CONTROLLING CHEMICAL and BIOHAZARDS ASSOCIATED WITH BT-WMD

INCIDENTS

Philip G. Hauck, MS, MSHS CIH, SM(NRM)

6/2005

Controlling Microbial Hazards

This presentation will address safety issues associated with Bioterrorism agents, and how to protect personnel taking samples in the field and processing samples in the laboratory.

As part of the overall process of investigation, environmental samples have to be taken at several points in the investigation process. Final clearance also has to be established before a space is reoccupied.

There may be human culture specimens that have come into the lab for evaluation.

THESE AGENTS ARE PRESUMABLY HOT–

HOW DO WE HANDLE THESE MATERIALS SAFELY?

Risks of Exposure to BT Agents:Risks of Exposure to BT Agents:

– Aerosolized AgentsAerosolized Agents

– Sprays / SplattersSprays / Splatters

– Infected Individuals / animalsInfected Individuals / animals

– Direct contact with deposited materialDirect contact with deposited material

– Direct contact with contaminated articlesDirect contact with contaminated articles

Risk AssessmentRisk Assessment

We can use the Industrial Hygiene Paradigm!!

Source - Pathway - Receiver

We Can select proper PPE

We Can use vaccines, antibiotics

We Can surround and Contain the Hazard

CATEGORY A and BCATEGORY A and B Bacterial Agents:

• Yersinia pestis• Bacillus anthracis • Brucella abortis; B. canis, B.suis• Burkholderia mallei• Francisella tularensis• Chlamidia psittaci• Coxiella burnetti

Viral Agents:• Variola major (smallpox)• Viral hemorrhagic fevers• Viral encephalitis viruses• Emerging viruses (Hanta, Nipah, Hendra, • Hantavirus, SARS)

http://www.bt.cdc.gov/agent/agentlist-category.asp

CATEGORY A and BCATEGORY A and B Fungal Agents:

• Coccidioides immitis• Histoplasma capsulatum (NOT ON LIST)

Toxins:• Anthrax toxin(s)• Botulinum Toxin• Tetanus Toxin• Epsilon Toxin• Ricin• Staphylocoocal Enterotoxin B• Endotoxin (gram negative bacteria)Water-Borne Agents (CATEGORY B’s):• Salmonella typhi, Vibrio cholera,Food-Borne Agents (CATEGORY B’s):• E. coli toxigenic strains

1. Engineering Controls

The following are engineered devices used to control, or contain and remove dangerous agents away from the individual handling these materials.

“ Biological Safety Cabinets (BSCs) are among the most effective and the most commonly used primary containment devices in laboratories working with infectious agents.” BMBL 4th Edition; page 200.

- Class I, II, III BSCs; Class Is have little utility today, IIs and IIIs are preferred for Biosafety applications

- Class II Type A; Type B1; Type B2; Type B3 (Type A / B3) BSCs; These are the workhorses of biosafety

- Class III BSC’s; Most protective of all the BSCs

- All use HEPA Filters – the “magic” of BSCs

Biosafety Cabinet Type II A / B3

A. front openingB. sashC. exhaust HEPA filterD. rear plenumE. supply HEPA filterF. blower

Source: CDC / Primary Containment for Biohazards: Selection, Installation and Use

of Biological Safety Cabinets; 2nd Edition

Class II, Type B2 Biological Safety Cabinet

A. front opening,

B. sash,

C. exhaust HEPA filter,

D. supply HEPA filter,

E. negative pressure exhaust plenum,

F. filter screen

Note: The carbon filter in the building

exhaust system is not shown.  The cabinet

exhaust needs to be connected to the

building exhaust system.

Class III Biological Safety Cabinet

A. glove ports with O-ring for attaching arm-length gloves to cabinet. B. sash,

C. exhaust HEPA filter, D. supply HEPA filter, E. double - ended autoclave or pass-through box.Note: A chemical tank may be installed which would be located beneath the work surface of the BSC with access from above.  The cabinet exhaust needs connection to the building exhaust system.

