The UK Health Security Agency

The UK Health Security Agency

November 2021

David Pearce

Regional Deputy Director, UKHSA

UKHSA launched on 1 October:

2 UKHSA

UKHSA builds on UK strengths and what we have learnt and

developed since the pandemic. This includes:

3 UKHSA

Science-led, evidence based, the UK is a genomics powerhouse – we

produce around 40% of global sequences – that provides huge opportunities

across health protection

New ways of collaborating between academia, local government and

industry have shown huge benefits in vaccines and testing that must be

captured.

Health protection has links across government and is part of the wider

national security infrastructure.

We have built world-leading data science, analysis and surveillance

capabilities that are at the heart of UKHSA.

UKHSA’s unique contribution

4

A need to change … The core building blocks of UKHSA:

• Scientific excellence: scientific and intellectual leadership nationally and

internationally, including training and research.

• Data, analysis and surveillance strength: high-quality all-hazards

surveillance, data science and analysis.

• Operational agility and flexibility: system leader modelling excellence in

agile and responsive operations with ability to scale as needed

• Global health security and preparedness: creating a stronger global health

protection system through international surveillance, action and partnerships.

• System leader, forging partnerships with wider system, academia &

industry: a hub for innovation and collaboration, supporting the UK’s competitive

advantage in health science, technology and academia.

• Maximising the social and economic impact of health security: Articulating the benefits of health security and providing expertise across Govt.

Lessons learned

from the global

pandemic

New and growing

risks

Bringing together

expertise and skills

across system

UKHSA

5 UKHSA

Mission and Objectives for UKHSA:

To achieve this, the UKHSA will:

DETECT: detect and monitor infectious disease and external threats to health

Ob

jective

s

PREVENT: take action to mitigate threats to health before they materialize and build the nation’s health resilience and

security

ANALYSE: analyse threats to health and how best to prevent and control with a robust evidence and knowledge base

RESPOND: take action to mitigate threats to health when they materialise

LEAD: lead a system-wide response in partnership with local authorities, NHS, academia and industry inc. building a

workforce

Mission: To provide health security for the nation by protecting from infectious disease and

external hazards

From launch to full operating capability:

6 UKHSA

Define

IOC

Start to

deliver

IOC

Define

FOC

Deliver

FOC

Start

Jenny Harries appointed as

CEX and Ian Peters as

Chair.

Defined

our ‘Initial

Operating

Capability’

(IOC)UKHSA is

launched

Further work to

get us to ‘Full

Operating

Capability’ (FOC)

UKHSA

becomes a

globally

renowned public

health security

organisation.

UKHSA is a leader for

health security:

• Working

internationally to

strengthen global

health security

• A trusted source of

advice to government

and to the public

• Reducing inequalities

in the way different

communities

experience and are

impacted by

infectious disease,

environmental

hazards, and other

threats to health

Spending

Review

submission

(August) Spending

Review

settlement

(Autumn)

OCT 21

OCT 21 - OCT 22

MAR 23

ONWARDS

AUG – SEP 21

We are here

APRIL 21

JUNE 21

Remit Letter published

NOV 21

6 month business

plan published

APR 22

3 year strategy

and annual

business plan

published

How UKHSA is organised

UKHSA Chief Exec

Customer,

Comms &

Innovation

Technology

Data,

Analytics &

Surveillance

TestingHealth Protection

Ops

Public Health &

ClinicalScience

Strategy,

Policy &

Programmes

People

Commercial

& Corporate

Services

Finance

Corporate

Services

Enabling Functions

OperationsPublicHealth

Key

PUBLIC HEALTH OPERATIONS ENABLING FUNCTIONS CORPORATE SERVICES

Public Health & Clinical:

A global leader which collaborates

across the Public Health systems to

provide trusted health security and

clinical & public health professional

leadership, through reliable advice,

guidance, evidence and assurance,

which delivers measurable

improvements in keeping people safe.

