COVID-19 infection prevention and control for hospital workers in Indonesia

Introduction

The outbreak of SARS-CoV-2 in 2019 led to a global pandemic, posing unprecedented challenges to healthcare systems, particularly in hospitals.

Purpose

This study explores the intricacies of strategies employed for preventing and controlling COVID-19 in Indonesian hospitals, with a particular focus on the protocols, challenges, and solutions faced by healthcare professionals.

Methods

Using a cross-sectional analysis, we examined 27 hospitals and uncovered disparities in their preparedness levels. During our investigation, we observed the robust implementation of infection prevention measures, which encompassed stringent protocols, adequate ventilation, and proper use of personal protective equipment. However, shortcomings were identified in areas such as surveillance, mental health support, and patient management.

Discussion

This study underscores the importance of addressing these gaps, suggesting tailored interventions, and continuous training for healthcare staff. Effective leadership, positive team dynamics, and adherence to comprehensive policies emerge as pivotal factors. Hospitals should strengthen weak areas, ensure the ethical execution of emergency protocols, and integrate technology for tracking and improving standard operating procedures. By enhancing the knowledge and skills of healthcare workers and maintaining strong management practices, hospitals can optimize their efforts in COVID-19 prevention and control, thereby safeguarding the wellbeing of professionals, patients, and communities.

Hospital preparedness for COVID-19 in Indonesia

Introduction

As a disaster-prone country, hospital preparedness in dealing with disasters in Indonesia is essential. This research, therefore, focuses specifically on hospital preparedness for COVID-19 in Indonesia, which is important given the indication that the pandemic will last for the foreseeable future.

Methods

During March to September 2022, a cross-sectional approach and a quantitative study was conducted in accordance with the research objective to assess hospital preparedness for the COVID-19 pandemic. This research shows the level of readiness based on the 12 components of the rapid hospital readiness checklist for COVID-19 published by the World Health Organization (WHO). Evaluators from 11 hospitals in four provinces in Indonesia (Capital Special Region of Jakarta, West Java, Special Region of Yogyakarta, and North Sumatra) filled out the form in the COVID-19 Hospital Preparedness Information system, which was developed to assess the level of hospital readiness.

Results

The results show that hospitals in Capital Special Region of Jakarta and Special Region of Yogyakarta have adequate level (≥ 80%). Meanwhile, the readiness level of hospitals in West Java and North Sumatra varies from adequate level (≥ 80%), moderate level (50% - 79%), to not ready level (≤ 50%).

Conclusion

The findings and the methods adopted in this research are valuable for policymakers and health professionals to have a holistic view of hospital preparedness for COVID-19 in Indonesia so that resources can be allocated more effectively to improve readiness.

Integration of knowledge and local wisdom for disaster resilience in Anak Krakatau volcano

Indonesia lies on the Pacific Ring of Fire, where most of the area is highly unstable, making it a site of numerous volcanoes and earthquakes, so it needs to enhance its social system through knowledge, awareness, and local wisdom to create disaster resilience. Previous research has discussed resilience through societal knowledge and awareness, but there is a gap in understanding the local wisdom. Therefore, this study aims to present how the resilience process concerns with the community based on the local wisdom and knowledge for the community in Anak Krakatau, Banten. This research employs observations on the conditions of facilities and infrastructure of access road, in-depth interviews with local people, and bibliometric review over the last 17 years. A total of 16 articles were selected and reviewed for this study, after comprehensive analysis from 2000 documents. It is stated that preparing for natural hazards requires the integration of knowledge and local knowledge. Prior to the occurrence of a natural calamity, knowledge is dependent on the structure of a home in order to create a resilient structure, while local lore relies on the omens of nature.

Contribution

The integration of knowledge and local wisdom can fulfil the resilience process in terms of preparedness and after effect of natural hazards. These integrations must be evaluated for disaster mitigation policies in order to develop and implement a comprehensive disaster mitigation plan for the community.

