MEDICAL TERMINOLOGIES AND ABBREVIATIONS

MEDICAL TERMINOLOGIES

 Mostly Derived from Greek and Latin words.

 Has 3 basic parts
 Root word - beginning
 Prefix - middle
 Suffix – ending
ROOT WORD
 the main part of the medical term that denotes
the meaning of the word.

PREFIX
 beginning of the term
 shows how meaning is assigned to the word.
 escription: number/amount, size, location,
color, etc.
SUFFIX RULE
 found at the terminal portion or at the end of the  The plural form of medical terms is made by
term (Ending). changing the end of the word and not by simply
 condition: pertaining to a process or procedure; adding (S), which follows the rule for irregular
amount, location, etc. nouns.
 denotes the meaning of the root word

MEDICAL TERMINOLOGIES

NOOTE: NOT INCLUDED SA PPT)

CHAIN OF INFECTION
BASIC CONCEPTS ON BIOSAFETY & BIOSECURIT Organizational Ethics: Biosafety invented at Camp
Detrick before bioweapons developed.
LABORATORY BIOSAFETY A.G. Wedum MD - Safety "S* Division - first division to
 Containment principles, technologies and practices be activated in 1943
implemented to prevent unintentional exposure to
pathogens and toxins, or their unintentional release. Asilomar Conference in 1975
 General principles for dealing with potential
BIOSAFETY biohazards related to GMOs were drafted
 “Protect the worker from the bad bugs.”  It was suggested that containment should be an
essential consideration in the experimental design
LABORATORY BIOSECURITY and that the effectiveness of the containment
 Protection, control and accountability for valuable should match the estimated risk.
biological materials within laboratories in order to
prevent unauthorized access, loss, theft, misuse, mid-1970s
diversion or intentional release.  Designation of 4 levels of biosafety

BIOSECURITY 1976
 “Protect the bugs from bad workers”.  First edition of the National Institutes of Health (NIH)
guidelines for research involving DNA molecules
LABORATORY ACQUIRED INFECTIONS (LAI) was published
 Infections (symptomatic / asymptomatic)
 Acquired through laboratory related activities as a 1984
result of working with infectious agents  First edition of a guidebook, called Biosafety in
 Microbiological and Biomedical Laboratories was
CAUSES OF LABORATORY EXPOSURES produced
 Causative or defined event  U.S. NIH and Centers for Disease Control and
 20% → equipment failure Prevention (CDC)
 80% → human factors  Now considered a major reference text for biosafety

TOP ACCIDENTS RESULTING IN INFECTION 1990

 Spillage  Directive on the protection of workers from risks
 Needle stick injury related to exposure to biological agents at work
 Glass shards (European Commission)
 Directive on the contained use of genetically
ROUTES OF LABORATORY EXPOSURES: modified microorganisms (European Commission)

INGESTION (via mouth) ORGANIZATIONS

 Consumption of a substance by an organism (CDC) CENTERS FOR DISEASE CONTROL AND
PREVENTION
INOCULATION
 Provides oversight of public health and safety,
 Act of introduction of a substance into the Body. including the laboratory
(ex. Injection)
(OSHA) OCCUPATION SAFETY & HEALTH
CONTAMINATION ADMINISTRATION
 Presence of a minor and unwanted substance or  Develops and enforces workplace standards to
impurity in the skin or mucous membrane protect employees’ safety and health.
 Recommendations include guidelines addressing
INHALATION
blood-borne pathogens, chemical safety,
 Act of drawing air or other substances into the lungs phlebotomies, latex gloves, ergonomics, & any
other potentially hazardous situation that may be
HISTORY OF BIOSAFETY found in the workplace
A.G. Wedum, MD
 U.S. Biological Research Laboratories at Fort  International Federation of Biosafety Associations
Detrick  World health organization
 one of the pioneers in developing biosafety
measures after the Second World War BIORISK ASSOCIATION PHILIPPINES
 evaluated the risks of handling hazardous biological  Philippines biosafety/security organization
agents and developed practices, equipment, and
facility safeguards for their control
FUNDAMENTAL CONCEPTS: PERSONAL PROTECTIVE EQUIPMENT (PPE)