HEPA Filters and ULPA Filters are challenged with a 0.3 micron, monodisperse DioctylPhthalate (DOP) aerosol, that mimics particles in the breathable zone. Note that capture efficiency is high on both sides of the curve

Almost all breathable hazards are eliminated by BSC use - the HEPA filter effectively removing particulates (but not gases!!)

Source: The Baker Co.

Face velocity Face velocity Radionuclides/ Biosafety Radionuclides/ Biosafety Product Product

TypeType (lfpm)(lfpm) Airflow Pattern Airflow Pattern Toxic Chemicals Level(s)Toxic Chemicals Level(s) Protection Protection

Class I * Class I * 75 75 In at front; out thru rear and top through HEPA filterIn at front; out thru rear and top through HEPA filter No No 2,3 2,3 No No

open frontopen front

Class II Class II 75 75 70% recirculated through HEPA; exhaust through HEPA70% recirculated through HEPA; exhaust through HEPA No No 2,3 2,3 Yes Yes

Type AType A

Type B1Type B1 100 100 30% recirculated through HEPA; exhaust 30% recirculated through HEPA; exhaust Yes Yes 2,3 2,3 Yes Yes

via HEPA and hard ductedvia HEPA and hard ducted (Low levels/ (Low levels/

volatility)volatility)

Type B2Type B2 100 100 No recirculation; total exhaust via HEPA and hard ductedNo recirculation; total exhaust via HEPA and hard ducted Yes Yes 2,3 2,3 Yes Yes

Type B3Type B3 100 100 Same as IIA, but plena under negative pressure Same as IIA, but plena under negative pressure Yes Yes 2,3 2,3 Yes Yes

to room and exhaust air is ductedto room and exhaust air is ducted

Class IIIClass III NA NA Supply air inlets and exhaust through 2 HEPA filtersSupply air inlets and exhaust through 2 HEPA filters Yes Yes 3,4 3,4 Yes Yes

*Glove panels may be added and will increase face velocity to 150 lfpm; gloves may be added with an inlet

air pressure release that will allow work with chemicals/radionuclides

BMBL: Comparison of Biological Safety Cabinets

a. Engineered Laboratory Space:

i. Ventilation(Directional, 100% In / 100% Out)

ii. Negative Pressure within Lab Spaces (0.05-0.1” W.G.)**

iii. Safety Interlocks (double-door entry)

iv. Special floor/ wall surfaces

b. Other Safety Devices:

i. Screw Cap Tubes

ii. Bucket enclosures / rotor enclosures on centrifuges

iii. Pipettors

iv. Vacuum line safety flasks / line filter devices

v. Autoclaves

**1.0 “ W.G. = 250 Pa(scals); range is 12.5 to 25 Pa vacuum inside space

Engineering Controls: (continued)

These are practice-based controls that control hazards through established activities based on knowledge gained from working with infectious agents.

a. Standard Laboratory Practices:

i. Direct contact control-“Good Housekeeping” and spill management

ii. Aerosol control-limiting activities that can generate aerosols

iii. “Sharps” control

iv. Waste decontamination and disposal

v. Surface disinfection

2. Administrative Controls

b. Vaccinations: there are a limited number of vaccines available

c. The CDC Biological Safety Levels: recommended practices and equipment (go to: www.cdc.gov/od/ohs; BMBL)

i. BSL 1

ii. BSL 2

iii. BSL 3

iv. BSL 4

d. The NIH Risk Groups: implied practices and equipment

(have to use Appendix G in the NIH Guidelines) *i. Risk Group 1

ii. Risk Group 2

iii. Risk Group 3

iv. Risk Group 4

*http://www4.od.nih.gov/oba/rac/guidelines/guidelines.html

2. Administrative Controls: ( continued )

BSLBSL Agents Agents PracticesPractices Safety Equipment Safety Equipment Facilities Facilities

(Primary Barriers) (Secondary Barriers)(Primary Barriers) (Secondary Barriers)

