Executive Summary

Executive Summary: Biosafety Technical Page

The purpose of this technical page is to introduce the concept of biosafety, how to implement biosafety practices at the non-human primate/human interface in “range country captive centers,” settings, (hereafter referred to as centers) and how COVID-19 impacts and challenges effective and safe biosafety practices in these centers. Our goal is to promote human and animal health and safety through the information and resources provided on this page.

Introduction of Terms: Here we discuss biosafety as a professional term, and how biosafety and biosecurity compare to one another as professional practices. Both biosafety and biosecurity are focused on the ideas of prevention and control of health hazards (in this case infectious diseases). There are many strategies to prevent or control the spread of an infectious disease. These have been described holistically within the “Hierarchy of Controls” framework, created by the United States Centers for Disease Control and Prevention (CDC) and United States National Institute of Occupational Safety and Health (NIOSH). An overall approach to designing a system with the above in mind is called “Prevention Through Design”, and involves a systems, risk-based approach to building all levels of the hierarchy into a safety plan for any workplace.

Risk-Based Approaches to Biosafety: We also introduce risk analysis, and how understanding risk influences biosafety. The field of Infectious Disease Risk Analysis was created to support decision making in the face of uncertainty. In the case of emerging infectious diseases, the lack of available information (and resulting high degree of uncertainty) can make disease management confusing and frustrating. The current COVID-19 pandemic is a good example of the need for a risk-based approach to support prevention and control efforts. Systems mapping can be done to highlight areas of concern for disease transmission, followed by how those critical points in the system can be handled to mitigate the spread of disease.

Designing a Risk-Based Biosafety Program for Prevention and Control of COVID-19 at the Human/Great Ape Interface: Uniquely complex settings, such as great ape centers, pose specific risks from human-animal interactions and subsequent disease transmission. Therefore, characterizing risk in this setting can be challenging. Exposure pathways at the human-animal interface exposure pathways can be classified as very high, high, medium, or lower risk, all based on “likelihood of exposure.” To most effectively prevent or reduce disease transmission, it is important to understand the transmission routes of SARS-CoV-2.

Core Biosafety Measures: This section of the technical document is focused on understanding and implementing the Hierarchy of Controls. Once all the risks and critical points of disease transmission have been identified using the systems mapping and risk-based approach to biosafety, prevention and control measures can be created and implemented in the workplace. The control and prevention methods discussed herein specifically concern COVID-19 (but are useful for any highly transmissible zoonotic disease), and how to keep both humans and animals safe as they navigate their work/living environment. Some points of discussion (within the so-called hierarchy of controls) include, elimination controls, engineering controls, administrative control methods, and personal protective equipment (PPE).

PPE Training Program (currently in development): In this section, we will provide a link to an online training resource that dives deeper into COVID-19, biosafety, and working closely with animals on a day-to-day basis. Completion of this training will signifiy an individual’s understanding of facts about biosafety and COVID-19, as well as the skills and knowledge to implement occupational health and safety best-practices to avoid infection with SARS-CoV-2. Competency in biosafety and clinical practices is important in reducing the incidence of disease, specifically COVID-19, in centers in which humans and non-human primates frequently interact with one another very closely.

In summary, this technical document provides information on biosafety and COVID-19. Herein, we provide information and resources to practice system’s mapping according to risk level, and how to implement prevention and control methods to limit the spread of disease. We also plan to provide a training tool that anyone working with animals can use to improve their skills and better understand best practices in maintaining both human and animal health in a work environment.

Introduction to Biosafety and Biosecurity

The general public uses these terms interchangeably, but there are differences that matter in a professional setting.

