Biorisk management is fundamental to global health security

Biorisk management is fundamental to global health security |

By Samantha Dittrich, manager, Global Health Security Agenda, APHL

Over the past 60 years, the number of new diseases per decade has increased nearly fourfold. Since 1980, the number of outbreaks per year has more than tripled. These alarming trends have serious implications for human and animal health as well as severe and lasting economic consequences in affected areas.

In order to address these human health threats, a One Health approach is needed. One Health recognizes that the health of people is connected to the health of animals and the environment, and calls for interdisciplinary collaboration and communication in healthcare and public health practice. With the Global Health Security Agenda (GHSA) in progress, the One Health approach is more important than ever before, and partners must come together to accelerate progress towards a world safe and secure from infectious disease threats.

Inside public health laboratories around the world, scientists handle dangerous pathogens while testing human, animal and environmental specimens for disease. But these pathogens aren’t just confined to laboratory vials and storage tubes: they travel. Often diseases originate in local communities where samples are collected at healthcare facilities that are not equipped to safely and securely handle them. Blood, stool and even animal carcasses may be stored at clinics or emergency operations centers for hours or even days before the samples are transported to laboratories, often on via methods that lack the security requirements for safe sample handling, storage and disposal.

  • Safe handling of pathogens in a laboratory or public health setting by scientists or clinicians is biosafety. Simply put, biosafety is keeping yourself (the public health laboratory professional) safe from laboratory mishaps.
  • Keeping dangerous pathogens secure and out of the hands of someone who may want to use them intentionally to harm others is biosecurity.

Biosafety and biosecurity are fundamental parts of the GHSA. Laboratory biorisk management means instituting a culture of rigorous assessment of the risks posed by infectious agents and toxins and deciding how to mitigate those risks. It involves a range of practices and procedures to ensure the biosecurity, biosafety and biocontainment of those infectious agents and toxins. Threats posed by deliberate release (aka, bioterrorism) and accidental release of infectious agents from a laboratory can happen anytime and anywhere. To mitigate the risks, it is critical that we are prepared to prevent, detect and respond to these threats.

Biorisk management is fundamental to global health security |

As a partner in the GHSA, APHL collaborates with ministries of health worldwide to develop effective national laboratory systems. One of the ways we do that is by providing guidance to our global partners to reduce laboratory biosafety and biosecurity risk. All laboratories – whether they test human, animal or environmental specimens – should develop and maintain biorisk management systems tailored to their unique operations and risks. There is no one-size-fits-all biorisk management system.

Most recently, APHL drafted a Biorisk Management Framework as a tool for partners in Ghana. The Framework offers a comprehensive, systematic approach to laboratory biorisk management. It includes a list of essential elements Ghanaian laboratories can use to assess their operations and better integrate and enhance biosafety and biosecurity programs, whether it is a human, veterinary or environmental laboratory.

In the coming months, APHL will work with partners from public health laboratories, local hospitals, and the veterinary and research communities to discuss a comprehensive, standardized approach to the development of a national Biorisk Management Framework. The goal of this One Health effort is to reduce laboratory biosafety and biosecurity risk.

Preventing the next outbreak will require a One Health approach with close collaboration among the health, animal, agriculture, defense, security, development and other sectors. APHL will be there as a partner, advisor and sounding board for countries working to better manage laboratory biosafety and biosecurity risk.


The post Biorisk management is fundamental to global health security appeared first on APHL Lab Blog.

From Paper to PC in Mozambique: Implementing Electronic Laboratory Information Systems

From Paper to PC in Mozambique: Implementing Electronic Laboratory Information Systems |

By Elizabeth Toure, senior specialist, Global Health, APHL, and Reshma Kakkar, manager, Global Health LIS, APHL

Dr. Isabel Pinto, Director of the National Directorate of Medical Assistance (DNAM) at the Mozambique Ministry of Health, has a clear and simple vision for the future of public health in Mozambique: quality information. “Information is key for all decisions,” she says.

