Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-26T09:12:24.720Z Has data issue: false hasContentIssue false
  • English
  • Français

Agent of Opportunity Risk Mitigation: People, Engineering, and Security Efficacy

Published online by Cambridge University Press:  08 April 2013

Margaret E. Graham ,
Michael G. Tunik ,
Brenna M. Farmer ,
Carly Bendzans ,
Aileen M. McCrillis ,
Lewis S. Nelson ,
Ian Portelli ,
Silas Smith ,
Judith D. Goldberg  and
Meng Zhang
...Show all authors
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Agents of opportunity (AO) are potentially harmful biological, chemical, radiological, and pharmaceutical substances commonly used for health care delivery and research. AOs are present in all academic medical centers (AMC), creating vulnerability in the health care sector; AO attributes and dissemination methods likely predict risk; and AMCs are inadequately secured against a purposeful AO dissemination, with limited budgets and competing priorities. We explored health care workers' perceptions of AMC security and the impact of those perceptions on AO risk.

Methods: Qualitative methods (survey, interviews, and workshops) were used to collect opinions from staff working in a medical school and 4 AMC-affiliated hospitals concerning AOs and the risk to hospital infrastructure associated with their uncontrolled presence. Secondary to this goal, staff perception concerning security, or opinions about security behaviors of others, were extracted, analyzed, and grouped into themes.

Results: We provide a framework for depicting the interaction of staff behavior and access control engineering, including the tendency of staff to “defeat” inconvenient access controls. In addition, 8 security themes emerged: staff security behavior is a significant source of AO risk; the wide range of opinions about “open” front-door policies among AMC staff illustrates a disparity of perceptions about the need for security; interviewees expressed profound skepticism concerning the effectiveness of front-door access controls; an AO risk assessment requires reconsideration of the security levels historically assigned to areas such as the loading dock and central distribution sites, where many AOs are delivered and may remain unattended for substantial periods of time; researchers' view of AMC security is influenced by the ongoing debate within the scientific community about the wisdom of engaging in bioterrorism research; there was no agreement about which areas of the AMC should be subject to stronger access controls; security personnel play dual roles of security and customer service, creating the negative perception that neither role is done well; and budget was described as an important factor in explaining the state of security controls.

Conclusions: We determined that AMCs seeking to reduce AO risk should assess their institutionally unique AO risks, understand staff security perceptions, and install access controls that are responsive to the staff's tendency to defeat them. The development of AO attribute fact sheets is desirable for AO risk assessment; new funding and administrative or legislative tools to improve AMC security are required; and security practices and methods that are convenient and effective should be engineered.

(Disaster Med Public Health Preparedness. 2010;4:291-299)