Factors Associated with Psychosocial Symptoms Experienced by Students in Response to COVID-19 Pandemic: A Multivariate Analysis

The COVID-19 pandemic has significantly impacted many sectors, including the education sector. After in-person school activities were suspended due to the pandemic, a number of educational institutions in Indonesia reported concerns in implementing online learning due to the institutions' unpreparedness. This issue may potentially induce mental health disorders among students and triggers long-term stress. This study aimed to examine factors linked to the psychosocial symptoms of anxiety, stress, and depression in response to the early stage of the COVID-19 pandemic. An online cross-sectional study in Indonesia was conducted with 433 undergraduate and senior high school students aged 15 to 26 years old, both female and male. The self-reported symptoms were analyzed using both bivariate and multivariate linear regression methods. It was found that the percentage of participants with depression symptoms was 66%, while 61% and 43% participants experienced stress and anxiety respectively. The bivariate analysis presented strong correlations between anxiety and gender, learning duration and use of gadgets, internet expenses, and highly-interrupted learning. Furthermore, the multivariate regression revealed that only anxiety was significantly linked to internet expenses. This study indicates that many students are affected by COVID-19, the impacts of which manifest in psychosocial issues in the form of anxiety. We suggest that creating a supportive and positive family environment would help to alleviate some of these issues.

Emergency Management System in Indonesia: An evaluation of emergency patient management in 2020

Indonesia has its emergency patient management system regulated in Public Safety Center (PSC) 119 as stated in Indonesia’s Health Ministry Regulation No. 19 (2016). An evaluation to assess the ongoing management of this system is a must to ensure its continuous development. This study assessed the ongoing emergency patient management system using instrument indicator questionnaires developed by the authors. The questionnaire consists of 28 indicators from 8 assessment aspects including: policy, planning, program implementation, communication, transportation, referral, management reviews, and emergency services. Questionnaires were distributed and completed questionnaires were received from 88 respondents from 21 provinces of Indonesia. Validity test results counted the coefficient correlation of all indicators above r value table (0.2096) and all Alpha Cronbach’s indicators value above 0,80. The value indicator is considered poor if its average score is below the average score of the overall indicators and is considered good if it is above the average overall indicator score. The assessment result there is twelve indicators from this study shows a below average value (66) . Data acquired in this study can be used as a preliminary reference for continuous improvement of Indonesia’s emergency management system operated by the PSC.

Patient Safety Culture in Dentistry Analysis Using the Safety Attitude Questionnaire in DKI Jakarta, Indonesia: A Cross-Cultural Adaptation and Validation Study

OBJECTIVES

This study aimed to analyze a cross-cultural adaptation of the Safety Attitude Questionnaire (SAQ) for Indonesian dentists.

METHODS

A cross-sectional study was conducted on 250 general dentists in health services in Jakarta, Indonesia. The first step included cultural adaptation and translation, which was followed by the development of the tested questionnaire through expert agreement and by validity and reliability analysis using Spearman correlation coefficient, Cronbach α , and interclass correlation coefficient. The SAQ consisted of 30 items and 6 dimensions (safety climate, teamwork climate, job satisfaction, stress recognition, perception of management, and working conditions).Respondents were members of the Indonesian Dental Association who voluntarily filled out a Google-based questionnaire from September to October 2020.

RESULTS

A total of 250 respondents with a response rate of 16.4% demonstrated a total Cronbach α value of 0.897, whereas the value per item ranged from 0.890 to 0.905, which suggested an acceptable and good to very good internal consistency. The interclass correlation coefficient value varied from 0.840 to 1.000, which meant almost perfect agreement. The correlation coefficient of 30 questions items resulted in a total SAQ score ranging from 0.422 to 0.699 (moderate to strong correlation) and between 6 dimensions to total SAQ score ranging from 0.648 to 0.772 (strong correlation).

CONCLUSIONS

The Indonesian version of the SAQ exhibited good validity and very good reliability and potential to be used for evaluating dentists' patient safety culture in Indonesia.

