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050-v70-CSEDLPS02 exam Dumps Source : RSA Data Loss Prevention(R) Certified System Engineer 7.x
Test Code : 050-v70-CSEDLPS02
Test Name : RSA Data Loss Prevention(R) Certified System Engineer 7.x
Vendor Name : RSA
Q&A : 100 Real Questions
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The middle East operations of RSA, The protection Division of EMC (NYSE: EMC), today announced the advancement of the RSA™ records Loss Prevention (DLP) Suite through new capabilities that are designed to enable regional valued clientele to relaxed the delicate information it really is most essential to their groups.
The RSA DLP Suite is engineered to deliver unified, seamless information policy orchestration across the enterprise, enabling clients to discover and computer screen sensitive records and apply the appropriate enforcement mechanisms to at ease delicate facts throughout the IT stack.“Securing statistics is an counsel management system. To be successful, facts ought to first be recognized and classified; different controls need to be applied to keep away from the statistics’s loss, and the commercial enterprise-vast management of those controls needs to be as efficient as viable,” said Mohammed Amin, Regional supervisor, EMC core East & North Africa. “This unlock of the DLP suite is an important development in addressing this overall manner in a holistic method. The RSA DLP Suite is engineered both to deliver the capability to orchestrate policies that comfortable sensitive information within the datacenter, community, and on the endpoints, and to provide one of the crucial industry’s most powerful records discovery and detection capabilities, which are key to a firm’s means to determine risk and protect towards sensitive records loss no rely where the data resides. ”
within the center East, RSA have already found significant cognizance of records Leakage issues. Kieran Hernon, Key Account manager of RSA, center East explained, “The Gulf nations were alert to facts leakage long before their European and US counterparts. The subculture of particular person and corporate privacy, long fostered in this area, have focused businesses on the safety of records belongings and many companies therefore already have the processes and guidelines in region to execute on a full facts leakage strategy. in this regard, the adoption of the vital expertise is a natural step in opposition t closing the loop in suggestions security and because of this, middle East consumers are neatly trained on the current hodge-podge of factor products in the marketplace. At RSA, we're definite that our clients will discover the overall answer presented in the newly launched RSA DLP Suite, a really welcome breath of fresh air.”
New features give Accuracy and Scalability
The RSA DLP Suite is likely one of the trade’s most complete information loss prevention options, and is designed to supply shoppers with essentially the most strong database of guidelines to cozy statistics for each regulatory (PCI, privateness laws) and non-regulatory (highbrow property, enterprise method/operations facts) security drivers. This design simplifies the mixing of DLP expertise into latest IT infrastructures. These capabilities along with the RSA DLP Suite’s dispensed grid architecture provide market leading accuracy and scalability. The DLP Suite comprises RSA DLP Endpoint, RSA DLP network, and RSA DLP Datacenter, with general administration of the Suite supplied by the RSA DLP enterprise supervisor.• RSA DLP community is designed to find delicate records traveling over the community corresponding to email, IM, or webmail traffic, after which applies the acceptable action comparable to block, quarantine, or encrypt.• RSA DLP Datacenter is engineered to find delicate, unprotected records in the facts middle and provides quite a number remediation alternatives and can work in conjunction with different items within the RSA facts security gadget, such because the RSA™ File protection manager, which is designed to give the means to audit user access to sensitive files or folders, and then enable role based mostly entry controls using encryption.
The RSA DLP Suite also is engineered to provide broad, foreign DLP assist. For overseas agencies and multinational businesses, the DLP Suite is designed to give finished, pre-packaged policies for international markets that map to crucial foreign statistics rules and non regulatory safety drivers. Out of the container, it comes with a database of greater than 100 distinctive policy templates for a range of security drivers.
Getting begun With information Loss Prevention know-how
For agencies who are searching for assistance with their information safety approach, take into account abilities risks linked to the lack of delicate records, or believe that the assignment of securing all delicate suggestions is too expensive, RSA is introducing the RSASM DLP RiskAdvisor carrier. With RSA DLP RiskAdvisor, businesses can at once benefit visibility into where sensitive data is unprotected and accept concrete remediation concepts to in the reduction of the possibility of delicate records loss. The excessive have an effect on provider helps valued clientele prioritize their needs in keeping with enterprise possibility and grants measurable consequences in preventing information loss.
Powering RSA’s facts security equipment
The RSA DLP Suite additionally provides the strategic hub for the RSA™ facts protection equipment, a group of items and capabilities that put into effect a holistic method for securing statistics. The statistics safety system is designed to allow purchasers to find and monitor sensitive tips; enforce controls, corresponding to encryption and statistics loss prevention, and record and audit to show that delicate data is secure. The RSA DLP Suite is engineered to give coverage orchestration for the RSA information security system, enabling different statistics handle and audit mechanisms from RSA, EMC and third events, to be leveraged as a part of a holistic system. The DLP Suite permits agencies to define policies centered around the statistics itself, and leverage handle mechanisms all through the infrastructure to remediate risk and implement coverage.
The RSA DLP Suite will be available in may also 2008. shoppers with current help agreements may be in a position to upgrade to the RSA DLP commercial enterprise supervisor in addition to to upgrade for presently licensed components; other accessories of the RSA DLP Suite no longer currently licensed might be purchasable for additional fees.
RSA, The security Division of EMC, is the premier company of safety options for company acceleration, assisting the area's leading companies succeed with the aid of solving their most complicated and sensitive security challenges. RSA's information-centric strategy to security guards the integrity and confidentiality of information all over its lifecycle - no be counted where it moves, who accesses it or the way it is used.