Science:

Embed science and research at the core

of the work to tackle the major public

health challenges we face: new and

emerging infections of high

consequence or pandemic potential,

climate change, air pollution, antibiotic

resistance and vaccine confidence.

Testing:

Deliver integrated and scalable testing

and laboratories capacity across UKHSA

corporate, global, national and place-

based operations, supply chains, and

digital and technology systems.

Health Protection Operations:

Deliver responsive and effective

operational health protection services to

protect against harm from exposure to

all-hazards threats; Providing and co-

ordinating services at a regional and sub-

regional level using a place-based

approach; Improving quality and

resilience of operations; Managing cases

and incidents; Ensuring preparedness

for, and operational coordination and

leadership in response to, major

incidents and pandemics on a national

scale; Ensuring a consistent approach to

UK border health, and; coordinating UK

global health protection response

Customer, Comms & Innovation:

Acting as the ‘customer conscience’ for the

UKHSA, championing a culture of innovation

where users and recipients of our health security

services are at the heart of all UKHSA design,

delivery and communication with our stakeholders;

be that a service, product, solution, or programme.

Technology:

Identify, design, develop, deploy, secure and run

world class IT services and ultimately protect the

Nation’s health through Technology. Integrating

former PHE ICT and T&T IT Operations teams to

deliver cutting-edge digital and IT services to

UKHSA internal staff and external customers.

Data, Analytics & Surveillance:

Putting the full power of health and non-health

data in the hands of those who need it and

enabling the health protection ecosystem through

the provision of world-class analytics capability to

inform health protection activities, decision-

making, action and outcomes.

Strategy, Policy & Programmes:

Set the strategic direction for UKHSA, supports the organisation

to deliver the business plan and evaluates performance of

delivery. The function plays a critical coordination and

integration role to make sure UKHSA is greater than the sum of

it’s parts, provides health security for the nation and delivers

value for money.

People:

Enabling UKHSA to be an organisation which people want to

join, thrive when they do, and where our people can make a

difference to life chances for the communities we serve.

Commercial & Corporate Services:

Deliver an integrated suite of Corporate Services to support UK

HSA to meet the health security challenges of our nation and

maximise value for money.

Finance:

Leading a first-class, strategic Finance team to enable the

delivery of UKHSA’s strategic vision, working as the corporate

guardian of the budgets and protection of the accounting officer.

Maximising the efficiency of UKHSA’s property portfolio.

Tackling health inequalities

8 UKHSA

Questions?

The Microbiology of Tattoo Ink, Water and Green Soap

Dr Heather AirdFood, Water and Environmental Microbiology Services, York Laboratory

Overview of Session

• The Tattooing process

• Overview of expected standards for tattooing premises

• Infection associated with tattooing

• Surveys

• Results

Tattoo Ink, Water and Green Soap10

The Tattooing Process


• The artist will draw or stencil a design onto the

skin

• The area is cleaned with alcohol or an antiseptic

• A thin layer of ointment such as petroleum jelly

is applied

• A tattoo machine with sterile needles attached is

dipped in ink that has been decanted from stock

bottles and the ink forced into the dermal layer

of the skin by injection

• At various stages the skin may be sprayed or

wiped with a tissue soaked in green soap to

remove blood and excess ink

Prevalence

• Survey in 2015 of 1700 UK adults

• 30% if those in the 25-39 years age group have at least one tattoo

• 21% of those in the 40-59 years age group

• 13% of those in the 18-24 years age group

• 9% of the 60+ group


Standards

• Licencing & registration provisions

• Specific – Model Bylaws

• General – H&S, Risk assessment & COSHH

• Pubic Health Legislation (Part 2A Orders)

• Tattooing and Piercing Industry Union

• Certified training?

