APHL recently checked in with Drew Fayram, the safety officer at the State Hygienic Laboratory at the University of Iowa, to get his perspective on the progress of the CDC/APHL biosafety and biosecurity program. Initiated in 2016 with support from the Domestic Ebola Supplement to the Epidemiology and Laboratory Capacity for Infectious Diseases Cooperative Agreement, the program aims to strengthen biosafety and biosecurity practices at public health and clinical laboratories nationwide. The Centers for Disease Control and Prevention (CDC) and APHL are collaborating as partners in this initiative.
Tell us about laboratory biosafety and biosecurity risk management prior to the CDC/APHL program.
Prior to the CDC/APHL program, there was great variation in biosafety and biosecurity staffing at public health laboratories. Many labs had someone who worked on biosafety part-time in addition to other roles, while a few larger labs had several biosafety specialists and added another to conduct outreach to clinical laboratories when funding became available through the CDC/APHL program.
At Iowa, we had a safety officer who had other extensive management duties. After she retired, we hired another individual to oversee safety, security and building operations. In 2015 when we received funding from the CDC/APHL program, I assumed all of the biosafety roles at the Hygienic Lab, along with outreach to clinical labs. A year later, our Safety and Security Officer retired and I took on all safety duties, including but not limited to biosafety.
How has the CDC/APHL biosafety and biosecurity program benefited you as a laboratory safety officer?
The CDC/APHL program has benefited me professionally and personally. Historically, there was no formal entry point into the field of laboratory biosafety and biosecurity. As far as I know, no US colleges offer a major in biosafety. But now the field is becoming more standardized with common resources and language, which has made it easier to bring you up to speed on regulations and best practices. The CDC/APHL program has played a big role in this, along with other groups like the American Biological Safety Association International (ABSA).
For me, the CDC/APHL program has helped advance my skills and build professional connections through in-person training, online meetings and networking opportunities. Through the program, I have connected with staff from other public health labs, CDC, ABSA International, USAMRIID and the Eagleson Institute, as well as laboratory scientists from other countries. The connections with ABSA are particularly valuable, as people there have spent their careers helping scientists conduct laboratory science safely. Without the support of the CDC/APHL program, I would never have been able to meet so many people in such a short time and so early in my career, nor would I have received the quantity or quality of training made possible by the program.
Has the program led to improvements in biosafety and biosecurity practice at the State Hygienic Laboratory in Iowa?
The trainings offered through the CDC/APHL program have better prepared me to serve as a resource for staff to help identify tools and best practices in biosafety and biosecurity. As a matter of fact, I was a few minutes late to this interview because someone stopped me in the hall to ask a question about a biosafety issue. I believe my efforts to serve in this role encourage staff to remain more alert to biosafety and biosecurity considerations. It’s becoming part of our culture. I also work closely with our Safety Committee, which brings together staff from all areas of the lab to proactively address safety issues at our facility before they cause anyone potential harm.
How has the CDC/APHL program changed biosafety and biosecurity practices at clinical labs in Iowa?
Our lab has offered workshops on rule-out of bioterrorism agents to clinical labs in our state for many years, and we have always emphasized biosafety practices at these workshops. The CDC/APHL program has allowed us to offer additional workshops specifically focused on biosafety and biosecurity to train clinical labs on how to conduct a biosafety risk assessment to make sure that they are taking appropriate steps to mitigate risks associated with infectious agents. The assessment is theirs, not mine. I share an assessment template, but advise them to adjust it to meet their needs. The staff then conduct the assessment at their facility themselves.
For some staff, the assessment is a new experience. Many are familiar with quality risk assessment, but not biosafety risk assessment. But regardless of past experience, staff have successfully identified potential, actionable risks, such as biosafety cabinets that require replacement or procedures that should be performed inside a biosafety cabinet.
As a result of the assessments, I’ve started to see a change in attitude at clinical laboratories. Before, staff accepted risks because they recognized the importance of fast test results for ensuring the best patient outcome possible. They may have thought, “That extra step is going to slow me down, and our patients aren’t going to get their treatment as quickly.” Now through the CDC/APHL program, risk assessment is becoming a part of daily operations, and labs are finding ways to mitigate risk while still getting test results quickly.
What’s more, our relationship with these laboratories continues beyond the risk assessment. I usually get around one phone call and several emails each week from clinical laboratories asking biosafety-related questions. Many clinical labs now have staff who, as part of their regular duties, are paying additional attention to biosafety issues and engaging in conversations about best practices. I believe the consideration of biosafety issues in every day practice is an even more valuable outcome of the CDC/APHL program than putting a checkmark in a box on a risk assessment form.
If Congress does not reauthorize funding for the CDC/APHL biosafety and biosecurity program in 2018, how would this affect public health labs and their clinical laboratory partners?
If the program is not continued, we risk losing our investment in highly trained laboratory biosafety officers in public health labs. There is a tight market for this skill set. If federal funding does not continue to support these positions, many biosafety officers could be scooped up by universities and research centers, leaving the public health system without their expertise.
Likewise, clinical labs could lose training resources provided by biosafety officers, such as training on packaging and shipping infectious substances. Each clinical lab should have a minimum of two staff trained for this purpose, and frequent turnover at these labs means that new staff often must start from the beginning.
Unfortunately, we’re already experiencing some challenges. The number of packaging and shipping trainings offered by APHL contractor Dr. Pat Payne has been reduced, and we are on the waiting list to get her back. She is a true expert on this highly complex topic who keeps up on the latest IATA and DOT requirements, and other developments affecting shipping of hazardous agents. The reduction in trainings results from cuts to the cooperative agreement that supports APHL training.
In Iowa, our lab has made a commitment to continue the biosafety program regardless of federal funding. If need be, we may offer fewer workshops, develop fewer resources and contract for fewer third-party developed courses, but we will continue to serve as a resource for clinical labs in our state. However, I expect that many – if not most – public health labs may not have the capacity to make this kind of commitment.
What would you say to legislators who discounted the value of the CDC/APHL biosafety and biosecurity program?
I would say that the duty of the public health system is to protect the health of the public. This includes their constituents. The CDC/APHL biosafety/biosecurity program was initiated to address issues identified during the US response to domestic Ebola cases in 2014 and other biosafety mishaps that occurred in the United States around that same time. You’ll remember that several US health professionals contracted Ebola Virus Disease. They and their families, along with those who provided care for these patients, lived with the associated stigma. Some people were hesitant to be around them out of fear for their own safety. Some, like Nina Pham, the Vietnamese nurse who contracted Ebola from a patient, continue to battle ongoing health problems as well.
US laboratory scientists are exposed routinely to hazardous pathogens, and the risks associated with this work must not be ignored. The CDC/APHL program is crucial to ensuring the nation’s public health system responsibly and vigilantly safeguards the health of their laboratory staff and communities during future public health emergencies. We must continue to take steps to proactively mitigate risks to healthcare and public health laboratory professionals.