RSA offers trade-main options in identification assurance & entry manage, information loss prevention & encryption, compliance & safety advice management and fraud protection. These solutions carry believe to thousands and thousands of consumer identities, the transactions that they operate, and the information this is generated. For greater suggestions, please visit www.RSA.com and www.EMC.com.# # #
RSA announced enhancements to the RSA facts Loss Prevention Suite, its suite of facts protection items which are engineered to discover, computer screen and protect sensitive data from loss, leakage or misuse whether in a datacenter, on the community, or out on the endpoints.
The latest free up of the RSA DLP Suite allows agencies to cozy delicate content material in a method that saves time and streamlines approaches for data safety personnel. sensitive records at relaxation can now be moved or quarantined instantly, decreasing administrative costs, and end users can apply self-remediation for delicate emails quarantined as a result of violations. additionally, the RSA DLP Suite is generates and sends experiences instantly to the acceptable personnel.
agencies will now be able to find structured content material in Oracle and SQL Server databases with native scanning and fingerprinting. The RSA DLP 7.0 Suite is also engineered to expand insurance plan of highbrow property with computerized file fingerprinting performance across all three modules of the DLP Suite: Datacenter, network, and Endpoint. further enhancements additionally make the RSA DLP Suite the most effective statistics loss prevention providing that helps CATIA, a multi-platform business utility suite used in the aerospace, car, and discrete manufacturing industries.
With 22 new policy templates, RSA also gives one of the vital complete DLP coverage and classification libraries within the business. These new guidelines include aid for North American electric powered Reliability Corp (NERC) compliance together with additional coverage for policies that assist offer protection to in my view identifiable statistics in Australia, Italy, Netherlands, Spain, Sweden, and New Zealand.
The RSA DLP 7.0 Suite is designed to integrate with the RSA enVision platform, RSA’s SIEM offering which is designed for simplifying compliance, bettering safety operations and risk mitigation, and optimizing IT and community operations throughout the computerized assortment, analysis, alerting, auditing, reporting and storage of all logs.
Microsoft and RSA, The security Division of EMC, observed Thursday they're going to companion on records loss insurance policy items and will at last see an precise construct in of RSA know-how into Microsoft systems.
The ensuing items will permit companies to centrally outline tips safety policy, automatically establish and classify sensitive information anyplace in the infrastructure, and use quite a number controls to offer protection to statistics at the endpoints, community, and statistics core, according to a joint commentary from RSA and Microsoft.
The plan has two phases, in accordance with officers with each agencies. RSA this month will ship its DLP Suite version 6.5, so they can combine tightly with Microsoft energetic directory Rights administration features within home windows Server 2008. The longer-time period section, which a few analysts noted turned into the extra noteworthy, will see Microsoft build RSA's DLP classification engine into Microsoft core structures and future counsel-insurance policy products. No date became given on the availability of these solutions.
"businesses proceed to battle to protect sensitive information across the business," mentioned Chris young, senior vice president of RSA. "element solutions require that varied policies and applied sciences be stitched together and independently managed, which is costly and complicated. "
The DLP market, which has grown eighty two percent year over yr, in response to Gartner Inc., has considered a number of acquisitions and consolidations within the ultimate yr. protection vendors Symantec and McAfee both bought DLP product makers. EMC received Tablus in 2007. The product concerned in Thursday's announcement is the Tablus product rebranded in keeping with rich Mogull, an analyst with Securosis.
"what is coming out immediately is unique however not overly unique," stated Mogull. "It gets greater pleasing down the street as Microsoft embeds the DLP expertise into their product line in different areas. clients can have, at the least, fundamental content material-consciousness capabilities built into the infrastructure. one of the crucial challenges with DLP is that to in fact offer protection to facts, we are looking to be able to give protection to it as top-rated we are able to, in as many areas as we will. The greater that capacity to analyze that content material is built into greater locations, the more straightforward it is for us to plug in, to take comprehensive examine facts insurance plan."
"they are moving toward some thing that could be progressive because Microsoft owns so many of the systems which are used with the aid of corporations these days," talked about Diane Kelly of protection Curve. "a lot of organizations are battling what they do with enterprise rights administration. They are attempting to marry it to their content administration, to their DLP prevention solutions. by means of embedding into Microsoft solutions, it generally is a video game changer."
This story, "statistics Loss Prevention equipment: How MS, RSA Will Work collectively" became at first published by using CSO.
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Zscaler is pushing past its SaaS-based Web filtering, extending its add-on services to include licenses for cloud-based antimalware, data loss prevention and secure Wi-Fi services and aiming it at Websense customers eager to shed outdated on-premise appliances.
Partners say the San Jose, Calif.-based vendor has been a solid choice for companies that are ripping out legacy, on-premise servers or are seeking to improve basic cloud content filtering services. By tweaking DNS settings to send traffic through Zscaler's platform, companies gain the same Web filtering controls and protection against known malicious websites, said Mark Robinson, president of Findlay, Ohio-based solution provider CentraComm, which has partnered with Zscaler for about three years.
"Content filtering is a perfect security service to have in the cloud because I think people are comfortable with that type of service being there," Robinson said, adding that Zscaler has been a winner in the midmarket where companies are more eager to shed on-premise servers for cloud-based services as part of cost-cutting measures.
