Operations: Emergency Response and Contingency Plans

Transcript

Date of session: 09/24/2024

Facilitator

Aufra C. Araujo, PhD

Centers for Disease Control and Prevention

DLSbiosafety@cdc.gov

Didactic Speakers

Benjamin Fontes, MPH, CBSP

Yale Environmental Health & Safety

benjamin.fontes@yale.edu

Aufra Araujo: Hello, good afternoon, good morning, and good evening, everyone. My name is Aufra Araujo, and I want to extend a warm welcome from the Centers for Disease Control and Prevention in Atlanta, Georgia. I am the CDC ECHO Biosafety Program Lead and the Acting Safety Team Lead in CDC's Division of Laboratory Systems.

Thank you for joining our eighth Extension for Community Healthcare Outcomes or ECHO Biosafety session for 2024. The topic for this interactive discussion is Operations: Emergency Response and Contingency Plans. Today's subject matter expert is Benjamin, or Ben, Fontes from Yale Environmental Health & Safety in New Haven, Connecticut. Let me for a moment to stop sharing these slides. And you know now is the moment when I'd like to invite you to turn on your cameras if you can.

And we have a quick icebreaker question: With the arrival of autumn, what are you most looking forward to in the next few months? So let's see. I will just randomly pick somebody, and then that person can randomly pick somebody else to respond. And feel free to enter your response in the chat as well. I see Marissa Painter. I hope I'm saying your name correctly. Would you like to unmute and share? What are you up to during the fall season?

Marissa Painter: Oh, nothing much. The thing I look forward to the most is probably any day below 60% humidity.

Aufra Araujo: Yes, hopefully, you'll get there during fall. Who would you like to ask the same question, Marissa? Are you going to pick somebody randomly from the list?

Marissa Painter: Let's see. How about Veronica Martins?

Veronica Martins: Let's see. That it doesn't rain too much. It gets too wet during the fall, so but at least in my area. It is good for the environment and all, but and we had a really bad summer. I just don't like driving with rain. I prefer to drive with snow, believe it or not. But that's it.

Aufra Araujo: But what are you going to do with all the rain? What are you planning to do during fall?

Veronica Martins: Will still work. I will still have to drive to work, so and no escape.

Aufra Araujo: I mean, for fun, Veronica. I like that. I still have to go to work.

Veronica Martins: Well, there's just one picture on, so I'll go with Benjamin Fontes.

Benjamin Fontes: I saw someone's response regarding the fire pit coal like warming up the fire pit outside on a cold evening or a start to the beginning of fall. I also enjoy that. So I wanted to echo the cozy evenings around the fire pit from Carisa Keeling. So thank you for putting that up.

Aufra Araujo: Awesome. You want to pick somebody to respond, Ben?

Benjamin Fontes: Kalpana if she's on the call.

Aufra Araujo: Kalpana, would you like to respond? What do you plan on doing during fall?

Benjamin Fontes: I'll go to Jessica then as my backup.

Jessica Avizinis: Am I truly the only one? Hello?

Aufra Araujo: Hello. We can hear you, Jessica.

Benjamin Fontes: We can hear you.

Jessica Avizinis: Okay, I'm just surprised. I'm normally, like one of 20. What am I doing during fall? I think, for me, the biggest excitement is Halloween for my kids and I - dressing up, candy.

Aufra Araujo: Love that. Would you like to call out on somebody else—

Jessica Avizinis: Sure.

Aufra Araujo: our next person?

Jessica Avizinis: How about Mary-Luise? Marie-Luise, sorry.

Marie-Luise Faber: Hi, everyone. I don't know. Fall is my favorite season, so everything that was mentioned, long walks. We have our big troop camping trip coming up beginning of October. So anything to be outdoors.

Aufra Araujo: Yeah, I love that. Thank you so much, everyone, for turning on the camera. I love to see everybody. That's really nice. And I can sympathize. Somebody wrote here we have a barn. No. That one is fun, the fire pit near the barn. But I was sympathizing with somebody who wrote no allergies, no bugs, lower humidity. I get you. I feel the same way.

Jessica Avizinis: Me, too.

Aufra Araujo: Thanks, everybody. So nice to see you all. And please, feel free to keep the camera on, or turn on the camera during the discussion, whatever feels comfortable to you. Let me go back to sharing this slide. Just a second. Not yet.

Jessica Avizinis: I can see them.

Aufra Araujo: But not in the presentation mode.

Jessica Avizinis: Oh, I see.

Aufra Araujo: There we go. Yes. All right. It's just a little delay here on my end, I guess. All right. So sharing these slides. Thank you all for participating in the icebreaker. Now, I'd like to provide a brief recap from last month's ECHO session which was in August. It featured Esmeralda Meyer who presented on Operations: Planning and Maintaining.

Esmeralda's discussion focused on ISO 35001 and highlighted the distinction between the planning and operational phase of biorisk management. She emphasized the importance of asking key questions during both phases, along with conducting risk assessments, allocating resources, developing SOPs, and training staff. Additionally, she stressed the need for awareness, preparedness for emerging threats, and competencies for personnel handling biological materials.

The box on this slide shows a poll question from the session and the response for where ECHO participants were in the implementation of biorisk management at their institution. You can read the summary there. We had 145 participants attending the session who were affiliated with 88 organizations. The map on the right shows where these participants are located. The states shaded in green had participants from at least one organization.

Also, in attendance were participants from 12 national organizations and organizations located in Belize in Canada. We encourage you to share information about our ECHO Biosafety sessions with your colleagues and to connect amongst yourselves via chat if you'd like. Yes, help us share the word about ECHO Biosafety. Before we continue, I'd like to address some technical aspects of our ECHO Biosafety sessions.

Please use the video capabilities of your device for this session. Currently, all audience microphones are muted. When engaging the discussion, please unmute yourself to speak. Closed captioning is provided through Zoom for this session. If you are experiencing technical difficulties during the session, please send a private chat message to George Xiang who is labeled as CDC ECHO Tech. George will do his best to respond to your issue.

If you are connecting to Zoom by phone only at the time of discussion, please introduce yourself by stating your name and institution before speaking. We encourage your active participation by sharing your knowledge and experience. Each laboratory is unique and your skill sets are unique, so your contributions to the discussion are valuable.

Here is a brief overview of today's session. I introduce our subject matter expert, Ben Fontes, who will provide a didactic presentation and real case discussion. Then my colleague, Dr. Mary Casey-Moore, will summarize today's discussion. Closing comments and reminders will follow, and we will adjourn this session. Today's session is being recorded. If you prefer not to be recorded, please disconnect now. The transcript, audio recording, presentation slides, and other resources will be posted on the DLS ECHO Biosafety website a few weeks after today's session.