Diversity and Potential Carbon Services of In-Situ Conservation Reserve in Gunung Sepuluh Timur Forest at Balikpapan, East Kalimantan

Establishing an in-situ conservation reserve is one of the strategic approaches to conserving an ecosystem and protecting it from immediate threats, including deforestation and land-use conversion. Kalimantan is one of the islands in Indonesia that is currently threatened by deforestation. To protect East Kalimantan diversity, mainly in Balikpapan, an in-situ conservation reserve has been established in Gunung Sepuluh Timur (GST) forest. In contrast, the information on tree diversity and how the presence of tree community within the forest can benefit the ecosystem are still limited. This research aims to assess the potential benefits and carbon storage of the GST conservation forest. The assessment method applied tree, pole, and sapling surveys combined with forest cover analysis using GIS and NDVI (Normalized Difference Vegetation Index) approaches. The GST contained 56 tree species, 25 pole species, and 16 sapling species. Diversity (H’) at tree stages was the highest (H’ = 0.759; 95%CI: 0.64-0.88) and H’ at sapling stages was the lowest (H’ = 0.719; 95%CI: 0.51-0.92). The carbon service potential of GST forest was 87.04 t C/ha on average. It was estimated that the economic benefits of GST in sequestering carbon based on the compliance market rate were equal to US$ 189,758/year.

Analysis of Fire Risk Assessment in South Jakarta 2021

Jakarta is the capital city of Indonesia, with a dense population of more than 10 million population. DKI Jakarta Province is divided into five city areas, including South Jakarta. South Jakarta has an area of 141,17 km2, with more than three million population. The scope for this study focused on two sub-districts in South Jakarta, which are Pasar Minggu and Jagakarsa. The objective of this study was to provide fire risk situations in two sub-districts of South Jakarta. The study used a descriptive method with non-probabilistic sampling. Data collection was performed from June 2021 to July 2021 through focus group discussions (FGDs) and filling out questionnaires. FGDs were performed to the Local Government Fire Brigade, and questionnaires were filled out by the head of the RW. The FGD guideline and questionnaire were developed based on the fire risk assessment checklist. The checklist instrument was developed by utilizing a disaster fire risk approach, including fire hazard, vulnerability, and fire protection, with twenty-two questions. The data was then analyzed using univariate analysis, bar, and spider chart. The results showed three RWs with severe-risk classification. The factors that increase the risk of fire are the use of combustible building materials and the high density of population and buildings. There were several recommendations contributed such as firefighters must have a list of the high-risk areas and develop a rescue evacuation plan, doing a routine inspection in each target area, and raising public awareness for the community to increase participation in fire risk management.

A self-assessment model for hospital safety culture maturity

Background: Studies on safety culture maturity in health care is very rare, and the existing ones only focus on patients and the use of Manchester Patients Safety Framework (MaPSaF) instrument. The objective of this study is to develop a comprehensive instrument for measuring safety culture maturity in hospitals.

Design and methods: This study used a cross-sectional design with three stages. First, we used secondary data analysis from the Hospital Accreditation Commission. Second, evaluation of primary data obtained from safety climate questionnaire. Third, we did focus group discussions, and in-depth interviews for validation of secondary data and development of DUTA-RS website. We analyzed using Structural Equation Modeling (SEM) test.

Results: DUTA-RS instrument contains 1,118 elements based on the first edition of the Indonesian Hospital Accreditation National Standard. Its safety culture maturity is at the proactive level (58.0%), with the highest accreditation levels of proactive (50.8%) and generative (48.7%). The variables affecting the safety culture maturity are situational and safety behavior variables, with leadership, risk management, and safety compliance as the strongest indicators. The weakest indicators of climate are organizational learning and communication. The mean value of climate for primary and secondary data is in the good category and showed in proactive level.

Conclusions: The DUTA-RS as a website to measure the safety culture maturity in accredited hospitals by taking the advantage of the existing information technology of hospital accreditation committee as the benchmark enables improvement of SCML in hospitals. Further studies are required for the development of DUTA-RS website.

