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VA Long Beach Healthcare SystemResearch and Development

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EmergencyPreparedness Plan

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Replaces version dated: 04/08/2015Review: Annually by SRS and R&D committee

___________________________________ __________________Neil Hoa, SRS Vice-Chair Date

___________________________________ __________________Steven Schreiber, MD, R&D Vice-Chair Date

Emergency Preparedness Plan VA Long Beach Healthcare System/Research and Development

Emergency Preparedness PlanTable of Contents

Leadership...................................................................................................................................... 3 Key Healthcare Group Personnel & responsibilities........................................................................3Designated Laboratory Personnel (DLPs)........................................................................................3Responsibilities of Designated Laboratory Personnel......................................................................4Communications/Reporting..............................................................................................................5Emergency Cascade..........................................................................................................................5Evacuation.........................................................................................................................................6Damage Assesment...........................................................................................................................6Clinical Research Areas....................................................................................................................7Personnel Pool..................................................................................................................................7Public Affairs....................................................................................................................................7Fire....................................................................................................................................................7Hazardeous Materials........................................................................................................................8Radioactive Spill.............................................................................................................................10Utility Failure..................................................................................................................................10Bomb Threat...................................................................................................................................11Animal Facility...............................................................................................................................11BSL 3 Facility.................................................................................................................................11

Air Flow System Failure.....................................................................................................11 Spills...................................................................................................................................11 Exposure Incidents..............................................................................................................13 Power Failure......................................................................................................................13 Fire......................................................................................................................................13 Earthquakes.........................................................................................................................14

Recombinant DNA..........................................................................................................................14 Medical Surveillance..........................................................................................................14 Immunizations.....................................................................................................................15 Medical Examinations........................................................................................................15 Spills...................................................................................................................................16 Decontamination.................................................................................................................17 Reporting.............................................................................................................................18

Recovery Plan................................................................................................................................18References.......................................................................................................................................19Cascade Recall Plan (appendix A)..................................................................................................20Designated Persons List/Evacuation Route (DLPs) (Appendix B)................................................21

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Research and Development Emergency Preparedness Plan

I. Leadership A. General Responsibilities

1. Each employee is expected to respond to an emergency situation by providing leadership necessary to protect life, property and carry out the responsibilities of the Service and the Medical Center

2. Any employee that discovers an emergency situation will act as the Incident Commander until relieved by a Designated Laboratory Personnel or by someone with more institutional authority. As Incident Commander the employee will assure patient, visitor and employee safety, and will report the incident to the appropriate contacts as designated below.

B. Key Health Care Group (HCG) Level Personnel and Responsibilities

1. HCG level order of succession is as follows:i. ACOS/ Researchii. Administrative Officer/ Researchiii. Safety Coordinatoriv. Animal Caretaker Staffv. Program Assistants

2. The following Research HCG individuals will automatically return during an emergency when contacted through Send Word Now.

i. ACOS/ Research ii. Administrative Officer/ Researchiii. Animal Caretaker Staffiv. Safety Coordinatorv. Radiological Safety Officervi. Industrial Hygiene Officer.vii. Biological Safety Officer

3. Functions of Key Personneli. The ACOS will assume overall command of the emergency

Responseii. The AO will serve as the primary point of contact and will

coordinate the emergency responseiii. The Animal Caretaker will coordinate responses that have a direct bearing on the animal facility (see section XIII).iv. The R&D Safety Coordinator will work with the Industrial Hygiene Officer to coordinate responses that involve Hazardous Chemicals and Agents (see section IX), utilities, and general

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Safety issues with facility emergency responses. The Industrial Hygiene Officer is also the facility Safety Officer. The Industrial Hygiene Officer will assume this role directly if the emergency is restricted to Research HCG.

v. The Radiation Safety Officer will coordinate aspects of the emergency response that involve radioactive hazards (see section X).

vi. The Biological Safety Officer will coordinate Emergency Responses that involve the BSL-3 facility (see section XIV) and responses that involve the containment of recombinant DNA (see section XV).

C. Designated Laboratory Personnel

Each laboratory has a Designated Laboratory Person (DLP) that will coordinate the Emergency Response within that laboratory. Designated Personnel are listed in Appendix B.

