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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 3  |  Issue : 1  |  Page : 35-38

Biosecurity-related biomedical laboratory practices in Pakistan: Educating personnel regarding transportation of biohazardous substances


1 Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
2 Department of Pediatrics and Child Health; Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan

Date of Submission16-Nov-2018
Date of Decision16-Jan-2019
Date of Acceptance19-Jan-2019
Date of Web Publication13-Mar-2019

Correspondence Address:
Dr. Sadia Shakoor
Department of Pathology and Laboratory Medicine, Pediatrics and Child Health, Aga Khan University, Karachi
Pakistan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bbrj.bbrj_20_19

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  Abstract 


Background: Unchecked and unregulated transport of biohazardous material is a serious risk to the population and the environment. More importantly, packaging and knowledge of transport requirements and regulations is essential among personnel preparing and dispatching biohazardous shipments. To ensure safe transport practices among biomedical staff, regular training sessions are required but are not frequently carried out. We report on pre- and posttest knowledge among clinical laboratory and biomedical staff from southern Pakistan after such training. Methods: A basic questionnaire developed from the International Air Transport Association Dangerous Goods Regulations was prepared and administered to 36 participants in two different workshops carried out in April 2016 in Karachi, Pakistan. Questionnaires were administered before (pretest) and after (posttest) the practical training exercises to test comprehension. Scores from each participant were entered in MS Excel. Normalized learning gains (NLGs) were calculated for each participant. Results: Participants demonstrated lack of baseline knowledge of transport regulations and procedures for biohazardous material. After a full-day training session comprising lectures, demonstrations, as well as hands-on application of triple packaging requirements for refrigerated, dry ice, and ambient temperature shipments, the average NLG for 36 participants was 0.7 ± 0.3. Conclusions: Our results show that baseline knowledge of biosecurity and transport guidelines among laboratory personnel in southern Pakistan is poor. Moreover, hands-on workshops can be instrumental in increasing knowledge and understanding of these guidelines among personnel and should be conducted regularly.

Keywords: Biohazard, biosafety, biosecurity, Dangerous Goods Regulations, International Air Transport Association, Pakistan, shipment, training


How to cite this article:
Shafaq H, Qureshi SM, Shakoor S. Biosecurity-related biomedical laboratory practices in Pakistan: Educating personnel regarding transportation of biohazardous substances. Biomed Biotechnol Res J 2019;3:35-8

How to cite this URL:
Shafaq H, Qureshi SM, Shakoor S. Biosecurity-related biomedical laboratory practices in Pakistan: Educating personnel regarding transportation of biohazardous substances. Biomed Biotechnol Res J [serial online] 2019 [cited 2019 Mar 25];3:35-8. Available from: http://www.bmbtrj.org/text.asp?2019/3/1/35/254099




  Introduction Top


Laboratory personnel in lower middle-income countries face many challenges in providing accurate measurements, one of which is unavailability or inaccessibility of reference-level services in many parts of respective countries. Distance of reference-level centers and laboratories requires that infectious or biohazardous material is shipped from one laboratory to another, usually from a peripheral laboratory or point-of-care clinic to a reference-level laboratory. Transport of biological material may be within country or between countries. In either case, transport through air is regulated by the International Air Transport Association (IATA) Dangerous Goods Regulations (DGR);[1] the same principles, however, also apply to transport via roads and highways or railways. In all such cases, personnel transporting biohazardous material include a laboratory worker with requisite knowledge of required collection systems, tubes, or organism storage requirements in cases where the biohazardous material is a live microorganism. The risks of unsafe transportation, whether by air or any other route, cannot be overemphasized. Dissemination of infectious organisms is a definable risk, and risk assessment exercises have been undertaken to define risks for many transport activities.[2],[3] However, erring on the side of caution is essential and prudent, even when transporting substances known not to harbor hazardous organisms, as many other organisms untested for, or hitherto unknown to humankind, may be present and spread in naïve populations.

In Pakistan, international regulatory requirements for air cargo operations are implemented by the Civil Aviation Authority (CAA),[4] and a “no objection certificate” issued by the CAA is required for the transportation of dangerous goods. To ensure safe export of human biological materials, the National Bioethics Committee (NBC)[5] of Pakistan issued “ethical guidelines for collection, usage, storage, and export of human biological materials (HBM)” on June 18, 2016, and the government has decided that Pakistani customs department should take prior approval before sending any human biological samples for research purpose from the NBC effective from May 10, 2017. Despite existence of these guidelines for safe transportation of infectious agents and with ever-growing need of sending samples within and outside Pakistan to reference laboratories, awareness and initiatives regarding training on safe packaging and shipment are not a formal part of taught curricula, and informal workshops and trainings are not commonly conducted. In an effort to bridge this gap and address this important issue, we conducted two IATA packaging and shipment training workshops for laboratory personnel in April 2016 in Karachi, Pakistan.