Implementation of Safety Leadership in Nursing Management: A Systematic Mixed Studies Review

Background: Safety leadership positively influence safety compliance amongst employees in health care. It is necessary to understand how far nursing management has played its roles in attaining safety leadership. Objective: This study is aimed to explore the safety leadership implemented by nursing management in enhancing the health care system. Methods: This study conducted a systematic mixed studies review of current literature focusing on nursing managerial and safety leadership. Five key terms, safety leadership and head nurse or headward, first-line nurse manager, nurse leader, or nurse administrator, were used to retrieve relevant articles. Potential articles were found in seven extensive databases (EBSCO, Sage Publication, Scopus, JSTOR, Wiley online, ProQuest and Emerald). We included English research articles or review papers, available full-text, and published from September 2010 to September 2020. Irrelevant and redundant articles were excluded. Two data extractors analyzed the relevant reports. Results: The search yielded 40 articles. But, after duplicates were removed, eleven full-text articles involving 5361 respondents were reviewed. The review papers included qualitative studies (n = 3), cross-sectional survey (n = 6), and (quasi) experiments (n = 2). The most significant proportion (40%) of the study was conducted in the American region. Four themes were generated, including role of safety leadership, development of safety leadership, support, and barriers. The review highlights that the nurse leaders play essential role in the development and implementation of safety leaderships in the hospital wards though they face challenges which need supporting team works, professionals, and standards. Conclusion: Adopting safety leadership as a part of nursing management requires support from policymakers, institutions, and nursing leaders. The leaders should understand the complexities of the institutional structures and functional relationships in the health care system to meet patient safety standards

Factors affecting nurses' ability to provide effective care in a disaster response: a review

Disasters cause death, trauma, and psychological distress. Comprising the largest number of healthcare workers, nurses play a crucial role in reducing the impact of a disaster. The objective of this review is to identify the factors that influence nurses’ ability during a disaster emergency response to provide adequate care. This research was conducted by doing a literature search from the Pro-Quest and Science-Direct databases using the PRISMA-ScR to screen the articles. The final results included 13 articles. An analysis was performed to identify themes in line with the purpose of the review. All factors affecting nurses’ ability to respond to a disaster situation were classified into three themes: 1) factors increasing nurses’ ability, 2) barriers to delivering effective nursing care, and 3) support needed to maintain the nurses’ ability. During an emergency situation due to a disaster, adequate knowledge and skill to save lives, treat injuries, manage stress and coordinate between teams are the basic competencies needed for optimal care. Nurses’ clinical experience or previous disaster experience and training could increase nurses’ adaptability in disaster conditions. Support from nurses’ workplace and proper implementation of disaster management policy enhance nurses’ services and prevent barrier under disaster condition. The results emphasize that future training should aim for improving nurses’ knowledge and skills, including the knowledge of nurses’ family to protect themselves and deal with disasters. Such knowledge increased family preparedness, which is an important factor to enhance nurses’ willingness to work following a disaster.

Significance for public health

This review provides an overview of the factors affecting nurses’ performance in responding to a disaster. This information is important to related parties in making necessary plans and actions so that nurses, who comprise the majority of the healthcare workforce, can deliver safe, effective, and efficient health services to the public during disasters.

Associations Between Ambient Particulate Air Pollution and Cognitive Function in Indonesian Children Living in Forest Fire-Prone Provinces

Smoke from forest fires can reach hazardous levels for extended periods of time. We aimed to determine if there is an association between particulate matter ≤2.5 µm in aerodynamic diameter (PM_2.5) and living in a forest fire-prone province and cognitive function. We used data from the Indonesian Family and Life Survey. Cognitive function was assessed by the Ravens Colored Progressive Matrices (RCPM). We used regression models to estimate associations between PM_2.5 and living in a forest fire-prone province and cognitive function. In multivariable models, we found very small positive relationships between PM_2.5 levels and RCPM scores (PM_2.5 level at year of survey: β = 0.1%; 95% confidence interval [CI] = 0.01% to 0.19%). There were no differences in RCPM scores for children living in forest fire-prone provinces compared with children living in non-forest fire-prone provinces (mean difference = -1.16%, 95% CI = -2.53% to 0.21%). RCPM scores were lower for children who had lived in a forest fire-prone province all their lives compared with children who lived in a non-forest fire-prone province all their life (β = -1.50%; 95% CI = -2.94% to -0.07%). Living in a forest fire-prone province for a prolonged period of time negatively affected cognitive scores after adjusting for individual factors.