[Related: Tech 10 Security Products: Advanced Threat Protection]
Since Zscaler's launch in 2008, the company has added antivirus and antispyware to its Web filtering service. It has embraced the channel with the addition of Lane Bess as COO in 2011, a former Palo Alto Networks veteran who has spearheaded its early channel initiatives. Zscaler added email security in 2010 with data loss prevention capabilities that extend to SMTP and webmail. The services are added on as separate licenses with prices ranging from $1 to $5 per user, per month.
Last year it introduced a cloud-based sandbox to inspect suspicious files for detection of so-called advanced threats that use custom malware or zero-days. The APT service supports Windows systems and Android devices. Support for Mac OS X is due out later next year and engineers are still working on support for iOS devices.
The company can decrypt SSL traffic for inspection and is in line to block threats before a system is infected. If it detects outgoing communication to a remote server, it also will block an attempt to upload stolen data. The new guest Wi-Fi protection manages and secures guest Wi-Fi with global administration, policy management, reporting and analytics. Access points are directed to Zscaler for full inspection and threat protection, the company said.
Zscaler said it also added more robust administrative and reporting tools, but it is working on capabilities to prioritize alerts for incident responders.
NEXT: Zscaler Battling Websense, McAfee
Zscaler is competing with a host of other Web security gateway makers, including Symantec, Intel Security (formerly McAfee) and security vendor Websense. All the vendors are moving to cloud-based services and can be deployed as a proxy or bridge mode for some services. Other companies sell a range of appliances for midmarket and enterprise customers who want hands-on reporting and logging and capabilities that extend to hybrid environments. Blue Coat and Cisco Systems are the market-share leaders in the space, according to research firm Gartner.
Websense is battling Zscaler and Intel Security for new customers, partners tell CRN. Websense and other vendors make the case that organizations with complicated environments require a hybrid approach with on-premise systems that can scale and cloud-based services to support threat detection and other security capabilities. In a recent interview with CRN, Websense CEO John McCormack said the company was bolstering its support and services organization and reaching out directly to customers to manage threats that are growing increasingly complex. McCormack said the value is in the software and its ability to scale in complicated environments to meet true enterprise-class needs.
"We run our software so we can get the most juice possible out of the Intel innovation curve and put all the logic to take advantage of that inside our software and optimize it to that, but it takes a lot more than just a box to scale something," McCormack said. "Try dealing with Active Directory, federations that are at 200,000 users. It's pretty incredible in distributed environments that are global. There's a lot of elements to scale."
Robinson said Zscaler has been bolting on additional services that appeal to the midmarket, "but the wholesale mentality of moving traditional intrusion prevention and firewall border security into the cloud isn't happening yet." Zscaler has told partners that it is committed to maintaining open standards to make it easier to integrate other security technologies into the platform.
The Zscaler service is also getting new competition from San Francisco-based OpenDNS, which sells antimalware and phishing protection as well as guest Wi-Fi security. OpenDNS launched a management console for MSPs in June, enabling them to license its Umbrella threat protection services to SMBs and the midmarket.
Zscaler said it expanded its list of technology partnerships with vendors that can integrate identity management, network analysis and traffic management capabilities using Zscaler APIs to connect to the cloud-based services and still function properly.
The company has integration partnerships with CA Technologies, Centrify, SafeNet and Microsoft for single sign-on, multifactor authentication, data protection and identity management. The cloud security platform can feed data into broader network security and risk analysis platforms and in that space partners with BT Assure, Logrhythm, RSA and Symantec. Zscaler also partners with Ipanema Technologies and Viptela for securing traffic and wide area network management.
ZScaler maintains a three-tier channel program for resellers and system integrators, with minimum requirements for registered partners a commitment of five deals per year to gain access to deal registration and other benefits. Midtier partners commit to a minimum annual license revenue of $250,000 and gain access to lead referrals, marketing and presales technical support. The company requires its top-tier Summit partners to have a business plan, commit to license sales of $1 million or more, and have consulting and engineering services certification.
A Zscaler spokesperson said 80 percent of its business is "touched" by the channel. The company said its is achieving 92 percent growth in terms of new business.
PUBLISHED OCT. 21, 2014
SUNNYVALE, CA, Oct 07, 2015 (Marketwired via COMTEX) -- Blue Coat Systems, Inc., a market leader in enterprise security, today announced it has added seven new partners to the Blue Coat Encrypted Traffic Management (ETM) Ready Program, bringing the total number of partners to 17. This group of leading security vendors forms the largest industry collaboration to help customers expose and combat threats hiding in encrypted traffic while also protecting privacy and ensuring compliance. Launched in March 2015, the ETM Ready Program is designed to prepare and certify Blue Coat Technology Alliance Partners to integrate SSL visibility solutions into the Blue Coat architecture, resulting in best-in-class security products to effectively detect and eliminate the hidden threats in encrypted traffic.
New members eSentire, Gigamon, LogRhythm, ManagedMethods, Symantec, TopSpin Security and Trend Micro join founding ETM Ready partners CA Technologies, Cyphort, Damballa, Fidelis Cybersecurity, HP, Lastline, RSA, SafeNet, Inc. (now Gemalto), Venafi and VSS Monitoring.