• Guidance Toolkit (July 2013)

• Standards for good practice

• Consent

• Aftercare

• Infection control


Infection

• Bloodborne viruses (Hep B, Hep C, HIV)

• Practices to minimise exposure to blood must be in place

• Use of PPE

• Immunisation

• Skin infections

• Heat, Redness, Swelling, Pain, fever

• Allergic reaction to certain inks



Prevalence of Tattoo infections

• Prevalence of infections is unknown (not notifiable)

• Infection prevention and control procedures should include

• Hand hygiene and skin care

• PPE

• Sharps and body fluid exposure controls

• Waste handling

• Cleaning and disinfection of the environment

• Tattooing premise should have a process in place for aftercare that ensures that clients knows how to recognise and infection and seek medical advice if necessary

• If they are notified by a client that and infection has occurred they are supposed to document this and take action and document what has been done.


Surveys of Tattooing premises

• Hygiene in tattooing premises XR14 (2012-13)• Water

• Swabbing of treatment areas

• Tattoo ink, water and green soap XR36 (2018-19)• Ink

• Water used to make green soap

• Diluted green soap used in tattooing process


XR14 Hygiene in Tattoo and Piercing Premises2012-13

• 860 samples in total from 19 LA’s

• 232 waters

• 591 swabs of treatment areas

• 33 spray bottles

• No ink

• 16% of waters had Pseudomonas aeruginosa

• 6% of swabs had ACC higher than expected

• 1.5% of swabs had Staphylococcus aureus

• 3% of spray bottles had Pseudomonas aeruginosa


XR36 Tattoo Ink, water and green soap2018-19


Sampling

• Sub-sample of ink from in use bottles, 2 inks per premises

• Water sample, taken from the tap used to make up disinfectants, no flushing or disinfection of the outlet prior to sampling

• In-use diluted green soap from the container being used in the premises

• Transported under refrigerated conditions to arrive at the lab in the same microbiological condition as at the time of sampling


Testing

• Tested within 24h of collection

• Ink was tested for Aerobic and Anaerobic bacteria per mL

• Water was tested for Pseudomonas aeruginosa per 100mL

• Diluted green soap was tested for Pseudomonas aeruginosa and Enterobacteriaceae per mL


Survey Questionnaire

• How long has this premises been registered?

• How many tattooists work at this premises?

• Does the premises carry out Tattooing or Tattooing & Piercing?

• Once opened how long are inks in use before they are discarded?

• Is a product data sheet available for the ink samples collected?

• What is used to clean client’s skin prior to tattooing?


What did we want to see?

• Ink should be sterile (<20 cfu per mL)

• Water should not be contaminated with Pseudomonas aeruginosa

• Green soap should be free of Enterobacteriaceae and not be contaminated with Pseudomonas aeruginosa


Results

• 33 Local Authorities participated in this survey collecting 1065 sample from 276 premises.

• 532 inks (19%)

• 262 diluted green soaps (39%)

• 271 waters (9%)

• 54% (148/276) premises gave all satisfactory results

• 46% (128/276) premises gave at least one unsatisfactory results

• 1% (3/276) premises gave unsatisfactory result for all samples tested


0 100 200 300 400 500 600

INK (532)

GREEN SOAP (262)

WATER (271)

Table 1 Sample types submitted

Satisfactory Unsatisfactory

Reason for premises failures


All results

All results satisfactory (54%) Ink failures only (11%) Water failures only (4%)

Green soap failures only (9%) Ink & water failures (3%) Ink & green soap failures (17%)

water & green soap failures (2%) All sample failures (1%)

Does the premises carry out Tattooing or Tattooing & Piercing?


Tattooing only premises

Ink as a cause

water as a cause

green soap as a cause

Tattooing & piercing premises

Ink as a cause

water as a cause

green soap as a cause

Ink


0

100

200

300

400

500

600

<20 20 to <100 100 to <1000 1000 to <10000 10000 to <100000 >100000

Ink

ACC AnCC

Length of registration?


56

50

53

59

80

71

44

50

47

41

20

29

0 10 20 30 40 50 60 70 80 90 100

0,new,<1 (25)

1-5 (150)

6-10 (62)

11-20 (22)

>20 (10)

Not answered (7)

Table 2 How long has the premise been registerd?


How long is ink used for?