I'd like to remind everyone that these slides contain presentation material from speakers who are not affiliated with CDC. Presentation content from external speakers may not necessarily reflect CDC's official position.

With that, now it is my pleasure to introduce today's presenter. Ben Fontes has been a Certified Biological Safety Professional since January 1998 and is an active member of the American Biological Safety Association, ABSA, International. He served as ABSA President, Councilor, and Chair of their past Training and Education Committee. Ben has also served on the Board of the International Federation of Biosafety Association, IFBA, serving three years as Board Chair.

He has been one of the technical experts from IFBA on ISO Technical Committee 212's Working Group 5 Drafting Team for ISO 35001, its companion guide, and a new ISO Biosafety Technical Specification. He currently serves as Senior Associate Director and Biosafety Officer at Yale Environmental Health & Safety. It is my pleasure to have Ben presenting for us today. Ben, the floor is yours.

Benjamin Fontes: Thank you, Aufra.

Aufra Araujo: I'll stop sharing so you can share your slides.

Benjamin Fontes: Thank you, Aufra. Thank you so much for the invitation. And thank all of you who have willingly showed up for the presentation. I really appreciate your time. And this is I've learned about ECHO. I was very excited to make this ECHO presentation. And it's everybody teaches, everybody learns. So you all have a breadth of knowledge and experiences. Feel free to put your experiences in the chat and share with others or raise your hand if you'd like to share something.

We are all doing basically the same things. But as was mentioned previously, I was on the drafting team for ISO 35001, Biorisk Management for Laboratories and Other Related Organizations. And I've been asked to talk about emergency response and contingency plans. Now, these are some of the shortest sections in ISO 35001. But bringing it to life is what you're tasked to do, as we are here at Yale University. And so some of the things that you should have in place.

And if you don't, work with others at your institution to develop written plans that cover both emergency response and contingency planning at your institution. It takes a village to do this. You need a team of experts not only from within your institution. You can look at other sections within EHS. Everyone is writing emergency response plans. And it's much easier to edit another plan from another group, let's say, radiation safety or chemical safety than to start de novo if you haven't had any plans at all.

And always ask-- I learned this from Jim Welch-- always ask who else should be at the table when you're sitting down to write your plans. Because you really want to encompass the feedback from as many people as you can within your organization and from outside your organization. As many of you who work with select agents know, you have to do a threats risk and vulnerabilities assessment and make sure that all possible and credible incidents are evaluated.

Now, you don't have to have select agents to write emergency response plans. They should be part of any biohazard response plan at that point. Once you identify the issues, you have to come up with response scenarios and response solutions. And that's what we'll be talking about here today.

Now, the first sentence under this section is that you have to establish, implement, practice, and maintain emergency response and contingency plans and procedures. And as we mentioned, they have to be written. They have to be documented. People need to know where they are, what they say, and what they're supposed to do. And the best way to make sure people are aware is that all relevant individuals associated with the plan should have input into its development and also be trained on those plans.

And then we'll be talking about exercises as well on how to practice your plan and learn from your plan at that point. And as new information comes in, whether it be regulatory-based, whether you learn from your exercises, that information or new risk assessment information on a pathogen should be incorporated back into your plan.

This is a brainstorming session with individuals from our institution, from Environmental Health and Safety, and other departments within the University, in addition to our partners from the city of New Haven. And this is discussing what we would do in the event or the impact of a hurricane coming. We heard that there was going to be a considerable number of hurricanes, maybe up to 20 this season.

So we wanted to make sure we got all of our partners together, people from our power plants, facilities, custodial, animal care, human subjects, and research. We wanted a Connecticut agricultural experimental station. They have similar laboratories. We wanted other colleagues who might have been through this before-- fire department, police, other emergency response groups. The Yale New Haven Hospital sent some individuals. It was really important to get all of these minds together to talk about all of the different aspects.

And we did identify quite a few things that we were either unaware of or things we needed to focus on in the event of a Category 2, 3, or higher hurricane that could hit New Haven. So this is what I mean about who else should be at the table. And we do ask everyone else who else should we invite to the next drill to improve upon those as well. So this is an example of that village in action so to speak.

Some simple messages-- be ready, game-ready as they say. And as we train fellow biosafety officers, we always remind them, and also researchers, the response to the emergency begins before the emergency occurs. And that's where the planning and implementation come through so that when an emergency happens, you're not trying to figure out and determine how to respond. Everyone should have an idea of what the response is going to be.

I can tell you that when you get into the room or you get into the actual emergency, it's hard to, in advance, identify exactly what you're going to see. Equipment changes, materials change, people change the way they work sometimes, things fall, things get dropped. You don't know. But what you can be ready for is how to identify where the risk are, how to perform a decontamination, how to restore the laboratory to normal operation. So a lot of that begins with communication with the individuals who are involved in the incident.

And another Jim Welch comment that I wanted to bring out is start with the end in mind. So if you have a horrible incident or a terrible incident, what is the best possible resolution? What needs to occur? What should occur? What do you want to occur? And then work backwards from that. And then work your way back to that perfect response or the best possible response you can envision for your institution.

So covering all aspects of the organization's biorisks, including safety, security, medical issues, and environmental emergencies. And it's hard to put your arms around this. It's something that you have to do you. With this group of experts, with this group of individuals and stakeholders, with the researchers, with the people doing the work, with all of the support groups, with your local partners, you have to identify all of the possible things that could happen. And the list can get very long, very fast.

So sometimes you can group things. Spills are always going to have a similar type of response. Exposures are going to have a similar type of response. Biosecurity events will have a similar type of response in terms of who's notified and how they're going to assist at the start and who else needs to be notified in certain events. So you can actually have certain categories and columns. And using the drills and exercises really shows you what can happen, especially if there are poor work practices and non-conformity.

And they're really teaching moments for the people involved, especially when they see the ramifications of the response. Like you can have a suspicious person, and think it might just be a, "Oh, this should only take about a half an hour to deal with." But when you deal with the officials, the professionals who are tasked for responding to these types of events, you can see that some of these things will be significant in its response when life safety comes first as well.

Now, one of the things we do here is make sure that everybody at the table knows when we're dealing with biohazards. There are multiple ways that biohazard can escape the facility, and we look at through the ventilation system or the air if you don't have HEPA filters, or if the HEPA filters leak or there's a spill, through the waste if the waste is untreated. There have been some very famous incidents around the world with foot and mouth disease where biohazards haven't been treated before disposal.

Items that are not disinfected or decontaminated. That's something we're really working with our researchers on in making sure that they're performing the appropriate cleaning and disinfection and treatment of their waste against spills and releases outside of primary containment devices. Spills during transport where moving between labs. In the infected hosts. Researchers have to be aware of the signs and symptoms of disease that they're working with and ensure that they're reporting these promptly so they can quarantine at home until further notice from healthcare professionals.