Biosafety has varying definitions depending upon the context of its use, but a good general definition is, “methods that are used to stop a biohazard from spreading out of a given place or causing harm” (Cambridge dictionary). In this context a biohazard is something such as a disease or chemical that may harm people, animals, or the environment (Cambridge dictionary). The Australian Department of Health describes biosecurity as all the measures taken to minimize the risk of infectious diseases caused by viruses, bacteria or other microorganisms entering, emerging, establishing or spreading in a defined area (country, city, laboratory, building, etc.), potentially harming human or animal populations, food security and economy (https://www1.health.gov.au/internet/main/publishing.nsf/Content/ohp-biosecurity-information.htm). Sometimes, the two are used differently, geopolitically, in which case biosafety aims at protecting public health and environment from accidental exposure to biological agents, and biosecurity deals with the prevention of misuse through loss, theft, diversion or intentional release of pathogens, toxins and any other biological materials. Recently, biosecurity has merged into the UN/WHO Global Health Security Agenda as a discipline, or specialty, creating some confusion.

Both biosafety and biosecurity are focused on the ideas of prevention and control of health hazards (in this case infectious diseases). Prevention can be defined as the precautionary measures implemented to halt or prevent disease transmission or prevalence in a population. Prevention strategies, such as vaccinations, prevent infection from other individuals or the environment and are used to reduce the spread of an incoming risk. Control can be defined as the reduction of disease incidence, prevalence, morbidity or mortality to a locally acceptable through deliberate efforts (Centers for Disease Control and Prevention, accessed 9/14/2020). Control strategies, such as treatment for a specific pathogen or disease, are used to reduce the spread of disease from an infected individual to a non-infected individual. The efficacy of prevention and control strategies are often assessed through the use of diagnostic tests that identify specific pathogens or infectious agents. How diagnostic tests are used at the individual, population and environmental levels is explained in more detail on the diagnostics technical document on the Hub.

There are many strategies to prevent or control the spread of an infectious disease. These have been described holistically within the “Hierarchy of Controls” framework below.

Figure 1: CDC/NIOSH Hierarchy of Controls.

Source: accessed August 18 2020

This model, created by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. National Institute for Occupational Safety and Health (NIOSH), is a system used to deploy effective controls (risk management) within an organization, workplace, or community to identify the most effective ways to control a hazard (Source accessed August 18 2020). The control methods at the top (wide part of the pyramid) are generally considered to be the most effective, while those at the bottom (tip of the pyramid) are the least effective when it comes to reducing risk. Specific examples of risk reduction measures in each category include:

Elimination: proper disinfection (chemical, application method, concentration and time) to achieve elimination of infectious agents.
Substitution: this category often applies more to the use of hazardous chemicals (often for disinfection) that may pose toxic threats. In these cases, substituting less risky chemicals (or treatments for instance) can decrease overall occupational risk. The use of bleach versus other potential cleaning methods for food safety in a sanctuary setting is an example often discussed.
Engineering Controls: animal exhibit, or clinic/hospital, design is an example of specific attempts to create a safer human-animal interface in a sanctuary setting.
Administrative Controls: these methods are focused on HOW people work within the engineered system above to minimize the spread of disease through adjusted workflow. Some examples include differentiating between the “dirty” and “clean” parts of a lab, clinic or animal enclosure; the order in which a person dons and takes off PPE; how animal food is delivered, cleaned, stored and prepped are all examples of adjusting workflow.
Personal Protective Equipment (PPE): this includes techniques for creating physical barriers to the release of a disease agent from one individual or blocking an agent's ability to find a portal of entry into a susceptible individual. Examples include wearing gloves, face masks, face shields, or safety goggles when working in an environment that favors or enhances disease transmission.

An overall approach to designing a system with the above in mind is called “Prevention Through Design”, and involves a systems, risk-based approach to building all of the above into a safety plan for any workplace (Source: Centres for Disease Control and Prevention) - this includes both infectious and non-infectious hazards like chemicals, toxins, etc. The specifics of this program may be overkill for a sanctuary/center or field setting (eg. they are often designed for larger hospitals, factories, or office buildings), but the principles and “design thinking” are relevant to any type of work and may be taught and practiced to increase the effectiveness of disease risk management strategies at the human-animal interface.

