biological risk management implementation: experiences ...€¦ · biological risk management...

Biological Risk Management Implementation: Experiences with

Ebola in West Africa and Elsewhere

Dr. Gavin Macgregor-SkinnerAssistant Professor

Public Health Preparedness for Disasters and Terrorist EmergenciesHershey College of Medicine

The Pennsylvania State UniversityGlobal Projects Manager

Elizabeth R. Griffin FoundationEmail: [email protected], [email protected]

Website: http://www.ergriffinresearch.org/about/news.php

http://www.ergriffinresearch.org/about/news.php

Bosnia & Herzegovina – 1996

Credit: Gavin Macgregor-Skinner/MoD

Center for Food Security and Public Health Iowa State University 2006

Biological Risk Management (BRM) - 2006

• Overall process of awareness, education, evaluation, and management

• Designed to improve disease control– Foreign and domestic diseases

• Provide tools to identify and minimize risk

Tuberculosis Laboratory Biosafety Manual 2012

Standards used to develop the guidelines• In 2008, the European Committee for

Standardization published laboratory bioriskmanagement standard CWA 15793, which highlighted the key factors that need to be considered to successfully establish and implement a biorisk management system. The standard supports the use of a risk-based approach and does not use risk classifications for biological agents or laboratory safety, or the containment levels as described in WHO's Laboratory biosafety manual. The principles established in CWA 15793 were used to develop this biosafety manual and provide guidance on the minimum requirements for TB facilities conducting diagnostic procedures.

Sandia National Laboratories

Indian Journal of Community and Family Medicine – Dec 2015

Singapore – School of Chemical and Life Sciences

Ebola – WHO Public Health Emergency of International Concern – Aug 8, 2014

Source: Jerome Delay / AP Photo

Ebola Laboratories – 16 March 2015

Ebola Treatment Unit & Lab

Ebola Case Finding – WHO 5 March 2015

Sharing in near real-time – SMS Text Message

• mHero• DHIS 2.0• RapidPro• iHRIS• U-Report• mTrac• Frontline SMS• Ushahidi• Magpi• WhatsApp• Kobo

ERGF Ebola Response Team in Nigeria

Source: Dr. Gavin Macgregor-Skinner

Ebola Response Team in Nigeria - Nurses


Ebola TV & Radio Interviews http://www.ergriffinresearch.org/about/news.php


Nigeria - Ebola Rapid Resilience Program

Gamification - Progression, Epic Meaning, Discovery

Telemedicine

Killing Ebola - Bleach, Soap and Water

Source: Stringer / Reuters

Mobile Phones

Ebola Response – Local Innovation

Source: HLN Morning Express

Indonesia – Avian Influenza

H5N1 confirmed in 30/33 Provinces; 216/444 Districts

Source: GOI and FAO Indonesia

Health Clusters Risk Management H5N1: Indonesia 2007

Credit: Gavin Macgregor-Skinner/USAID

Participatory Risk Mapping

Credit: Gavin Macgregor-Skinner/USAID

Risk Assessments - Decision Making


Manage Actions – Dashboards (DoD)

Source: https://ebolaportal.org

West Africa: Ebola Preparedness 16 March 2015

Always On Risk Assessment:Hospital Level 1 Trauma Center

Pauline Cafferkey - Nurse

12 Oct 2015 - 58 close contacts quarantined, 40 confirmed direct contact with bodily fluids, 25 received Ebola vaccine (unlicensed rVSV-ZEBOV vaccine)

Afghanistan – Biorisk Management Systems

Afghanistan - Biorisk Management Systems Team Approach

Afghanistan – Lab Risk Assessments

Findings (Facility Assessment-CPHL) Achievements of the indicators are

summarized according to 11 areas Average achievement of indicators by CPHL

was 48%.