Safety Climate Survey Among Employees in a Feminine Care Products Manufacturing Company

Manufacturing and construction companies are significant contributors to most accidents in Indonesia. Accident frequency rate (AFR) can be reduced by adopting an appropriate management system, technical approach, and safety culture at the workplace. Employees' perception of Work Safety culture is the key to success in minimizing AFR. A survey of employees' perception of safety can identify their reality concerning the Safety Climate at their workplace. The study aimed to observe Safety Climate through a survey of employees' perception on the dimensions of management commitment, safety communication, safety rules and procedures, supportive environment, personal safety involvement and needs, and safety training. The study discusses possible ways to improve the safety climate in their organization and provides feedback to maintain and improve it. A mixed-methods descriptive design was used for this study. The sample size was determined using the Slovin formula and the sample selection using the Proportionate Stratified Random Sampling method. The survey was conducted on 156 employees using a questionnaire model with a personal approach to all levels of employees in a feminine care products manufacturing company. The survey result was analyzed quantitatively through assessments on questionnaires and qualitatively through employees' comments. The study found employees' perception of safety climate to be at a reasonable level. The management commitment dimension in this study has the best assessment result. The analysis results showed that the active role of the leadership, strong safety values to build employee interaction, employee involvement and investment in training programs for employees were critical keys to the successful implementation of Occupational Safety.

The correlation between work environment and patient safety in a general hospital in Indonesia

Patient safety is an important for health care services in the hospital setting. The most difficult obstacle in ensuring patient safety is creating a safety. The objective of this study was to determine the correlation between the hospital work environment, nurses' characteristics, and patient safety. The method was a descriptive correlative study with a cross-sectional approach. The data were obtained from 123 ward nurses through using valid and reliable questionnaires. The results showed a significant relationship between hospital work environment and nurses' characteristics (education level, length of service, and training concerning patient safety) (p<.05). In contrast, nurses' age and marital status were not related to patient safety in the hospital (p>.05). Findings indicate that the hospital work environment and nurses' characteristics are related to patient safety. The study recommended to build a model of patient's safety culture that includes all aspects that influence patients' safety culture.

Analysis of Bio-Risk Management System Implementation in Indonesian Higher Education Laboratory

Developing countries face various challenges in implementing bio-risk management systems in the laboratory. In addition, educational settings are considered as workplaces with biohazard risks. Every activity in a laboratory facility carries many potential hazards that can impact human health and the environment and may cause laboratory incidents, including Laboratory Acquired Infections (LAIs). In an effort to minimize the impact and occurrence of these incidents, it is necessary to evaluate the implementation of a bio-risk management system in every activity that involves handling biological agents. This study was conducted in an Indonesian higher-education institution, herein coded as University Y. This is a descriptive, semi-quantitative study aimed at analysing and evaluating the implementation of the bio-risk management systems used in laboratories by analysing the achievements obtained by each laboratory. The study used primary data that were collected using a checklist which referred to ISO 35001:2019 on Laboratory Bio-risk Management. The checklist consisted of 202 items forming seven main elements. In addition, secondary data obtained from literature and document review were also used. The results show that out of 11 laboratories examined, only 2 laboratories met 50% of the requirements, which were Laboratory A and B, achieving good performance. Regarding the clauses of standards, a gap analysis identified leadership, performance evaluation, and support as elements with the lowest achievement. Therefore, corrective action should be developed by enhancing the commitment from management as well as improving documentation, policy, education and training.

Broccoli-Soybean-Mangrove Food Bar as an Emergency Food for Older People during Natural Disaster

Older people risk poor nutritional status during natural disasters due to low intakes of energy, carbohydrates, protein, and fat. A food bar is a form of emergency food product that contains carbohydrate and protein, and is practical for disaster situations. The study aimed to investigate the effect of a broccoli-soybean-mangrove food bar on older people's weight following natural disasters. A quasi-experimental pre-post intervention study was designed using 33 subjects at the treatment group of various nutritional status types of older people during two weeks with balanced nutrition education over two weeks. Bivariate analysis with a paired t-test used to test whether weight, macronutrient intakes, and balanced nutrition knowledge were significantly different before and after the study. The study showed broccoli-soybean-mangrove food bar consumption resulted in a significantly increased weight of 0.2 kg, energy (291.9 kcal), protein (6.1 g), carbohydrate (31.1 g), dan fat (15.6 g) intakes. Balanced nutrition education of older people could also substantially increase knowledge of older people regarding nutrition (11.8 points). The proportion of malnourished subjects who gained weight was more remarkable than normal subjects in the first and second weeks of the intervention. However, the proportion of normal nutritional status subjects having increased macronutrients intakes was higher than the malnourished subjects. These findings recommend broccoli-soybean-mangrove food bar consumption to significantly improve weight and macronutrients intakes in older people following a natural disaster. It is necessary to make the broccoli-soybean-mangrove food bar more available, accessible, and affordable to all people in emergencies, mainly for older people.