Risk-Based Approaches to Biosafety

The field of Infectious Disease Risk Analysis was created to support decision making in the face of uncertainty. The risk analysis approach is a set of methods that support “prevention through design,” and involves following a structured process that allows for better characterization (assess) to prevent introduction and then reduction (control) of disease risks within a given system if introduction can’t be prevented. It also allows us to identify areas of greatest uncertainty for research. When designing biosafety protocols it is important to first understand and accept that disease transmission may be adequately controlled and prevented, but the risk is never completely controlled under the best of circumstances (ie. there is no such thing as zero risk).

In the case of emerging infectious diseases, the lack of available information (and resulting high degree of uncertainty) makes disease management confusing and frustrating - especially when compounded by fear. The current COVID-19 pandemic, with its vast degree of complexity and uncertainty, is a great example of the need for a risk based approach to support prevention and control efforts. The urgency of this need has recently increased due to:

The spread of SARS-CoV-2 from animal to human populations (Please see the study, linked here, for an example of SARS-CoV-2 transmission from human to animal populations, and then spilllover back to humans from infected animals) and
The identification of a broad array of potential susceptible/competent mammalian hosts for SARS-CoV-2 greatly increases the number of potential transmission pathways.
The current lack of preventative measures and fully validated diagnostics in animals

The first step in implementing a risk-based approach is examining the diseases, or “hazards,” of greatest concern in the context of the problem. This step is known as “hazard identification” in the jargon of Risk Analysis. In the case of human-nonhuman primate interfaces, we are often concerned with those that can be transmitted between humans (human-human transmission), animals (animal-animal transmission), and humans and animals (zoonotic/anthropozoonotic transmission). This technical page is intended to model the development of a risk-based approach for prevention of an infectious disease, such as COVID-19, in the conservation workplace (sanctuary or in situ field site), and how to select and implement biosafety practices based on that system. COVID -19 is a good example because it is currently a high priority, and because it is relevant to all the interfaces discussed above. After hazards are identified (ie. COVID-19), the next step involves thinking holistically about how disease may enter and spread through the system, as well as the likelihood and consequences of disease entry and spread. Once this “baseline risk” is established, prevention and control strategies for risk management can be discussed and assessed.

Systems Mapping for Biosafety Planning

Good, comprehensive biosafety programs are best designed and implemented by viewing the workplace, whether a physical structure or a forest, as a system. Biosafety tools are then designed to reduce disease transmission risk by blocking the ability of a virus (in this case) to successfully move along a given disease transmission route/pathway. The routes and risks differ between systems, so first the systems in which individuals at risk are working need to be identified and described. For example, a home, shop, school, village, city, wildlife park, or sanctuary can be seen as a system. Many of these can be combined in to a larger dynamic system (eg. a person traveling from home to work and back in a day could be defined as a daily system). Usually, the system is mapped through the creation of a conceptual diagram. The figure below provides an example.

Mapping human to human transmission.png

Figure 2: Crude systems diagram mapping pathways for human-human transmission of respiratory viruses.

Source for this graphic

Once the system in question is defined and mapped, the identification of critical points that enable disease introduction and spread can begin. Identification of these critical disease transmission points allows for the planning and implementation of risk reduction biosafety measures, such as physical distancing or the use of appropriate PPE. It can be useful to refer to the hierarchy of controls again at this stage. After selecting best tools, execution of biosafety measures consists of three parts: basic knowledge (what PPE to use), application (how to properly use PPE), and operationalization (proper and consistent implementation under working conditions). The figure below illustrates how systems mapping can be done to highlight areas of concern for disease transmission, and then how those critical points in the system can be handled to mitigate the spread of disease.

Systematic diagram of respiratory infection.png

Figure 3: Systems diagram of respiratory transmission including control/risk management procedures, highlighting covering coughs and washing hands. (Source Website)

Biosafety failure can occur due to uncontrollable circumstances, such as faulty equipment, but more often it is as a result of inadequate selection, planning, or improper/inconsistent use and implementation. Thus, communication (planning, training or implementation) with all stakeholders is key for both design and implementation planning. Proper stakeholder involvement includes inclusion of all those who influence or are affected by the system such as managers, health professionals, animal care staff, field biologists, local public health authorities. For more information on who/what stakeholders can be and how to best involve them in your organization’s activities, please see the following PDF(link) created by the Centers for Disease Control and Prevention.

