Facility-Associated Release of Polioviruses into Communities-Risks for the Posteradication Era.

The Global Polio Eradication Initiative continues to make progress toward the eradication target. Indigenous wild poliovirus (WPV) type 2 was last detected in 1999, WPV type 3 was last detected in 2012, and over the past 2 years WPV type 1 has been detected only in parts of 2 countries (Afghanistan and Pakistan). Once the eradication of poliomyelitis is achieved, infectious and potentially infectious poliovirus materials retained in laboratories, vaccine production sites, and other storage facilities will continue to pose a risk for poliovirus reintroduction into communities. The recent breach in containment of WPV type 2 in an inactivated poliovirus vaccine manufacturing site in the Netherlands prompted this review, which summarizes information on facility-associated release of polioviruses into communities reported over >8 decades. Successful polio eradication requires the management of poliovirus containment posteradication to prevent the consequences of the reestablishment of poliovirus transmission.

UK's initial operational response and specialist operational response to CBRN and HazMat incidents: a primer on decontamination protocols for healthcare professionals.

The UK is currently in the process of implementing a modified response to chemical, biological, radiological and nuclear and hazardous material incidents that combines an initial operational response with a revision of the existing specialist operational response for ambulant casualties. The process is based on scientific evidence and focuses on the needs of casualties rather than the availability of specialist resources such as personal protective equipment, detection and monitoring instruments and bespoke showering (mass casualty decontamination) facilities. Two main features of the revised process are: (1) the introduction of an emergency disrobe and dry decontamination step prior to the arrival of specialist resources and (2) a revised protocol for mass casualty (wet) decontamination that has the potential to double the throughput of casualties and improve the removal of contaminants from the skin surface. Optimised methods for performing dry and wet decontamination are presented that may be of relevance to hospitals, as well as first responders at the scene of a chemical incident.

Lessons Learned From Implementing an Incident Command System During a Local Multiagency Response to a Legionnaires' Disease Cluster in Sydney, NSW.

The incident command system (ICS) provides a common structure to control and coordinate an emergency response, regardless of scale or predicted impact. The lessons learned from the application of an ICS for large infectious disease outbreaks are documented. However, there is scant evidence on the application of an ICS to manage a local multiagency response to a disease cluster with environmental health risks. The Sydney Local Health District Public Health Unit (PHU) in New South Wales, Australia, was notified of 5 cases of Legionnaires' disease during 2 weeks in May 2016. This unusual incident triggered a multiagency investigation involving an ICS with staff from the PHU, 3 local councils, and the state health department to help prevent any further public health risk. The early and judicious use of ICS enabled a timely and effective response by supporting clear communication lines between the incident controller and field staff. The field team was key in preventing any ongoing public health risk through inspection, sampling, testing, and management of water systems identified to be at-risk for transmission of legionella. Good working relationships between partner agencies and trust in the technical proficiency of environmental health staff aided in the effective management of the response. (Disaster Med Public Health Preparedness. 2018;12:539-542).

Work incidents with biological material in the nursing team of a hospital in Mid-Western Brazil / Trabajar accidentes con material biológico en el personal de enfermería en un hospital de la región central de Brasil / Acidentes de trabalho com material biológico na equipe de enfermagem de um hospital do Centro-Oeste brasileiro

Abstract Objectives: To investigate and describe the occurrence and characteristics of Work Incidents (WI) with Potentially Contaminated Biological Material (PCBM), the frequency and variables related to this occurrence among nursing categories. Methods: A descriptive and cross-sectional study with a quantitative approach was performed at a referral hospital in the State of Mato Grosso, Mid-Western Brazil. Results: Women represented 90.5% of all participants and the mean age was 42.59 years. A total of 46.6% of professionals reported having undergone exposure to PCBM, 60.9% stated not having made a report, and 42.6% reported having participated in training courses on this subject. Comparing the occurrence of WI between nursing assistants and nurses, nursing assistants were more affected (p = 0.022). Conclusions: Among nursing professionals, the number of WI is high, recurrent and underreported. Continuing education on this theme is required to ensure the quality of care and promote workers' health.

