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Photo by Sam Yu
Numerous cautionary signs adorn a door to a BSL-3 lab at USAMRIID. 
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By Alison Walker
News-Post Staff
awalker@fredericknewspost.com
FREDERICK– The Army’s lead biodefense laboratory amped up its safety and security measures after an April 2002 breach in containment revealed institutional problems – lax adherence to and enforcement of existing policies.
The breach began a rededication to safety at the U.S. Army Medical Research Institute of Infectious Diseases at Fort Detrick, USAMRIID Commander Col. George Korch Jr. said.
“We’ve certainly gone to great lengths to increase the level of vigilance and surveillance,” he said.
The current biosurety program – combining biological safety and security – ranges from enforcement of safety procedures at the researcher level to controlling what exits laboratories in air, waste and water.
Fort Detrick’s Commanding Gen. Eric Schoomaker said enforcing safety among laboratory personnel is similar to police officers attempting to enforce seatbelt and speeding laws.
“The role of the command is to ensure people in the laboratory never lose respect and become callous and sloppy,” he said. “They’re responsible to themselves, their fellow workers and their families.”
Five people in USAMRIID’s 37-year history have developed infections due to contact with agents they worked with in USAMRIID’s laboratories.
Col. Korch said five infections is the “proof of the pudding,” he said, comparing that number to the thousands of man-hours of people handling dangerous agents during that period.
“You take all this and you start looking at (USAMRIID’s) safety record, and in terms of the overall numbers, this is tremendously safe,” Col. Korch said. “And that’s what we really strive for.”
In 2002, USAMRIID officials mandated a two-person rule, which creates peer pressure to follow safety protocol by requiring material be handled by two people of equal experience, training and qualification.
USAMRIID is phasing out the rule due to space and staff limitations, replacing the physical presence of another person with video surveillance.
The institute is the process of completing video surveillance, with closed-circuit television cameras that allow the security team to monitor all areas in USAMRIID.
Laboratory suite supervisors also now conduct monthly suite inspections and include safety performance in personnel evaluations. USAMRIID’s biosafety officer conducts quarterly walk-through safety inspections.
Fort Detrick’s safety office and the Department of the Army safety office inspect laboratories for safety and adherence to the Biosafety in Microbiological and Biomedical Laboratories manual.
USAMRIID began its Elite Roaming Observers Force in 2002. The force is made up of military personnel who receive safety and biosurety training, including preparation for laboratory operations. EROF members patrol laboratories, checking for adherence to safety and security measures.
Dr. Steven Hinrichs directs the University of Nebraska Center for Biosecurity in Omaha, which modeled its own biocontainment laboratories after USAMRIID’s and studies protection against agents of bioterrorism.
Dr. Hinrichs said on-site inspections, such as EROF’s, may help persuade researchers to follow safety rules more than video surveillance alone.
Human eyes can judge safety compliance in detailed work and can also judge if personnel are tired or overworked, he said.
Video surveillance, Dr. Hinrichs said, is suitable for judging yes/no questions, such as whether a researcher is authorized to be in the lab or is wearing proper protective equipment.
Dr. Philip Brachman, a professor at Emory University’s Rollins School of Public Health in Atlanta, reviewed a database of USAMRIID’s mishap reports between April 1, 2002 and Dec. 1, 2005. Employees are encouraged to file the reports in any situation in which they were potentially exposed to a biological agent.
He said several cases of potential exposure involved employee error, likely not due to bad policies but to those personnel not following protocol.
Dr. Brachman said EROF’s random checks may help curb USAMRIID safety violations.
“Maybe just the presence of a person with a clipboard and red hat would sharpen up a person’s practices,” Dr. Brachman said.
USAMRIID Safety Officer Maj. Chris Ansell said while USAMRIID hopes to increase safety adherence as much as possible, safety officials want to avoid being overly punitive, which could discourage mishap reporting.
Based on recommendations listed in the report of investigation on the 2002 breach in containment, USAMRIID improved its training program. The current safety program includes basic safety training and re-training for anyone involved in research.
New personnel must read and sign laboratory procedures before they can work in laboratories. Workers are also required to complete Laboratory Essential Training tailored to their specific duties and the agents they may handle, Maj. Ansell said.
Workers must also complete a suite orientation, which includes an extensive tour by the suite supervisor, and they must study with lab mentors before they can work on their own.
All workers receive training on blood-borne pathogens, hazard communication and chemical hygiene training, Maj. Ansell said. Lab personnel are required to take refresher training courses annually.
Dr. Gigi Kwik Grönvall, a biosafety and biosecurity expert at the University of Pittsburgh Medical Center’s Center for Biosecurity in Baltimore, said training is critical in safety adherence.
“You have to develop a culture of people interested in being safe and ensuring they practice safe procedures,” she said.
Dr. Grönvall worked as a postdoctoral associate at USAMRIID from 2000 to 2001 and said USAMRIID had and continues to have an excellent safety reputation.
A balance between getting scientific work done and practicing good biosurety can make laboratory safety officers’ work difficult, she said. “It’s important for them to protect people from themselves – it’s easier to get things done if you don’t take the proper precautions.”
Efforts to reduce errors and biological defense mishaps should include limiting the amount of time lab personnel spend in isolation, Dr. Hinrichs said. “Being on top of your game is critical.”
He said lab personnel should be encouraged to do lab work in the middle of the day, so they’re not tired or rushing against the clock, factors that can make even the best trained researcher more likely to make mistakes.
In a 2002 report on the breach in containment by the U.S. Army Medical Research and Materiel Command, which oversees USAMRIID, researchers reported being overworked, due to processing large volumes of evidence in the 2001 anthrax attacks.
Several mishap reports between 2002 and 2005 also included supervisors’ comments of researchers having excessive workloads.
Dr. C.J. Peters, the director for biodefense at the University of Texas Medical Branch Center for Biodefense and Emerging Infectious Diseases, served as USAMRIID’s deputy commander in the late 1990s.
Dr. Peters said USAMRIID has an excellent safety record, which he attributes partially to a culture of safety carried over from USAMRIID’s previous work on offensive biological weapons before 1969.
“They worked on a lot of dangerous biological organisms, a lot that they didn’t have treatment for, so they tried very hard to be sure nothing happened,” he said.
Dr. Randal Schoepp, chief of the Applied Diagnostics Branch in USAMRIID’s Diagnostic Systems Division, said USAMRIID’s record of only five confirmed laboratory-acquired infections is excellent. “Considering what we work with, that’s amazing,” he said. “That’s a phenomenal number.
“(The number of confirmed exposures) is exceptionally low,” Dr. Schoepp said. “I’ve worked in industry, in academia, and I’m still impressed every day with the program here at USAMRIID.”
Former USAMRIID personnel said safety protocol was generally strictly followed in the late 1980s during their employment.
Judith Sanders, a former Special Immunizations Program nurse, worked at USAMRIID in the late 1980s. Dr. Frank Malinoski, a former medical virologist, worked at USAMRIID from 1986 to 1992.
Ms. Sanders said many of the physicians working at USAMRIID during her employment were trained in the field, making them appreciate the importance of adhering to safety protocol and reporting potential exposures.
“They took everything seriously– the caliber of people overseeing the labs was that everyone had an appreciation of what they should do,” Dr. Malinoski said. “They had a good appreciation for what the risks were.”