And of course, from a biosecurity standpoint, inventories are critical in making sure that you are aware of where all of the biohazards are and that they haven't been tampered with because they can be purposefully removed for untoward events. And then it's with these six sort of blocks, we look at all of the possible things that could occur around there and then develop plans to address any of those issues that have been identified if they were to occur. So we found this to be a good sort of mechanism for identifying the plans.

Now, at this point, because it's ECHO and it's like you teach and you learn at the same time if anybody has any other mechanisms that they use to gather information on incidents, please put that in the chat. It'll be monitored and we'll even get a chance to read them out or give you a chance to talk about how some of those incidents have been identified and how you've addressed emergency response planning for them as well.

So and, I mean, I don't have to really stop, but I'll be notified when there's sufficient information in the chat to share that point. And I do have a time period here I'm working with as well.

So the organization shall ensure provision of timely and appropriate medical care for work-related illness and injuries and prepping the implementation. And we're fortunate here. We have a health system and a health care group that actually provides occupational health and employee health services. So we do have that 24/7 365 access to health care for our researchers. And we do have partners at our local hospital at that point.

But if you don't have this, there are companies that provide these services. You can partner with other healthcare facilities and clinics. But arrangements do need to be put in place. And again, the response to the emergency starts beforehand. Individuals should be cleared so that they can safely work with biohazards, and that starts with a private medical consultation. Some of the regulations, some of the older ones still require a baseline serum sample. So look into that if that is applicable in your area.

Our state is highly regulated for biohazards-- our little state of Connecticut. Immunizations. If there's required immunizations, that becomes important. Not all emergency responders who might show up might not be immunized for the pathogens that are in the room. And that's something that needs to be discussed. Will you have an emergency waiver for allowing people in with additional personal protective equipment? So that's something to discuss in your emergency response planning.

And again, for about the last 20, 25 years when we look at laboratory-associated infections and laboratory-acquired infections, it pains me as a biosafety professional to see that the individuals identifying the laboratory-acquired infections are the emergency room physicians or health care providers at a local hospital, as opposed to the individual themselves.

An individual working with a biohazard, their PI, the biosafety group there, the employee health group, should all be constantly reviewing the signs and symptoms of infectious disease so that if an infection does occur, you're the one self-quarantining at home, you're the one reporting it, you're the one notifying the local health department, the state, and if possibly the CDC. It shouldn't be up to the local emergency department to identify that you're infected with what you're working with. And that's a message that needs to go to all researchers handling biohazards.

And then everybody needs to know the post-exposure response procedures. And you have to really do everything you can. Researchers minds are engaged with discovering a cure to the disease or ailment they're working on or trying to solve a puzzle that might never be solved in their lifetime. So they're always constantly thinking and engaging in other things. So really keep it first and foremost, what to do in the event of an exposure, spill, or another incident.

And we'll talk about some of the things you can do to keep that in the forefront as well. And then don't forget about people. People need to know if their health status changes to contact. But you also should periodically be reviewing their health status or private medical meetings with groups, especially those working with higher-risk material.

And then ensuring appropriate coordination with external emergency response groups. Well, it showed you that in our first picture of the hurricane drill where we had our local and regional emergency response groups were present there. But certainly, your police, your fire, your security, facilities operations, business continuity, public affairs, other health officials should be present.

And you could invite them. If they can't make it, they can send a designee. But make sure you follow up with the drill that was conducted and also the findings and lessons learned. And provide all the documents to the people who even don't show up. And it's a good placeholder for them so they can learn as well, even if they didn't attend. I think it's really important with those other groups to make sure they know where your facility is. So that's why a combination of live drills with mock materials but on-site in combination with the tabletop exercises.

So the last thing you want is a call goes out, and then individuals really, they might be able to find the building, but they have no idea where in the building the laboratory is. Now, for biosecurity, that's a good thing. But for emergency response, it's a really bad thing. So make sure you're getting tours of people there. And those tours need to be repeated because people change jobs quite often. Opportunities exist in different areas. They now have different responsibilities.

Especially in the fire department, there are new frontline emergency responders being hired every month. And you don't know which truck is going to show up. And it should be someone with some type of familiarity. So hopefully, you've toured enough people through your facility so they know where they are. And that's an important point to take home.

There is a drill with our city fire and city police that had had a medical issue associated with a researcher in a containment laboratory. And what's really important is we were able to have about 155 different firefighters have an opportunity to come up to the facility and actually see it, where it is to get the feel of the layout, see what the entrance and exit and anterooms look like, look at the configuration, the size, the shape, the width of the doors. They could assess what they would do in an event.

And then we had to run the drill multiple times because there were so many emergency responders that were interested in seeing the new containment facility when it opened. So this was also a lot of lessons were learned here at that point. But once they're on-site, make sure you let them do the jobs that they're trained to do. Don't try to conform and put them in a box. You have to learn how their boxes work. And these drills give you an opportunity.

And developing the plans with them give you an opportunity to learn their language and lingo and how they interact with their staff and how they interact with others. And everyone at your institution should be aware of the Hazardous Waste Operations Regulations-- the HAZWOPER standards-- and know that the local fire department is the incident commander if 911 is called. So once they're on-site, they are in charge and you are playing a supporting role.

And that is a lesson that needs to be shared with everybody on your own emergency response teams, but also your administrative groups, public affairs folks, and everyone else because they do have to defer to the incident commander. Only one person can make the decisions once the external agencies are called in. So and, again, making sure that these incidents, the credible and foreseeable emergency scenarios that could impact the organization's risk are identified.

And I think is written by ISO in a way that there are always going to be events that you can't imagine. And if those do occur, at that point, we are going to be updating our plans when they do occur. So these brainstorming sessions, every time we can get people at the table, we are asking them questions about other things that could come up and what would they do if, and then taking notes during those sessions.

So always plan a little bit of extra time during a drill for not only lessons learned about the drill you just worked on, but ideas for future drills, or based on this, what else could have occurred. What else did we miss? Or based on this, what if we had activists coming in? What if someone actually broke down with an infection and reported symptoms now at this point? So we wanted to gain as much information as we could at that point.

So putting those lists together, vetting them with your staff, trying them out, and then bringing everybody in, and then working through it. But that list needs to grow. And we always learn from each other. If we to conferences, if we read journals, if we find out about other incidents, if it's something that we haven't thought about, we're going back to the table. We might even call that institution. We want to get that information and bring it in as well and update our own plans if it's something that we neglected or forgot at that point.