62%

27%

37%

32%

65%

68%

54%

39%

45%

41%

56%

0% 20% 40% 60% 80% 100%

Organization and management

Documents

Specimen collection, handling and transport

Data and information management

Consumables and reagents

Equipment

Laboratory testing performance

Facilities

Human resources

Biorisk management

Public health functions

Kenya – Biorisk Management Systems

Kenya Lab Performance Indicators

iFormBioRisk application from iPad

USA - It Is Not Just The PPE


N95 Fit Testing

Culture of Safety

• Insert video Dr. Tom Frieden, CDC Director –The head of the CDC was grilled… (July, 2014)

Source: Health Affairs 2011; 30:559-68

Adapting and applying the lessons of High Reliability Science to health care

enables hospitals to reach levels of quality and safety that are comparable to

those of the best high reliability organizations. – aviation, nuclear power,

amusement parks, NASA

High Reliability Organization Hospitals

• Atlantic Health• Barnes-Jewish• Baylor• Cedars-Sinai• Cleveland Clinic• Exempla• Fairview• Froedtert• Intermountain

• Johns Hopkins• Kaiser-Permanente• Mayo Clinic• Memorial Hermann• NY-Presbyterian• North Shore-LIJ• Northwestern• OSF• Partners Healthcare

• Stanford Hospital• Trinity Health• Virtua• Wake Forest Baptist• Wentworth-Douglass

Elizabeth R Griffin Foundation HRO Labs

Our approach is to assist hospitals and labs with a Continuing Education Plan and to do this we have developed the following modules to arm leaders to make an informed decision to pursue Safety Culture Excellence:• Module 1. Understanding and Breaking Out of the Cycle of Avoiding Failure• Module 2. Safety Culture and Performance Excellence Strategy• Module 3. Prestrategy Reality• Module 4. Starting Point Evaluations• Module 5. Forming and Norming Culture• Module 6. Roadmap to Safety Excellence – Compliance and Culture• Module 7. Making the Decision to Move Forward

Biorisk Manager

It’s Easier than Ever to Communicate, Collaborate,

Connect

… and it’s essential

Biological Risk Management Implementation: Experiences with Ebola in West Africa and ElsewhereBosnia & Herzegovina – 1996Biological Risk �Management (BRM) - 2006Tuberculosis Laboratory Biosafety Manual 2012Slide Number 5Slide Number 6Indian Journal of Community and Family Medicine – Dec 2015Slide Number 8Ebola – WHO Public Health Emergency of International Concern – Aug 8, 2014Ebola Laboratories – 16 March 2015Ebola Treatment Unit & LabSlide Number 12Sharing in near real-time – SMS Text MessageERGF Ebola Response Team in NigeriaEbola Response Team in Nigeria - NursesEbola TV & Radio Interviews �http://www.ergriffinresearch.org/about/news.phpNigeria - Ebola Rapid Resilience ProgramSlide Number 18Slide Number 19Slide Number 20Slide Number 21Killing Ebola - Bleach, Soap and WaterMobile PhonesEbola Response – Local InnovationIndonesia – Avian InfluenzaHealth Clusters Risk Management H5N1: Indonesia 2007Participatory Risk MappingRisk Assessments - Decision MakingManage Actions – Dashboards (DoD)West Africa: Ebola Preparedness 16 March 2015New Approaches to Risk Visualization – Geographic Information SystemAlways On Risk Assessment:�Hospital Level 1 Trauma CenterPauline Cafferkey - NurseSlide Number 34Slide Number 35Afghanistan – Biorisk Management Systems Afghanistan - Biorisk Management Systems Team ApproachAfghanistan – Lab Risk AssessmentsKenya – Biorisk Management SystemsKenya Lab Performance IndicatorsiFormBioRisk application from iPad USA - It Is Not Just The PPEN95 Fit TestingCulture of SafetySlide Number 45Slide Number 46Slide Number 47High Reliability Organization HospitalsElizabeth R Griffin Foundation HRO LabsBiorisk ManagerIt’s Easier than Ever to Communicate, Collaborate, Connect