Resumen Objetivos: Evaluar y describen la ocurrencia y características de los accidentes industriales (AT) potencialmente contaminados con material biológico (MBPC), la frecuencia y las variables relacionadas con la aparición de la categoría de enfermería. Método: Estudio descriptivo transversal, con abordaje cuantitativo, realizado en Hospital referencia en el Estado de Mato Grosso, Brasil. Resultados: Las mujeres representaban el 90,5% de los participantes; la edad media fue de 42,59 años. Un total de 46,6% de los encuestados reportó haber sufrido exposición a MBPC, y el 60,9% no había hecho la notificación, el 42,6% dijo que había participado en una formación sobre el tema. La comparación de la ocurrencia de AT entre los grupos de las enfermeras y auxiliares de enfermería, auxiliares fueron los más afectados (p = 0,022). Conclusión: En los profesionales de enfermería, el número de AT es elevado, recurrente y subnotificado. La educación permanente relacionada con la temática es necesaria para garantizar la calidad de la asistencia y promover la salud del trabajador.

Resumo Objetivos: Investigar e descrever a ocorrência e as características dos Acidentes de Trabalho (AT) com Material Biológico Potencialmente Contaminado (MBPC), a frequência e as variáveis relacionadas à ocorrência entre as categorias de enfermagem. Método: Estudo descritivo, transversal, de abordagem quantitativa, realizado em um hospital referência no estado de Mato Grosso, Brasil. Resultados: As mulheres representaram 90,5% dos participantes e a média de idade foi de 42,59 anos. Um total de 46,6% dos profissionais relatou já ter sofrido exposição a MBPC, e 60,9% referiram não ter realizado a notificação e 42,6% afirmaram terem participado de treinamentos sobre a temática. Na comparação entre a ocorrência de AT entre os grupos de enfermeiros e auxiliares de enfermagem, os auxiliares foram mais acometidos (p = 0,022). Conclusão: Nos profissionais de enfermagem, o número de AT é elevado, recorrente e subnotificado. A educação permanente relacionada à temática é necessária para garantir a qualidade da assistência e promover a saúde do trabalhador.

Analysis of multiple tank car releases in train accidents.

There are annually over two million carloads of hazardous materials transported by rail in the United States. The American railroads use large blocks of tank cars to transport petroleum crude oil and other flammable liquids from production to consumption sites. Being different from roadway transport of hazardous materials, a train accident can potentially result in the derailment and release of multiple tank cars, which may result in significant consequences. The prior literature predominantly assumes that the occurrence of multiple tank car releases in a train accident is a series of independent Bernoulli processes, and thus uses the binomial distribution to estimate the total number of tank car releases given the number of tank cars derailing or damaged. This paper shows that the traditional binomial model can incorrectly estimate multiple tank car release probability by magnitudes in certain circumstances, thereby significantly affecting railroad safety and risk analysis. To bridge this knowledge gap, this paper proposes a novel, alternative Correlated Binomial (CB) model that accounts for the possible correlations of multiple tank car releases in the same train. We test three distinct correlation structures in the CB model, and find that they all outperform the conventional binomial model based on empirical tank car accident data. The analysis shows that considering tank car release correlations would result in a significantly improved fit of the empirical data than otherwise. Consequently, it is prudent to consider alternative modeling techniques when analyzing the probability of multiple tank car releases in railroad accidents.

[Incidence of biological accidents at work and immune status for vaccine-preventable diseases among resident physicians in specialist training at Ferrara University Hospital]. / Studio di incidenza sugli infortuni biologici nei medici in formazione specialistica dell'Azienda Ospedaliero - Universitaria di Ferrara e stato immunitario nei confronti delle principali infezioni prevenibili.