People's Response to Potential Natural Hazard-Triggered Technological Threats after a Sudden-Onset Earthquake in Indonesia

(1) Background: We aim to examine whether people activate initial protection behavior, adopt evacuation behavior, worry about the possibility of a tsunami, and consider natural hazard-triggered technological (Natech) situations in a sudden-onset earthquake. The literature suggests that risk perception is a significant predictor of people's response to potential Natech threats. We aim to empirically verify the variables relating to people's responses. (2) Methods: We conducted a household survey following a January 2018 earthquake in Indonesia. (3) Results: Immediately after the earthquake, almost 30% of the respondents assembled at the evacuation point. However, sequential steps of people's response were not observed: evacuation immediately after the earthquake was due to worry about the possibility of a tsunami, but this worry was not related to Natech damage estimation. The relevant factors for evacuation behavior were information access, worry about the possibility of a tsunami, and knowledge of groups and programs related to disaster risk reduction (DRR). The survey location (two villages), perceived earthquake risk, and DRR activity participation are less relevant to the behavior of assembling at the evacuation point. (4) Conclusions: Contrary to the existing literature, our results do not support that higher risk perception is associated with evacuation behavior, or that immediate evacuation is related to foreseeing cascading sequential consequences.

Hospital safety index: assessing the readiness and resiliency of hospitals in Indonesia

Purpose

This study aims to assess the hospital readiness and resiliency in a disaster-prone Indonesia.

Design/methodology/approach

Hospital Safety Index (HSI), containing 151 items, was used to assess ten hospital in West Java and five hospitals in Yogyakarta.

Findings

The average level of HSI for the hospitals under investigation is B, indicating that their ability to function during and after emergencies and disasters are potentially at risk, thus, intervention measures are needed in the short term. Hospitals in Yogyakarta scored lowly in terms of their emergency and disaster management, even though they have previously experienced major disasters in 2006 and 2010.

Practical implications

The role of the government is crucial to improve hospital readiness and resiliency in Indonesia. It is recommended that they: identify disaster-prone areas so that their hospital readiness and resiliency can be assessed; assess the readiness and resiliency of hospitals the prioritized areas; implement intervention measures; re-assess the readiness and resiliency of hospitals in the prioritized areas after implementing intervention measures; and develop a framework to ensure that the hospitals can maintain their level of readiness and resiliency over time.

Originality/value

Research on hospital readiness and resiliency in Indonesia is still limited despite the size of the country and its proneness to disasters. This research has investigated the feasibility and value of using HSI to assess hospital readiness and resilience in Indonesia.

Evaluation of the implementation of occupational health, safety, and environment management systems in higher education laboratories

Laboratory researchers and students may expose to hazardous and toxic chemicals. Implementation of the Occupational Health, Safety, and Environment Management System (OHSEMS) has become a critical aspect in higher education. This study presents an overview of the evaluation of the implementation of the OHSEMS in higher education laboratories. The implementation of the OHSEMS is to prevent occupational accidents in the laboratory. The study design is a semiquantitative descriptive study. The aim of the study is to evaluate the implementation of the OHSEMS in higher education institution laboratories by evaluating the percentages of OHSEMS compliance in higher education laboratories. Five aspects are evaluated: occupational health, safety, and environment (OHSE) policy and commitment, planning, implementation, evaluation, and management review. The result shows that the average compliance with the OHSE policy and commitment aspect is 59.4% and for the planning, implementation, evaluation, and management review, the average compliance percentage are 33.0%, 65.3%, 26.0%, and 0.0%, respectively.

