques. Ten days later, on a Saturday, matter began oozing out of her exposed eye. Over the next six days, Beth made persistent, repeated attempts to get help. She first went to her internist, who referred Beth to the emergency room. There, she was diagnosed with pinkeye (conjunctivitis) and told that there was no need for testing for the herpes B virus.

On Monday, the Primate Center’s occupational health nurse required Beth to complete an incident report that stated, “No follow-up necessary.” That day, Beth called the hospital’s infectious disease department directly, asking for evaluation, but was told, “A physician must make the referral.” She again called her internist, who referred her to ophthalmology instead of infectious disease. The ophthalmologist diagnosed cat scratch fever and treated her with doxycycline, without testing for herpes B virus.

The next day her symptoms worsened, with a pounding headache, and for the fourth time she called her internist, who referred her to the doctor on call, who referred her to the ophthalmologist the next day. Overnight, she developed photosensitivity, a shooting, pounding headache, and nausea and vomiting.

On her follow-up visit, the ophthalmologist called the infectious disease physician, who immediately admitted Beth to the hospital, where herpes B virus testing was performed and treatment with intravenous acyclovir was begun. Three days later, a central line was inserted, and she was placed on ganciclovir as well as total parenteral nutrition.

Two weeks later, her symptoms improved, and she was discharged with a central line. But overnight, her neck pain, which had begun two days before discharge, increased, and by morning she was unable to move her legs. She was rushed to the emergency room and admitted to the intensive care unit with ascending disseminated myelitis. By early evening, she was intubated, and by morning she was paralyzed to the level of her C2 vertebra. It was thought by her physicians that the herpes B virus infection was resolved. She was treated for postviral autoimmune disease, was given massive doses of intravenous steroids, and re...

Table of contents

• Cover
• Table of Contents
• Foreword
• Preface
• About the Author
• chapter 1: Infectious Disease Pioneers
• chapter 2: Understanding Containment
• chapter 3: Biological Risk Mitigation
• chapter 4: Human Risk Factors
• chapter 5: Four Primary Controls of Safety
• chapter 6: Understanding Human Behavior
• chapter 7: The Containment Philosophy
• chapter 8: Plans + Behaviors = Outcomes
• chapter 9: Intrinsic Safety
• chapter 10: Building a One-Safe Culture
• chapter 11: Emergency Preparedness and Response to Biological Risks
• chapter 12: Standard Operating Behavior
• chapter 13: Effective Training Strategies
• chapter 14: The Beaking Method
• chapter 15: Safety Surveillance Programs
• chapter 16: Responsible Leadership
• Image Credits
• Index
• End User License Agreement