Transcript Slide 1

Laboratory Emergency Management
Survey
Canadian Animal
Health
Laboratorians
Network
Calgary, AB
June 8th, 2010
Maria Spinato, DVM DVSc MBA
Vahab 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)
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
http://www.www.aphis.usda.gov/animal_health/nahln
 network of 62 labs (2010)
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
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Survey questions based upon guidelines
developed by the Emergency Preparedness
Workgroup of the American Association of
Veterinary Laboratory Diagnosticians (AAVLD,
2003)
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52 questions, LimeSurvey electronic format

Invited participants were the 10
provincial/university labs most likely to be
responding to FAD outbreak (CAHSN)
CAHSN Laboratories
CAHSN legend:
■ Partner Laboratories
CFIA Laboratories
St. John’s
Edmonton
Abbotsford
Saskatoon
Winnipeg
St-Hyacinthe
Charlottetown
Truro
Fredericton
Guelph
Plum Island, NY
Ames, IA
Mexico City
Dr. Grant Maxie
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
Quality Assurance and Accreditation
Does the lab have a QA Officer?
Lab accreditation or certification
5 labs ISO/IEC 17025
2 labs AAVLD
5 labs other:
- CFIA
- working towards 17025
Quality Assurance:
Standard Operating Procedures
Does the lab have SOPs for:
Containment Facilities and Biosafety
Does the lab have a Biosafety
Officer?
Containment testing facilities:
Level 2 – 10 labs
Level 2+ (FAD) – 7 labs
Level 3 – 2 labs
How does the lab dispose of large carcasses that
are level 3 or FAD pathogen suspects?
Laboratory Information Management System
Is the LIMS linked or accessible to
other data management systems?
LIMS able to sort outbreak sample
subset?
Yes – 6 labs
No – 4 labs
Laboratory Information Management System
Method of tracking samples
between lab sections?
Method of tracking samples
referred out to another lab?
Does the lab have an emergency response
plan?
Emergency Response Plans
Does your province have a current
Foreign Animal Disease
Emergency Support (FADES)
plan?
Does the FADES plan clearly
define the roles and responsibilities
of the lab and lab staff?
Laboratory Access
Who has access to specimen
reception and administrative
offices?
Who has access to testing
laboratories?
(Maintenance and custodial staff:
supervised? biosafety
training?)
Emergency Contact Information?
Human Resources – Surge Capacity
How would the lab manage surge testing demand during an
outbreak?
Human Resources – Business Continuity
How would the lab manage business continuity (routine testing)
during an outbreak?
Human Resources
Unionized staff categories?
Directors/Managers – 30%
Supervisors/Sections Heads – 60%
Technical – 100%
Administrative – 90%
Pre-existing labour agreements to
permit overtime, reassignment or
hiring of contractors during an
emergency?
No – 60%
Yes – 40%
California 2002-2003 Exotic Newcastle
Disease Outbreak – Surge Testing Demand
25000
20000
15000
10000
5000
0
Jan Feb Mar Apr May Jun
Jul
Aug
Dr. Grant Maxie
Surge Testing Demands
Have standing purchase orders
been negotiated with major
suppliers to permit rapid delivery of
essential consumables and
reagents?
Yes – 3 labs
No – 7 labs
Has the lab identified funding
sources to pay for staff and
consumables during an
emergency?
Yes – 4 labs
No – 6 labs
Participation in FAD Test Exercises
FAD Incidents and Lessons Learned Sessions
Has the lab been involved in a real
FAD or suspected FAD incident?
Yes – 6 labs
No – 4 labs
Was a post-incident “lessons
learned” session conducted?
Yes – 3 labs
(N/A – 4 labs)
No – 3 labs
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
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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:
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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
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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
 Lab Emergency Preparedness – All Hazards
25000
20000
15000
10000
5000
0
Jan
Feb Mar Apr May Jun
Business Continuity
Jul
Aug
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
Dr. Darcy Shaw
Dr. Grant Spearman
Dr. Jim Goltz
Dr. Lise Robert
Dr. Grant Maxie
Dr. Mark Swendrowski
Ms. Marilyn Jonas
Dr. Ole Sorensen
Dr. Paul Kitching
Newfoundland and Labrador
Prince Edward Island
Nova Scotia
New Brunswick
Quebec
Ontario
Manitoba
Saskatchewan
Alberta
British Columbia
Ms. Joanne Sigfusson, Deputy Director, CAHSN
Dr. Grant Maxie, Director AHL, University of Guelph
Funded by University of Guelph/OMAFRA Emergency Management
Research 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.