11 Not known Not known Standard Standard None required None required Open benchOpen bench

to consistently to consistently Microbiological Microbiological top sink required top sink required

cause disease incause disease in PracticesPractices

healthy adultshealthy adults

22 Associated with humanAssociated with human BSL-1 plus: BSL-1 plus: Primary barriers = Class I or Primary barriers = Class I or BSL-1 plus:BSL-1 plus:

disease, disease, practice Limited access practice Limited access II BSCs or other physical II BSCs or other physical Autoclave available Autoclave available

hazard = percutaneous injury,hazard = percutaneous injury, Biohazard warning signs Biohazard warning signs containment devices used containment devices used

ingestion, ingestion, "Sharps" precautions "Sharps" precautions for all manipulations for all manipulations

mucous membrane exposure mucous membrane exposure Biosafety manual Biosafety manual of agents that cause of agents that cause

defining any needed defining any needed splashes or aerosols splashes or aerosols

waste decontamination waste decontamination of infectious materials; of infectious materials;

or medical surveillance or medical surveillance PPEs: laboratory coats; PPEs: laboratory coats;

policies policies gloves; face protection gloves; face protection

as needed as needed

BMBL Section IIIBMBL Section III Summary of Recommended Biosafety Levels for Infectious Agents Summary of Recommended Biosafety Levels for Infectious Agents

BSLBSL Agents Agents PracticesPractices Safety Equipment Safety Equipment Facilities Facilities

(Primary Barriers) (Secondary Barriers)(Primary Barriers) (Secondary Barriers)

33 Indigenous or exotic agents Indigenous or exotic agents BSL-2 practice plus: BSL-2 practice plus: Primary barriers = Primary barriers = BSL-2 plus: BSL-2 plus:

with potential for aerosolwith potential for aerosol Controlled access Controlled access Class I or II BCSs Class I or II BCSs Physical Physical separation from separation from

transmission; disease maytransmission; disease may Decontamination of all waste Decontamination of all waste or other physical or other physical access corridors Self-closing, access corridors Self-closing,

have serious or lethalhave serious or lethal Decontamination of lab Decontamination of lab containment devices containment devices double-door access double-door access

consequencesconsequences clothing before laundering clothing before laundering used for all open used for all open Exhausted air Exhausted air not recircul- not recircul-

Baseline serum Baseline serum manipulations of agents; manipulations of agents; ated Negative airflow into ated Negative airflow into

PPEs: protective lab clothing; laboratoryPPEs: protective lab clothing; laboratory

gloves; respiratory protectiongloves; respiratory protection

as needed as needed

44 Dangerous/exotic agentsDangerous/exotic agents BSL-3 practices plus: BSL-3 practices plus: Primary barriers = All procedures BSL-3 plus: Primary barriers = All procedures BSL-3 plus:

which pose high risk of life-which pose high risk of life- Clothing change before Clothing change before conducted in Class III BSCs conducted in Class III BSCs Separate building or Separate building or

threatening disease,threatening disease, entering entering or Class I or II BSCs or Class I or II BSCs isolated zone isolated zone

aerosol-transmitted labaerosol-transmitted lab Shower on exit Shower on exit in combination within combination with Dedicated supply and Dedicated supply and exhaust, exhaust,

infections; or related agents infections; or related agents All material decontam All material decontam full-body, air-supplied, full-body, air-supplied, vacuum, and vacuum, and

decon systemsdecon systems

with unknown risk ofwith unknown risk of -inated on exit from -inated on exit from positive pressure personnel suit positive pressure personnel suit

transmissiontransmission facilityfacility

Summary of Recommended Biosafety Levels for InfectiousSummary of Recommended Biosafety Levels for Infectious AgentsAgents

Risk Group 1 Risk Group 1 Agents that are not associated with disease in Agents that are not associated with disease in

(RG1) (RG1) healthy adult humans healthy adult humans

Risk Group 2 Risk Group 2 Agents that are associated with humanAgents that are associated with human

(RG2)(RG2) disease which is rarely serious and for which disease which is rarely serious and for which preventive or therapeutic interventions are preventive or therapeutic interventions are oftenoften available available

