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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
Source: Dr. Gavin Macgregor-Skinner
Ebola TV & Radio Interviews http://www.ergriffinresearch.org/about/news.php
Source: Dr. Gavin Macgregor-Skinner
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
Source: Dr. Gavin Macgregor-Skinner
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
Source: Dr. Gavin Macgregor-Skinner
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