1. Laboratory Acquired Infections (LAIs) Physical Security Personnel Security Material Control & Accountability Transport Security Information Security International Biological Threat Reduction Program Global Security Programs Sandia National Laboratories Albuquerque, NM USA BEP Advanced Biorisk Officers Training Pilot Certificate Program in the Philippines SAND No. 2011-4549P Sandia National Laboratories is a multi-program laboratory managed and operated by Sandia Corporation, a wholly owned subsidiary of Lockheed Martin Corporation, for the U.S. Department of Energy's National Nuclear Security Administration under contract DE-AC04-94AL85000

2. Learning Objectives By the end of the unit, participants should be able : Define Laboratory Acquired Infections and describe how they are acquired Understand how Biorisk Management can be used to define practices to prevent LAIs Examine your laboratory/facilities for gaps in protecting against LAIs 1

3. 2 Definition All infections acquired through laboratory or laboratory- related activities regardless whether they are symptomatic or asymptomatic in nature. Examples? What are LAIs?

4. Symptomatic LAIs by Time Period and Agent Category 3 Source: Harding, A.L., Brandt Byers, K.. Epidemiology of laboratory–associated infections. In Fleming, D.O. and Hunt. D.L. Biological Safety: Principles and Practices. 4 th edition. Washington, DC: ASM Press, 2006; 53-77.

5. Most Frequently Reported LAIs 4 Infectious Agent Rank Order (# cases 1930-1978) Infectious Agent Symptomatic Cases (1979-2004) Brucella spp.426M. tuberculosis199 Coxiella burnetii280Arboviruses192 Salmonella spp.258Coxiella burnetii177 F. Tularensis225Hantavirus155 M. tuberculosis194Brucella spp.143 B. dermatitidis162Hepatitis B virus82 VEE146Shigella spp.66 Ch. psittaci116Salmonella spp.64 C. immitis93Hepatitis C virus32 Hepatitis B virus82Neisseria meningitidis31 TOTAL1982 1074 Source: Harding, A.L., Brandt Byers, K.. Epidemiology of laboratory–associated infections. In Fleming, D.O. and Hunt. D.L. Biological Safety: Principles and Practices. 4 th edition. Washington, DC: ASM Press, 2006; 53-77.

6. 5 Inhalation (aerosols) Percutaneous inoculation (needle and syringe, cuts or abrasions from contaminated items, and animal bites) Contact between mucous membranes and contaminated material (hands or surfaces) Ingestion (aspiration through a pipette, smoking or eating) How are they acquired? Ingestion Inhalation Percutaneous Contact

7. Class Exercise: Protecting Against LAIs In your groups, discuss how you prevent LAIs Please write your answers on ‘post it’ note and place on your flip chart. Report to the class Now group these methods into categories: Please write your answers on ‘post it’ note and place the on your flip chart. Report to the class 6

8. Hierarchy of Controls (HOC) 7 Elimination or Substitution Engineering Controls Administrative Controls Practices and Procedures Personal Protective Equipment Control methods at the top of the list are in general more effective and protective than those at the bottom.

9. Cataract University Example Individually, carefully read the Cataract University exercise Divide into groups Identify problems with Biorisk Management. These problems could be associated with assessment, mitigation or performance Use post-it notes, one for each problem Place post-it notes on your flip chart How have these problems affected the university? Report results to full group 8

10. Summary What are some of the key considerations for protecting against LAIs? How can we ensure they are being implemented as intended? 9