The hospital as a work environment is particularly characterized by various risks for healthcare workers (HCWs). The main risk is represented by biological accidents, associated with the parenteral transmission of pathogens. Biological injuries can occur during the care service and the manipulation of biological fluids. Hepatitis B (and hepatitis D), hepatitis C and HIV are the most common infections transmitted by biological injuries. Physicians should acquire awareness of the risks associated with their professional activity during their training as medical residents (MRs). Some infectious diseases are preventable by vaccination and the "National Immunization Plan 2017-2019" (PNPV) recommends HCWs vaccination against hepatitis B, influenza, measles -mumps -rubella, chicken pox, and pertussis. Besides, not only HCWs' vaccination can prevent the disease in healthcare professionals, but it also may reduce the transmission to patients. Therefore, active immunization of HCWs by recommended vaccinations plays an important role to prevent disease cases, complications and death in patients. An increased awareness of risk behaviors is the first important point to address in order to reduce biological accidents and infectious diseases transmission, so as to reduce their frequency. Besides, HCWs' vaccination is useful to reinforce protection and to prevent the transmission of some infectious diseases in case of exposure. The aim of this five-year incidence study is to investigate the MRs' biological accidents characteristics and to analyze the MRs' immune status at the University of Ferrara in the period 2011-2015. Data on MRs' biological accidents and immune status at Azienda Ospedaliero-Universitaria of Ferrara in 2011-2015 were analyzed by Microsoft Excel 2007 Software. In this study, the percentage of MRs' biological injuries compared to the total number of MRs showed an annual variability, with a peak in 2011 (11.9%). During the analyzed period, there were 190 biological injuries among the MRs: 81% were percutaneous injuries and blood was the biological fluid involved in 86.3% of cases. The most frequent lesion was puncture (62.6%), occurred in 41.1% of cases by suture needles; 46.3% of accidents occurred in the operating block. These data can be explained by the more invasive and at risk activities carried out in these Operative Units. The high injuries percentage in MRs may be related to less work experience and inadequate training or informations about personal protective equipment use. Among MRs, 93.7%, 93.3% and 96.6% were immune to measles, chicken pox and hepatitis B, respectively; only in the case of rubella, 11.9% of MRs was not immune. This research showed, accordingly to published data, high adhesion to hepatitis B vaccination. However, the healthcare workers' vaccine coverage is still sub-optimal; active immunization by recommended vaccines should be implemented for both parenteral and airborne diseases. As a matter of fact, the recent measles outbreak has involved healthcare workers (4689 cases of measles, 305 in HCWs). Finally, the General Directorates of Health-care settings should improve healthcare personnel adhesion to vaccinations, such as influenza, by promotion activities in the workplace. A proposal in order to achieve coverage objectives could be making vaccinations mandatory, as well as already implemented in other countries.

Evaluación de la percepción de riesgo en el personal de enfermeraí en la atención de pacientes sospechosos de riesgo biológico IV / Evaluation of the perception of risk in the nursing staff in care of patients with suspected biological hazard

Introducción. El personal sanitario es una población especialmente vulnerable a los riesgos derivados del ejercicio de su profesión. La complejidad que tiene la atención de los pacientes con virus Ébola lleva al estudio de la percepción de riesgo de este colectivo. Objetivo. Conocer la percepción de riesgo en el personal de enfermería que atendió a los pacientes con sospecha de Fiebre Hemorrágica Virus Ébola (FHVE). Material y métodos. Estudio transversal realizado en el Hospital Clínic de Barcelona. Se incluyeron 19 profesionales de enfermería que atendieron directamente a pacientes con sospecha de FHVE. Los datos se recogieron mediante un cuestionario de evaluación dimensional del riesgo percibido junto a variables sociodemográficas y un posterior análisis estadístico. Resultados. Un 68 % del personal de enfermería refirió tener un nivel de conocimiento elevado del riesgo asociado al factor de estudio. Un 42 % determinó que había una posibilidad muy alta de experimentar un daño. Un 63 % apreció que las consecuencias más nocivas se experimentarían a corto plazo y, finalmente, un 48 % valoró que había un riesgo muy alto de accidente o enfermedad asociado al factor de estudio, frente a un 5 % que lo valoró muy bajo. Conclusiones. Las respuestas obtenidas ponían de manifiesto que los profesionales de enfermería poseían un nivel de conocimiento muy alto sobre el riesgo asociado al factor de estudio, y que el temor emocional era también muy elevado (AU)