Designing a Risk-Based Biosafety Program for Prevention and Control of COVID-19 at the Great Ape Interface

A. Systems Mapping for Great Ape Sanctuaries and In Situ Conservation Sites

This resource is concerned with biosafety as it pertains to managing risks associated with transmission of SARS-CoV-2 in great ape sanctuaries or field conservation settings. This setting is uniquely complex since transmission may occur at human-human, animal-animal, or human-animal interfaces (in both directions multiple times). In sanctuary settings, the risk of transmission between and among the differing human populations (conservation workers, tourists, worker families, other local people) - and NHPs - creates the potential for local wildlife reservoirs and spillback to humans. In in-Situ conservation settings, there are additional dynamics of human interaction both within (researchers, tourists and park workers) and along park boundaries (local inhabitants/villages, extractive industries, agriculture, etc.). The complexity of these systems is represented in figure 4.

Figure 4: a systems diagram of the human-human-great ape interface in a sanctuary setting in response to SARS CoV2 (Author: Sulistyo 2020, Used with permission from BOSF)

Nyaru Menteng Orangutan centre, Central Kalimantan

At this point, one should have a) mapped the workflow of the system, b) identified areas of greatest exposure between humans and animals, and c) understand the context of important potential routes of transmission. Figure 2 above is recopied here and is a good example of implementing several types of biosafety controls such as face coverings, physical distancing, disinfection and hand washing.

Systematic diagram of respiratory infection.png

This model can, and should, be applied to COVID-19 at the sanctuary level to ensure the health and safety of both humans and animals and reduce the risk of SARS-CoV-2 transmission between the two populations. However, it is important to understand that some of the most effective prevention strategies, such as elimination and substitution, may be challenging to implement in places where COVID-19 is already present.

B. Characterizing the Risk of Differing Human Interfaces: What is a risky job?

As shown in the diagrams above, one must consider several different categories of humans when considering the sanctuary or in situ great ape interface. For transmission to occur, many things have to “go right” for the virus:

The infectious agent must be present - there must be an infected human who is infectious (regardless of the presence of clinical signs);
There must be exposure between infectious and susceptible individuals - the infected human must be in the presence of a susceptible animal (by human transmission standards “competent exposure” means < 2 m for > 15 min);
Virus must actually enter the susceptible individual - The virus must be expelled from the host and received on the mucous membranes (directly or indirectly) of the susceptible animal, and
The susceptible animal must be infected, which depends upon factors specific to that individual animal (dose, immune status, concurrent disease, etc.)

The alternative pathway includes indirect transmission via contact with a contaminated part of one’s environment. The biosafety measures covered in this module assume that points 1, 3 and 4 may happen, and focus on risk reduction measures for point 2 above.

As you can see in Figures 4 and 5, not all human-animal exposure pathways are the same. Exposure differs greatly in spatial proximity (distance), frequency, and length of time under differing conditions. These interfaces are generically described in terms of human-ape transmission potential below.

Human Category	Proximity	Frequency	Time	Personal Exposure	Risk
Conservation Worker (Park or Sanctuary)	High - intentionally directly engage the human-ape interface	High - daily	Med-High - depends upon job	Local or Regional	High
Tourist	Med-High - intentionally directly engage the human-ape interface	Low - one or few times	~1 hour - time limited	Local, Regional and Global	Medium
Researcher	High - intentionally directly engage the human-ape interface	High - daily	High - usually all day	Local, Regional and Global	Very High
Local Community Member	Low - (indirect exposure)	Low	Low	Local, Regional	Low (unless cohabitate with one of above)
Local worker (extractive industry, day labor, food supply, etc.)	Medium - (likely not intentional, but close exposure does occur, especially through contaminated waste)	Low-Med	Low-Med	Local, Regional and Global	Medium

Table 1: Risk-based approach to ranking the human-NHP interface in terms of exposure risk for sanctuaries and in situ conservation sites.