79

89

83

75

75

82

100

67

21

11

17

25

25

18

0

33

0 10 20 30 40 50 60 70 80 90 100

<1month and variations of (34)

<6 months (127)

<1 year and variations of (93)

>1 year and variations of (24)

until finished - or at expiry (81)

until finished(164)

Not answered(3)

Varies depending on brand and ingredients (6)

Table 3 How long is the ink used for before discarding it?


What is used to clean client’s skin prior to tattooing?


66

72

74

81

120

80

100

82

80

34

28

26

19

20

0

18

20

0 10 20 30 40 50 60 70 80 90 100

DILUTED GREEN (134)

DILUTED GREEN &antibacterial agent (50)

ALCOHOL (35)

DETTOL (16)

DETTOL+ (5)

HIBISCRUB (5)

HIBISCRUB + (5)

OTHERS (11)

NOT answered (15)

Table 4 What is used to clean skin before tattooing?


Summary

• Tattooing is very popular.

• It is regulated via licencing and registration routes but there is no mandate for businesses to agree to use the current good practice toolkit.

• We don’t really have good data on how often tattoo infections/ reaction occur as this is not notifiable.

• Survey in 2018-19 looked at 276 premises and found that overall 46% of them lead to an unsatisfactory result based on a gold standard assessment of ink, water and the use of green soap.

• No clear processes for management of ink stocks

• Green soap despite not being a disinfection is used most frequently to disinfect skin in tattoo premises

• 38% of the green soap samples tested failed microbiologically due to the presence of Pseudomonas aeruginosa, Enterobacteriaceae or both.


The Investigation of a National Listeria Outbreak

Elaine Forester Out-posted Scientist – Field Services (FW&E Microbiology Laboratory York)

The involvement of FW&E in outbreak investigations

• Ensure that all relevant information is properly collected and assessed

• Provide assistance in the collection and transport of samples including those whichcomply with requirements for the handling of Formal Samples including on-siteassistance

• Ensure prompt processing of all samples and confirmation of the identity of anyrelevant organism isolated including forwarding to reference labs

• Ensure prompt communication of results

• Provide expert advice and interpretation of test results

• Provide an expert member of staff (normally a Food Examiner) to assist outbreakcontrol teams

• Prepare reports, certificates and witness statements as necessary and act as anexpert witness in court

The Investigation of a National Listeria Outbreak33


UKHSA Colleagues:

• Consultant in Public

Health Infection

• UKHSA

Laboratories

• Health Protection

Teams

• Field Services

• Out-Posted

Scientists

External Stakeholders:

• Local Authorities

• Food Standards

Agency

• Cefas

• NHS

• HSE

• Commercial Customers

FW&E Laboratories

“Listeria monocytogenes is a widely distributed environmental contaminantwhose primary means of transmission to humans is through contamination offoodstuffs at any point in the food chain, from source to kitchen. The totalelimination of Listeria monocytogenes from all food is impractical and may beimpossible”

‘Conclusion and Recommendations’ – WHO working group report, 1988


What is listeriosis?

• A bacterial infection caused primarily by Listeria monocytogenes although L. grayi and L. ivanovii have also been implicated

• Infection of the CNS or a bacteraemia seen in immunocompromised, elderly or very young individuals

• Gastroenteritis also seen in healthy individuals following consumption of a large infective dose


High Risk Groups


• Individuals at the extremes of age – the elderly, infants

• Pregnant women, specifically the foetus

• Immunocompromised individuals –particularly individuals suffering from cancer, weakened GI systems, transplant patients etc.

• Infectious dose is unknown but may be <1000 cells

Listeriosis - Symptoms

• Healthy adults (including pregnant women) – mild infection

• flu-like symptoms (fever, muscle aches, chills)

• or gastroenteritis (diarrhoea, nausea)

• Immunocompromised or individuals at extremes of age (elderly/neonates) –Severe infection

• Infection passes into the blood – Septicaemia

• Infection passes into the CNS – Severe flu-like symptoms, tremors, seizures and meningitis

• Infants may also show breathing difficulties and have a skin rash


The organism and its characteristics

• Gram positive short rods – 0.4-0.5µm x 0.5-2.0µm

• Facultative anaerobe

• Catalase positive, oxidase negative

• Growth over a wide temperature range 0-42◦C• Psychrotrophic organism – growth at refrigeration temperatures

• Peritrichous flagella – tumbling motility at 20-25◦C

• Optimum temperature for growth is 30-37◦C• L. monocytogenes produces listerioslysin O (haemolysin)

• Ubiquitous in the environment

• At least 17 species


What makes a food high risk?

