Laboratory Emergency Management Survey

Canadian Animal Health

Laboratorians Network

Calgary, ABJune 8th, 2010

Maria Spinato, DVM DVSc MBAVahab 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)

http://www.inspection.gc.ca/english/anima/surv/cahsnrcsze.shtml

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

network of 62 labs (2010)http://www.www.aphis.usda.gov/animal_health/nahln

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

Survey questions based upon guidelines developed by the Emergency Preparedness Workgroup of the American Association of Veterinary Laboratory Diagnosticians (AAVLD, 2003)

52 questions, LimeSurvey electronic format

Invited participants were the 10 provincial/university labs most likely to be responding to FAD outbreak (CAHSN)

CAHSN Laboratories

Dr. Grant MaxieMexico City

Plum Island, NY

Ames, IA

St. John’s

CharlottetownTruro

Fredericton

St-Hyacinthe

Guelph

WinnipegSaskatoon

Edmonton

Abbotsford

CAHSN legend:■ Partner Laboratories CFIA Laboratories

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

Does the lab have a QA Officer?

Lab accreditation or certification

5 labs ISO/IEC 170252 labs AAVLD5 labs other:

- CFIA- working towards 17025

Quality Assurance and Accreditation

Does the lab have SOPs for:

Quality Assurance: Standard Operating Procedures

Does the lab have a BiosafetyOfficer?

Containment testing facilities:

Level 2 – 10 labsLevel 2+ (FAD) – 7 labsLevel 3 – 2 labs

Containment Facilities and Biosafety

How does the lab dispose of large carcasses that are level 3 or FAD pathogen suspects?

Is the LIMS linked or accessible toother data management systems?

LIMS able to sort outbreak samplesubset?

Yes – 6 labsNo – 4 labs

Laboratory Information Management System

Method of tracking samplesbetween lab sections?

Method of tracking samplesreferred out to another lab?

Laboratory Information Management System

Does the lab have an emergency response plan?

Does your province have a currentForeign Animal DiseaseEmergency Support (FADES) plan?

Does the FADES plan clearlydefine the roles and responsibilitiesof the lab and lab staff?

Emergency Response Plans

Who has access to specimenreception and administrativeoffices?

Who has access to testinglaboratories?

(Maintenance and custodial staff: supervised? biosafety training?)

Laboratory Access

Emergency Contact Information?

How would the lab manage surge testing demand during an outbreak?

Human Resources – Surge Capacity

How would the lab manage business continuity (routine testing) during an outbreak?

Human Resources – Business Continuity

Unionized staff categories?

Directors/Managers – 30%Supervisors/Sections Heads – 60%Technical – 100%Administrative – 90%

Pre-existing labour agreements topermit overtime, reassignment orhiring of contractors during anemergency?

No – 60%Yes – 40%

Human Resources

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Jan Feb Mar Apr May Jun Jul AugDr. Grant Maxie

California 2002-2003 Exotic NewcastleDisease Outbreak – Surge Testing Demand

Have standing purchase ordersbeen negotiated with majorsuppliers to permit rapid delivery ofessential consumables andreagents?

Yes – 3 labs No – 7 labs

Has the lab identified fundingsources to pay for staff andconsumables during anemergency?

Yes – 4 labs No – 6 labs

Surge Testing Demands

Participation in FAD Test Exercises

Has the lab been involved in a realFAD or suspected FAD incident?

Yes – 6 labsNo – 4 labs

Was a post-incident “lessonslearned” session conducted?

Yes – 3 labsNo – 3 labs(N/A – 4 labs)

FAD Incidents and Lessons Learned Sessions

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

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: 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

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

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Jan Feb Mar Apr May Jun Jul Aug

Business Continuity

Lab Emergency Preparedness – All Hazards

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 Newfoundland and LabradorDr. Darcy Shaw Prince Edward IslandDr. Grant Spearman Nova ScotiaDr. Jim Goltz New BrunswickDr. Lise Robert QuebecDr. Grant Maxie OntarioDr. Mark Swendrowski ManitobaMs. Marilyn Jonas SaskatchewanDr. Ole Sorensen AlbertaDr. Paul Kitching British Columbia

Ms. Joanne Sigfusson, Deputy Director, CAHSNDr. Grant Maxie, Director AHL, University of Guelph

Funded by University of Guelph/OMAFRA Emergency ManagementResearch 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.