Risk Group 3 Risk Group 3 Agents that are associated with serious or lethalAgents that are associated with serious or lethal

(RG3)(RG3) human disease for which preventive or human disease for which preventive or therapeutic therapeutic interventions interventions may bemay be available (high available (high individual risk individual risk but low community risk)but low community risk)

Risk Group 4 Risk Group 4 Agents that are likely to cause serious or lethalAgents that are likely to cause serious or lethal

(RG4)(RG4) human disease for which preventive or human disease for which preventive or therapeutic therapeutic interventions are interventions are not usuallynot usually available available (high (high individual risk and high community risk) individual risk and high community risk)

Source: NIH Guidelines: http://www4.od.nih.gov/oba/rdna.htm

NIH Guidelines: Basis for the Classification of Biohazardous Agents by Risk Group (RG)

APPENDIX B. CLASSIFICATION OF HUMAN ETIOLOGIC AGENTS ON THE BASIS OF HAZARD

Appendix B-I. Risk Group 1 (RG1) Agents

Appendix B-II. Risk Group 2 (RG2) Agents Appendix B-II-A. Risk Group 2 (RG2) - Bacterial Agents Including ChlamydiaAppendix B-II-B. Risk Group 2 (RG2) - Fungal Agents Appendix B-II-C. Risk Group 2 (RG2) - Parasitic Agents Appendix B-II-D. Risk Group 2 (RG2) - Viruses

Appendix B-III. Risk Group 3 (RG3) Agents Appendix B-III-A. Risk Group 3 (RG3) - Bacterial Agents Including RickettsiaAppendix B-III-B. Risk Group 3 (RG3) - Fungal Agents Appendix B-III-C. Risk Group 3 (RG3) - Parasitic AgentsAppendix B-III-D. Risk Group 3 (RG3) - Viruses and Prions

Appendix B-IV. Risk Group 4 (RG4) Agents Appendix B-IV-A. Risk Group 4 (RG4) - Bacterial AgentsAppendix B-IV-B. Risk Group 4 (RG4) - Fungal Agents Appendix B-IV-C. Risk Group 4 (RG4) - Parasitic Agents Appendix B-IV-D. Risk Group 4 (RG4) - Viral Agents

Appendix B-V. Animal Viral Etiologic Agents in Common Use

Appendix B-V-1. Murine Retroviral Vectors

Emergency Management Issues

( Post-Incident)

If you / your organization is involved in making a response…..

Who are the players*?– Local Incident Command / Emergency Preparedness

Group (IC/EPG) for your Facility (Don’t have one-get one!!)

– NYPD – 911 (and FDNY if fire/ explosion is involved OCT-2900)

– FBI (NYPD will notify)

– NYC Health Department – (311) or

788-9830 (days); 764-7667 after-hours

– NYS Health Department –

518 – 473 – 1730(d); 518-465-9720 (a-h)

– CDC ( Local and State Health Authorities will call)

What needs to be in place?– A Written, Response and Emergency Procedure

identifying the “who, how, what, where and when” of each procedure, in detail, not outline form. Scope and Limitations of activity must be defined

– Contact numbers and names of key officials in the agencies listed above are located in specific areas for First Responder use.

Key Hospital / Laboratory Officials who will interact with youry Representatives.

Local NYPD Precinct Commanders / Bioterrorism Liaison officer(s; EMS; Disaster Response

Names of NYC health officials handling Chemical/ bioterrorism emergencies.

Training in the actual procedures used to initiate and follow the Response and Emergency Response Plan (RERP). a. Your staff must know beforehand:

– What constitutes a Chem / BT Incident?– What degree of response will you participate in?

b. Client Institutional Officials must develop official policies.– How will cases be recognized? Handled? Who responds?

c. NYC Health Dept. Guidance; NYSDOH, CDC– What protective equipment will your Health Professionals use in handling /

treating cases?– What practices for Protective Isolation will be used to quarantine BT-Agent

infected cases from other patients?

d. Safety and Health Personnel have plans developed.– How will all equipment, instruments, clothing and PPE be decontaminated,

cleaned/discarded, re-used?– Infection Control, Chemical exposure control; develop policies/procedures.