And then the training. It's required in the regulations as I mentioned with HAZWOPER. And once people have their initial 24-hour training in the US, we have to provide at least eight hours of training per year. And it's difficult to focus just on one hazard because there are multiple hazards in a laboratory and a research environment at your institution. So there are health physics, or radiation safety, chemical safety, physical safety hazards, biohazards, obviously.

And this is where you can make sure people are aware of what would happen if the incident command structure is activated, what their roles are, what levels of response they're eligible to participate in, and then your own practices. But putting on an SCBA (self-contained breathing apparatus) for a chemical drill is important because an incident commander might demand an SCBA for a biohazard drill. If you tell them, well, I think a PAPR (powered air-purifying respirator) would be okay. But they're the incident commander and they say, well, it's only people who wear an SCBA are going to be allowed to clean this up. And then guess what? You're going to be wearing an SCBA.

So as much practice that you have with different hazards, or you can have a mixed exposure. It could be a radioactive biohazard incident. And now you really have to partner with other groups. And multiple different types of equipment may be needed in those situations. So always keep your ears and eyes open. Always be ready to learn and work with your colleagues locally within your institution, and also regionally within the area around your institution because there are emergency responders in every municipality at that point.

And then train. And these incident command drills with local emergency responders are important and actually shows deference to the rules that you are aware. But make sure you do have a person parked at the incident command station for communication so that you can get information communicated to the leaders, and information can come back to the people at your institution that need to know what's going on as well.

And this is just a quick little slide of the zones. We always want to train our own emergency responders on what is likely going to happen once the incident command is set up and that'll be in the cold zone. And then there's a transition down to the area of the hazard. The hot zone is where the incident occurred. Even if it's a needle stick, they're still going to use the different zones and make sure that they keep the sort of containment area blocked off, and then transition to where the leaders are at that point.

So it's important that you're aware of that hierarchy at this point. So the emergency exercises should be conducted at regular intervals. That's a shall if you're going to conform to this standard, and it's a shall if you are working with higher-risk biohazards as well. And those of you who have had or have select agent licenses or registrations that have been approved, you have to do at least three drills a year-- incident response, biosafety, and a biosecurity one.

And you have to make sure that you are game-ready, that people are ready for the types of incidents identified in your plans. The incident response plans are very, very detailed. We have to have meetings once a month just with our own staff here in biosafety just to review what those plans are because you keep adding to them. They seem to never get smaller. They just seem to keep growing. And as you onboard new people, it's very difficult to give them the entire plan just in one sitting.

So we hold monthly meetings where we review different parts of our emergency response plans with our responsible officials and alternate responsible officials at that point. And then it's important, as I mentioned, not only to do the live drills but to also do the tabletops. And we have done both. This is the hurricane drill that I was talking about here. And we did have about 30 people responded from within Yale and outside of Yale.

And we really gained a lot of invaluable information. And there were some things that we thought we had in place that may not have been, but there were a lot of other things that we thought were gaps that were actually strengths when we got the individuals in the room and got some of the questions answered in regard to the response the University has ready for hurricanes across the campus.

And then one of the other things you have to do is make sure the people handling biohazards are trained. So ensure that they know what to do in the event of a spill. Spill signs should be provided to individuals or they could use a sharpie to write spill, but they do need to know they must evacuate the laboratory. And we'll talk about how you can work to get information to educate them on why it's important to evacuate the laboratory.

But it's important that they do that. If they try to spend time in the lab or moving PPE, they could actually be contaminated by what just spilled if it was a spill or release outside of primary containment. So every opportunity you have in the training, initial training, and on refresher trainings, make sure you're reminding people of what their roles are in event of an emergency. And this is just a slide of some of the steps we're asking people to take.

We know that they might be contaminated. It's okay. We will decon the anteroom as well as the laboratory. But we do need you to get out of the laboratory. The anteroom is a safer location. Airflow should be going away from you and into the laboratory at that point. Give us a call once you've cleaned up, posted the sign. Give us the facts. Let us know what you need. And then at that point, a team will be assembled to perform the decontamination. So it's just one of these things where we want people to leave, clean themselves up, report, get a sign posted, make sure individuals are not accessing the lab at that point.

And again, making these realistic. For a hurricane, we reached back to the last time there was a Category 2 hurricane-- 1985 it might have been-- that hit New Haven. So we actually looked at news reports from that. I think it was Hurricane Gloria. And we organized a drill based on if that were to hit today. There have been a lot of other superstorms and a lot of significant damage.

But there was a lot of footage of how that hurricane impacted the state of Connecticut and Long Island. And so we were able to use a lot of that for estimating the power outages, and the blocked roads, and maybe not having access to fuel. So we were able to take something that really happened in the state of Connecticut, and the number of people who lost power, and the amount of people who couldn't come to work, and built that into a drill over five days. And it was sort of staggering how significant that storm was.

But it was pretty fantastic how many of the groups had learned from that back then or learned from other storms and were prepared and ready with really strong responses. So that was something that we left that tabletop drill with, was that we are in a little better shape than we thought if something were to occur. Now, if it turns into a Category 5 hurricane, there's not much you can do. But we now know what we would do in advance of one of those events to make it safer in the event that large numbers of people can't arrive or make it to campus.

So the other thing, too, is celebrating things that go very, very well. We are always adding into our training success stories. There was a high-risk needle stick that occurred over a year ago. And we're always preaching wash immediately-- wash, notify, and then report. And in this particular case, the individual left the lab because they have to remove PPE to wash, washed immediately for 15 minutes with soap and water, notified PI, texted lab manager, contacted employee health, notified us.

Lab is just off limits. Individual was able to get to employee health, was offered post-exposure prophylaxis within 40 minutes after the incident occurred. I contacted the person about an hour after the initial report came in, and the person was very, very satisfied with the response and really felt that with the assistance they got through the health clinic, that there was really going to be a low likelihood of having a seroconversion at that point. And the person-- it's been well over a year and there's been no sign of any infection.

So those prompt responses, I mean, you have to evaluate what occurred. And through that evaluation, we identify corrective measures. But in terms of dealing with what was a high-risk exposure, it was handled very, very well promptly. We used to always say the solution to pollution is immediate dilution to get people to get to the sinks to wash up or to the eyewash. But try to make your messages memorable and make them short and simple. It's very, very important to make sure it's much easier to remember a very short and terse SOP than it is a five-page document with 70 bullets.

And then near misses as well, or if you hear about incidents at other institutions that went well to share those. And it's important to do that. And then if you have old events, you can also use them and bring them back and put people in that same scenario and situation. What would you do if, you know? Because it seems like the higher the risk is, to me, it appears that the work is actually conducted much safer because people get much more training. There's more hands-on. It just seems to work a lot better in terms of people complying with the requirements.