Paper-based systems are the norm for tracking health information in most laboratories in Mozambique. There are backlogs of paper forms needing to be recorded into laboratory logbooks; patients waiting weeks or months for routine laboratory test results; and public health officials lacking timely disease surveillance data to inform public health responses. Simply put, paper-based systems are laborious, prone to errors and unmanageable.

Dr. Isabel Pinto, Director of the National Directorate of Medical Assistance (DNAM) at the Mozambique Ministry of Health | www.APHLblog.orgNow Dr. Pinto and her team are tackling this challenge with the help of APHL’s Mozambique field team. Their goal is to move all of Mozambique’s major laboratories from paper-based to electronic laboratory information systems (LIS) to better capture and track clinical and public health data. Laboratories around the world use LIS to manage patient and public health data including ordering diagnostic tests, capturing test results, generating reports and tracking samples.

Transitioning laboratories from a paper-based system to an electronic system is no small task. Dr. Pinto and the APHL Mozambique team began this endeavor by implementing an enterprise LIS for the country’s eight main referral hospital laboratories. Each laboratory first needed to be equipped with a network server to store and transmit data, the LIS software and computers to store and retrieve data from the server, diagnostic equipment that electronically transmits patient results to the LIS and well-trained laboratory staff to effectively use the LIS to support their work. In many cases, installing an LIS even requires an overhaul of the laboratory’s workflow because certain processes often prove to be redundant when an electronic system is introduced. After several years of intensive work and funding from the CDC and PEPFAR, all eight hospital laboratories are now equipped with LIS.

Beyond the LIS, a secure central database was also created within the Ministry of Health to capture the participating laboratories’ information. Data from all laboratories using the LIS are sent to this central database on a near real-time basis allowing for rapid analyses and reporting, and the ability for national decision makers, such as Dr. Pinto and her colleagues, to provide feedback to laboratories throughout the country.

With the central database at the Ministry of Health and LIS at major referral hospital laboratories, the APHL Mozambique team, working with the CDC, turned to the country’s health centers as the next phase. For these smaller health centers, installing LIS is not yet feasible due to limited infrastructure and staff capacity, so laboratory scientists still rely on a paper-based system to track their samples and data. The paper-based system becomes especially arduous when health centers need to send samples to a referral hospital for additional testing. To address this problem, APHL, working with the LIS vendor, developed a simple software application that creates a unique barcode for each sample after it is collected and transmits the test order and patient data electronically to the referral laboratory. The health center then ships the sample to the referral laboratory where the barcode is scanned into the LIS, and the previously entered patient and sample data are matched with this barcode. Once testing is completed, the referral laboratory returns the test results to the health center via the same application. While not the ultimate solution, it is a significant step forward. This software application drastically reduces the dependence on paper-based systems, which means faster and more accurate results for patients, higher data quality for public health officials and less overwhelmed laboratory staff. Thanks to funding through PEPFAR, nearly 60 health centers across Mozambique are now using this software application, and the APHL team is working with partners to install it at an additional 100 health centers.

Many challenges still remain. Most significantly, linking rural health centers to the system poses unique logistical and infrastructural challenges given inconsistent electricity and internet connectivity in those areas. The APHL Mozambique field staff continues to work to find creative solutions that will allow even the most remote locations to order tests and track results electronically.

Project by project, Dr. Pinto’s vision for Mozambique’s public health system is taking shape. Millions of laboratory records are flowing into Mozambique’s central database. What’s more, laboratories in Zambia, Tanzania, Kenya, Ethiopia and Vietnam have looked to Mozambique as a model for their own LIS solutions.

Now Dr. Pinto and her team face a new challenge: analyzing all that data.


The post From Paper to PC in Mozambique: Implementing Electronic Laboratory Information Systems appeared first on APHL Lab Blog.