• Manufactured with no processing step capable of destroying Listeria spp.

• Little or no preservation factors

• Long shelf life under chilled conditions

• Ready-to-eat product

• Product formulation supports growth

• Potential post process contamination

• Potential consumption by vulnerable groups


Foods Associated with Listeria

Traditionally associated foods:

• Pâté

• Soft cheese

• Cooked meats and sandwiches

• Coleslaw

• Shellfish

New and novel foods:

• Celery and fruit

• Bean sprouts

• Caramel apples

• Ice cream


Food Associated - Cases and Clusters in England and Wales


Headline News!


A national outbreak of listeriosis

• 8th May – NW Out-posted Scientist made aware of 2 cases of listeriosis at MRI at GM Food Liaison Group meeting (both deceased)

• Both patients were on different wards for different periods with some overlap. Both wards were served by a shared kitchen

• 1st case identified as 1/2a Clonal Complex (CC) 8

• 3rd case at MRI not linked to first 2 cases

• 14th May – Discussion with Manchester CC regarding formal sampling

• 15th May - Local Authority look at 5 kitchens on the MRI site

• Some issues identified but nothing of significance

• Sandwiches bought in from Good Food Chain – case 1 ate chicken mayo sandwiches on several occasions, the food history for case 2 was unknown at this stage


Investigation – questions to ask

• What foods have been consumed?

• Nosocomial infection?

• Who provides the foods to the patient?

• Which Local Authority/ies is/are responsible?

• Is sampling going to take place?

• Will samples be taken formally?

• Any common foods flagging up?

• Any issues identified with food providers?


A national outbreak of listeriosis

• 15th May – Formal sampling carried out at MRI, chicken sandwiches from GFC not taken at this time.

• 19th May – Chicken mayo sandwich identified as being eaten by both patients when they were both in hospital at the same time

• 20th May – Follow up visit to MRI to look at other food outlets on-site – chicken mayo & sweetcorn sandwich taken but formulation had changed since patients were in hospital

• Samples taken from MRI – all negative

• 2nd case also identified as 1/2a CC8 (SNP address of 4.6.34.265.297.308.345) and indistinguishable from case 1 by WGS

• Outbreak control meetings led by NHS Trust up until this point


A national outbreak of Listeria monocytogenes

• 21st May – PHE take over management of ICT meetings

• 23rd May – 3rd case of listeriosis in a Liverpool resident who attended Aintree Hospital as an out-patient and then as an in-patient

• Indistinguishable by WGS from first 2 cases

• 24th May – link established with common sandwich supplier, Good Food Chain

• Identification of a common supplier to both hospitals sought but food history difficult to obtain due to extreme poor health of third patient

• Foods implicated at this point – Chicken mayo, sweetcorn, melon, pre-cut fruit

• Sweetcorn later ruled out as it wasn’t an ingredient in the sandwiches consumed by the first two cases


Potential source identified– Good Food Chain


• Epidemiological link to chicken sandwiches

• Sandwiches to Manchester and Aintree Trusts traced back to GFC

Early indicators

• Chicken Mayo sandwiches flagged up early as a potential source

• Following the 3rd confirmed case Good Food Chain flagged up as a common supplier to both Trusts

• GFC inspected – no issues identified

• Used a private lab for Listeria testing – no recent positives

• Assemble sandwiches – cooked chicken bought in

• Supply ~ 100 hospital sites

• GFC undertakes voluntary product withdrawal of 6 products on 25th May

• Cooked chicken supplier identified as North Country Quality Foods


Investigation progresses

• By 31st May – 3 cases identified and all 3 are deceased

• IMT recommend not serving other sandwiches supplied by the company to patients with significant immunosuppression until further investigations rule out the risk – letter sent to NHS Trusts