1. Designated Personnel will be issued the following items in order to make them easily identifiable:

i. A hardhatii. A brightly colored safety vestiii. A whistleiv. A flashlight

D. Responsibilities of Designated Laboratory Personnel

1. Education

DLP’s must be familiar with the Evacuation Route and Assembly Area that has been assigned to their laboratory. DLP’s are responsible for making sure that all laboratory personnel know the evacuation plan. The Chair of the SRS, through the SRS Coordinator, will arrange for the training of DLP's on an annual basis. The SRS Coordinator will maintain a record of attendance.

2. In Emergency In the event of an emergency the DLP will:

a. Direct Laboratory personnel to the appropriate exit and assembly area.

b. Open all doors, checking door knobs for heat prior to opening, check under desks, in bathrooms and closets for occupants

c. When it is verified that all personnel have been evacuated, then close the laboratory entrance door and hang an “Evacuated” door sign on the door knob.

d. Proceed to the designated assembly area and verify that laboratory

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personnel are accounted for.e. Upon leaving, note any areas of severe damage.f. Do not allow anyone to re-enter the building until the all clear has

been given.g. Verify that all laboratory personnel are accounted for h. Designated Laboratory Personnel will assist with the facility response

to an emergency. Work within the research building will not resume until hospital safety officials have checked for explosive gases and other hazards, and declared the building safe for occupation.

i. The Research HCG will accomplish business restoration consistent with the procedures developed for the Emergency Plan Manual Specific Hazards Section.

j. Please refer to the following special Emergency Plans as needed:I. VMU Emergency Plan (Section XIII)

II. BSL-3 Emergency Plan (Section XIV)III. Recombinant DNA (Section XV)

3. DrillsEmergency drills will be coordinated with facility fire drills on an annual basis. Additional drills will evaluate specific hazards in targeted area, e.g. areas where radioactive or chemical spills may occur. Drill outcomes will be evaluated by the Safety Officer and reported to the SRS at the next convened meeting

II. CommunicationsA. Reporting

1. To report any emergency situation call 562-826-50002. To report a fire, call 562-826-8000 x44443. To report a break-ins or other malicious behavior, call:

VA Police at x5000 FBI, (310) 477-6565

4. Call Richard Beam (VHALB Director of Public and Community Affairs) x5498.5. To report abnormal room temperature very hot/cold and other engineering problems call x3714.6. Chemical spills: call x3713 or x3714.7. Cardiac arrest: call x3333.8. Rapid Response Team: Call x22229. Emergency Room: Call x3558

B. Emergency Cascade1. In the event of an emergency the Research HCG will activate the Emergency Cascade (Appendix A).

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2. Each person on the cascade list is responsible for contacting the next person on the list. In the event that the next person cannot be contacted then the next person after that will be contacted. The last person on each branch of the list will report back to the top and verify completion of the cascade.

III. Evacuation

A. In case of earthquake or other emergency Research employees will evacuate the research building when it appears that tremors are over or it is otherwise safe to leave the building. Before leaving, check for and turn off all flames, Bunsen burners, etc.

B. Designated Personnel (DLPs)(DLP’s) working in restricted laboratory areas will be responsible in an emergency for assuring safety of entry into those areas (electrical, biological, toxic, radiation exposures). Other persons are advised to stay clear of the area unless given specific instructions by responsible persons.

C. Emergency Escape Routes & ProceduresEmployees will generally follow the evacuation paths that are posted on the wall maps in building 138. Laboratory personnel will exit through either the North or South Exit doors unless exit through the closest door has been blocked.

1. Each Laboratory has been assigned an exit that is closest for the majority of personnel within the laboratory. Assigned exits are designated in Appendix B. Laboratories in the basement or the 2nd floor should proceed first to the stairwell that is closest to their assigned exit.

2. Laboratory personnel are to move a safe distance from the building and assemble where they see the DLP from their laboratory.

Note: During construction, interim life safety plans will be developed, reviewed and implemented to assist personnel with the best emergency exit strategy.

IV. Damage Assessment

A. With input from DLP’s, damage assessment is performed by the Radiation Safety Officer and Industrial Hygiene Officer.

B. When the building is cleared for access, the ACOS/Research and AO for Research or their official designees will perform a damage assessment.

C. Research staff will report any latent, delayed damage that may occur.

V. Clinical Research Areas

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Emergency responses in clinical research areas will follow the facility Emergency Plan.

