Biosafety Principles: Separation, Seclusion & Containment Successfully differentiate concepts and apply specifications and standards Tobias van Reenen tvreenen@csir.co.za

Contents SWINE FLU ISOLATION Contents: Definitions & Concepts Transmission Routes Biosafety Laboratories Isolation Models SWINE FLU ISOLATION

Concepts and Definitions (Airborne Contamination Control) Barrier Concept (ISO 14644-4): https://www.thestar.com/ http://www.wehrmed.de/article/1372-barrier-nursing.html

Concepts and Definitions (Airborne Contamination Control) Barrier Concept (ISO 14644-4):

Biosafety What is it? Infectious Microorganisms 9/15/2019 Biosafety What is it? DISCIPLINE in addressing the Safe Handling, Manipulation and Containment of: Infectious Microorganisms Hazardous Biological Materials “safety from exposure to infectious agents”

Biosafety vs. Containment 9/15/2019 Biosafety vs. Containment Lab Practices & Standards Primary Safety Equipment (BSCs, PPE etc.) Facility Design and Eng. Systems Adapted from Office of Health and Safety, CDC

BSL- Standards & Regulations (R178 Table1) 9/15/2019 BSL- Standards & Regulations (R178 Table1) R178 Table 1

Which BSL Classification? 9/15/2019 Which BSL Classification? Risk Group (Biosafety Code) Pathogenicity and infectious dose Potential outcome of exposure Natural route of infection Other routes of infection – Lab manipulations? Evidence of lab-acquired infections Lab procedure risk? Genetic manipulation of organism? Effective prophylaxis or therapeutic interventions? Dr PA Jensen CDC

9/15/2019 Typical BSL Labs

9/15/2019 Typical BSL Labs WHO 2004

9/15/2019 Typical BSL Labs WHO 2004

Isolation Models Contact Infection Isolation Mixing Ventilation Negative pressure with anteroom not required

Isolation Models Airborne Isolation Negative pressure required for airborne infection patients Positive pressure required for protective isolation Exhaust must be discharged 3m away from other ventilation openings and windows

Isolation Models Measles TB SARS Airborne Infection Isolation – Negative Pressure Measles TB SARS Mixing ventilation Negative pressure required Anteroom preferred (space permitting)

Isolation Models Protective Isolation Positive pressure for aseptic - protection of susceptible patients “Bubble” or “Sink” anteroom for burns room (depending on adjacent spaces) Bubble anteroom better protects burns patient Higher risk of agent release during movement Sink prevents burns sepsis from spreading to ICU

Isolation Models Ward level isolation is NOT appropriate High Level Isolation (Viral Haemorrhagic Fevers) Ward level isolation is NOT appropriate Requires Dedicated Staff patient access routes access to labs and decontamination equipment

Design Tips: DOs and DON’Ts 4-MOST DON‘Ts: Don’t use dual pressure isolation units Don’t share ventilation systems or electrical conduits with other wards Don’t use swing doors in units without anterooms Don’t HEPA filter exhaust unless: respiratory protection is prescribed for that isolation model and safe exhaust is not possible

Design Tips: DOs and DON’Ts Interlock supply and exhaust systems Use pressure gradients of > 10 Pa Combined fluctuations and gauge errors can exceed 10 Pa Use visual air-pressure indicators Hang sliding doors outside room Use automatic door closers but avoid PIR door openers

Dr PA Jensen (US CDC) Edwina Fleming

WWW.IUSSONLINE.CO.ZA RSA Act R1390: REGULATIONS FOR HAZARDOUS BIOLOGICAL AGENTS RSA Act R178: REGULATIONS RELATING TO THE REGISTRATION OF MICROBIOLOGICAL LABORATORIES AND THE ACQUISITION, IMPORTATION, HANDLING, MAINTENANCE AND SUPPLY OF HUMAN PATHOGENS Biosafety in Microbiological and Biomedical Laboratories – 5th Ed (US CDC 2009) Laboratory Biosafety Manual– (WHO 2013)

Tobias van Reenen (tvreenen@csir.co.za)