Introduction. Healthcare personnel is especially vulnerable to the risks derived from their job. The complexity that has the care of patients with Ebola justifies the study of the perception of risk of such professionals. Objective. To know the perception of risk in the nursing staff that takes care of patients suspected of suffering the Ebola virus. Material and methods. Transversal study carried out in the Hospital Clínic of Barcelona. 19 professionals of nursing staff that attended suspected Ebola patients were included in the study. The data was collected through a questionnaire of dimensional evaluation of the perceived risk along with sociodemographic variables and a subsequent statistics analysis. Results. A percentage of 68 % of the nursing staff refereed having a high level of knowledge of the risk associated with the factor of this study. A percentage of 42 % determined that there was a very high possibility of being harmed. A percentage of 63 % considered that the most harmful consequences would appear in short term, and finally a percentage of 48 % considered that there was a very high risk of accident or illness associated to the factor of this study, whereas a percentage of 5 % considered the risk to be very low. Conclusions. The answers obtained showed not only that nursing staff had a very high level of knowledge regarding the risk associated to the factor of this study, but also that the emotional fear was very high (AU)

Epidemiology of Emergency Medical Services-Assessed Mass Casualty Incidents according to Causes.

To effectively mitigate and reduce the burden of mass casualty incidents (MCIs), preparedness measures should be based on MCIs' epidemiological characteristics. This study aimed to describe the epidemiological characteristics and outcomes of emergency medical services (EMS)-assessed MCIs from multiple areas according to cause. Therefore, we extracted the records of all MCIs that involved ≥ 6 patients from an EMS database. All patients involved in EMS-assessed MCIs from six areas were eligible for this study, and their prehospital and hospital records were reviewed for a 1-year period. The EMS-assessed MCIs were categorized as being caused by fire accidents (FAs), road traffic accidents (RTAs), chemical and biological agents (CBs), and other mechanical causes (MECHs). A total of 362 EMS-assessed MCIs were identified, with a crude incidence rate of 0.6-5.0/100,000 population. Among these MCIs, 322 were caused by RTAs. The MCIs involved 2,578 patients, and 54.3% of these patients were women. We observed that the most common mechanism of injury varied according to MCI cause, and that a higher number of patients per incident was associated with a longer prehospital time. The highest hospital admission rate was observed for CBs (16 patients, 55.2%), and most patients in RTAs and MECHs experienced non-severe injuries. The total number of deaths was 32 (1.2%). An EMS-assessed MCI database was established using the EMS database and medical records review. Our findings indicate that RTA MCIs create a burden on EMS and emergency department resources, although CB MCIs create a burden on hospitals' resources.

Epidemiology of Emergency Medical Services-Assessed Mass Casualty Incidents according to Causes

To effectively mitigate and reduce the burden of mass casualty incidents (MCIs), preparedness measures should be based on MCIs' epidemiological characteristics. This study aimed to describe the epidemiological characteristics and outcomes of emergency medical services (EMS)-assessed MCIs from multiple areas according to cause. Therefore, we extracted the records of all MCIs that involved > or = 6 patients from an EMS database. All patients involved in EMS-assessed MCIs from six areas were eligible for this study, and their prehospital and hospital records were reviewed for a 1-year period. The EMS-assessed MCIs were categorized as being caused by fire accidents (FAs), road traffic accidents (RTAs), chemical and biological agents (CBs), and other mechanical causes (MECHs). A total of 362 EMS-assessed MCIs were identified, with a crude incidence rate of 0.6-5.0/100,000 population. Among these MCIs, 322 were caused by RTAs. The MCIs involved 2,578 patients, and 54.3% of these patients were women. We observed that the most common mechanism of injury varied according to MCI cause, and that a higher number of patients per incident was associated with a longer prehospital time. The highest hospital admission rate was observed for CBs (16 patients, 55.2%), and most patients in RTAs and MECHs experienced non-severe injuries. The total number of deaths was 32 (1.2%). An EMS-assessed MCI database was established using the EMS database and medical records review. Our findings indicate that RTA MCIs create a burden on EMS and emergency department resources, although CB MCIs create a burden on hospitals' resources.

