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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
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Bosnia & Herzegovina – 1996
Credit: Gavin Macgregor-Skinner/MoD
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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
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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.
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Sandia National Laboratories
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Indian Journal of Community and Family Medicine – Dec 2015
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Singapore – School of Chemical and Life Sciences
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Ebola – WHO Public Health Emergency of International Concern –
Aug 8, 2014
Source: Jerome Delay / AP Photo
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Ebola Laboratories – 16 March 2015
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Ebola Treatment Unit & Lab
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Ebola Case Finding – WHO 5 March 2015
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Sharing in near real-time – SMS Text Message
• mHero• DHIS 2.0• RapidPro• iHRIS• U-Report• mTrac• Frontline
SMS• Ushahidi• Magpi• WhatsApp• Kobo
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ERGF Ebola Response Team in Nigeria
Source: Dr. Gavin Macgregor-Skinner
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Ebola Response Team in Nigeria - Nurses
Source: Dr. Gavin Macgregor-Skinner
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Ebola TV & Radio Interviews
http://www.ergriffinresearch.org/about/news.php
Source: Dr. Gavin Macgregor-Skinner
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Nigeria - Ebola Rapid Resilience Program
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Gamification - Progression, Epic Meaning, Discovery
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Telemedicine
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Killing Ebola - Bleach, Soap and Water
Source: Stringer / Reuters
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Mobile Phones
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Ebola Response – Local Innovation
Source: HLN Morning Express
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Indonesia – Avian Influenza
H5N1 confirmed in 30/33 Provinces; 216/444 Districts
Source: GOI and FAO Indonesia
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Health Clusters Risk Management H5N1: Indonesia 2007
Credit: Gavin Macgregor-Skinner/USAID
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Participatory Risk Mapping
Credit: Gavin Macgregor-Skinner/USAID
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Risk Assessments - Decision Making
Source: Dr. Gavin Macgregor-Skinner
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Manage Actions – Dashboards (DoD)
Source: https://ebolaportal.org
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West Africa: Ebola Preparedness 16 March 2015
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Always On Risk Assessment:Hospital Level 1 Trauma Center
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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)
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Afghanistan – Biorisk Management Systems
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Afghanistan - Biorisk Management Systems Team Approach
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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
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Kenya – Biorisk Management Systems
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Kenya Lab Performance Indicators
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iFormBioRisk application from iPad
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USA - It Is Not Just The PPE
Source: Dr. Gavin Macgregor-Skinner
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N95 Fit Testing
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Culture of Safety
• Insert video Dr. Tom Frieden, CDC Director –The head of the
CDC was grilled… (July, 2014)
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Source: Health Affairs 2011; 30:559-68
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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
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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
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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
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Biorisk Manager
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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