Human-animal interface exposure pathways can be classified as very high, high, medium, or lower risk. All of these are based upon the idea of “likelihood of exposure” between humans and apes in this example. A “high risk” exposure is currently commonly defined as a) proximity within 2 m for a total of 15 min or more with an infectious individual, or b) having contact with the infectious secretions from a patient with COVID-19 or contaminated patient care environment, without using proper PPE or not performing appropriate hand hygiene (US Centers for Disease Control and Prevention; accessed 9/14/2020).

The factors in the model above used to rank risk include:

Proximity of humans to apes: what is the likelihood that this category of humans will have a high risk exposure to a susceptible ape, or vice versa?
Frequency: how often will this category of humans have a potentially high risk exposure to a susceptible ape, or vice versa?
Time: is the exposure of this category of humans to apes (or vice versa) likely to be high risk (>15 min)?
Personal exposure: what is the cumulative personal exposure of the category of humans potentially exposed to a susceptible ape, or vice versa? This is categorized into local, regional (regardless of international borders), and global definitions.

The above rankings are built from the United States Occupational Safety and Health Administration Occupational Risk Pyramid, which is similar to those implemented by the European Union and WHO. For more information please follow this link: Safety and Health Topics | COVID-19 - Hazard Recognition.

It is important to note that risk levels are NOT static, but dynamic, meaning they can change. These categories (or others that fit an individual situation better) will need to be regularly reassessed in order to ensure that you are practicing the best biosafety procedures according to your locally assessed risk level.

C. Transmission and Ecology - SARS-CoV-2

To most effectively prevent and reduce disease transmission, it is necessary to understand the transmission routes of SARS-CoV-2. An overview of disease transmission routes in general can be viewed by following this link to National Geographic Methods of Disease Transmission, accessed August 21 2020). It has been confirmed that SARS-CoV-2 may spread by both direct and indirect transmission pathways. The fecal-oral route of transmission for SARS-CoV-2 has not been confirmed, but the virus has been detected in feces from COVID-19 patients (Source: NCBI accessed August 24 2020). The evidence base for aerosol transmission of SARS-CoV-2 is increasing (World Health Organization updating page on aerosol transmission of SARS-CoV-2: Source: WHO), and may change the current working definition for exposure in high-risk scenarios. The diagram below characterizes high risk transmission routes of zoonotic coronaviruses, including SARS-CoV-2, but is limited mostly to the “spillover” story (from wildlife to humans; zoonosis) and unfortunately does not include the larger ecological picture of potential risk of anthropozoonosis. This is highlighted in figure 5.

Conceptual diagram of COvid-19 spillover.jpg

Figure 5: Conceptual Diagram of Coronavirus Spillover and Amplification

Source for image

A more comprehensive look at potential transmission expands the story to include anthropozoonotic (spill back or reverse zoonosis) transmission risk. The “spillback” infection of domestic pets and or the large felids from owners or zoo keepers exemplifies this complex potential risk. An evidence based approach based on current molecular epidemiological methods expands the potential ecology of susceptibles

Figure 6: Ranking of host susceptibility “risk of being infected” based upon genomic evidence (Damas et al., )

Core Biosafety Measures

This section reviews biosafety measures commonly employed using the hierarchy of controls model (maybe link back or include again)

A. Elimination

Disinfection: Disinfection is an important process in reducing or preventing the presence of infectious diseases in the environment, especially in high risk workspaces with increased human and animal interactions. A disinfectant is a chemical agent that is used especially on hard surfaces and in water (such as drinking water or wastewater) to destroy, inactivate, or significantly reduce the concentration of pathogens (Source: Meriam-Webster Dictionary Accessed 14th September 2020). Disinfectants kill certain bacteria, viruses, mildews, or fungi, and they are used on non-living things, such as stall floors, trailers, buckets, and door handles, to kill the microorganisms living on that inanimate surface. Most disinfectants have a label provided by the manufacturer that communicates the chemical composition of the disinfectant and the known harmful effects of any hazardous substances within the disinfectant. These differ from other cleaning products, such as cleaners or antiseptics. Cleaners do not kill microorganisms, but are important to use with disinfectants because they remove dirt from objects and surfaces. Removing dirt is very important because some disinfectants, such as bleach, are inactivated by organic (dirt) material. Antiseptics are used on living organisms, such as human skin, to kill any microorganisms living on the body’s surface.