Analisis descriptivo de los accidentes biologicos registrados en la Mutua de Accidentes de Trabajo / Descriptive analysis of biological accidentes in mutal work accident

Hay varias profesiones, como jardinería, policía, limpieza, bomberos, trabajadores sociales y especialmente el personal sanitario, que presentan un elevado riesgo de padecer accidentes biológicos en su trabajo. Es por ello, que se realiza un análisis descriptivo de los accidentes biológicos registrados en la mutua de accidentes de trabajo (MCMutual Copérnico) de Barcelona desde el 1 de enero al 31 de diciembre de 2013. Durante este período de tiempo se han registrado 364 nuevos casos de accidentes biológicos, de los cuales se dieron en un 90% en personal sanitario, y de ellos un 61,8% en enfermería. La mayor accidentalidad se produjo por pinchazos con agujas (81,8%). En cuanto al sexo afectado, éste fue mayoritariamente el femenino en un 83,5% de los casos. La zona del cuerpo donde ocurren los accidentes en su mayoría corresponde a las manos (91,2%). Se observa asimismo que la serología de la fuente que predomina en los casos es desconocida (45,8%). Se deduce de todo ello que sería necesario mejorar y aumentar las medidas de carácter preventivo, para la disminución de los accidentes biológicos que pudieran ser evitables (AU)

The are professions, such gardening, police, cleaning, fire, social workers and specially health care workers, who are at high risk of biological accidents in their occupational tasks. It is therefore, a descriptive analysis of biological accidents in mutual work accident (MC- Mutual Copérnico) of Barcelona from January 1 to December 31, 2013 is performed. During this period there have been 364 new cases of biological accidents, which occurred in 90% of healthcare workers, of whom 61.8% in nursing. Most accidents occurred needle stick (81.8%). Regarding the affected sex, this was mostly female (83.5%) cases. The area of body where the accidents occur mostly correspond to the hands (91.2%). It also notes that the serology of the source that dominates cases is unknown (45.8%). It follows from this that would be necessary to improve and increase preventive measures for the reduction of biological accidents that could be avoidable (AU)

Accidentes biológicos en trabajadores de un área sanitaria del Servicio Gallego de Salud / Biological exposure-related injuries in workers in a health system of the health service of Galicia, Spain

Objetivo: El objetivo principal del presente estudio es describir los factores relacionados con los accidentes biológicos en trabajadores de un área de salud. Método: El estudio fue realizado en un área sanitaria del Servicio Gallego de Salud que incluye cuatro centros hospitalarios y 72 centros de atención primaria, con una población en torno a los 6000 trabajadores. Se han utilizado los datos disponibles en el sistema de registro de accidentes laborales ocurridos en centros sanitarios del Servicio Gallego de Salud para el año 2011. Se identificaron 194 accidentes con riesgo biológico. Se describe el tipo de exposición, lugar del accidente, objetos materiales, tareas relacionadas con el accidente y sus causas. Resultados: La mayoría de los accidentes con riesgo biológico se producen por pinchazos (82%). Las áreas donde se producen más accidentes son hospitalización (37%) y quirófano (25%). Los dispositivos más frecuentemente implicados son las agujas de sutura (15%) y las de insulina (15%). Las causas principales registradas son la falta de formación e información y de mecanismos de bioseguridad. Conclusiones: Se debe potenciar la formación e información a los trabajadores junto con la implantación de mecanismos de bioseguridad, ya que esta última medida por sí sola no parece suficiente para reducir el número de accidentes (AU)

Objective: The objective of this study was to describe the factors involved in biological exposure-related injuries occurring in workers from a health system in Galicia, Spain. Methods: The study was conducted in a health system of the Health Service of Galicia, that included four hospitals and 72 primary care centers, with nearly 6000 workers. The study used occupational injury data available o in the injury registry of the Health Service of Galicia for the year 2011. We identified 194 biohazard-related injuries. Exposures, locations, devices, tasks and causes of these incidents were analysed. Results: The majority of biological exposures occurred through needlestick injuries (82%). The areas where more injuries occurred were in inpatient wards (37%) and operating rooms (25%). The devices most frequently involved were suture needles (15%) and insulin needles (15%). The most frequently recorded causes were lack of training and information, together with lack of biosafety devices. Conclusions: Worker training and information should be promoted along with the implementation of biosafety devices, as the latter measure alone does not seem sufficient to reduce the number of injuries (AU)

Reaerosolization of Bacillus spp. in outdoor environments: a review of the experimental literature.