• Confirmed cases are Serotype 1/2a, Clonal Complex(CC) 8 with a SNP address of 4.6.34.265.297.308.345

• Legal Issues - Balance of public health action vs commercial impact considered as part of ongoing and further communications. Proportionate advice to trusts and evidence behind that advice

• By 2nd June – 5 cases in 4 NHS Trusts

• Lots of press interest


Communications

• Letters sent to affected healthcare organisations

• PHE Briefing notes released

• Q&A distributed by NHSE

• Reactive and proactive statements to the public


Investigation of the food chain

• GFC confirmed as supplier of sandwiches to both Trusts

• Investigations/sampling carried out by Local Authority and samples submitted to FW&E Laboratory, Colindale

• Potential issue identified with shelf life at GFC (p+3 – guidance is p+2 in hospital setting)

• Samples of unopened cooked chicken submitted to the PHE lab confirmed as positive for L. monocytogenes and present at unsatisfactory levels >100cfu/g

• Cooked chicken supplier identified as Salford based company, North Country Quality Foods


Investigation starts at North Country Quality Foods


Joint working – PHE OPS/LA

• Discussions with Salford BC about food and environmental sampling

• Formal sampling advised in case the investigation results in legal proceedings

• Accompanied EHO’s on sampling visit (multiple visits were carried out as the investigation progressed)

• Provided advice on areas to swab and foods to sample

• Provided advice to FBO on cleaning procedures and further sampling

• Coordinated submission of samples to the laboratory

• Communication and interpretation of results to LA and other Stakeholders as required



Investigation at NCQF

• Several visits to premises

• Food sampled including recalled food on subsequent visits

• Advice provided on the best places to carry out environmental swabbing

• Areas swabbed:• Hand contact points – switches, control pads etc.

• Food contact points - slicing and dicing machines including hard to clean areas

• Vac packer

• Scored areas of machinery which may harbour biofilms

• Areas where staff move from low care to high care e.g. hand contact points, changes in footwear (wellies)

• Cleaning equipment

• Chiller fans – often located at height and grills not cleaned

• Trolley wheels


The Investigation of a National Listeria Outbreak 57

The Investigation of a National Listeria Outbreak 58

Complex equipment can harbour biofilms and may need to be dismantled

So where did we find it?

• Foods:

• Pastrami

• Chicken

• Gammon

• Ham

• Beef

• Turkey

• Cooked bacon

(mixture of 1/2c CC9 and 1/2a CC121)


• Swabs:• Boots

• Roller arm screws

• Floor

• Slicer

• Scales

• Scoop

(1/2c CC9 )

Changes in Outbreak Control Teams (OCT’s)

• At the start - local issue in Greater Manchester, situation at MRI – Investigation and OCT’s led by NHS Trust. Local Authority - Manchester CC, GM PHE HPT and FW&E York represented

• GM PHE HPT take over as lead for OCT meetings

• FSA brought in on the recommendation of Manchester CC

• As the incident escalated to a National Enhanced incident, PHE takes a national lead

• As situation develops and implicated suppliers identified as located in Salford and Stafford, the corresponding LA’s become involved

Rapidly developed from a local to a national incident!


Summary of investigation

• L. monocytogenes detected in the environment at both factories but different CC’s to outbreak strain

• L. monocytogenes detected in cooked meat product originating from NCQM and sampled from GFC (outbreak strain)

• Isolates from cooked meat and clinical samples linked by whole genome sequencing

• 9 cases confirmed including 6 deaths

• Deaths associated with 4 NHS Trusts

• Cases with no deaths associated with a further 3 NHS Trusts

• GFC supplied the affected products to a further 43 NHS Trusts



Outcomes

• NHS letter about temperature (cold chain) and use by dates (<5ºC and p+2 day shelf life)

• Trust registered as FBO (MRI)

• Training for clinical staff on food hygiene

• On-site retailers to follow recommendations with regards to temp and UB – still on-going

• Food ordered by patients is recorded, but, it’s not recorded if they actually ate it – should it be?