The aim of our study was to inform the current status of knowledge regarding IATA guidelines among laboratory personnel and to demonstrate the value of workshops and hands-on training in acquiring new knowledge in this important and emerging field of biomedical science.


  Methods Top


Two full-day workshops were organized in Karachi, Pakistan, sponsored by the Fogarty Global Infectious Disease Research Training Program, National Institute of Health in April 2016 in Karachi, Pakistan. Participant selection was based on nominations requested from all the leading biomedical institutes and laboratories functional in Karachi. Workshops were focused on creating general awareness regarding guidelines for safe transportation of dangerous goods regulated by international organizations. A panel of highly trained experts who were well versed and actively involved in transportation of dangerous goods took part in the discussions and training and facilitated the audience in understanding the United Nations (UN) classification of dangerous goods and proper labeling of UN codes and symbols for documentation requirements. Since all the participants were affiliated with medical, biological, and veterinary laboratories from Karachi, the workshop content especially focused on shipment of Categories A and B infectious substances. Hands-on training exercises and scenario-based group activities were designed to enhance understanding and application. Training included mock sessions for preparation and packaging of samples for transportation. A simple, 10-item questionnaire was developed to assess the knowledge of the IATA guidelines among participants [Supplementary File 1], with one point awarded for each correct answer and a maximum possible score of 10 (100%). The same questionnaire was administered before (pretest) and after (posttest) the workshop to assess for the effectiveness of learning among participants.



Data on pre- and posttest questionnaire scores were entered in MS Excel, to calculate learning gains (LGs) (posttest scores-pretest scores) as well as normalized LG (NLGs) (LG/100% – pretest scores).[6],[7] All the participants attended the same training, with the same instructors, and spent a similar amount of time receiving the training; we, therefore, considered participants' homogeneous and analyzed results of the two separate workshops together. LG was calculated for each participant and was also converted to NLG to adjust for pretest knowledge level. The maximum attainable NLG was 1.0, indicating maximum gain of knowledge and, therefore, maximum learning effectiveness. A mean NLG was calculated for all the participants. Ethical integrity was preserved by anonymizing data from participants.


  Results Top


Two workshops were conducted in April 2016 in Karachi, Pakistan. These workshops were attended by 36 participants from medical, clinical, and veterinary laboratories. Female-to-male ratio of the participants was 0.75. All the participants had a master's degree in one of the biological sciences. More than 90% of the participants felt that the workshops were well organized and addressed all aspects of shipping of infectious agents in great detail.

Pretest scores of the participants were an average of 38.1 ± 19.8%. Posttest scores averaged 85.5 ± 13.6%. The mean NLG for the 36 participants was 0.7 ± 0.3, indicating effective learning. [Figure 1] shows the percentage of the participants with NLG scores, indicating the highest number of participants with NLG between 0.6 and 0.9.
Figure 1: Percentage of workshop participants obtaining respective normalized learning gain. Normalized learning gain = learning gains (posttest scores–pretest scores)/maximum possible learning (100% – pretest scores). Since most participants have normalized learning gain of 0.6–0.9, the workshops are considered effective in imparting knowledge regarding shipment of biohazardous material

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[Figure 2] is a plot of the individual participants' NLGs versus their pretest scores expressed as a percentage. The plot shows that LGs among workshop participants are independent of pretest scores (r2 = 0.2).
Figure 2: Plot of normalized learning gains against pretest scores of each workshop participant. The relationship is independent of participants' pretest scores (r2 = 0.2)

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  Discussion Top


Our results provide useful insight into two important aspects of the status of biosecurity practices in Pakistan's biomedical laboratories. First, our evaluations reveal the poor status of knowledge regarding IATA shipping and packaging guidelines among biomedical laboratory workers in Karachi, Pakistan. Second, we have shown that practical 1-day hands-on workshops increase such knowledge among biomedical scientists and their learning is independent of any preexisting knowledge.

The necessity of safe transport of infectious substances was identified in 1953 when the International Civil Aviation Organization (ICAO), a subsidiary of UN economic and social council, proposed guidelines for safe transportation of dangerous goods by air. The IATA integrated the ICAO guidelines with further restrictions and published comprehensive recommendations as the DGR.[8] These guidelines are applicable to transport of biohazardous substances on all international and national flights. The IATA guidelines further recommend formal training and certification for all shippers and handlers with recertification every 2 years. Dangerous goods are classified into different categories by the UN Committee[9] and assigned proper shipping names and UN numbers for identification. Infectious substances are classified as Category 6.2 and further divided into Categories A and B. Infectious materials comprising or harboring potential biological agents that can cause life-threatening illness in humans and animals are classified in Category A. Other infectious substances are all categorized under Category B.[10] After identification and classification, the important steps in transportation of infectious agents include packaging, labeling, and documentation;[11] infectious materials should be transported in packaging in compliance with the UN packaging instructions. Briefly, all infectious substances should be shipped in a “triple packing container” which is commercially available and has been tested through standardized tests including 9-m drop, puncture, stacking, and pressure tests.[10] Marking and labeling is of prime importance and must include information of categorization, technical information, and addresses of the shipper and the consignee.