Today, the number of both business and consumer websites using SSL encryption as the default for securing all data in transit continues to grow. According to Blue Coat Labs research, of the top 10 most visited web sites, 100 percent of them use HTTPS, or encrypted traffic, rendering 100 percent of that traffic invisible to all security devices unless it is decrypted. The growing use of encryption to address privacy concerns is creating a perfect set of conditions for cyber criminals to hide malware inside encrypted transactions. In fact, Blue Coat researchers have found that it often reduces the level of sophistication required for malware to avoid detection, thereby making it easier for malware to get onto the network. The Blue Coat researchers found that over a typical seven-day period, out of 1.1 million new sites identified and classified, over 40,000 requests were newly-classified malicious HTTPS sites and 100,000 requests -- or approximately 10 percent -- to Command-and-Control HTTPS sites were already infected.
"Currently, encrypted traffic is a huge blind spot for enterprise visibility. The importance of privacy will ensure this trend continues, but investments in network security are largely being wasted when encrypted traffic isn't being inspected," said Adrian Sanabria, senior security analyst at 451 Research. "Sophisticated attackers know that evading defenses to get command and control traffic or data out of the enterprise is often as simple as using encryption in transit and perhaps a proxy or two. However, the technology to decrypt that traffic is only half the challenge -- the other half is to leverage existing network security investments, which is why Blue Coat's partnering efforts are so important."
"As our customers increasingly adopt SSL visibility tools, the need for a solid way to manage them is growing. Blue Coat's SSL visibility solution combined with its ETM Ready Program is an excellent solution that provides enterprises with insight into previously hidden threats," said Davitt J. Potter, senior engineering manager with Arrow ECS. "As with any technology or tool that grants access to sensitive data, a rock-solid way to audit, manage, and control access to those powerful tools becomes necessary. We're finding the combination of Gemalto's SafeNet Luna SP HSM and Blue Coat's SSL visibility solution makes deployment, management, and the scalability and usability of these tools simpler and more secure."
"We're definitely seeing a market need for the management and administration of the security infrastructure as more organizations face increasing SSL/TLS encrypted traffic and need effective protection of the certificates and keys along with it," said David Etue, vice president, business development, identity & data protection, Gemalto. "Working with Blue Coat and having our industry-leading HSMs certified with the ETM Ready program is a great asset for our customers."
"Encryption is the tool of choice to protect privacy. But it is also quickly becoming yet another method of attack across the threat landscape," said Peter Doggart, vice president of business development for Blue Coat. "Our customers are telling us that protecting employee and customer data is critical, but they also need to protect their network and the sky-rocketing use of encryption is hindering their ability to do so. Blue Coat and our ETM Ready partners are working to ensure enterprises can protect both privacy and their networks even as their use of encryption grows."
About the ETM Ready Program The ETM Ready Program is designed to enable Blue Coat technology partners to build solutions that help combat security threats hidden in encrypted traffic while preserving privacy, policy and regulatory compliance. By integrating their products with the Blue Coat SSL Visibility Appliance, Blue Coat technology partners' products can offer certified solutions to detect, prevent and eliminate the hidden threats in encrypted traffic. For more Information, please visit https://www.bluecoat.com/partners/etm-ready-certified-partners.
What Blue Coat ETM Ready Partners are saying: "Today's best practice in network security requires multiple inline security appliances to have visibility into the growing amount of SSL encrypted traffic. Integrating Blue Coat's SSL visibility appliance with the GigaSECURE security delivery platform gives our joint customers scalable infrastructure that unobtrusively enables security analytics and inspection at scale." - Johnnie Konstantas, director of security solutions marketing, Gigamon
"Detecting and responding to today's cyber threats requires pervasive visibility across the entire network, including visibility into encrypted SSL traffic. The combination of Blue Coat's encrypted traffic management solution and LogRhythm Network Monitor delivers a powerful new way to detect threats concealed within SSL traffic and provides a holistic view of application, network, and user activity, while preserving privacy and regulatory compliance." - Matthew Winter, Vice President of corporate & business development, LogRhythm
"ManagedMethods is pleased to be part of Blue Coat's Encrypted Traffic Management Ready Certification Program. With the increasing use of cloud applications and services (SaaS) in the enterprise, it is imperative that IT security organizations gain visibility into their usage. The combination of Blue Coat's encrypted traffic management appliances and the ManagedMethods' Cloud Access Monitor product provide customers with a potent new weapon in the fight against Shadow IT. This is crucial today as most SaaS applications use encrypted traffic, which creates blind spots that traditional security measures cannot inspect." -Charlie Sander, CEO, ManagedMethods
"With SSL encrypted traffic seen as an attractive place to hide malware, it's important for IT to gain visibility for such traffic in order to prevent data leaks and other malicious activity. Symantec Data Loss Prevention (DLP) helps customers identify and protect sensitive information. By integrating with the Blue Coat SSL Visibility Appliance, our customers will now have an additional option to easily identify and monitor sensitive data shared outside of the organization." - Nicolas Popp, vice president, information protection, Symantec
"Integrating with Blue Coat's encrypted traffic management solution enables TopSpin an even better analysis and detection of the attackers' activities with the Internet and provides a complete picture of the attackers activities inside the organization and outside of the organization." - Doron Kolton, CEO, TopSpin Security
"Trend Micro Deep Discovery provides unprecedented visibility throughout a customer's network to mitigate next generation threats including targeted and zero-day attacks that can be delivered through encrypted communications. Working in concert with Blue Coat's SSL Visibility Appliance will apply Deep Discovery's dynamic capability to analyze this traffic and ensure these sophisticated attacks are contained in virtually real time. This, in turn, will provide customers with additional peace of mind without compromising privacy or performance." - Kevin Simzer, CMO, Trend Micro
New Blue Coat ETM Ready Program partners include: eSentire
eSentire(R) is the leader in Active Threat Protection solutions and services, the most comprehensive way to defend enterprises from advanced and never-before-seen cyber threats. eSentire's flagship offering, Network Interceptor, challenges legacy security approaches, combining behavior-based analytics, immediate mitigation and actionable intelligence on a 24x7x365 basis. Protecting more than $2.5 trillion in Assets under Management (AuM), eSentire is the trusted choice for security decision-makers in the financial services, legal, healthcare, mining, engineering and construction, and technology industries.