Recommendations….

• All outlets within a healthcare setting will maintain a minimum FHRS 4

• Applies to all sources of food provision on NHS premises including commercial and charitable organisations

• Implementation of FSA ‘listeriosis guidance for vulnerable groups’ adopted across NHS site

• Pre-packaged food from outside suppliers – production + 2 day shelf life

• If product is recalled, more effective delivery of message to those that may be affected e.g. using notices on wards, hospital radio etc.

• Receipt and storage of sandwiches/salads at <5ºC until point of service and advice about not storing for >4 hours at ambient

Sandwiches continue to be supplied in hospitals…


Questions?


Environmental Investigations for Sars-CoV-2; Can swabbing assist in COVID-19 Management?

Rob Johnston, Out-posted Scientist UKHSA

Environmental Sampling in COVID-19 Incidents; overview of session

• The role of the UKHSA (PHE) Food Water and Environmental Microbiology Laboratories

• Viral (influenza) preparations and environmental contamination

• SARS-CoV-2 and Environmental investigations in healthcare environments

• Environmental investigations in the East Midlands Region, England

• Swabbing in chilled food production environments in the East Midlands –concerns about ventilation and air handling in chilled food environments

• Swabbing as a potential investigative and management tool in chilled food and other environments

Environmental Sampling in COVID-19 202167

PHE Food, Water and Environmental Microbiology Laboratories

• 2009 – some 26 Food, Water and Environmental Microbiology Laboratories

• 2020 - 3 PHE FW&E Laboratories; London, Porton and York

• 6 Out-posted Scientists (OPS) across the country aligned to the UKHSA (PHE) FW&E Microbiology Laboratories


UKHSA (PHE) Biosafety Team

Understanding Organisations within the UK June 2020; Remote Food Hygiene Inspections of Chilled Food Production and Supply to non-EU Countries


Planning for Pandemic - FluReflections on Regional Exercise 2005

• A number of organisations have developed their flu planning responses

• Pandemic Influenza Groups - actions taken away to consider hospital capacity, treatment centres and community care issue

• Mass vaccination centres have incorporated elements for generic planning

• Mass fatalities workstream has engaged with the coroners, including temporary mortuary provision

• Media and accessible information for the public is being considered

•(Swine flu followed in Spring 2009/2010)

2016 Environmental Deposition of Influenza Virus…; research suggested that individuals who release the most virus are likely to result in greater risk of environmental contamination, but quantifying this indirect pathway is challenging.

https://www.sciencedirect.com/science/article/pii/S1876034115001926


https://www.sciencedirect.com/science/article/pii/S1876034115001926

Covid-19 and Healthcare Environments

• Occupational exposure in healthcare settings have been associated with transmission of SARS-CoV from patients to healthcare workers

https://pubmed.ncbi.nlm.nih.gov/32298249/

• Nosocomial transmission may account for 20% of infections in inpatients

• The impact of testing and infection prevention and control strategies on within-hospital transmission dynamics of COVID-19 in English hospitals | medRxiv

• Some studies have detected little or no surface contamination in intensive care units but have detected wider contamination in general wards


• Question; could environmental sampling be used as a tool to assist COVID-19 investigations and incident management




Covid-19 and Environmental Sampling

• Environmental sampling for SARS-CoV-2 has been undertaken to (1) provide epidemiological evidence on the extent of outbreaks and (2) provide evidence on the hazard posed by contaminated surfaces, water and air.