Have an Incident Command System in place

http://www.osha.gov/SLTC/etools/ics/index.html

Client Organization’s RERP must overlap with your RERP

re: Who, What, When, and Where; Who is responsible? In charge? for what? When?Etc.

Clear definition of what is expected, scope of operations, limitations

IHIH

Securing An Incident Location

– ACTIVATE your Facility RERP - Notify Your IC/EPG!– COMMUNICATE with external agency officials*– EVACUATE the victims from the release area– DECONTAMINATE the victims (see 5. below!)– VACATE the incident site and secure it– ISOLATE the victims; control access to them– EVALUATE the victims, primary / secondary contacts– ISOLATE the incident site; seal-off and lock-out

access to the area– INVESTIGATE the incident site (Outside Agencies*)– DECONTAMINATE the incident site - only if told and when, to

do so!– DOCUMENT(ate) all activities, ie. Phone logs, lists

of people on premises, agencies, etc

Collecting / Preserving Evidence

– Protecting Health and Safety of Victims is first!!– Collecting Personal Clothing and Effects – evidence!!

- agent may be present on these items Need to contact NYPD at the beginning of the incident-they

have to establish chain-of-custody for collecting and holding evidence

incident scene = crime scene!

– Try to obtain information about the incident as to “who; what; when; where” was in the area.

Note: This is probably better left to the NYPD or FBI w/re: their investigation. You may need to know this information in order to determine if more than one release / one site is involved on your premises for decontamination purposes.

– Limit Access to Agency representatives who have to investigate the victims / incident site

FRP . . . at a glance What is it?

Signed agreement among 27 Federal departments and agencies, including the American Red Cross, that:

Provides the mechanism for coordinating delivery of Federal assistance and resources to augment efforts of State and local governments overwhelmed by a major disaster or emergency

Supports implementation of the Robert T. Stafford Disaster Relief

and Emergency Assistance Act, as amended (42 U.S. Code 5121, et seq.), as

well as individual agency statutory authorities

Supplements other Federal emergency operations plans developed to address specific

FRP . . . at a glance

In anticipation of a significant event likely to result in a need for Federal assistance

In response to an actual event requiring Federal assistance under a Presidential declaration of a major disaster or emergency

Federal Response Plan http://www.fema.gov/pdf/rrr/frp/frp2003.pdf

a. FEMA http://www.fema.gov/ b. DofJustice http://www.dhs.gov/dhspublic/

and

http://www.usdoj.gov/jmd/ps/dojepm.htmc. FBI* http://www.fbi.gov/ (LFA)d. CDC / USDA www.cdc.gov and www.usda.gov e. EPA www.epa.gov (clean-up activities, FIFRA)f. Homeland Security http://www.dhs.gov/dhspublic/ (LFA)g. OSHA www.osha.gov

*http://www.fbi.gov/anthrax/amerithraxlinks.htm

State of NY Role: (Regional Authority)

NYS Police

http://www.troopers.state.ny.us/

b. NYSDoH http://www.health.state.ny.us/home.html

c. NYS Emergency Management Office

http://www.nysemo.state.ny.us

C. NYC Role:

a. Mayor’s Office

– Office of Emergency Management (OEM)http://www.nyc.gov/html/fdny/pdf/pr/2004/strategic_plan/goal_1.pdf

– Department of Health www.nyc.gov/health. Or 311http://www.nyc.gov/html/doh/pdf/bt/bt-emergencyguide-employers.pdf

c. NYPD - 911

d. FDNY - OCT-2900

PPE must protect the following:PPE must protect the following:

–EyesEyes

–Nose and MouthNose and Mouth

–Respiratory TractRespiratory Tract

–Skin Skin

Personal Protective EquipmentPersonal Protective Equipment

PPE is:PPE is:

–Respiratory ProtectionRespiratory Protection

–Eye ProtectionEye Protection

(i.e. goggles, glasses, face shields)(i.e. goggles, glasses, face shields)