Now, ensuring that you have adequate contingency measures. What happens if the biosafety cabinet stops working in the middle of working at this point? What if the autoclave fails? What if the iris scan breaks down? What if the key card doesn't work? What if the HEPA filter fails during certification? What if a freezer goes down? So you have to be ready and have contingency plans. You can have companies that can get a backup freezer on campus. You can have a backup freezer plugged in. There could be another freezer already identified.

But having these discussions with the researchers, identifying resources, identifying a list of what you need, and then moving forward to then identifying what should be the next steps. Because we just identified this as an issue that is a contingency where we might need some backup support. If it takes a long time to get filters for your biosafety cabinet or for your exhaust cabinets, make sure you have backups somewhere in a safe location on campus so you don't have to have a long wait period to get them. And that would really help with downtime.

So developing those lists and then getting people together. What would happen? When do we have to stop work? Is there something we could do? Is there another location where we can do this work safely? So those are some of the things to keep in mind. Now, I told you this was the shortest section in ISO 35001. The drafting team is currently working on a technical specification which is going to be a companion guide to ISO 35001.

And there's going to be a significant amount of feedback and guidance for how to implement ISO 35001. And emergency response and contingency plans will be a lot more robust in that technical specification as well too. So look for that to come out probably in the next nine months to a year.

Again, we can talk about some of the more significant things that may happen, but make sure anybody working at your institution knows the basics of emergency response. We mentioned the 1, 2, 3s, or ABCs. So in fire safety, everybody should have two ways to get out of their building. And they might need to know how to do it blind sometimes. If there's a smoke situation, they're on their hands and knees. People need to know where the emergency water stations are. Showers and eyewashes and how to use them. And it's important that that occur.

There is a person on this call who responded to an emergency where the individual got soaked using an eyewash. And we couldn't figure out why they were getting soaked using an eyewash. And they said their whole body was sort of getting soaked. It's because they were a new student or a new researcher in the lab and no one showed them how to use an eyewash. So they were cupping water in their hands and just throwing at themselves. And the person on the call was able to provide some hands-on training pretty quickly. I think it was Danielle if I still see her on there, who was the hero that day to make sure that filled in what the lab should have done for the training at that point.

And then responding to an exposure. It's very nerve-wracking when you get an exposure. It's important to make sure that people know that these are very, very successful interventions. Immediate washing for 15 minutes with soap and water. Notifying folks, you notify people so they're aware that you might have just been hurt. You notify that you've been exposed. But it's important there because there's more help. The more people you notify, the more help you get. And then reporting to health services where you get the real medical help that you need at that point.

So we have manuals. We have posters. And we have cards that we give to people that all say the same thing-- wash the affected area, notify the principal investigator or lab manager if they're available, and then us, and then contact Yale Health or Yale Acute Care. It's just really important that everybody knows what to do. And that if there's a spill, people need to evacuate the laboratory. Get everybody out. Or if it's a big open space, get to a safe distance away from the area. At that point, look where the fume hood is to see where air might be moving to.

And then people should know that they should report suspicious events or activities as well. And again, folks should know how to assess airflow into their laboratories, whether it be negative or not. Holding a Kimwipe at a door if the door is open just slightly or at the bottom of the door, it can tell you if the lab is negative or positive, even if it's not a containment lab, if it's just a regular lab, And then it's good to have spill posters up so people do know to get out.

As we mentioned, a spill in a cabinet does not need an evacuation of the room, making sure people are decontaminating any potentially exposed skin or contaminated skin at that point, bagging anything that needs to be bagged, contacting colleagues for spare pants, socks, and shoes if needed. We do have some scrubs and slippers we can provide as well. It's important to have those, especially in higher containment labs. But having those posters in the lab prominently posted so that even if people forget, they can just say, oh, the poster, and then go and take a look at it. Don't miss an opportunity to train people on spill cleanup.

So in this particular situation, we have our regular biosafety training live. We are having a mock spill. And during the mock spill, we are asking the class, based on the training that you got, based on the manual, based on slides you were shown, how would you clean this particular spill. The class picks the pathogen. People look at the pathogen safety data sheet, look at the risk. They talk about evacuation. After a certain period of time, they assemble a spill team. They assemble others. And then they gather their supplies, and then they clean up their spills. And then they disinfect any reusable equipment.

People talk about contact time. And then they help each other safely doff their PPE, which I think is really important to do that. Other ways you can identify and that helps identify hazards coming into your institution is through shipping. We're fortunate here to have an eShipGlobal shipping program that identifies what's coming in or going out. Hopefully, people are registering their work. But if you see something that's not registered, you can actually work with that lab and then identify the plans that are needed.

Facility validations. Once a year when we are doing our validations of our containment labs, we actually do smoke release or bead release tests, and then identify in a worst-case situation. We have a spill or release outside of a biosafety cabinet, and we have an exhaust fan shut down at the same time. Our administration and all of the researchers in that building are going to want to know, and the admin people are going to want to know, did the pathogen get out of the laboratory?

And that is something we have done with some flask spills where we have fluorescent beads inside them. And this is an example of just dropping a flask and then counting the fluorescent beads. You can do that in the lab. You can have it in the anteroom, in the hallway, with a person exiting the door, shutting the exhaust fans off, so supplies, exhausts are all off. There's a group at the Porton Down in England, Allan Bennett, I think, was the lead author that actually spills actual pathogens in their test lab. And then you can look at the number of aerosols and the number of colony-forming units they could find per cubic meter of air.

We found that this slide coming up with the three flasks that are falling, this was the spill that the UK group had the largest number of aerosols. So this is the one we calibrate to. It does take a lot of work, and it's very difficult to get the beads. And then you need a fluorescent microscope to count them after. So we've actually used smoke as a very quick surrogate with particle counters.

You can release these in a room and have particle counters in the anteroom, in the hallway. And once a year, we're actually verifying that our labs will contain a spill or release outside of a primary containment, or a spore oopsie as we like to call them, in the event of a release during a catastrophic fan failure at the time of the spill. Now that's never happened, but we keep testing our labs to make sure everybody knows what also the critical evacuation point is at that point.

So I mentioned take videos of your drills. You can use them in future years. Take photos. Create case studies. Develop case studies. Be a student of emergency response. Identify what's been happening in other places, in journals, or you hear on your coffee break that this occurred. Contact them. Get more information. Write it up. But please don't ever say it can't happen here. As soon as you do that, you're opening yourself up to the Murphy's law thing.

So look at old laboratory-associated infections. You can study these things, identify them. And invariably, a spill is likely. We look at the laboratory-acquired infections that have occurred where the 80% of the people who didn't know how they got infected, it's believed that aerosols were likely implicated in those exposures. And most of those aerosols might have been from spills, so that's something to think.