It is highly important that you read the labels on all cleaning and disinfectant products prior to their use. Never mix ammonia and bleach products, as this combination produces a toxic gas that can be fatal when inhaled.

For guidance on disinfecting or cleaning work or personal spaces, please see this resource by the United States Centers for Disease Control and Prevention: Link to resource

The United States Environmental Protection Agency (EPA) has also compiled a list of approved cleaning and disinfecting products for use against the SARS-CoV-2 virus, here: Link to resource

B. Engineering Controls

Exhibit and Facility Design

Engineering controls are favored over administrative and PPE controls because they are used to remove the hazard (in this case, the SARS-CoV-2 virus) from the environment. These control methods are often more difficult to implement, but are the most effective, long-term protective measures. Exhibit and facility design directly impact workflow, and can be manipulated as an engineering control method to enhance or improve biosafety practices at the human-nonhuman primate interface. Enclosure design and workflow can be assessed using a risk-based analysis that identifies the critical points in the enclosure that allow for human-animal disease transmission. Additionally, critical points of disease transmission also exist and need to be identified in procedures involving enclosure design, such as the cleaning of and maintenance of enclosures, that can be changed as the enclosure itself is altered.

Human-animal interactions at the level of the animal’s enclosure poses a risk to both human and animal health. According to the European Association for Zoos and Aquariums, biosafety is key during the cleaning of animal enclosures and equipment within them, to reduce the risk of disease or disease transfer (Source: EAZA Standards for the Accomodation and Care of animals in zoos and Aquaria Accessed 15th September 2020). As previously stated, there is risk for transmission of SARS-CoV-2 as an aerosol or droplet. This mode of transmission is more likely to occur when performing aerosol/droplet-generating procedures, such as cleaning animal enclosures, and the virus is present in the environment or NHP or human bodily fluids/secretions.

However, the exhibit and facility design can be manipulated to decrease the risk of disease transmission. For more detailed information on designing low-risk enclosures and facility settings, please refer to the following sources:

C. Administrative Controls

Physical/Social Distancing

Physical distancing, also commonly referred to as social distancing, is a biosafety administrative control measure intended to limit your exposure to SARS-CoV-2, in combination with the other risk management strategies described in this section. As previously described, SARS-CoV-2 can spread when an infected individual is in close contact with a non-infected individual. Implementing physical distancing is a control measure that can reduce close contact, and therefore reduce the spread of the virus in a population. The United States Centers for Disease Control and Prevention includes both proximity (2 m) and time (>15 min) in the definition of a close contact (inferring high risk exposure) (Source Website, accessed August 21 2020). Designing protective measures must consider both time and proximity when implementing social distancing as a risk management strategy.

Physical distancing can be practiced both at home and at work. Maintaining a distance of at least 6 feet (2m) is extremely important if someone in your household has, or thinks they have, COVID-19. Try to avoid crowded or congested areas at work, and maintain a distance of at least 6 feet (2m) between yourself and others when possible, while also practicing proper hand hygiene and wearing the appropriate PPE to keep yourself and others safe.

Recent studies indicate that people who are infected and asymptomatic likely also play a role in the spread of COVID-19. Since people can spread the virus before they know they are sick, it is important to stay at least 6 feet away from others when possible, even if you—or they—do not have any symptoms. We all have a part to play in reducing the spread of COVID-19 and keeping one another healthy and safe. Physical distancing is only successful when it is done in combination with the other techniques mentioned here on this technical page. Please always be conscious of those around you, both at home and in public, and do your part in stopping the spread of COVID-19.

D. Personal Protective Equipment (PPE)

Personal protective equipment, or PPE, represents the last line of defense in the hierarchy of controls for reducing or eliminating exposures to occupational hazards. It is the fundamental method of protecting workers from workplace hazards. These can include physical, chemical, biological, and radiation risks. PPE also protects against carrying chemical or biological contaminants from one individual or site to another, or from the worker to other workers and animals directly. Requirements for wearing PPE are formulated through a risk-based approach. Once these requirements, based on perceived risks, are determined, you can design and implement management practices for proper PPE in the workplace to best reduce occupational risk exposures.