Gigamon Gigamon provides an intelligent Visibility Fabric(TM) architecture for enterprises, data centers and service providers around the globe. Gigamon's technology empowers infrastructure architects, managers and operators with pervasive and dynamic intelligent visibility of traffic across both physical and virtual environments without affecting the performance or stability of the production network. Through patented technologies and centralized management, the Gigamon GigaVUE portfolio of high availability and high-density products intelligently delivers the appropriate network traffic to management, analysis, compliance and security tools. Gigamon has been designing and building traffic visibility products since 2004 and its solutions are deployed globally across vertical markets including over half of the Fortune 100 and many government and federal agencies. Learn more at www.gigamon.com, the Gigamon Blog, or follow Gigamon on Twitter, LinkedIn or Facebook.
LogRhythm LogRhythm, a leader in security intelligence and analytics, empowers organizations around the globe to rapidly detect, respond to and neutralize damaging cyber threats. The company's award-winning platform unifies next-generation SIEM, log management, network and endpoint monitoring and forensics, and security analytics. In addition to protecting customers from the risks associated with cyber threats, LogRhythm provides innovative compliance automation and assurance, and enhanced IT intelligence.
Consistently recognized by third-party experts, LogRhythm has been positioned as a Leader in Gartner's SIEM Magic Quadrant report for four consecutive years, named a "Champion" in Info-Tech Research Group's 2014-15 SIEM Vendor Landscape report and ranked Best-in-Class (No. 1) in DCIG's 2014-15 SIEM Appliance Buyer's Guide, awarded the SANS Institute's "Best of 2014" award in SIEM and received the SC Magazine Reader Trust Award for "Best SIEM Solution" in April 2015. Additionally, the company earned Frost & Sullivan's SIEM/LM Global Market Penetration Leadership Award and has been named a Top Workplace by the Denver Post. LogRhythm is headquartered in Boulder, Colorado, with operations throughout North and South America, Europe and the Asia Pacific region.
ManagedMethods ManagedMethods' mission is to provide customers with an easy to use, efficient and effective Cloud Security Solution. We believe in the basics. You cannot secure what you do not know exists. Shadow IT is a real problem, but it does not need to be. With our products, companies can easily monitor and control the use of Cloud Applications (SaaS) and reduce their cloud risk.
Founded in 2013 by industry veterans of enterprise performance and security software, ManagedMethods products focus around the growing use of Cloud applications and services that are at the core of today's mission critical business functions.
Symantec Symantec Corporation is an information protection expert that helps people, businesses and governments seeking the freedom to unlock the opportunities technology brings -- anytime, anywhere. Founded in April 1982, Symantec, a Fortune 500 company, operating one of the largest global data-intelligence networks, has provided leading security, backup and availability solutions for where vital information is stored, accessed and shared. The company's more than 19,000 employees reside in more than 45 countries. Ninety-nine percent of Fortune 500 companies are Symantec customers. In fiscal 2015, it recorded revenues of $6.5 billion. To learn more go to www.symantec.com or connect with Symantec at: http://www.symantec.com/social/.
TopSpin Security TopSpin Security provides a solution that protects organizations from loss of valuable data and prevents disruption of operations. The emphasis is on accuracy, minimal overhead and simplicity of deployment and usage. The company's solution DECOYnet(TM) incorporates a set of unique security engines that discover infected assets in organizations before damage is done. These include active deception, automatic configuration to networks and automated structured analysis of network traffic. For more information, visit www.topspinsec.com.
Trend Micro Trend Micro Incorporated, a global leader in security software, strives to make the world safe for exchanging digital information. Built on 26 + years of experience, our solutions for consumers, businesses and governments provide layered data security to protect information on mobile devices, endpoints, gateways, servers and the cloud. Trend Micro enables the smart protection of information, with innovative security technology that is simple to deploy and manage, and fits an evolving ecosystem. All of our solutions are powered by cloud-based global threat intelligence, the Trend Micro(TM) Smart Protection Network(TM) infrastructure, and are supported by more than 1,200 threat experts around the globe. For more information, visit TrendMicro.com.
About Blue Coat Systems Blue Coat is a leader in enterprise security, providing on-premise, hybrid and cloud-based solutions for protecting web connectivity, combating advanced threats and responding to security breaches. Blue Coat is the global market leader in securing connection to the web and counts nearly 80 percent of the Global Fortune 500 as its customers. Blue Coat was acquired by Bain Capital in March 2015. For additional information, please visit www.bluecoat.com.
Blue Coat and the Blue Coat logo are registered trademarks or trademarks of Blue Coat Systems, Inc. or its affiliates in the United States and certain other countries. All other trademarks mentioned in this document are the property of their respective owners.Media Contacts Maureen O'Connell Blue Coat Systems firstname.lastname@example.org 408-541-3279
SOURCE: Blue Coat Systems, Inc.