Laboratory twinning builds strong lab systems and relationships

Laboratory twinning builds strong lab systems and relationships |

By David Mills, PhD, retired director, Scientific Laboratory Division, New Mexico Department of Health

When I first got involved in twinning, I had no idea that Halloween costumes would be part of the process. Let me explain.

During my time as director of the New Mexico public health laboratory, APHL connected my team with an equivalent lab in Paraguay. This entailed sending personnel to train their laboratorians, who later came to Albuquerque to see our work in action. Our “twin” labs developed strong bonds and this “twinning” project left a good taste in everyone’s mouth.

A year later, when APHL asked if we’d help Uganda’s Central Public Health Laboratory evolve into a national reference lab, we jumped at the chance to twin again.

Our first step was to visit Uganda to learn about their priorities and see what was truly achievable. We had an instant rapport with the Ugandan team and their director, Steven Aisu, and our discussion quickly reinforced how well matched our labs were. Our team had just moved from an old, cramped facility to a state of the art facility, just as the Ugandan team needed to do.

Because Aisu’s team was developing a new paradigm without ever seeing the process in action, our task was to help them clearly visualize the goal and then make it a reality through technical assistance, management and leadership training. We were all excited to get started.

The second step was for Sally Liska, retired director of the San Francisco public health lab, and me to hold training sessions in Kampala, the capital of Uganda. I loved doing these interactive courses because, for me, teaching is the best way to learn.

The Ugandan team was eager to know everything about how we ran our biosafety level 3 (BSL-3) lab, so the third step was for the Ugandan team to visit our facility in New Mexico. They met with experts from epidemiology to IT, quality assurance to maintenance, as well as senior officials. They were especially interested in how we worked with agricultural and environmental partners; Aisu described such collaborations as akin to bridging chasms. We shared our hard-won experiences. His team quickly gained proficiency in physical and scientific quality systems.

Just as important, we built strong relationships that will last.

I invited the team to my home for their last night in New Mexico before their return flight to Uganda. It happened to be Halloween, but we had been so busy it hadn’t come up in conversation. When the first trick-or-treaters arrived, I suddenly realized that my friends had never experienced the holiday. They were surprised and enchanted to find witches, ghosts and other costumed children at the door. It’s a good thing they were delighted—150 creatures of the night rang our bell over the next few hours! The following morning, we said farewell, but not goodbye.

I retired in 2015, but my connection to the Uganda team has continued without breaking stride. In June 2016, I went to Kampala for two weeks to help them develop strategic plans for their national health lab system and for oversight and regulation of the country’s entire health system. On my team were APHL consultants Kim Lewis and John Pfister, who has retired from the Wisconsin state lab.

A month later, we three musketeers facilitated a stakeholders’ meeting to review those plans and helped refine the strategic plan for their new facility (built by CDC) as they prepared for the September 2016 grand opening.

The New Mexico team has continued working with the Ugandan team as they transitioned into their new roles, and I have jumped in with both feet as a consultant through APHL. If they can stand my jokes, the least I can do is help them take their next steps. It’s my calling.

A Little Extra Fun…

This story isn’t directly related to my work with the laboratory, but I love telling it! While we were in Uganda, we stayed in a small hotel where the friendly manager would often come and chat. One day, she asked, “Have you ever had an avocado before?” I said, “Yes, I make guacamole with avocados.” She’d never heard of guacamole, so I described it and she grimaced, saying, “That sounds terrible!” I offered to make some anyway.

Laboratory twinning builds strong lab systems and relationships |

Two days later, I had a night off from teaching and was sitting in the lobby when the manager came up to me and said, “We’re ready! Let’s make the guacamole. The whole kitchen staff is waiting!” Sure enough, a chef with a tall white hat and his crew were lined up behind the ingredients: avocados, lemon juice, garlic, onions. I was astonished and eager to get cooking!

Together, we made a huge batch for the hotel staff and served it on fried corn tortillas. Everyone was game to try it. Although first their reactions were uniformly polite yet skeptical, they eventually grew enthusiastic.

My conclusion: Guacamole is an acquired taste.


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