BIOSAFETY ISSUES LAB COATS AND GOWNS

 Laboratory safety  used to protect from infectious fluids
 Blood borne pathogens  don’t wear lab coats outside of the lab or take them
 Recombinant dna home
 Biological waste disposal  cuffed sleeves can protect the wrists and lower
 Transport of biological materials arms
 Respiratory protection
 Bioterrorism and select agents GLOVES
 Mold and indoor air quality  wear disposable vinyl, synthetic or n-dex nitrile
 Occupational safety gloves when working with biohazardous materials
 Health in the use of research animals  avoid latex gloves (may cause allergies)
 do not reuse gloves
CONTAINMENT  do not wear gloves outside of the laboratory
 The principle of holding or be capable of holding or  wash hands after removing gloves
including within a fixed limit or area
 Biocontainment: preventing the release of biological EYE AND FACE PROTECTION
agents  protect mucous membranes and prevent ingestion
whenever there is potential for splash to eyes/face
PRIMARY BARRIERS
 Primary containment equipment FOOT/SKIN PROTECTION
 (control hazard at source)  open toed shoes, sandals and other open footwear
 BSC should be prohibited
 HEPA filter  shorts and other garments that leave skin
 Laminar flow hood unprotected are not appropriate
 Animal enclosures
 Sealed centrifuge rotors RESPIRATORY PROTECTION
 two types: air supplying and air purifying
SECONDARY BARRIERS  full face, half face, papr (powered air purifying
 (structure surrounding primary barrier) respirator)
 Sealed perimeter  N95 respirators
 Exhaust HEPA filters  N100 respirators
 Liquid effluent treatment
 sealed laboratory walls and floors BIOSAFETY CABINETS (BSC)
 Bscs provide effective primary containment for work
PRINCIPLES OF BIOSAFETY with infectious material or toxins when they are
 Practice and procedures properly maintained and used in conjunction with
 standard practices good laboratory techniques
 special practices and considerations  Class I BSC: Personnel and Environment
 Safety equipment Protection
 Facility design and construction  Class II & III BSC: Personnel, Product and
 Increasing levels of protection Environment Protection
 HEPA filters (not for chemical vapors)
STANDARD MICROBIOLOGICAL PRACTICES
 Most important concept / strict adherence FUME HOODS
 Aware of potential hazard - Removes toxic chemical (ducting sys./ductless)
 Trained and proficient in techniques - No HEPA filter -> not for biohazard agents

SAFETY EQUIPMENT LAMINAR FLOW CABINETS

 Primary containment barrier  Product protection (no personnel protection)
 Minimize exposure to hazard  Not for biohazard agents or chemical fumes
 Engineering controls / equipment
 Ppe HEPA & ULPA FILTER
 Biological safety cabinets  HEPA: High Efficiency Particulate Air
 ULPA: Ultra Low Penetration Air
 Important definitions:
 HEPA: 99.99% - at 0.3 microns
 ULPA: 99.999% - at 0.12 microns
Note: The "classical" definition of EPA filter is 99.97% at RISK GROUP 2
0.3 microns, but nowadays all BSC and LF in US use  A pathogen that can cause human or animal
99.99% at 0.3 um disease but is unlikely to be a serious hazard to
laboratory workers, the community, livestock or the
HEPA/ULPA CAPACITY environment.
 Removes a broad range of airborne contaminants:  Laboratory exposures may cause serious infection,
 fine dust but effective treatment and preventive measures
 smoke are available and the risk of spread of infection is
 bacteria (typical size: 500 to 0.3μm limited.
 soot  Biosafety level 2
 pollen  Typical work area: Biosafety cabinet / laminar
 adioactive particles flow hood
 impurity ion →can affect integrated circuit  Example:
speed  Hepatitis B virus
 HIV
ANNUAL BSC TESTING  the salmonellae and Toxoplasma spp.
 hepa filter leak test
 inflow velocity test RISK GROUP 3
 downflow velocity test  A pathogen that usually causes serious human or
 airflow pattern test animal disease but does not ordinarily spreadfrom
one infected individual to another. Effective
FACILITY DESIGN AND CONSTRUCTION treatment and preventive measures are available.
Secondary barriers / engineering controls  Biosafety level 3
 contributes to worker protection  Typical work area: Class 3 biosafety cabinet
 protects outside the laboratory  Example:
 example:  M. tuberculosis
 building and lab design  St. Louis encephalitis virus & Coxiella burnetti
 ventilation  Yersinia pestis
 autoclave  SARS virus
 cage wash facilities
RISK GROUP 4
INCREASING LEVELS OF PROTECTION  A pathogen that usually causes serious human or
animal disease and that can be readily transmitted
Biosafety levels from one individual to another, directly or indirectly.
 Increasing levels of employee and environmental Effective treatment and preventive measures are
protection not usually available.
 guidelines for working safely in research and clinical  Biosafety level 4
laboratory  Typical work area: Full isolation suits
 Example:
CLASSIFICATION OF INFECTIVE  Ebola
MICROORGANISMS BY RISK GROUP  Marburg or Congo-Crimean hemorrhagic fever
viruses
RISK GROUPS
 assignment of microorganisms based on: BIOSAFETY CONTAINMENT LEVELS
 pathogenicity  Combination of laboratory practices and
 mode of transmission and host range procedures, safety equipment (primary barriers)
 local availability of effective preventative and laboratory facilities (secondary barriers)
measures  somewhat related to risk groups
 local availability of effective treatment
BIOSAFETY LEVEL 1
RISK GROUP 1  for risk group 1 safety practices:
 A microorganism that is unlikely to cause human or  restrict or limit access when working.
animal disease.  prohibit eating, drinking, and smoking.
 Biosafety level 1  prohibit mouth pipetting.
 Typical work area: Open bench  needles and sharps precautions
 Example:  basic level of containment
 S. cerevisiae (yeast)
 Lactobacillus
 B. subtilis
BIOSAFETY LEVEL 2 BIOSAFETY LEVEL 4
 for risk group 2 safety practices:  for risk group 4
 bsl-1 practices plus:  dangerous and exotic agents
 use biological safety cabinet (bsc)-class ii  transmitted via aerosol route
 use leakproof containers  maximum containment
 clinical, diagnostic, teaching & other laboratories  class iii bsc
 splashes or aerosols is low  suit laboratory