Keywords

academic medical centershazardous substancessecurityrisk assessmentrisk perceptionshealth personnelpersonnel, hospitalterrorismsecurity measures
Type
Original Article
Information
Disaster Medicine and Public Health Preparedness , Volume 4 , Issue 4 , December 2010 , pp. 291 - 299
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Natarajan, N.The healthcare and public health sector overview. Crit Infrastructure Protect Rep. 2008;7.1:2-3, 18-19.Google Scholar
2.HHS and USDA select agents and toxins: 7 CFR Part 331, 9 CFR Part 121, and 42 CFR Part 73. http://www.selectagents.gov/Select%20Agents%20and%20Toxins%20List.html. Accessed October 8, 2009.Google Scholar
3.Department of Homeland Security. 6 CFR Part 27 Appendix to Chemical Facility Anti-Terrorism Standards; Final Rule. http://www.dhs.gov/xlibrary/assets/chemsec_appendixa-chemicalofinterestlist.pdf. Accessed March 20, 2010.Google Scholar
4.US Drug Enforcement Administration. Title 21 Food and drugs: chapter 13-drug abuse prevention and control. Controlled Substances Act. http://www.justice.gov/dea/pubs/csa.html. Accessed October 28, 2009.Google Scholar
5.Table 1: Radionuclides of concern. http://www.nrc.gov/reading-rm/doc-collections/enforcement/security/2005/ml053130250.pdf. Accessed October 8, 2009.Google Scholar
6.Farmer, BM, Nelson, LS, Graham, ME, et alAgents of opportunity in academic medical centers: agent identification, agent profile, and institutional risk and preparedness. Disaster Med Public Health Prep. 2010;4:318–325.CrossRefGoogle ScholarPubMed
7.Food and Drug Administration. Medical Devices. http//www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/PostmarketRequirements/HumanFactors/ucm119185.htm. Published May 13, 2009. Accessed October 5, 2010.Google Scholar
8.Subbarao, I, Lyznicki, JM, Hsu, EB, et alA consensus-based educational framework and competency set for the discipline of disaster medicine and public health preparedness. Disaster Med Public Health Prep. 2008;2 (1):57–68.Google Scholar
9.Blumenthal, D, Ferris, TG.Safety in the academic medical center: transforming challenges into ingredients for improvement. Acad Med. 2006;81 (9):817–822.Google Scholar
10.Hodgson, K.First defense. Using design elements to strengthen security efforts. Health Facil Manage. 2003;16 (3):16–20, 22, 24-25.Google ScholarPubMed
11.Centers for Disease Control and Prevention. Biosafety in Microbiological and Biomedical Laboratories (BMBL), 5th ed. http://www.cdc.gov/od/ohs/biosfty/bmbl5/bmbl5toc.htm. Published April 13, 2009. Accessed March 29, 2010.Google Scholar
12.Gotay, A.Establishing security awareness guidelines in a hospital setting. J Healthc Prot Manage. 1994;10 (2):80–83.Google ScholarPubMed
13.Chipley, M, Kaminskas, M, Lyon, W, et alReference Manual to Mitigate Potential Terrorist Attacks Against Buildings. Washington, DC: Federal Emergency Management Agency; 2003:426.Google Scholar
14.Department of Veterans Affairs, Office of the Inspector General. Emergency preparedness in Veterans Health Administration facilities. Report no. 04-03266-51. http://www4.va.gov/oig/54/reports/VAOIG-04-03266-51.pdf. Published January 6, 2006. Accessed March 26, 2010.Google Scholar
15.Waudby, MH.Measuring perception as a component of a security assessment. J Healthc Prot Manage. 2004;20 (2):8–28.Google ScholarPubMed
16.Office of the Inspector General, Department of Health and Human Services. Summary report on universities' compliance with select agent regulations. http://oig.hhs.gov/oas/reports/region4/40502006.pdf. Published June 2006. Accessed September 30, 2010.Google Scholar
17.Baram, M.Biotechnological research on the most dangerous pathogens: challenges for risk governance and safety management. Saf Sci. 2009;47:890–898.Google Scholar
18.Office of the Inspector General, Department of Health and Human Services. Summary report on select agent security at universities. http://www.ofr.harvard.edu/homeland_security.php. Published March 2004. Accessed September 30, 2010.Google Scholar
19.Slovic, P.Public perception of risk. J Environ Health. 1997;59:22–23, 54.Google Scholar
20.Jahrling, P, Rodak, C, Bray, M, Davey, RT.Triage and management of accidental laboratory exposures to biosafety level-3 and -4 agents. Biosecur Bioterror. 2009;7 (2):135–143.CrossRefGoogle ScholarPubMed
21.Sanquist, TF, Mahy, H, Morris, F.An exploratory risk perception study of attitudes toward homeland security systems. Risk Anal. 2008;28 (4):1125–1133.Google Scholar
22.Rees, K.Securing our hospitals—an executive summary of the GE security & IAHSS healthcare benchmarking study. J Healthc Prot Manage. 2008;24 (1):113–115.Google ScholarPubMed
23.Sidel, V, Gould, R, Cohen, H.Bioterrorism preparedness: cooptation of public health? Med Glob Surviv. 2002;7:82–89.Google Scholar