So again, we like to share, like the farther back you can look, the further in the future you're likely to see, so being a student of history. Look at the anthrax outbreak that occurred in Sverdlovsk where the spores were released and traveled quite a distance. The latest one that happened, the Brucella leak that occurred, over 10,000 cases downwind from a pharmaceutical production plant from an improper decontamination step.

And then those things have happened. I don't think they'll happen here from a production standpoint, but the fact that a release did lead to that kind of exposure. But also, it gets in the mindset of individuals. This was, I think, a case that happened in 1928. I saw it in a publication from 1960. But there were 75 Q fever cases downwind of an abattoir. And the people who were infected were 7 miles down, but a 1-mile-wide swath. So just the fact that the pandemic has helped us greatly. But researchers should know about the transmission of aerosols and how they can impact many away from a laboratory if that were to occur.

Now, here's just a picture we sort of saw during the pandemic. In the chat, anything wrong with this

photo? Anything interesting? Anything different? I'll go back. Sorry. Yeah, there's how many different SOPs are in play here at this point? Somebody fully dressed. Others seem to have a mask and gloves on. Some people have the mask below the chin. So not really sure what is going on here, but it's interesting. I'm sure it's okay, but it just looks very, very interesting at that point. Yeah, good noticing the mask that's on the chin.

Now, the other thing you want to do, making your trainings memorable is going to be giving them facts, feeding people facts. Like I was unaware of how significant gloves leak until I arrived here and I was having a conversation with a professor. And he was basically, Ben, understand with this FDA leak rate, for every 20 pairs of gloves that you wear in your lifetime, one glove in each of a pair of 20 is going to have a hole in it.

So one out of every 40 gloves in a box is going to have a hole in it that will let microorganisms get through that people won't be able to see, feel. It's going to happen. So double-gloving is critical at that point. And then looking at the additional leaks you could have once those gloves are on and how the membrane can stretch. And researchers and everyone in emergency response needs to know that. It's very critical to have that information. So feeding them facts.

Now, we were announced a conference in 2015, and the keynote speaker had been Dr. Crozier who was infected with Ebola in West Africa. He was taken care of at Emory University Hospital. And he was asked the question how did he get infected? There wasn't a needle stick, there wasn't a splash. There wasn't an aerosol because he was covered from head to toe and had respiratory protection on. He didn't know, and so we're having to guess. I have seen some possible responses.

Anyone in the chat want to guess what the likely, a plausible route of exposure was for the individual dressed something like that? That's not Dr. Crozier. That's just a stock CDC photo. Doffing, yeah. Yes, definitely doffing. You guys all got at that point. And that's really critical. But take those messages back to make sure that people are doffing appropriately. And also they would have these pressure sprayers to decon people sometimes. And they would spray them, but you wouldn't cover all of the surfaces of the PPE that might have been contaminated. So there were a lot of things to look at there, but doffing was certainly one of them there.

Okay, so facility discussion here. A containment facility staff member called the DHS office to report a suspicious person who obscured their identity with a hoodie, hat, sunglasses, and a surgical mask. The report indicated the person went onto the laboratory floor and down the lab access corridor with a backpack. The person left very shortly after without the backpack. What are we going to do in this particular situation?

Let's in the chat, or people can talk if they want. Restrict access to the area. Who should we call? Notify security. Who is responsible for this incident? You guys are on top of this. Get the cameras. This is fantastic. So contact cameras. Can you get a photo of the person from the video cameras that you have? Yeah. Is this an EHS issue or is it a police or security issue? I think you guys have got the right temperature on this.

Both. We're all responsible. But who's taking the lead on the suspicious backpack? We need an incident commander. You're right. You're right. It is a security-- it is an incident here. So I'm going to show you a video, and it looked like the person was able to get on the floor by piggybacking by just waiting for someone to open a door and then following.

And then video footage can actually get images of the individual. And then you could send this picture while the emergency response incident and securing the building and the bomb squad is working. You then can make sure you're sending that photo out to anyone who might need it at that point. So that's very, very important. And again, you're right. City police, the bomb squad is kind of shared here. But our University individuals who are part of that would be part of that as well. Again, public affairs needs to notify others because when people see fire trucks or other trucks showing up when people are being asked to evacuate a building, they're going to want to know why.

But if this was a legitimate person who was just dressed that way maybe because of COVID. And maybe there was something wrong with their eyes or something like that and they like to wear hats. But they were dropping off a backpack for a colleague, a friend, and they were told, leave it on the floor. But they just didn't know where the person was. So they wanted to try to find them. And then they realized they had to go. So it might have been something like that. But life safety comes first. So police will not clear the scene until they're satisfied that it is not dangerous at that point. So it's really important. I think you guys really nailed that one.

And then the other one we had is dispatch just called Health and Safety to report a researcher just contacted them. While working, a coworker working with rabies virus just fell, collapsed on the floor, contaminated themselves with rabies virus while transferring flasks from the biosafety cabinet to the incubator. Coworker is not responsive, flask released virus when hitting the floor. Security has been called, has called 911 to request immediate medical at this point. From your standpoint and health and safety professional or whatever other discipline you're in, what are your next steps here?

Biosafety officers should be notified. Contain the spill. Mobilize for decon. You guys are pros. We have a lot of instructors for this course. Is it pseudotyped or not? So this is actually viable rabies virus. So this is infectious rabies virus. But that's a very good question. Is it something that's not infectious or something that is?

Follow the incident response plan. Yep, at that point. Do you think everybody showing up for the response will be immunized against rabies? And then what do you do in that situation? Probably not, no. Right.

And hopefully, this incident is already in your emergency response plans and it's been updated for each of the agents that you guys would have at that point. And then EMS, no. Yeah, so there needs to be some type of huddle in there. But if it's a true medical, you do need to get somebody in that room as soon as possible. So having this discussed before the incident occurs, that you would waive the immunization requirement with advanced personal protective equipment at that point.

So here's just an image from a drill we did for this particular scenario. And then making sure the SCBAs were thought to be significant personal protective equipment. Just ensuring that we don't have sharps associated with the exposure as well. And then decontamination needs to occur. But once they're in, they're going to follow their protocols. They're going to follow their policies at that point.

And there's probably going to be a minimum of six people needed-- two in the room, two in the anteroom, and likely, two in the outer corridor at that point. And this is a very, very old drill. So that's a board that doesn't even meet code today. But this is some of the things that they were using back then. So this was just quick. I want to let you know that there's a much longer version of the slides available that will be available later as a resource. And there's also a group of about six or seven such exercises like this with questions and notes that you can use for your own emergency response training.