BIOSAFETY LEVEL 3 BIOSECURITY CHALLENGES

 for risk group 3 safety practices:  biological materials
 bsl-2 practices plus:  no devices to detect pathogens being removed from
 use bsc-class ii 100% air exhausted to outside facility
through double hepa filtration or hepa plus  easy to hide small vials, filter paper
incineration.  present in clinical labs, research labs, private
 cabinet is gas tight and sealed, with operation  labs and government labs
performed through rubber gloves.
 use complete ppe (personal protective equipment). 5 ELEMENTS OF BIOSECURITY
 for agents that pose an increased risk of aerosol 1. PHYSICAL SECURITY
spread 2. PERSONNEL SECURITY
 more emphasis on primary and secondary barriers 3. PATHOGEN SECURITY
 controlled access to the laboratory and ventilation 4. TRANSPORT SECURITY
requirements 5. INFORMATION SECURITY
 all laboratory manipulations are performed in a bsc
TOPIC: BIORISK MANAGEMENT CONSEQUENCE
 Factors that affect the severity of the incident
BIORISK MANAGEMENT AND THE AMP MODEL
BIORISK DETERMINING THE LIKELIHOOD OF AN EVENT
 Risk associated to biological toxins or infectious LEVEL DESCRIPTOR LIKELIHOOD-DESCRIPTION
agents. 1 Rare May occur only in exceptional
 Biorisk = Biosafety + Biosecurity Risks circumstances
2 Unlikely Could occur at some time
KEY COMPONENTS OF BIORISK MANAGEMENT 3 Possible Might occur at some time
4 Likely Will probably occur in most
BIORISK MANAGEMENT (BRM) circumstances
 A system or process to control safety and security 5 Almost certain Expected to occur in most
risks associated with the handling or storage and circumstances
disposal of biological agents and toxins in
laboratories and facilities (CEN Workshop ASSESSING CONSEQUENCES
Agreement CWA 15793:2011) LEVEL DESCRIPTOR CONSEQUENCE
 Is the integration of biosafety and biosecurity to DESCRIPTION
1 Insignificant No injuries, low financial loss.
manage risks when working with biological toxins
2 Minor First aid treatment, on site
and infectious agents (CWA 15793 Laboratory
release immediately contained.
Biorisk Management Standard).
3 Moderate Medical treatment required, on
site release contained with
AMP MODEL OF BRM: BIORISK MANAGEMENT outside assistance, high
 WHO 2010 financial loss.
 Assessment 4 Major Extensive injuries, loss of
 Mitigation production capability, off site
 Performance release with no detrimental
effects, major financial loss.
AMP MODEL OF BRM: ASSESSMENT 5 Catastrophic Death, toxic release off site with
ASSESSMENT detrimental effect, huge
 Process to identify the hazards and evaluate the financial loss.
risks associated with biological agents and toxins.
 Define the situation Determining If Risks Are Acceptable Or Not
 Define the risks  Takes into account in considering the adequacy of
 Characterize the risks any existing controls, and deciding whether or not
 Determine if risks are acceptable or not the biorisk is acceptable.