Due to the known transmission routes of SARS-CoV-2, respiratory protection is highly important in protecting individuals from COVID-19 and reducing disease incidence in the workplace. Facial personal protective equipment includes masks (surgical and other officially validated options), respirators, and face shields. As previously discussed, the factors that influence your PPE selection are anticipated workplace hazards (splash/spray v. aerosol v. touch), the durability of the PPE for the intended tasks, and the fit of the PPE. Availability and conservation of resources for high risk occupations is now an additional factor. As PPE shortages will continue to affect nations and communities world-wide, alternative facial protection has been implemented and heavily debated in terms of efficacy and best practice for use. Cloth masks, or facial covers, are not PPE, but are now widely accepted, recommended, and used as a preventative measure to reduce the transmission of SARSCoV-2 (source protection, meaning that they are more likely to prevent release of the virus than prevent the wearer from inhaling the virus from the environment).

First, you need to know the difference between a face mask and respirator, which have differing levels of protection and different uses. A respirator is a tight-fitting, fit-tested and disposable filtration barrier that protects the wearer from aerosolized hazards and large droplets. N95 respirators are the PPE most often used to control airborne infection exposures, such as SARS-CoV-2, and their effectiveness is highly dependent upon proper fit and use (Strategies for Optimizing the Supply of N95 Respirators: COVID-19, accessed 7/31/2020). N95 respirators are intended to be used once and then properly disposed of and replaced with a new N95 respirator. Respirators must be used in the context of a comprehensive, written respiratory protection program that meets the requirements of OSHA’s Respiratory Protection standard. The program should include medical evaluations, training, and fit testing. There are many other types of respirators available for use in a variety of workplace environments. The following infographic is an example of many different types of respirators, other than an N95, and their different agricultural uses.

A (surgical) face mask is a loose-fitting, disposable physical barrier between the wearer and the environment that can protect the wearer from splashes and large droplets, but is primarily used to protect the patient or environment from the wearer’s respiratory emissions. Face masks do not have filtering capabilities to protect the wearer from airborne contaminants. Face masks are produced and sold as PPE, with validated parameters and guidelines to be categorized as PPE. These are different from face covering (i.e. cloth face covers or homemade face covers), which do not qualify as PPE because they have not been validated as protective according to the same guidelines as face masks. Face covers are generally accepted as a resource to prevent the spread of SARS-CoV-2 within the parameters of the current pandemic, but it is important to recognize that they are not PPE. For definitions and detailed safe use of all face coverings, please refer to the technical NHP face cover brief on the Hub

When choosing between wearing either a respirator or a surgical mask, you need to consider the hazards you are potentially going to encounter in the workplace. According to the CDC and NIOSH (Use of Respirators and Surgical Masks for Protection | NIOSH, accessed 7/31/2020), both surgical masks and respirators can be used for infection control. Respirators are intended to be used for respiratory protection against airborne chemical or infectious hazards, unlike surgical masks. Surgical masks do not have the filtering capability that respirators do, and they are designed to protect sterilized or disinfected medical devices, supplies, and patients during surgery from the wearer. So, respirators protect the wearer from incoming threats, and masks generally protect the environment from contamination by the user/wearer.

Face shields are durable forms of PPE that can be disinfected for multiple uses. Face shields are considered a form of PPE most useful for protection from droplets, and not aerosols. Because there is significant risk associated with COVID-19 and droplet transfer, they may serve a critical, protective function to the eyes, ears, nose, and mouth. Face shields should not be used as a substitute for respiratory protection, but are most effective when used adjunctly to respiratory PPE. Additionally, face shields provide a protective barrier that prevents the wearer from touching their face and face mask/cover with potentially contaminated gloves or hands. You are likely going to encounter and utilize face shields while on rotations, so be sure to understand their protective mechanism and that they should always be worn in combination with a face mask/cover.