So we were asked to give you guys gifts that can keep on giving. So we tried to set that up in a way that you could use some of these exercises for you. So I will just end with my favorite slide in all the world, and that is Nkosi Johnson's quote to the International AIDS Conference to "Do what you can, with what you have, in the place that you are, in the time that you have," from the book, We Are All The Same by Jim Wooten. Because I do believe we are all the same. And I think the chat shows that we're basically, all thinking and doing about the same things. So with that, I'd like to thank you for putting up with me and take any questions that you might have at this point.

Aufra Araujo: Thank you, Ben, for your excellent and informative presentation. We will open the floor for ideas, questions, or additional discussion points from the audience. We appreciate and encourage the discussion amongst all participants and invite you to share your experiences and challenges on this topic. Please remember to turn on your cameras if you can, and mics, and introduce yourself. We'd love to hear your thoughts, questions, comments.

So there is a question. How far do you go in evaluating airflow cascades across a facility for emergency response planning?

Benjamin Fontes: So, Jessica, we actually recently purchased an Evergreen. I'm not advertising for them. I just saw one of the biosafety cabinet certifiers use it. But instead of having a different Shortridge monitors, we bought a system where we can put a differential pressure monitor at every door within our BSL-3 facility. So you need quite a few of those. But so we can actually do the cascades at each door from the room where the incident occurs to the anteroom, to the hallway, to all the way down where the main entrance is.

So you can look at those cascades. And it's important too because if you have a positive at one door, but the next one is negative, that's information that you can also have for your report. So having those differential pressure monitors allow you to do that cascade. So it was an Evergreen telemetry system where the differential pressure monitors are really, really small, like the size of about two old pagers. And it transmits the information to Bluetooth so you can actually see everything in real time. And it gives you really nice graphs and charts of your pressurizations and the airflow changes.

Aufra Araujo: Ben, there is another question here. How do you contact HAZMAT or fire department in order to plan in a drill like this?

Benjamin Fontes: We ask our own emergency response leaders to reach out to their colleagues in the city. So they would be actually pleased to get the call because usually, they have their own training and exercise groups. And everybody is looking for their next drill or exercise to work on. They're contacting us a lot for some decontamination equipment that they've been offered to purchase. They sometimes have asked to have it evaluated or if they could get some practice using it in a room that's not in use.

So we've actually partnered with them, and we're constantly helping each other out. So you can just reach out and ask to speak to the training coordinator. Send an email. Let them know who you are and you'd just like to set up a Zoom call, or if you want to give a tour, offer a tour of your facility. There's a variety of ways you can do it. But have your leaders work with their leaders.

Or if you don't have, you can just reach out yourself and say, look, I'm the biosafety officer, I'm the EHS director, I'd like to establish a relationship where you guys can actually tour and see our facility during down or safe time. So there's lots of ways. And my email was on the slides that you'll get. Just it takes a village. There's 60 people outside my door who can help me help you, so looking forward to doing that.

Aufra Araujo: Excellent. Yes, I heard somebody in one of our previous presentations mention don't wait to share business cards during an incident. It's always good to contact beforehand. I love that. There is another question here, Ben. What about if I spill into a corridor where the air may go into common areas if someone contaminated were to move into the hallway?

Benjamin Fontes: Yeah, we did that drill last year, sort of standing in the hallway. And we were like, well, what happens if we spill? A spill happens. People are supposed to transport things. Right. But what happens if we spill something in the hallway and within the containment corridor, and you have 10 labs off of that corridor? And so we did that. We actually spilled it. But before we did, we ran the theatrical smoke. And we wanted to make sure we saw. And we were like, oh, the air is just going to go straight down and it's going to go into every room. So the safest place would be near the entrance/exit to the lab.

And when we ran the smoke, we were astonished. The smoke went in the opposite direction. And we're like, what's going on? And then when we looked behind us, they add a supplemental cooling fan. So another supply fan was added and it was pushing the air back towards the entrance. And it started walking in a certain direction and then coming back. So the safest place to be was where we thought was the most dangerous place. So actually, doing the airflow monitoring before the drill was critical.

But then knowing where the air is going to go from checking out during, let's say it was the fans are on and air is going into those laboratories. So we were able to identify who could get contaminated, who wouldn't, who did we need to take to a clean area and get showered, remove their clothing, give them scrubs, shower them out, get them over to health services for evaluation. Or get a list of all the people that might have potential exposure. Here's the pathogen safety data sheet or the infectious agent card.

But yeah, of the 14 people that were in the facility, 10 were potentially exposed. Four were not, and including the person who spilled it. And then that list has to go to health services. And from that point, they determine do we quarantine at home? Do we wait for symptoms to show? Depending on what the agent was at that point. So yeah, that was a very interesting drill, hallway spill where you're not in a containment environment.

Aufra Araujo: There is one. I think might be the last question. What are your thoughts on the alternative viewpoint of the person who spilled the biomaterial staying inside the BSL-3, assuming that person was not injured or exposed? What are your thoughts about that person doing the initial cleanup?

Benjamin Fontes: Yeah, so leave no one behind. On that drill, the coworker pressed the emergency sort of phone, which is a wall speaker phone. And part of the drill was to test whether or not you could hear somebody in a PAPR. And the police could hear him, and he could hear the police. And he didn't know first aid, CPR, or AED training. He wasn't trained on that. And but he stayed in the room. He did stay in the room.

And he said to the police officer I will start the decontamination of the floor to make it safe when they come in. And then I will, without touching the individual, I'll do the best decon of the individual's Tyvek suit as I could. So that individual did stay in the room because they had the PAPR on and they would also be showering out. So under those circumstances, with the medical, they did stay in the room to help with the response. And they also decontaminated the emergency responders on their way out of the facility to get to the shower as well.

Aufra Araujo: Perfect. Thank you so much, Ben. That was an excellent presentation and discussion. Thank you, everyone, for participating. Now, I will invite my colleague, Dr. Mary Casey-Moore, who is a Health Scientist in CDC's Division of Laboratory Systems, to provide a summary of the discussion from today's session. Mary.

Mary Casey-Moore: Okay, thank you, Aufra. Within the presentation, the discussion put our emergency response planning to the test. We explore two scenarios from biosecurity breaches to biohazard incidents centered around a critical question. What would you do if this happened in your facility? Given our thorough discussion in each case, I'll just highlight some of the common responses regarding those scenarios.

So in the first scenario, we had a suspicious individual incident where within the facility, there was a staff member who reported a suspicious individual who obscured their identity and entered the laboratory. People were prepared in their thought processes regarding what to do first-- restrict the area, taking a look at the security camera, and also getting the police and public outreach involved.

Within the second scenario with our medical emergency with rabies virus, again, the group was quick to recognize that they should secure the area, notify biosafety officers, PIs, on-site emergency responders, and mobilize for decon. It was also mentioned to stay calm and follow the incident response plan for those type of medical emergencies.