–BootsBoots

–““Bunny” and “Moon” SuitsBunny” and “Moon” Suits

Saranax - coated coveralls + Full enclosure suitsSaranax - coated coveralls + Full enclosure suits

–GlovesGloves

Personal Protective EquipmentPersonal Protective Equipment

Know your PPE:Know your PPE:

Level A Combination [RG-3,4]:Level A Combination [RG-3,4]:

Airtight / Gastight Totally covering suit with SCBA, Airtight / Gastight Totally covering suit with SCBA, Hoseline or oxygen-generating rebreather.Hoseline or oxygen-generating rebreather.

Level B Combination [RG2,3; +/- 4]: Level B Combination [RG2,3; +/- 4]:

Chemically resistant suit, with SCBA, Hoseline or Chemically resistant suit, with SCBA, Hoseline or oxygen-generating rebreather. Sometimes oxygen-generating rebreather. Sometimes

PAPR’s PAPR’s used.used.

Level C Suit [RG-2,3]:Level C Suit [RG-2,3]:

Chemically resistant suit with an Air Purifying Chemically resistant suit with an Air Purifying Respirator(APR), Powered Air Purifying Respirator Respirator(APR), Powered Air Purifying Respirator (PAPR). (PAPR).

PPEPPE

Source: Lab Safety Supply

Source: ILC Dover,Inc.

Air – Purifying Respirators

Atmosphere – Supplying Respirators

Respirator Types

Source: NIOSH

Small Scale OperationsSmall Scale Operations (Room size clean-ups)(Room size clean-ups)

Basically we can borrow from available remediation Basically we can borrow from available remediation technology.technology.

Who handles respirable particles @ 5 u in length? Asbestos Who handles respirable particles @ 5 u in length? Asbestos removers! removers! http://www.ci.nyc.ny.us/html/dep/pdf/asbestos.pdf

Plastic Drapes (6 mil), HEPA (Micro-) traps, Access Enclosures, walk-Plastic Drapes (6 mil), HEPA (Micro-) traps, Access Enclosures, walk-through tanks, glove bags, HEPA vacuums - all of these can be through tanks, glove bags, HEPA vacuums - all of these can be adapted to small scale decontamination procedures.adapted to small scale decontamination procedures.

Personal Protective Equipment must be selected in order to protect Personal Protective Equipment must be selected in order to protect users in the “Hot Zone” or containment area. Usually designed for users in the “Hot Zone” or containment area. Usually designed for Particulates…can protect against aerosols, too!Particulates…can protect against aerosols, too!

Disinfectants are available for decontaminating the space - have to Disinfectants are available for decontaminating the space - have to know what is effective as a know what is effective as a space disinfectantspace disinfectant and what is a and what is a surface active disinfectantsurface active disinfectant. Some common Disinfectants used:. Some common Disinfectants used:

Paraformaldehyde and water in electric Paraformaldehyde and water in electric skillets skillets (aka Formaldehyde)(aka Formaldehyde)

Vaporized Hydrogen PeroxideVaporized Hydrogen Peroxide

Chlorine DioxideChlorine Dioxide

GlutaraldehydeGlutaraldehyde

Ethylene Oxide Ethylene Oxide

Sodium HypochloriteSodium Hypochlorite

DisinfectantsDisinfectants

Fabrication of Containment Structures and Aerosol Control

Basically we can borrow from available remediation technology. The Basically we can borrow from available remediation technology. The “Occupational Safety and Health Guidance Manual for Hazardous Waste “Occupational Safety and Health Guidance Manual for Hazardous Waste Activities”Activities” NIOSH/OSHA/USCG/EPA is a good model for setting up a site for NIOSH/OSHA/USCG/EPA is a good model for setting up a site for remediation: remediation: www.cdc.gov/niosh/85-115.html

–Establish an over-all control of the site with respect to controlling access, Establish an over-all control of the site with respect to controlling access, operational activities, site emergencies, clearance criteria and turn-over of the operational activities, site emergencies, clearance criteria and turn-over of the site to owners. The size of the incident will actually dictate who/which agency site to owners. The size of the incident will actually dictate who/which agency has overall control over the site.has overall control over the site.