Challenges in Implementing a Biorisk Management Program at Universitas Indonesia: A Checklist Tool for Biorisk Management

Rapid development and advancement of bioresearch at a university's laboratories can have both positive and negative implications for public health and the environment. Many research activities in which biological materials have been created, modified, stored, and manipulated require safety procedures to keep the negative effects on humans and the environment as low as possible. The Occupational Health, Safety and Environmental (OHS&E) Department of the University of Indonesia (UI) is trying to increase the awareness and responsibility of its university members and laboratory staffs who work with biohazard materials by creating a biorisk checklist. The checklist was developed based on WHO guidelines and the National University of Singapore (NUS) Laboratory Manual, which contains 311 questions about the management, administration, and handling of various hazards, recombinant experiments, and animal and plant experiments. A gap analysis was run against the checklist in 14 laboratories at the University of Indonesia Salemba campus, which daily works with highly infectious pathogens and high-risk agents. Overall result showed that none of these laboratories had met all of the checklist items, and there were only 2 laboratories that had implemented more than half of the items. This checklist was proven to be a simple tool for assessing laboratories that handle and store biohazard materials, and it could be used as a monitoring tool for biorisk programs as well. It also could be further developed as a laboratory software application to increase its effectiveness and its accuracy.

Comparative assessment of three in vitro exposure methods for combustion toxicity

A comparative assessment of three approaches for the use of human cells in vitro to investigate combustion toxicity was conducted. These included one indirect and two direct (passive and dynamic) exposure methods. The indirect method used an impinger system in which culture medium was used to trap the toxicants, whilst the direct exposure involved the use of a Horizontal Harvard Navicyte Chamber at the air/liquid interface. The cytotoxic effects of thermal decomposition products were assessed using the MTS (3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium) assay (Promega) on a selection of human cells including: HepG2, A549 and skin fibroblasts. A small scale laboratory fire test using a vertical tube furnace was designed for the generation of combustion products. Polymethyl methacrylate (PMMA) was selected as a model polymer to study the cytotoxic effects of combustion products. NOAEC (no observable adverse effect concentration), IC10 (10% inhibitory concentration), IC50 (50% inhibitory concentration) and TLC (total lethal concentration) values were determined from dose response curves. Assessment using the NRU (neutral red uptake) and ATP (adenosine triphosphate) assays on human lung derived cells (A549) was also undertaken. Comparison between in vitro cytotoxicity results against published toxicity data for PMMA combustion and predicted LC50 (50% lethal concentration) values calculated from identified compounds using GCMS (gas chromatography mass spectrometry) was determined. The results suggested that the indirect exposure method did not appear to simulate closely exposure via inhalation, whilst exposure at the air/liquid interface by using the dynamic method proved to be a more representative method of human inhalation. This exposure method may be a potential system for in vitro cytotoxicity testing in combustion toxicity.

In vitro cytotoxicity of selected chemicals commonly produced during fire combustion using human cell lines

Fire combustion products contain a broad range of chemicals, which have a multitude of possible toxic interactions in humans. The aim of this study was to evaluate the cytotoxicity of selected substances commonly produced during fire combustion. A range of human cell lines and cultures including: skin fibroblasts, HepG2 (liver derived), and A549 (lung derived cells) were used to represent different human target organs. The colorimetric MTS assay (3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium) was used to detect the cytotoxic effects of selected substances including: acetic acid, ammonia, formaldehyde, hydrobromic acid, hydrochloric acid, hydrofluoric acid, potassium cyanide, sodium fluoride, sodium nitrite, sodium sulphide, and sulphurous acid. In this study, the NOAEC (No Observable Adverse Effect Concentration), IC(10) (10% inhibitory concentration), IC50 (50% inhibitory concentration), and TLC (Total Lethal Concentration) values were determined. The ratio between in vitro IC50 to in vivo human toxicity data (Lowest Lethal Dose-LDLo and Lowest Lethal Concentration--LCLo) was also established. Results indicated a strong relationship between IC50 values on the cell types used: fibroblast and A549 (R2: 0.92), A549 and HepG2 (R2: 0.72), fibroblast and HepG2 (R2: 0.69). Good correlation was obtained between the IC50 against LDLo and LCLo when an appropriate adjustment factor was implemented. Results of this study indicated that in vitro methods could be a potential technique for assessing the toxicity of fire combustion products.