Providing On-Site Laboratory and Biosafety Just-In-Time Training Inside a Box-Based Laboratory during the West Africa Ebola Outbreak: Supporting Better Preparedness for Future Health Emergencies

Abstract

The Biological Light Fieldable Laboratory for Emergencies (B-LiFE) is a box-based modular laboratory with the capacity to quickly deploy on-site in cases of uncontrolled spread of infectious disease. During the 2014-2015 West Africa Ebola outbreak, this tent laboratory provided diagnostic support to the N'Zerekore Ebola Treatment Center (ETC), Guinea, for three months. One of the objectives of B-LiFE deployment was to contribute, as much as possible, to national capacity building by training local scientists. Two Guinean biologists were selected according to their basic biological knowledge and laboratory skills among 50 candidate trainees, and were integrated into the team through "just-in-time training" (JiTT), which helped the biologists acquire knowledge and laboratory skills beyond their expertise. The JiTT program was conducted according to standard laboratory procedures, in line with international biosafety guidelines adapted to field conditions. Supervised acquisition of field-laboratory practices mainly focused on biochemical testing and Ebola viral load quantification using routine PCR-based detection, including the Biofire FilmArray^® system (BFA), a novel, as yet non-validated, automated assay for diagnostic testing of Ebola virus disease at the time of B-LiFE deployment. During the JiTT, the two biologists were closely involved in all laboratory activities, including BFA validation and biosafety procedures. Meanwhile, this successful JiTT enhanced the B-LiFE in-field operational capacity and contributed to national capacity building. A post-training evaluation and contacts were organised to assess the evolution and technical skills gained by the two researchers during the B-LiFE mission. At the end of the B-LiFE mission, both biologists were enrolled in follow-on programmes to curb the epidemic spreading in Africa. These results demonstrate that during infectious disease outbreaks or major crises, the JiTT approach can rapidly expand access to critical diagnostic testing and train local staff to do so.

Keywords: BioFire FilmArray® BioThreat-E; ebola viral disease; just-in-time-training; mobile laboratory tent; molecular diagnosis.

Figure 1

Organisation of the B-LiFE base of operation during the Ebola mission in Guinea. There were several modules consisting of (a) fully equipped inflatable laboratory tent (1), two containers for laboratory supplies and the command centre with a satellite internet network (2), and the Ebola treatment centre located inside the red zone and apart from the B-LiFE (3). (b) The laboratory tent, supported by a cement platform, is surrounded by two fences, one of which protects the overall perimeter of the laboratory and its auxiliary structures (including the power supply and air conditioning), and the other encloses the sensitive operational area (i.e., the laboratory tent and two Algeco containers). The tent and the two containers delineate the clean zone. The red arrows indicate the path followed by ECT personnel when bringing in samples, starting at a decontamination station (foot and hand washing) and ending at a “Samples/Wastes” window in the inner fence, opposite the front of the laboratory. Samples are passed to the laboratory staff through this window. The laboratory staff follows the same path to dispose of the waste (the laboratory wastes are systematically stored next to the window). The entrance and exit to the laboratory are located at the front of the tent. The green arrows show the path that the B-LiFE members must take to enter the tent or reach the clean zone. The blue and brown circles within the inner fence’s right and left borders indicate the location of the poles that support the outdoor Wi-Fi access points (router). The three black circles on the front of the tent represent water taps (chlorinated water). The uninterrupted power supply (UPS) is represented by the black rectangle to the right of the Algeco container in the top left corner. (c) Inside the laboratory tent, different gloveboxes were used for virus inactivation (4), biochemical testing (c) (5)—note that the large plexiglass glovebox was not in place at the time of the photo. (d) The extraction (6) and PCR (7) workstations were located at the entrance of the laboratory.

Figure 2

Two portable negative-pressure gloveboxes. (a) The smaller glovebox was used for inactive Ebola virus in patient samples, perform malaria tests, and monitor biochemical parameters with the handheld blood analyser. (b,c) The larger glovebox was used to monitor biochemical parameters with the Piccolo Xpress and to prepare the Biofire Filmarray cassette for Ebola diagnostics (not shown).

Figure 3

Illustration of the waste disposal route. It consisted of (a) waste management at the sample reception desk (Samples/Wastes window) outside the tent, (b) waste collection inside the laboratory tent, either in table top bin (1) or larger waste container (2) based on the activity and volume of the waste, (c) evacuation of waste by road to the incinerator, (d,e) delivery of waste containers over the ETC fence using a chute leading directly to the incinerator area. Depending on the nature of the wastes, a dedicated team wearing full PPE used an incinerator (f) or (g) a purpose-built pit.

Figure 4

Biosafety training and qPCR procedures. A double fence surrounded the laboratory, the first to control entry to the site and perform biosafety measures (temperature monitoring, hand and shoe decontamination), the second to restrict access to the laboratory staff. (a) Samples were received through a window in the internal fence. The training focused on handling Ebola samples inside a negative-pressure glovebox, (b) first under supervision and then (c) autonomously, (d) to prepare a 96-multiwell plate for the qPCR inside a disposable glovebox, and (e) to perform biochemical tests. (f) Certificates of attendance were issued at the end of the JiTT program.

Figure 5

A breakdown by EVD status of the total cases and samples analysed during the B-LiFE Ebola mission in Guinea.

Figure 6

The BioFire FilmArray (BFA) system. (a) The BFA reader was installed inside the laboratory tent, (b) but outside the glovebox. (c) The BFA instrument was installed and connected to a computer with the adequate software-hardware. (d) The results generated by the trainees were transferred on a stand-alone computer to be reviewed and discussed with the staff.