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Before the 2014 Ebola virus disease (EVD) outbreak in West Africa, the U.S. capacity to provide care for patients with highly infectious diseases was limited to a small number of specialized biocontainment units (1–3). In response to the EVD crisis, the Johns Hopkins Health System renovated a deactivated clinical space into a biocontainment unit. In conjunction with the Office of the Assistant Secretary for Preparedness and Response, the Centers for Disease Control and Prevention (CDC), and the U.S. network of regional treatment centers, the Johns Hopkins Biocontainment Unit (BCU) increases the nation’s capacity to care for patients with highly infectious diseases. Critical care physicians played an important role in developing the BCU. The lessons learned from the design process can assist intensivists in the creation of similar units at their institutions and inform a national research agenda on biocontainment and highly infectious diseases.
The Johns Hopkins Office of Critical Event Preparedness and Response (CEPAR) oversees preparedness for Johns Hopkins institutions. When the CDC and the Maryland Department of Health and Mental Hygiene asked Johns Hopkins Hospital to consider becoming an Ebola treatment center, the CEPAR executive board and the president of The Johns Hopkins Hospital decided that the institution should build a dedicated unit to treat highly infectious diseases.
A leadership team was created that included experts in infectious disease, hospital epidemiology, pulmonary and critical care, clinical engineering, hospital design, nursing, and education. The team assembled an advisory council from the Johns Hopkins Health System to ensure that relevant stakeholders were included. The BCU team reviewed consensus guidelines on the characteristics of existing BCUs (1, 2, 5).
The team visited the Nebraska Biocontainment Patient Care Unit (Nebraska Medical Center, Omaha, NE) and the National Institutes of Health Special Clinical Studies Unit (Bethesda, MD). The BCU team also attended a seminar presented by Emory University (Atlanta, GA) and the CDC (Atlanta, GA). These experts shared design plans and offered lessons learned from their experience with EVD.
Given the urgency of the situation in West Africa, the project employed a fast-track model in which a single contractor was integrally involved in design. A recently deactivated 7,000 square foot clinical unit on the top floor of one of the main hospital buildings was chosen for its location away from other units. Plans were redrafted as the team incorporated knowledge from other BCUs.
The design and construction lasted 7 months (Figure 1). The cost of the project was approximately $5 million: $3.64 million for renovation and construction; $895,000 for capital equipment; $226,000 for staff training; and $242,000 for salary support for the leadership team. The accelerated timeline contributed to overall cost. Selected elements could be incorporated at other institutions to reduce cost while maintaining health care worker and patient safety.
Several important features were incorporated into the Johns Hopkins BCU (Table 1). The unit is located away from other clinical areas and has restricted key card access. A dedicated elevator provides a secure route for patient and waste transport without crossing clinical or public areas. Three large patient rooms are equipped for adult and pediatric care (Figure 2). The largest room includes two intensive care unit (ICU) headwalls for a pregnant mother and newborn child or two patients infected with the same pathogen (Figure 3).
Table 1. Key features of the Johns Hopkins Biocontainment UnitFeatures in Common with Existing BCUs at NIH, Emory, and Nebraska Unique Features of the JHH BCU • Secure entry and exit points • Unidirectional flow of staff through patient care areas • Onsite laboratory • Dedicated donning and doffing rooms for all patient care areas • Advanced air-handling system for airborne and droplet transmission • Ample physical space to accommodate obstetrics procedures including labor and delivery and cesarean sections • Highly trained nurse and clinician provider team including adult, pediatric, and obstetrics capabilities • Ample physical space to allow for onsite, sterile procedures, including limited surgery • Critical care capabilities in each room • Main patient care room with two ICU headwalls to provide care for family (e.g., parent and child) • Onsite portable radiology and ultrasound • Advanced telecommunication capabilities • Pass-through autoclaves for waste management
Each patient room and the laboratory have shared donning rooms and dedicated doffing rooms for personal protective equipment. This layout allows unidirectional flow of staff and materials to reduce the risk of cross contamination. The walls and floors in patient care areas are heat-welded and seamless (Altro, Wilmington, MA). Countertops are constructed of stainless steel or easy-to-clean surfaces resistant to hospital disinfectants. Donning rooms have pass-throughs to transfer supplies into the patient rooms. The laboratory and the back entrance have sealed pass-throughs that open only on one side at a time to minimize cross contamination.
Visual cues enhance provider safety. For example, doors are color-coded to enforce unidirectional flow. Green doors may be opened freely because they connect clean spaces. Yellow doors may be opened but only after performing a specific activity that is posted on a placard next to the threshold (e.g., donning personal protective equipment). Red doors are never opened from the red side to prevent backward movement from a contaminated space into a clean area (Figure 3).
The BCU is designed for infections spread via contact, droplet, and airborne routes. The design team examined CDC, American Society of Heating, Refrigerating, and Air-Conditioning Engineers, American National Standards Institute, and American Society for Healthcare Engineering guidelines for airborne infection isolation (AII) rooms and adapted them to build a specialized air-handling system (6, 7).
There is currently no evidence to guide the design of an air-handling system for an entire infectious diseases unit. The building’s air-handling unit supplies 100% outside air, using a minimum efficiency reporting value 16 filter that captures 99% of 1.0-μm particles. Supply air is controlled by the hospital’s building automation system. Each patient room and the laboratory exceed the minimum requirement of 12 air changes per hour for AII rooms. The donning and doffing rooms, clean transition room, and corridor exceed the minimum requirement of 10 air changes per hour for anterooms.