VI. Personnel PoolPersonnel needed for patient activities will be maintained in the service area. If personnel can be released, the Personnel Pool will be notified of their availability.

VII. Public Affairs

Inquiries from outside sources, including press and families should be forwarded to the Public Affairs Officer (PAO). The PAO should be made aware of any unescorted reporters. The PAO will instruct the reporters where to go to get more information about the event; if the reporter(s) refuses to leave the VA Police will be notified.

VIII. Fire

A. All Healthcare group staff shall receive an orientation to the location of fire exits, locations of fire alarm pulls and location of fire extinguishers. Each employee shall be familiar with the fire life safety plan for their area.

B. In the event of a fire alarm condition (Code Red) in the Research building the following procedures will be followed:

1. If a fire or smoke is discovered in the Service area, follow the R.A.C.E. procedures

2. Determine the location of the pull alarm. Pull alarm. 3. When the alarm sounds staff should assure that all smoke

barriers in and around the Service are closed. 4. When the alarm conditions are identified as being on the floor or

one floor above or below the Service activity consideration should be given to the need to terminate activities and prepare for possible evacuation.

5. No attempt by non-physicians will be made to treat or remove persons unless there are flames or strong gas odors threatening the life of the victim.

6. When the Fire Department arrives on scene, a key employee or someone with knowledge of the flammables and hazards will remain to assist the Fire Chief.

7. All other people should leave the hazardous area immediately.8. All employees will be responsible for the overall fire prevention and

control program in his /her area. However, it must be emphasized again that all employees are responsible for basic fire prevention.

IX. Hazardous Materials

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A. If a hazardous material spills within the service, the service personnel will follow service guidelines to contain the spill. If additional assistance in containment area is needed, the service personnel will notify the industrial hygienist or if unavailable the emergency center. The Hospital industrial hygienist will be notified of all spills and will assure that the spill is cleaned up and the area is safe to reoccupy.

B. Spills

Responses to spills of chemical hazards should follow the CLEAN acronym.

C- Confirm, Contain L- Leave E- Ensure, Enact A- Access SDS N- Notify

C onfirm, Contain:

Confirm if you have been exposed. If so then Leave and Enact. Confirm if someone else is present. If so: If they are injured then proceed to Leave and Enact. If they are not injured then: Confirm if you can manage the spill. To do this: Determine if the spill involves a caustic or flammable volatile agent. Determine if the spilled volume is greater than one pint.

If the spill is not caustic or volatile or if the volume is one pint or less, then it may be possible to manage the spill.

If you are not alone and the spill can be managed, then:

Contain the spill. Circle the spill area with a spill dam from the spill kit. Spill kits are provided in emergency response areas. These are located on the 4 corners of each floor (rooms 102, 120, 127, 143, 202, 219, 227, and 241) and in the Animal Research Facility (room 38B). You should be familiar with the location of the nearest area.

If nearest Spill Kit location is locked, look in the next closest one. If unable to get into that room, call Research Administration or VA Police for immediate access to the room.

Be aware that vapors from caustic agents can cause eye damage. Other volatile materials can quickly overcome you in areas with poor ventilation. If there is any doubt then do not attempt to contain the spill.

Never attempt to clean a spill alone. Always do the job with another trained individual.

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Never attempt to contain extremely hazardous materials.

L eave:

First evacuate any injured personnel. If the spill cannot be managed then leave the area.

E nsure, Enact:

Ensure that any person who has been exposed is treated promptly. If the eyes are affected then use the eyewash first. Next use emergency showers. You should be aware of the location of the nearest eyewash and shower. Contaminated clothing should be removed.

Enact spill procedure if the spill can be managed. Responders should wear personal protective equipment including a rubber apron, gloves, and a face shield.

Apply absorbent pads to the spill. Pads are provided in the Emergency Response area.

Do not attempt to clean the area yourself. If the spill involves a flammable agent then leave the area.

A ccess:

Determine what material was spilled and the volume of the spill. Access the Safety Data Sheet (SDS) for additional information. Have this information available when help arrives.

N otify :

Notify your local manager or supervisor. Call 3713 and ask to initiate the hazardous material notification

system. If it is after hours call the Medical Center Telephone Operator, “Dial O”. The Operator will call the Long Beach City Fire Department if needed.

The Facilities Management Operator will notify the Emergency Room (3358) in the event of a personal injury.

Close the laboratory door to contain any vapors generated by the spill.