–Firmly establish specific boundaries between zones, who is allowed into what Firmly establish specific boundaries between zones, who is allowed into what zones, under what conditions and with what training/PPE.zones, under what conditions and with what training/PPE.

–Know what / How much PPE to have on site. Know what / How much PPE to have on site. http://www.bt.cdc.gov/DocumentsApp/Anthrax/Protective/Protective.asp. .

–Know what disinfectants to use, and order in sufficient quantity to do the job.Know what disinfectants to use, and order in sufficient quantity to do the job.

–Establish a clearance level if none of the agencies involved has a clearance Establish a clearance level if none of the agencies involved has a clearance

level. level. http://www.cdc.gov/ncidod/EID/vol8no10/02-0398.htm

http://www.phppo.cdc.gov/nltn/pdf/LRN99.pdf

External Clean-upsExternal Clean-ups

Follow-Up Follow-Up TestingTesting

Several Agencies may set a clearance Several Agencies may set a clearance criteria or value for a given agent:criteria or value for a given agent:

Follow CDC recommended testing procedures if the Follow CDC recommended testing procedures if the agent has been evaluated by the CDC.agent has been evaluated by the CDC.

Follow EPA recommended testing procedures if the agent Follow EPA recommended testing procedures if the agent has been evaluated by the EPA.has been evaluated by the EPA.

Clearance criteria can come from several Gov’t Clearance criteria can come from several Gov’t Agencies.…USDA, OSHA, FEMA, etc.Agencies.…USDA, OSHA, FEMA, etc.

http://www.bt.cdc.gov/lrn

http://www.bt.cdc.gov/lrn/pdf/lrn-overview-presentation.pdf

http://www.bt.cdc.gov/lrn/ppt/lrn-overview-presentation.ppt

The CDC and several agencies have developed a Laboratory The CDC and several agencies have developed a Laboratory Response Network to identify Biological and Chemical agents in Response Network to identify Biological and Chemical agents in the event of a BT/CT attack.the event of a BT/CT attack.

The websites above detail the interplay between the CDC, The websites above detail the interplay between the CDC, Homeland Security and the EPA.Homeland Security and the EPA.

Laboratory Response NetworkLaboratory Response Network

Laboratory Response NetworkLaboratory Response Network

Sentinel Laboratories

Sentinel laboratories provide routine diagnostic services, rule-out and referral steps in the identification process. Although these laboratories may not be equipped to perform the same tests as LRN reference laboratories, they can test samples to determine whether those samples should be shipped toreference or national laboratories for further testing.

Laboratories at CDC or USAMRIID

LRN Structure for Agent Testing & Sample Flow

AnthraxLab

PlagueLab

Other AgentSpecific Labs

CDC BT Core Lab:Rapid Response &

Advanced Technology

Overt

Covert

By using a combination of engineering controls and By using a combination of engineering controls and administrative controls, biohazardous agents can be administrative controls, biohazardous agents can be contained safely. Unless genetically modified, the Risk contained safely. Unless genetically modified, the Risk Group assessments and Biosafety levels used for the Group assessments and Biosafety levels used for the naturally-occurring agent will also work for the BT-WMD.naturally-occurring agent will also work for the BT-WMD.

Work with biohazardous agents can proceed within a flexible Work with biohazardous agents can proceed within a flexible practice schedule that can be modified to address the practice schedule that can be modified to address the hazards and risks associated with the agenthazards and risks associated with the agent

NIH Risk Groups and CDC BSL’s can be used to perform risk NIH Risk Groups and CDC BSL’s can be used to perform risk assessments and establish safe work practices with a assessments and establish safe work practices with a given agentgiven agent

Both Risk Group 4 and BSL-4 Practices are most protective Both Risk Group 4 and BSL-4 Practices are most protective against unknown agents.against unknown agents.

ConclusionConclusion