The BCU is under negative pressure relative to the surrounding hospital. Contaminated areas are sealed to minimize air leakage and to maintain a negative pressure differential of at least –0.02 inches water gauge (w.g.) to adjacent areas. The patient care rooms and the laboratory are negative to the donning and doffing rooms, which are in turn negative to the main corridor. Air flows from outside the BCU into the corridor, from the corridor into the donning and doffing rooms, and finally into the contaminated space.
Supply air diffusers on the ceiling and exhaust vents on the lower wall create laminar flow. Air from the patient rooms is exhausted through high-efficiency particulate arrestance (HEPA) filters on the roof that capture 99.99% of particles with a size of 0.3 μm. Independent engineers certified by the Associated Air Balance Council and National Environmental Balancing Bureau performed flow testing and balancing in accordance with their standards.
Negative pressure is maintained through a dual rooftop fan system (Greenheck, Schofield, WI). In the case of one fan failure, the other fan maintains filtration and negative pressure for the entire BCU. Each clinical area has a pressure sensor that is remotely monitored by Facilities Engineering. If a sensor detects a drop in pressure below a set threshold, a light at the nurse’s station changes from green to yellow and the supply air to that area automatically shuts off so that it will not become positive to adjacent rooms. The air-handling system is connected to the emergency power of the hospital.
Onsite Diagnostic Laboratory
The BCU laboratory shares a donning room with Patient Room 3. The entry doors to both rooms operate on an interlock such that the doors cannot be opened simultaneously. The laboratory has two SterilGARD Class II biological safety cabinets (Baker, Sanford, ME) that contain four point-of-care testing instruments (Figure 4). Each cabinet is exhausted through the unit’s HEPA filtration system. In the case of pressure loss, the supply air to the laboratory shuts off. If the pressure loss continues, the exhaust vents from the laboratory close, and air is recirculated through the HEPA filters in each cabinet.
A test menu was constructed on the basis of available evidence and experience from laboratories that have cared for patients with EVD (8–12) (Table 2). Testing is performed by clinical laboratory scientists with training in infection control practices. The BCU laboratory will be expanding capacity to include molecular PCR testing for respiratory and blood pathogens, using a BioFire FilmArray (BioFire Diagnostics, LLC, Salt Lake City, UT). At present, specimens are transported in sealed containers to the Johns Hopkins Biological Safety Level-3 (BSL-3) Microbiology Laboratory for blood cultures, urine cultures, and respiratory virus and malaria testing.
Table 2. Laboratory testing panel and point-of-care devicesAnalyte/Panel Instrument Comprehensive metabolic panel (CMP) Abaxis Piccolo (Abaxis, Union City, CA) Electrolytes (Na, K, Cl) Abaxis Piccolo Magnesium Abaxis Piccolo Phosphate Abaxis Piccolo Lactate Abaxis Piccolo Heme-8 (CBC with differential) Sysmex pocH-100i (Sysmex, Lincolnshire, IL) Arterial blood gas w/co-oximetry Radiometer ABL90 (Radiometer, Brønshøj, Denmark) Venous blood gas w/co-oximetry Radiometer ABL90 Ionized calcium Radiometer ABL90 Whole blood INR Hemochron Signature (Accriva Diagnostics, San Diego, CA) Plasma equivalent aPTT Hemochron Signature Urinalysis Manual test Urine HCG Manual test ABO typing Glass slide test DIC blood film Manual test
Waste Handling and Decontamination
One of the challenges in a biocontainment environment is the handling of Category A medical waste (13–17). Category A waste is any infectious substance that is “capable of causing permanent disability or life-threatening or fatal disease in otherwise healthy humans or animals when exposure to it occurs” (18). Only a handful of civilian facilities process Category A waste, and the transportation cost to those facilities is substantial. Waste that has been autoclave sterilized can be transported as regular medical waste (16).
The Johns Hopkins BCU has an onsite waste-handling room with two pass-through autoclaves (Primus Sterilizer, Omaha, NE). Infectious material is loaded into the autoclaves on the contaminated side and, once sterilized, is removed on the clean side for processing as regular medical waste (Figure 5). Biological and chemical indicators are used with every autoclave cycle to ensure sterilization before transport off the unit. Autoclave protocols were derived from guidelines for BSL-3 and BSL-4 laboratories (19).
There are few data on the use of autoclaves for decontamination of clinical and patient-related waste. The BCU autoclave protocols were developed and validated through a rigorous process that used biological indicators embedded within mock patient trash loads. This ensures that effective kill of organisms is achieved in solid trash, liquid waste, and soiled linens.
Items that are reused on the unit are transported to a room off the waste-handling area, where they undergo disinfection with a hydrogen peroxide vapor system (Bioquell, Horsham, PA). This system also decontaminates patient care areas after discharge (20–23). The elevator is cleaned with hospital disinfectant and can undergo decontamination with vaporized hydrogen peroxide if a spill occurs during transport.
The plumbing is resistant to hospital disinfectants and has a dedicated waste water conduit to the hospital’s main sanitary system. This allows dilution of waste materials with disinfectants and protects the floors below in the case of a plumbing disruption.
Communication on the Unit
The isolation of patients and staff in a biocontainment unit presents challenges to communication. Each patient area has a mobile workstation with a camera, microphone, and screen to allow communication with staff as well as patient families (Polycom, San Jose, CA). The system is monitored from the nurse’s station and can be accessed remotely using a secure application. This facilitates patients’ connections to their families and allows consultative care without entering contaminated areas.