During after hours, contact the FOD, Facility Officer of the Day for assistance and to turn off room ventilation to contain vapors.

X. Radioactive Spill

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A. The magnitude of the spill will be assessed and the spill contained in a limited area.

B. Research Healthcare Group personnel contaminated by radioactive material will remove contaminated clothing and wash off with water the portion of their body affected by the spill.

C. The Radiation Safety Officer will be notified immediately. If he is not available a staff nuclear medicine physician will be contacted. If neither is available the Energy Center will be notified.

XI. Utility Failure

A. If a Utility Failure occurs, contact Facilities Management at x3713 or x3714.

B. If an Electrical Failure occurs, contact Facilities Management at x3713 or x3714.1. During an electrical power failure the following equipment is on

emergency backup power and may be used:

Freezers Incubators

2. During an electrical power failure the following locations have emergency backup (red) power sockets:

a. There are numerous emergency backup (red) power sockets on each floor in Building 138 (Research Laboratory Building).

3. Watera. Water is used to hydrate research animals. If water is cut off,

Animal Caretaker staff will be responsible for proper care of research animals and will follow proper procedures described in the Veterinary Medical Unit SOP.

i. Because of the nature of the equipment, the following pieces of equipment are considered unusable without flowing water.

a. Cage Washerb. Bottle Washerc. Autoclaves

ii. Hand washing will occur using chemical cleaning solutions kept in the core area for such use.

iii. Use of toilet facilities will be used only when necessary. They will be flushed only when solid material is introduced to the system.

b. Sewer Failure

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i. If notified of a sewer failure, personnel will restrain discharging effluent into the system, except when required for public health reasons.

XII. Bomb Threat

A. All bomb threats will be taken seriously. The bomb threat questionnaire should be completed immediately after receiving a threat. The VA Police should be notified immediately after receiving the threat.

B. If a bomb search is necessary all Key employees will comply with instructions from the bomb search team and will assist with the identification of any hazardous environments in the research building.

XIII. Animal Facility

Emergency Procedures for the Animal Facility are detailed in a separate VMU Disaster Plan.

XIV. BSL-3 Facility:

A. The BSL-3 Facility Air-Flow SystemProper airflow must be maintained at all times. An airflow system is an integral part of the design of the Facility, and is monitored by AC personnel, who are available 24 hours/day. VA maintenance personnel will ensure correct operation of air balance system every year.

Operating FailuresThe air handling and exhaust systems are interlocked. In the event the exhaust fails, the supply air shuts down. If the supply air malfunctions, the exhaust must remain on. The indicator panel in the anteroom indicates if there has been a failure of the ventilation system.

There are two possible failures. (1) The biosafety cabinets, but not the room air exhaust system, is on emergency power. If there is a power failure in the research building the air exhaust will shut down but the biosafety cabinets will continue to maintain negative pressure. If this occurs all work in the room will stop until the power returns. (2) If both the room air exhaust system and biosafety cabinet fail this will results in the complete loss of negative pressure in the BSL-3. If this happens all work in the BSL-3 will be stopped immediately. All personnel will leave and the room will be sealed shut with duct tape until the room is repaired.

B. SpillsAccidental spills of mycobacterium cultures or clinical specimens require special considerations in regard to decontamination procedures. All spills must be immediately reported to BSL-3 Facility personnel. Spills are divided into three types and should be dealt with accordingly.

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1. Spills within biosafety cabinets are handled immediately by the worker. Leave the biosafety cabinet running and cover the spill with a generous amount of 5% Lysol I.C. or 1:10 bleach. After 15 minutes, wipe up the liquid with paper towels. Equipment or supplies affected by the spill should be sprayed with 5% Lysol I.C. or 1:10 bleach and then wiped dry. Surfaces are then sprayed with 70% ethanol. All towels are disposed of in the biohazard waste container in the room.