Appendix I: Glossary of Terms

Aerosol: a suspension of tiny particles or droplets in the air, <5um, such as dusts, mists, or fumes that may be pathogenic; these particles may be inhaled or absorbed by the skin, and can sometimes cause adverse health effects for workers.(Centers for Disease Prevention and Control accessed 9/24/2020)

Anthropozoonotic: diseases or infections that primarily affect animals but can be naturally transmitted to humans; also known as reverse zoonotic disease transmission (Messenger et. al, 2014 accessed 9/24/2020)

Biohazard: is a biological substance that poses a threat to the health of living organisms (Source)

Biosafety: methods that are used to stop a biohazard from spreading out of a place or causing harm (Cambridge dictionary accessed 8/17/2020).

Biosecurity: the measures taken to minimize the risk of infectious diseases caused by viruses, bacteria or other microorganisms entering, emerging, establishing or spreading in a defined area (country, city, laboratory, building, etc.), potentially harming human or animal populations, food security and economy (Australian Government, Department of Health accessed 9/22/2020).

Direct transmission: the spread of disease directly from one infected person or animal to another. (Centers for Disease Control and Prevention accessed 9/24/2020)

Droplet: pathogen-containing fluid particles >5 μm in diameter (Purens, 2020 accessed 9/24/2020)

Endemic: the constant presence and/or usual prevalence of a disease or infectious agent in a population within a geographic area (Centers for Disease Control and Prevention accessed 8/29/2020)

Epidemic: an increase, often sudden, in the number of cases of a disease above what is normally expected in that population in that area; occurs when an agent and susceptible hosts are present in adequate numbers, and the agent can be effectively conveyed from a source to the susceptible hosts (Centers for Disease Control and Prevention accessed 8/29/2020)

Indirect transmission: occurs when a disease is passed from one individual or animal to another, without direct contact between them. (Centers for Disease Control and Prevention accessed 9/24/2020)

Infectious: Capable of spreading disease; also known as communicable (Centers for Disease Control and Prevention accessed 8/6/2020).

Pandemic: an epidemic that has spread over several countries or continents, usually affecting a large number of people (Centers for Disease Control and Prevention accessed 8/29/2020)

Pathogen: a biological agent that causes disease or illness to its host (Science Daily accessed 9/24/2020)

Risk: The likelihood of an occurrence multiplied by the consequences of that occurrence defines the risk of the occurrence (Woodruff 2005 accessed 10/06/2020)

Stakeholder: individuals or organizations that have an interest in or are affected by your initiative and/or evaluation and/or its results (CDC)

Transmission: the way pathogens move from an environment, animal, person, or object to another (Centers for Disease Control accessed 9/5/2020)

Well-being: This has many definitions depending on the discipline. This definition is widely used in public health: the state of feeling healthy and happy (Cambridge dictionary, accessed 8/29/2020); for additional information on well-being as a public health tool, please click on this link to a CDC website.

Appendix II: Regulatory Bodies and Influential Organizations in the World of Biosafety

Regulatory agencies enforce safety standards to promote and maintain human health. Sanctuaries, where animal and human interaction is frequent, involve increased risk in occupational procedures such as handling biological samples from various species of non-human primates, performing medical procedures involving non-human primates, and day-to-day husbandry activities. These procedures and settings, which are necessary for sanctuary success, result in increased risk of exposure to infectious agents at the human/animal interface. For this reason, maintaining biosafety through regulatory agencies is essential in protecting and promoting employee health and well-being. The following links are for global, european, american, asian, and african agencies and networks that may be involved at the sanctuary level or influence the day-to-day biosafety operations of sanctuaries, specifically in the context of COVID-19.

Global

Legal Atlas Team (pdf file): Regulatory Frameworks Governing Wet Markets, Wildlife, and Zoonotic Disease
World Health Organization (WHO)
The Food and Agriculture Organization of the United Nations (FAO)

European Union and Independent Agencies

United States

Africa

Indonesia

Networks

European Biosafety Network - COVID-19 Vaccination Programme (link to website)