Reaerosolization or resuspension-that is, the reintroduction of previously airborne particles into the atmosphere-is a complex phenomenon. Microbial reaerosolization is particularly poorly understood because few studies have been done in this area, and many of the studies that have been performed are not in the peer-reviewed literature. The reaerosolization of Bacillus anthracis in outdoor environments is of particular concern because of its stability and potential for use as a biological weapon. This review pulls together data from more than 30 publications, spanning field and laboratory experiments, to summarize the current state of our understanding of Bacillus spp. reaerosolization in outdoor environments.

Accidentes biológicos: estudio descriptivo de los trabajadores accidentados (junio de 2005-marzo 2009) en seguimiento por Asepeyo Madrid (AU) / Biological accidents: a descriptive study of workers who suffered accidents between june 2005 and march 2009 in Asepeyo, Madrid

La exposición laboral a agentes biológicos afecta a una gran variedad de actividades y ocupaciones, siendo los trabajadores del sector sanitario uno de los colectivos laborales más expuestos a este tipo de riesgo. Los virus de la hepatitis B (VHB), el virus de la inmunodeficiencia humana (VIH) y el virus de la hepatitis C (VHC) son agentes patógenos frecuentemente implicados en este tipo de accidentes. Es sabido que el método más efectivo para prevenir estas infecciones es un buen cumplimiento de la práctica de precauciones estándar para evitar accidentes. Si el accidente se produce, es importante el análisis de las circunstancias que llevaron al mismo para evitar que se repita. En este contexto hemos realizado un estudio descriptivo de las características de los trabajadores accidentados con riesgo de infección por VHB, VHC y VIH y las circunstancias que rodearon al accidente (AU)

Occupational exposure to biological agents is common to a great variety of professional activities. Sanitation workers are among the most exposed to this kind of risk. Hepatitis B virus (HBV), human immunodeficiency virus (HIV) and hepatitis C virus (HCV) are pathogen agents frecuently linked to this kind of accidents. It is well known that the most effective method to prevent this kind of infections involves following standard precautoniary measures. In case of accidents, it is important to analyze the circumstances surronding such events, so that new episodes can be prevented. In this framework we have conducted a descriptive study of the characteristics of the workers that suffered HBV, HCV and HIV inffections, as well as the circumstances surronding those accidents (AU)

Gestión del riesgo biológico y su integración con la Seguridad y Salud del Trabajo en el Centro de Inmunología y Biopreparados de Cuba / Biohazard management and its integration into Labor Health at the Immunology and Bioproducts Centre in Cuba

La evaluación de riesgos es útil para planificar y mejorar la Seguridad Biológica, el control de la calidad y la Seguridad y Salud en el Trabajo, considerando el marco legal vigente en Cuba y la inspección constituye una parte importante de estos procesos. Con el objetivo de identificar y evaluar el riesgo biológico en el Centro de Inmunología y Biopreparados se realizó esta investigación. La misma incluyó la identificación del riesgo biológico en tres áreas, la evolución de inspecciones de Seguridad Biológica y las medidas correctivas recomendadas. Los resultados permitieron diseñar e implementar el Reglamento de Seguridad en el se integraron las funciones de Seguridad Biológica y Seguridad y Salud en el Trabajo (AU)

Risk assessments are useful to plan and improve biological safety, quality control and in general health and safety at work, taking into account the legal framework in Cuba. Supervision is an important part of these processes. Research was done in order to identify and to evaluate the biohazard in the Immunology and Bioproducts Centre (CIBHO). It included the identification and risk assessment in three areas, the biological safety supervisions and its evolution and the corrective measures recommended. The results allowed to design and to implement a Safety Regulation which includes measures for biological safety and health and safety at work (AU)