Shipment and transportation of biohazardous materials is increasing globally, as well as within Pakistan. As new infectious outbreaks are anticipated and recognized and the need for reference-level confirmations increases, it is becoming essential for laboratory personnel everywhere to be able to transport such material safely. We conducted these training recognizing the need for biological substance shipment to reference-level laboratories within and outside Pakistan. However, very few biosecurity-focused teaching and learning activities have been held in the past with no published reports. Our results are a key indicator of the need for such training activities within the country. Not only are initial training and certification essential components of medical laboratory training, but also refresher trainings have been emphasized. According to the instructions by ICAO, it is mandatory to have refresher training every 2 years.

Our study has limitations. The workshops were conducted in only one city of Pakistan, and therefore, data generated are not representative of other provinces (which are autonomous in their health system and laboratory regulations). Moreover, we only conducted the posttest evaluation once and immediately after the workshop, and therefore, long-term retention of knowledge cannot be evaluated.


  Conclusions Top


As globalization is increasing and aiding the world in countless ways, biosciences have also made remarkable progress. Global access to information, biomaterials, and technologies unfortunately also poses a threat in terms of biological terrorism and global outbreaks of diseases. This can only be mitigated by enhancing biosafety and biosecurity in facilities around the world. Safe transportation of infectious agents is one of the most important aspects in this context. Our results highlight the imminent need for training biomedical laboratory staff in safe transport guidelines and protocols and also demonstrate the utility and effectiveness of practical workshops as an impactful learning strategy.

Acknowledgment

We acknowledge Miss. Shamsa Barkat Ali in providing logistics support in conducting training workshops.

Financial support and sponsorship

This work was supported by Grant Number 3D43TW007585-07S1 from the United States National Institutes of Health Fogarty International Center. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Luedtke J. Hazmat Transportation and Security: Survey and Directions for Future Research. Atlanta, GA: Department of Industrial and Systems Engineering, Georgia Institute of Technology; 2002.  Back to cited text no. 1
    
2.
Bakanidze L, Imnadze P, Perkins D. Biosafety and biosecurity as essential pillars of international health security and cross-cutting elements of biological nonproliferation. BMC Public Health 2010;10 Suppl 1:S12.  Back to cited text no. 2
    
3.
Meyer A, Zamir L, Ben Yair Gilboa A, Gelman B, Pfeiffer DU, Vergne T, et al. Quantitative assessment of the risk of release of foot-and-mouth disease virus via export of bull semen from Israel. Risk Anal 2017;37:2350-9.  Back to cited text no. 3
    
4.
Civil Aviation Authority. Air Cargo Operations: Operating Regualtions. Directorate of Aerospace and Aerodome Regulation: Civil Aviation Authority; 2015.  Back to cited text no. 4
    
5.
National Bioethics Committee Pakistan. Ethical Guidelines for Collection, Usage, Storage, and Export of Human Biological Materials (HBM). Pakistan: National Bioethics Committee Pakistan; 2016.  Back to cited text no. 5
    
6.
Weber E. Quantifying student learning: how to analyze assessment data. Bull Ecol Soc Am 2009;90:501-11.  Back to cited text no. 6
    
7.
Coletta VP, Phillips JA. Interpreting FCI scores: Normalized gain, preinstruction scores, and scientific reasoning ability. Am J Phys 2005;73:1172-82.  Back to cited text no. 7
    
8.
International Air Transport Association; 2017. Available from: https://www.iata.org/publications/store/Pages/DGR-print-manuals.aspx. [Last accessed: 2019 Jan 16].  Back to cited text no. 8
    
9.
Association of Southeast Asian Nations. Dangerous Goods Handling (All modes). Japan: Association of Southeast Asian Nations (ASEAN); 2014.  Back to cited text no. 9
    
10.
World Health Organization. Guidance on Regulations for the Transport of Infectious Substances 2015-2016. Geneva 27, Switzerland: World Health Organization; 2015.  Back to cited text no. 10
    
11.
Snyder JW. Packaging and Shipping of Infectious Substances, in Clinical Microbiology Newsletter. Louisville, KY: University of Louisville School of Medicine and Hospital; 2002.  Back to cited text no. 11
    


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