2. Accidents outside the biosafety cabinets, such as spilling a culture or breaking a rack of slants, require the following action:

i. Everyone in the room immediately exits.

ii. In the anteroom of the Facility, remove gown, and gloves and dispose of them in the biohazard waste. Wash hands with germicidal soap and water and then remove the disposable respirator.

iii. Everyone leaves through the outer door. A sign will be placed on the outer door to the Facility forbidding entrance.

iv. Contact BSL-3 personnel. See Appendix 4 for Emergency Call list in the event of a spill.

v. After one hour, the person responsible for the spill and BSL-3 personnel will enter the Ante-room. Employees must enter wearing standard BSL-3 PPE.

vi. BSL-3 personnel will direct the clean-up. After entering the inner room, the spill is covered with the powdered absorbent found in the spill kit, located in the Ante-room. Care must be taken to gently apply the powder in order not to re-aerosolize the spill. The absorbed infectious spill is then gathered and scooped into the biohazard container.

vii. The contaminated area on the floor is sprayed with 5% Lysol I.C. and wiped dry with a paper towel. All affected equipment, counters, and the walls must be sprayed with the disinfectant, allowing contact of at least 20 minutes, and then wiped dry. The floor must be mopped with a 1:10 bleach solution.

3. Major spills, such as a large culture that drops and splatters infectious broth throughout the room, a full shelf of the incubator toppling to the floor and sending slants and broth in all directions, etc., or a release occurring during centrifugation, must be dealt with in the following manner:

i. Everyone in the room must immediately stop what they are doing, properly dispose of their outer pair of gloves, and leave the room.

ii. In the Ante-room of the Facility, remove gown, and gloves and dispose of them in the biohazard waste. Wash hands with germicidal soap and water and remove the disposable respirator.

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iii. Seal the inner door with duct tape.iv. Exit through the outer door.v. Contact BSL-3 personnel. See Appendix 4 for the Emergency

Call List in the event of a spill.vi. BSL-3 personnel, equipped with an N95 respirator will assess the

degree of contamination and determine if the Facility will need to go through a decontamination procedure.

4. Spills that occur in equipment such as a centrifuge must be sprayed with 5% Lysol I.C. (not bleach), allowing 20 minutes (minimum) contact time, then wiped dry.

C. Exposure IncidentsIf a person working in the Facility spills contaminated material on exposed skin, the affected area should be washed with germicidal soap. If contaminated material is spilled on clothing, the affected article of clothing must be removed and placed in a biohazard bag, which is taped shut and must be autoclaved.

If an employee has reason to believe he/she has been exposed to Mycobacterium tuberculosis or any other biological or chemical material through contact, inhalation, or puncture, the following steps must be followed:

1. Report the incident to the Director (or designee) who will in turn notify

appropriate department personnel.2. Notify anyone else in the area that may also have been

exposed.3. An Employee Accident Injury Report will need to be completed.

These are available in the VAHS Research Office.4. The VA Occupational Health Clinic should be consulted and a PPD

skin test or other tests, as deemed necessary, scheduled. D. Power Failure

In the event of a black out, the employee's actions are determined by the response of the building's back-up generator. The loss of power to the building activates the emergency generator and power and should be restored within 50 seconds. If the power and lights are not restored after one minute, the operator must stop work and leave the room. Emergency lights in the corridor will activate to provide exiting capabilities. If the power remains off, the door to the inner chamber should be sealed with duct tape. Safety apparel is then properly discarded, and individuals may leave the Facility, after proper hand washing.

E. Fire1. Evacuation

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If the fire can be contained, extinguish the fire using a fire extinguisher. The Ante-room has an extinguisher available. If not able to contain the fire, evacuate immediately, and notify emergency personnel. Report to the fire- fighting authorities the specific agents, animals and special hazards associated with the BSL-3 Facility.

2. Cleanup and Disinfection

After a fire affecting the BSL-3 Facility, trained emergency personnel gowned, gloved, and using the appropriate respiration must assess the situation to determine the extent of contamination in the Facility and whether disinfection of the surfaces or a full decontamination of the Facility is required before resuming activities.

F. Earthquake The strength of an earthquake can vary and the employee’s actions are determined by the strength of the earthquake and resulting damage. The first step after a quake is to determine if the ventilation of the BSL-3 is still intact. This can be done by consulting either of the 2 air pressure monitors in the lab. If the ventilation is not functional then the door to the inner chamber should be sealed with duct tape. Safety apparel is then properly discarded, and individuals may leave the Facility, after proper hand washing. All damage is reported to the Engineering Section