DEFINING THE SITUATION RISK ASSESSMENT QUESTIONS:

 Identify the hazards and risks of the biological
PATHOGEN
agents to be handled  Risk group? ROT/MOT?
 Identify at-risk-hosts  Agent stability and ID50 (infectious dose)?
 Work activities and laboratory environment  Concentration?
(location, procedures, equipments)  Availability of effective prophylaxis (preventive
DEFINING THE RISKS measeure) or therapy? Antibiotic resistance?
 A review of how individuals inside and outside the  PSDS/MSDS (Public Health Agency of Canada
laboratory may be exposed to the hazards. Association or ABSA)
 Droplets
 Inhalation PROCEDURES
 Ingestion  Type of laboratory procedures?
 Inoculation
PERSONNEL
CHARACTERIZING THE RISKS  Skill level and vulnerability of at-risk personnel?
 Compare the likelihood and the consequences of
infection. PERSONNEL PROTECTIVE EQUIPMENT
 Appropriate combination of personal protective
RISK clothing and safety equipment? Place Appropriate
TIME _____________X_______________ facility and equipment for work to be done?
INCIDENT
PLACE
LIKELIHOOD  Appropriate facility & equipment for work to be done?
 Factors that affect whether or not the incident
happens
RISK ASSESSMENT PSDS – Pathogen Safety Data Sheet
 Involves 5 P’s
MSDS – Material Safety Data Sheet
1. Pathogen
2. Personnel SUBSTITUTION
3. Procedures  Involves the replacement of the procedures or
4. PPE biological agent with a similar entity in order to
5. Place reduce the risks.
 Bacillus anthracis (anthrax) = Bacillus thuringiensis
HAZARD, THREAT, RISK
ENGINEERING CONTROLS
HAZARD  Physical changes in work stations, equipment,
 Is an object that can cause harm production facilities, or any other relevant aspect of
the work environment that can reduce or prevent
THREAT exposure to hazards.
 Is a person who has intent and/or ability to cause  BSCs
harm to other people, animals, or the institution  Safety equipment
 Facility design
RISK
 Can be based on either a hazard and/or a threat ADMINISTRATIVE CONTROLS
 Is the likelihood of an undesirable event happening,  Refers to policies, standards, and guidelines used
that involves a specific hazard or threat and has to control risks
consequences.  Proficiency and competency training for
laboratory staff
 Display of biohazard or warning signages,
markings, and labels
 Controlling visitor and worker access
 Documenting written SOPs

PERSONAL PROTECTIVE EQUIPMENT (PPE)

 Devices worn by workers to protect them against
chemicals, toxins, and pathogenic hazards in the
laboratory.
 Least effective measure

SALERMO, 2015
 “Not one of the mitigation controls/measures is
completely effective at controlling or reducing all
risks. The effectivity of mitigating risks relies on the
combination of all the different measures and the
proper utilization of each.”
AMP MODEL OF BRM: MITIGATION

MITIGATION AMP MODEL OF BRM: PERFORMANCE

 Control measures put into place to reduce or
eliminate the risks. PERFORMANCE
 Elimination or substitution  Monitoring and continuous evaluation to ensure that
 Engineering controls the system is working the way it was designed and
 Administrative controls identifying opportunities for system improvement.
 Practices and procedures  Control
 Personal protective equipment  Assurance
 Improvement
ELIMINATION
 Involves the total decision not to work with a specific CONCEPT: SAFETY CULTURE
biological agent or even not doing the intended  The shared commitment of management &
work. employees to ensure the safety of work
 Offers the highest degree of risk reduction. environment.
 It encourages every individual in an org, to project
 Personnel who can decide for elimination:
a level of awareness and accountability for safety.
1. Biosafety Officer
 A culture of safety permeates all aspects of work
2. Chief Medical Technologist
environment
3. Medical Technologies
BIORISK MANAGEMENT (BRM) POST TEST:
 Is an integral part in the implementation of the
concept of biosafety and biosecurity in a laboratory. HAZARD
 It involves the process of assessment, mitigation,  It refers to anything in the environment that has the
and performance evaluation. potential to cause harm.
AMP MODEL
 Illustrates the balanced role among the components RISK
of BRM.  It refers to the possibility that something bad or
unpleasant (such as an injury or loss) will happen.
ROBUST RISK ASSESSMENT
 Is the heart of BRM. It ensures safety and security PERSONAL PROTECTIVE EQUIPMENT (PPE)
of the people working in the laboratory as well as all  It is the least effective mitigation measure according
the stakeholders in an organization. to the hierarchy of control.

The different mitigation procedures to be employed ASSESSMENT

 depend on the result of a robust risk assessment.  It is a process of identifying the hazards and
It is recommended not to overdo or underdo the characterizing the risks.
measures.
BIORISK MANAGEMENT (BRM)
PERFORMANCE EVALUATION  It refers to a system or process of controlling safety
 Is not a linear process, rather, it is a continuous and security risks associated with the handling,
process. storage, and disposal of biological agents and
toxins in laboratories and facilities.
MOST IMPORTANTLY
 Communicating BRM among the members of the
organization, especially to the top management.