• Main analytical methods to quantify – molecular methods (qPCR) and cell culture

• Molecular methods are generally swift, low cost and lower biosafety requirements

• qPCR can be useful in decision making on transmission risk – but critically it doesn’t detect the presence of infective virus

• Wastewater monitoring can be carried out to provide information on disease in a population

• Monitoring the presence of infection risk of SARS-CoV in the environment: approaches, limitations and interpretation Version 02/12/2020

• https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/945838/S0942_Environmental_Monitoring_of_Viral_Presence_final.pdf


Covid-19 and Environmental Sampling • Monitoring the presence of infection risk of SARS-CoV in the environment:

approaches, limitations and interpretation Version 02/12/2020


• A negative PCR sample may indicate

no infectious virus at the location and

time the sample was taken

• Positive PCR indicates the presence of

SARS-CoV-2 RNA

• Positive PCR doesn’t necessarily mean

infective virus is present

• A Ct value >35 indicates presence of SARS-CoV-2 RNA but probably not infectious virus

• A Ct value of about 25-34 may indicate possible presence of infectious virus.

• A Ct value <25 indicates possible presence of infectious virus if sample was taken from a

recently touched surface or close to infected people.

• However, it is possible to have Ct value <25 with no infectious virus

September 2020 Chilled Food ManufactureEast Midlands, England

• East Midlands; One of nine Regions in England

• Population of some 4,804,149 (population of New Zealand is 5,128,021)

• Area 6,034 sq miles (New Zealand is 103,488 sq miles)

• Mixed rural and urban areas with the county of Lincolnshire having the eastern seaboard coast

• East Midlands; Protected status for Melton Mowbray Pork Pies and Stilton Cheese etc etc

• Mixed industry and agriculture across the region, with many chilled ready-to-eat food manufacturers'


Summer 2020 Chilled Food ManufactureEast Midlands

• Summer 2020 – concerns about air handling units in large ready-to-eat food manufacturer

• Much of the air within the high care environment was recycled chilled air, some 90% (10% fresh air)

• This was adjusted with increased fresh air to some 20%,

• Challenges with the ability of the air handling units to chill down large volumes of ambient air to 3-12 ºC

• CIBSE (Chartered Institute of Building Services Engineers) COVID Ventilation Guidance Version 3

• https://www.cibse.org/coronavirus-covid-19/coronavirus,-sars-cov-2,-covid-19-and-hvac-systems


Summer 2020 Chilled Food Manufacture, East Midlands


What is a Building Management System (BMS)?



Summer 2020 Chilled Food ManufactureEast Midlands, England


What’s inside the metal box?



Summer 2020 Chilled Food Manufacture East Midlands


Overview of Swab Samples; Lincs site


Overview of Swab Samples; Lincs site


Summer 2020 Non-food Manufacture, East Midlands


Summer 2020 Non-food Manufacture, East Midlands


Environmental Sampling in COVID-19 Incidents; overview of session

• SARS-CoV-2 and Environmental investigations in healthcare environments; learning from research

• UKHSA (PHE) Food Water and Environmental Microbiology Laboratories –working with partners on testing

• Outbreak investigations in the East Midlands Region; multi-faceted team working

• Swabs, (accredited for bacterial targets) - useful for SARS-CoV-2 swabbing

• Swabbing as a potential investigative and management tool in chilled food and other environments


COVID-19 Recovery & Business as Usual? …….. Not Quite. Not Yet. Not at All?

• People

• Places

• Things and

• Stuff

• Impact of COVID-19 on UKHSA (PHE), our partners, the public, private sector and the NHS

• Impact of COVID-19 and lockdown on premises and the management of premises; eg food safety, food hygiene and water management issues

• Impact of the UK Exit from the EU

• Infectious disease challenges and the reconfigured UKHSA (PHE)


Thanks to Colleagues within UKHSA (PHE) and others on the COVID-19 response,

including UKHSA (PHE) Field Services, Health Protection Teams and othersLocal Authorities for the Public Health Response and field support by

Environmental Health teams and the Health and Safety ExecutiveSpecial thanks to UKHSA (PHE) Biosafety colleagues for the testing of

environmental samples Thanks to the UKHSA (PHE) Food, Water and Environmental Microbiology

Laboratories for support, management and logistics


Thank You


The UK Health Security Agency

Documents