XV. Recombinant DNA

A. Medical Surveillance.

The "NIH Guidelines for Recombinant DNA Research" state that it is the responsibility of the Institution to "determine, in connection with each project, the necessity for medical surveillance of recombinant DNA research personnel before, during, and after their involvement in this research" The Guidelines further require the principal investigator to investigate and report "in writing to ORDA and the IBC any serious or extended illnesses of a worker or any accident that results in (I) inoculation of recombinant DNA materials through cutaneous penetration, (ii) ingestion of recombinant DNA materials, (iii) probable inhalation of recombinant DNA materials following gross aerosolization, or (iv) any incident causing serious exposure to personnel or danger of environmental contamination." These activities constitute the minimum requirements for a medical surveillance program for recombinant DNA research. The Guidelines also recommend that the medical surveillance program provide for collection and maintenance of serum samples and for the immunization of all workers who may work with known pathogens for which an effective vaccine is available. This section provides further guidance to institutions on activities that may be considered for inclusion in a medical surveillance program. The extent of any medical surveillance program will vary greatly, depending upon the nature and size of the research project and the available medical facilities. For example, a comprehensive medical surveillance program including pre-assignment and periodic physical and other medical examinations may not be appropriate for laboratory workers involved in

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research requiring Pl and P2 levels of physical containment, whereas such a program may be advisable for workers engaged in certain research projects requiring P3 physical containment and would be recommended for workers engaged in research requiring P4 physical containment. The objective of this review is to provide pertinent information and call attention to various functions related to medical surveillance that are recommended for consideration, insofar as they are applicable to recombinant DNA research. These recommendations are intended to supplement normal pre-employment medical examinations that determine suitability of a prospective employee to a particular job situation.

B. ImmunizationsImmunization is generally recommended for laboratory workers who will be engaged in research with infectious organisms for which an effective vaccine is available. At some institutions, prior immunization may be required for certain Positions as a condition of employment. Where immunizations are required, evidence of antibody response should be demonstrated, whenever possible, before an employee begins to work with infectious organisms.

Detailed information on vaccines and general recommendations for the immunization of laboratory workers can be found in "Lab Safety at the Center for Disease Control" U. S. Department of Health, Education, and Welfare, Public Health Service, HEW Publication No. CDC 77-8118.

C. Medical ExaminationsIt is impossible to make specific recommendations concerning the need for either Pre-assignment or periodic medical examinations for laboratory workers engaged in recombinant DNA research. Such recommendations must be determined on a case by case basis and will depend on the assessed hazards of the project and the individual needs of the laboratory worker. Where the potential for laboratory acquired illness is known to exist, medical examinations are appropriate. Pre-assignment medical examinations, in this case, will establish baseline data that may provide the basis for comparison in the event a laboratory acquired illness occurs. If pre-assignment medical examinations are provided, they should include a medical history, physical examination, skin test for tuberculosis, serology, selected biochemical tests, a complete blood count, urinalysis, needed immunizations, vision testing and an audiometric examination. An electrocardiogram should be taken for persons over 40 years of age and a Papanicolau smear for women. Periodic medical examinations of laboratory workers who are actively engaged in research with potentially hazardous organisms will be provided with the opportunity to update the employee's work history and to ensure that the employee has the opportunity to bring to the attention of the medical service any condition which may require more extensive examination. Although scheduled periodic medical examinations would be the ideal, the realities of cost and the availability of medical manpower make individualized non-routine medical attention more rewarding to the laboratory worker and the institution alike. Updating the work and medical histories of the laboratory worker could be achieved by having the

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worker periodically prepare and transmit to the medical service an interval medical report. The medical service could review each report and determine whether medical consultation is required. Then an appointment could be scheduled with the laboratory worker, if necessary. The following questions and, requests for information would be recommended for inclusion in an interval medical report:

i. Have you had any serious or extended illnesses since your last medical report.ii. Have you been off work and/or hospitalized due to illness

since your last medical examination or interval medical report?

iii. List the infectious agents you have been working with since your last medical examination or interval medical report.iv. List the source(s) of DNA, the nature of inserted DNA sequences and the hosts and vectors you have used in recombinant DNA studies since your last medical examination or interval medical report.v. List all drugs or medications you use. Include prescriptions and over-the-counter medicines taken on a regular basis. Please state the name of each drug and the frequency with which it is taken. Be sure to note antibiotics and antacids. Include any herbal medications or products.vi. List any drugs or medication you take only occasionally (e.g., laxatives, pain medication) including herbal medications / products.vii. List any accidents that resulted in inoculations, ingestion or probable inhalation. viii. Recombinant DNA materials since your last medical examination or interval medical report.