During our Q&A, some of the things I want to highlight is having an already established relationship between the facilities, public emergency responders, and other facilities responders as well as the public emergency responders, such as the police and the fire department. It was also emphasized that airflow monitoring during drills-- in this case, it was for hallway spills-- should be used to discover where the safest place could be. Which in Ben's case, when he mentioned where they thought was the best, was actually the worst place.

I also want to take a moment to celebrate some of the accomplishments and success within the chat by sharing a story that highlights their proactive measures and collaborative efforts. One participant from the Tennessee Public Health Lab shared that they recently conducted a man-down drill within their BSL-3 bioterrorism lab, which they hold every two to three years in collaboration with the fire and hazmat teams. They emphasize that the drills provided valuable learning experiences leading to updates to their incident response plan. All stakeholders were involved in the drill and followed competency training to ensure everyone is prepared for any potential emergencies.

And from this comment, another participant added that in their experience from a bioterrorism training where they were subjected to simulated accidental spills, they emphasize the importance of teaching people to work against reflexive reactions, noting how they remained calm and still during these scenarios. Overall, today's discussion highlighted the importance of being proactive in your planning and thorough in your training to ensure that you're ready to respond effectively. We appreciate everyone's active participation in these discussions. Ben, would you like to add any additional details about the discussion points that I may not have covered?

Benjamin Fontes: No, that was an excellent summation. I thank you so much for that. I just would like to say if there are any questions in the chat that we didn't get to. If there's a way to—

Aufra Araujo: I think you were muted, Ben.

Benjamin Fontes: Can you hear me now?

Aufra Araujo: Yes.

Benjamin Fontes: So excellent summation. I couldn't have done it better. That was fantastic. I was just going to say, I did see a couple of questions in the chat that we didn't get to. But if I could get the list of questions in the chat, I'll try to respond to the individuals who requested them. Like for the board, there's probably been three or four different boards since that drill occurred. But I could send the latest sort of sliders that we have at this point for that. And I'm sure Tennessee probably has some information from the drill that they just conducted as well too. So we can get some information on the boards to the individual who is looking for ordering information.

Aufra Araujo: Awesome. Thank you, Ben. I was going to mention that. Thank you so much for being so generous with your time. I really appreciate it. So I already have. So thank you, again, Ben, Mary, for summarizing the discussion. And a big thank you to all members of this biosafety community of practice for participating in the discussion today.

I have a few announcements that I'd like to share with you all before we conclude today's session. First, I'd like to discuss the post-session survey. The QR code on the slide and the link in the chat will take you to the Qualtrics survey. This survey should take no more than two minutes to complete. Your responses will be anonymous, so no unique identifying information will be sought or kept. And the feedback we receive will be summarized in aggregate only.

Your participation is voluntary, but we strongly encourage so we can continue improving the ECHO Biosafety Program and achieve better outcomes with this community of practice. We appreciate your time in completing the survey. If you have any questions about the survey, the ECHO Biosafety sessions, or if you have a laboratory biosafety challenge you'd like to present during the ECHO Biosafety session, please reach out to us at dlsbiosafety@cdc.gov.

All right. So as part of the Division of Laboratory Systems' commitment to biosafety and biosecurity, DLS is offering free access to the International Organization for Standardization, ISO 35001:2019 standard, entitled Biorisk Management for Laboratories and Other Related Organizations. The offer is currently limited to interested laboratories and organizations within the United States. The standard was first published in 2019, and it enables an organization to effectively identify, assess, control, and evaluate the laboratory biosafety and biosecurity risks inherent in its activities.

It defines the process to identify, assess, control, and monitor the risks associated with hazardous biological materials. It is suggested for the use of laboratories that test store, transport work with, or dispose of hazardous biological materials. So how can you request? We request that institutions wishing to gain access to the standard within the US designate a point of contact to facilitate the process.

Your point of contact (POC) will initiate the access request and assist in distributing access within your institution.

This is how the process works. First, your institution selects a POC responsible for biorisk management, such as a laboratory director, a biosafety officer, or a designee. Then second, the POC mails the DLS biosafety mailbox at dlsbiosafety@cdc.gov requesting access to the standard, along with your institution's name and physical address. Finally, if your institution is approved, DLS will email your POC with further instructions. The POC must then submit the names of individuals within your institution who would like to receive the ISO standard, including their work email address and the individual's roles in the organization.

This initiative aims to streamline the process to ensure that DLS has an organized list of individuals interested in receiving the ISO 35001 standard within each organization. DLS recognized the importance of this standard in enhancing biorisk management in laboratories and encourages your institution to participate. So for any questions, please contact us via the dlsbiosafety@cdc.gov email.

Also, the Division of Laboratory Systems is excited to celebrate Biosafety and Biosecurity Month this October. Our goal is to raise awareness about the importance of biosafety and biosecurity. As clinical and public health laboratories evolve, we can strengthen our biosafety and biosecurity practices through education, collaboration, and continuous improvement.

We encourage you to participate in our two upcoming events listed here on the website. On October 9th at 1:00 PM Eastern time, join the Safe Handling and Reporting of Highly Pathogenic Microorganisms in the Laboratory [webinar]. This will be a webinar featuring Mahtab Shahkarami from the California Department of Public Health, and Judi Green from CDC. And on October 16 at 1:00 PM Eastern time, don't miss the Lab Safety in the Age of AI, Evaluating Multimedia Options webinar with Imke Schroeder from the University of California. To learn more about the biosafety initiatives, please visit our page. It will be in the link with further information.

Next also, a special presentation on the Biosafety and Biosecurity Month. We are excited to have our next session on Tuesday, October 22nd at noon, Eastern time. The topic of discussion will be Biosecurity Aspects of Biorisk Management presented by Dr. Cristine Lawson, who is the Deputy Director for Biosecurity at the Biological Select Agents and Toxins Biorisk Program Office in the U.S. Department of Defense.

As a reminder, the transcripts, audio recordings, and presentation slides from previous ECHO Biosafety sessions are available on the DLS ECHO Biosafety website. Ben's presentation and resources will be available within a few weeks from today. Pay attention - the date changed. Usually, we meet the last Tuesday of each month, but in October, our ECHO session will be on the 22nd.

With that, we will adjourn. Thank you all for attending today's session. I hope you are intentional about having a safe and a fantastic day. We look forward to seeing you again in October. Bye.

Additional resources and related publications

• International Organization for Standardization. (2019, September). ISO 350001:2019: Biorisk management for laboratories and other related organisations.
• Centers for Disease Control and Prevention. (2024, January 26). 01/26/2024: Lab Update: Access to ISO 35001:2019 – Biorisk management for laboratories and other related organisations