Where a laboratory worker is maintained under an effective medical surveillance program, it is recommended that a final medical examination be provided prior to termination of employment.

D. Spills.

Reporting and Investigating of Accidents and IllnessesIf an organism containing recombinant DNA molecules were to acquire the capacity to infect and cause disease in man, the first evidence of this potential may be demonstrated by a laboratory acquired infection. For this reason, it is important to investigate any serious, unusual, or extended illness of a laboratory worker engaged in recombinant DNA research or any accident that involves inoculation of organisms containing recombinant DNA molecules through the skin, by ingestion, or probable inhalation. A finding that infection is associated with recombinant DNA research will provide sufficient warning for evaluation of hazards and initiation of additional precautions to protect the general public, if such protection is necessary.

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Prompt reporting of accidents involving overt exposures is essential. The laboratory worker involved with such an Occurrence should notify the principal investigator (or another person in authority in absence of the principal investigator) immediately. The principal investigator should determine the immediate action to be taken. This may include requesting the support of the medical service to help identify the possibility of infection and disease. A thorough investigation by the medical service would include the collection and analysis of appropriate clinical specimens. For example, if selfinoculation, cuts or abrasions involving a potentially hazardous organism occurred, it would be advisable to collect serum samples immediately after the incident and at an appropriate time following the incident for the purpose of demonstrating, if possible, seroconversion. After a massive aerosol exposure, it may be advisable to obtain nasal and skin cultures to confirm the exposure. Throat washings may be of value in confirming exposure following accidentalingestion. In the event that a laboratory worker develops diarrhea or other gastrointestinal symptoms following an overt exposure, it may be advisable to obtain stool specimens for analysis of contamination with the research agent.All major, unusual or extended illnesses of laboratory workers should be screened by the medical service for possible occupational origin and recorded for future reference. Also, first-aid and lost-time occupational accidents, as well asaccidents without personal injury but which result in exposure of the worker to a potential hazardous organism should be noted in the worker's individual medical case file together with the result of examinations deemed appropriate by the physician at that time. The investigation of accidents associated with recombinant DNA research should also include a review of techniques, procedures and types and uses of equipment that may have been involved in the accident. The investigation should also establish the circumstances leading to the accident. In addition, the investigation report should provide recommendations for preventing similar occurrences.

Decontamination1. Spills of material that is contaminated with recombinant DNA at a biosafety level 1 are generally treated in the same manner as normal microbiological or animal waste.

2. The following procedures will be followed if contaminants are at a biosafety level 2:

i. Contaminated materials that are decontaminated at a site away from the laboratory shall be placed in a closed durable leak-proof container prior to removal from the laboratory.

ii. Contaminated animal materials removed from the containment area shall be transferred to a non-breakable

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sealed primary container and then enclosed in a non-breakable sealed secondary container. All containers, primary and secondary, shall be disinfected before removal from the facility.

iii. Needles and syringes shall be promptly placed in a puncture-resistant container and decontaminated, preferably by autoclaving, before discard or reuse.

iv. Laboratory coats, gowns, smocks, or uniforms shall be worn while in the animal area or attached laboratory. Before entering non-laboratory areas (e.g., cafeteria, library, administrative offices), protective clothing shall be removed and kept in the work entrance area.

v. Special care shall be taken to avoid skin contamination with microorganisms containing recombinant DNA. Impervious and/or protective gloves shall be worn when handling experimental animals and when skin contact with an infectious agent is unavoidable.

E. Reporting

Any incident involving spills and accidents that result in environmental release or exposures of animals or laboratory workers to organisms containing recombinant DNA molecules shall be reported immediately to:

1. The Institutional Biosafety Committee, NIH/OBA.

2. The VISN 22 Office

3. ORO Western Region

Reports to the NIH/OBA shall be sent to the Office of Biotechnology Activities, National Institutes of Health, 6705 Rockledge Drive, Suite 750, MSC 7985, Bethesda, MD 20892-7985 (20817 for non-USPS mail), 301-496-9838, 301-496-9839 (fax).

XVI. Recovery Plan

Recovery from significant emergencies and disasters is specific to the magnitude of the disruption event. All staff will defer to the HCG/Service senior manager/supervisor before initiating recovery response actions. Depending on the magnitude of the disruption, senior manager/supervisor will take direction before initiating recovery actions using the following matrix:

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Major Event/Incident Type

HCG/Service Recovery Action

Authorizing Agent

Evacuation Re-enter building Safety Officer

Shelter In Place Return to normal operations Safety Officer

Lock Down Return to normal operations VA Police

Major Utility Disruptions Return to normal operations Safety Officer

Major Chemical/Biological Spills

Return to normal operations Industrial Hygienist/Safety Officer

Other Significant Disruptions

Return to new-normal operations

Medical Center Director

The medical center utilizes Hospital Incident Command System (HICS) in response to significant disruptive events. The magnitude of a disruptive event is defined by VALBHS’s Leadership actions and level of activation of the hospital’s Emergency Operations Plan (EOP) and HICS. Failure to comply with this procedure places a significant risk to life safety. Compliance is mandatory.

XVII. REFERENCES:

http://www.lama-online.org/OLAW-1.html

Fire: Refer to R&D Safety, Health and Fire Protection Program, July 2001.

Hazmat Spills: Refer to R&D Hazard Notification - Chemical Safety Guidelines, Microbiology/Infectious Diseases Safety Guidelines, Radioactive Materials Safety Guidelines. R&D Hazardous Surveillance Program, July 2001. R&D Chemical Hygiene Program, (OSHA Lab Standard 1910.1450) July 2001.

Earthquake: Refer to VALB Emergency Management Plan

Flood: Refer to VALBHS Emergency Management Plan

Bomb Threat: Refer to VALBHS Emergency Management Plan

Civil Disorder/Crime: Refer to VALBHS Emergency Management Plan

Recombinant DNA: NIH Guidelines for Research Involving Recombinant DNA Molecules (April 2002)

NIH Laboratory Safety Monograph 1/2/79

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http://www.lama-online.org/OLAW-1.html


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Appendix A

RESEARCH HEALTHCARE GROUP - CASCADE RECALL PLAN

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Christopher ReistACOS/R&Dx4941, x5801

C (562) 760-6041

Alicia Del Villarx4928

(323) 434-5502

Hamid M. Saidx5811

(949) 463-8263

Chuck Sohaskeyx4912

(562) 533-7207

Amrita Ahluwaliax5813

(949) 689.5175

S. Khalaghizadehx3393

(714) 809-4168

Mahmood NovinX2200

(714) 747-3973

Thay Q. Leex5344

(949) 248-4913

Michelle McGarryx5122

(760) 707-6204

Neil Hoax5814

(714) 444-1894

David StansburyX5838

(714) 839-4173

Judith Vallex5821

(714) 588-3275

Rachel Gonzalezx2898

(410) 925-9251

Brocton McCloddenX5287

(562) 841-4754

Sandra GrahamX4939

(714) 401-8705

Belizario Rodriguezx5822

(714) 768-0690

Linda Nguyenx7212

(714) 206-2401

Debbie Moreirax5822

(562) 274-3405

Brocton McCloddenx5287

(562)841-4754

Tammy Bonx4948

(562) 576-6667

Nikki Frousakisx4198

(562) 896-7024

Juan MirandaX4604

(310) 775-1469

Aliya Asgharx5212

(714) 343-7544

Sara Stanfordx5118

(949) 228-6036

Valerie Viramontesx5801

(323)721-1814

Kayli Nishimex5822

(562) 472-5883


Appendix B

Designated Persons and Evacuation Routes

Principal Investigator Designated Person Build / Room number Emergency Door To be Used

Hoa, Neil Hoa, Neil 138/141 NorthLee, Thay Q. McGarry, Michelle 138/103,105,107,112 NorthLevin, Ellis Valle, Judith 138/230,235,244 NorthMcLaren, Gordon McLaren, Gordon 138/129 NorthSassoon, Catherine S. Zhu, Ercheng 138/127,131,133 NorthTarnawski, Andrzej, S Ahluwalia, Amrita 138/102,104,106,109 NorthSohaskey, Charles Sohaskey, Charles 138/202,203,205,207 NorthMoradi, Hamid Moradi, Hamid 138/229 NorthSzabo, Sandor Deng, Xiaoming 138/B3,B19,228,233 NorthSaid, Hamid M. Rubina Kapadia 138/218,219,220,221 NorthWu, Sing Yung Wu, Sing Yung 138/236, 242 North

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