Clinical Staffing and Workflow
BCU team members self-selected through a process that included town halls, departmental meetings, e-mails, and word of mouth. There are currently 32 adult providers, 47 adult nurses, 14 pediatric nurses, 11 clinical laboratory scientists, 4 radiology technicians, and 7 respiratory therapists on the main team (Figure 6). Separate teams from pediatrics, obstetrics and gynecology, neonatology, and general surgery are available to provide care if needed.
Two physicians are on call to staff the BCU within 4 hours of activation. On activation, an electronic notification directs providers to an online system where they populate a 2-week call schedule. Each provider signs up for a minimum of three 12-hour shifts to limit the number of staff on the unit during activation. Division directors provide backfill support to minimize impact on the rest of the hospital. Providers do not work on other units during a BCU shift but are able to perform regular duties in the hospital before or after a shift.
A group of 12 nurses is on call to staff the first shift within 8 hours of notification. Once activated, an online system directs the remainder of the nurses to populate a 3-week schedule. During activation, nurses are exclusively assigned to the BCU and do not perform shifts on their regular units.
Only four nurses from the same unit work during a 3-week period to limit the impact of activation. Each 12-hour shift includes at least one intensive care unit nurse. The day shift has six nurses; the night shift has five. Two nurses will be in the room when caring for a patient with EVD. Nurse roles include charge, bedside, in-room buddy, autoclave operator, tasker, and donning/doffing assistant. Physician providers assist with these duties when not providing direct care. A hospital epidemiologist and infection prevention team supervises infection control practices on the BCU. They provide step-by-step instructions for donning and doffing and observe providers during clinical care.
Daily care rounds occur at the nurse’s station during morning shift change. Ethics team, social work, case management, consultant, and other support services join rounds remotely. The Office of Emergency Management holds daily briefings with the relevant command centers of the hospital. The office facilitates communication with Baltimore City and Maryland State Health Departments, the U.S. Office of the Assistant Secretary for Preparedness and Response, the CDC, and other relevant agencies.
Staff Training and Preparedness
Training is paramount to safety in a biocontainment environment. The BCU has a full-time nurse educator responsible for staff training in infection control procedures. This includes quarterly training and competency assessment in donning and doffing of personal protective equipment as well as performance of in-room procedures including phlebotomy, laboratory specimen handling, spills, waste management, and breach of protective equipment.
The nurse educator coordinates hospital-wide training exercises with the Hopkins Lifeline transport team, the Office of Emergency Management, and CEPAR. As a regional Ebola and Other Special Pathogen Treatment Center, Johns Hopkins Hospital will partner with the National Ebola Training and Education Center, an organization administered by Emory University, the University of Nebraska Medical Center, and Bellevue Hospital, to maintain readiness for EVD and other infectious diseases (24). The National Ebola Training and Education Center will develop preparedness guidelines for regional centers and conduct annual drills and after-action reviews.
Personal Protective Equipment and Supplies
The personal protective equipment used at Johns Hopkins Hospital was designed by Hospital Epidemiology and Infection Control in accordance with CDC guidelines. Materials Management procures and maintains adequate supplies of protective equipment and other materials critical to BCU operation.
In addition to the laboratory (see Table 2), the BCU has portable radiography capabilities with a DRX-Revolution mobile X-ray system (Carestream, Rochester, NY). A dedicated SonoSite X-Porte ultrasound machine (Fujifilm SonoSite, Bothell, WA) allows pleural and abdominal ultrasound, echocardiography, and obstetrics examinations and is used for invasive procedures such as line placement. A Thinklabs One digital stethoscope (Thinklabs, Centennial, CO) with disposable earphones allows auscultation while wearing a powered air-purifying respirator.
Pharmacy services are provided remotely by a pharmacist and a critical care clinical pharmacy specialist. The Johns Hopkins Critical Care and Surgery Pharmacy stocks the BCU using a “just-in-time” process to minimize expiration and waste. Core ICU medications are stocked in an automated dispensing cabinet (CareFusion, San Diego, CA) on the BCU before patient arrival. The pharmacy makes STAT deliveries to provide urgent medications.
Clinical Care and Procedures
The BCU has standard operating procedures for highly infectious diseases including EVD. A group of clinicians has trained in airway management and central line placement, using appropriate precautions. The Johns Hopkins Division of Nephrology developed protocols for renal replacement therapy, based on available guidelines (25, 26). The Department of Obstetrics and Gynecology developed BCU care pathways including labor and delivery and cesarean sections. The Department of Surgery built capacity for limited procedures on the BCU including abscess drainage, exploratory laparotomy, and thoracotomy. The Department of Pediatrics ensures that equipment and staff are available to care for critically ill pediatric patients, including neonates.
A number of ethical issues emerge when caring for patients with highly infectious diseases in nonepidemic settings (27). The Johns Hopkins Hospital Ethics Committee partnered with the BCU team to develop an approach for addressing these issues. The ethics team will also participate in daily care rounds.
Staff and Patient Wellness
BCU staff complete a respiratory evaluation by Occupational Health Services to ensure their safety while wearing a respirator. OHS monitors BCU staff with daily temperature and symptom checks during and after the care of patients. The BCU has worked with Spiritual Care, Social Work, and Child Life Services to address the potential needs of patients and their families. In addition to these services, BCU staff members are encouraged to engage the Faculty and Staff Assistance Program to deal with the challenges of working in a biocontainment environment. The BCU communication system allows patients and staff to access services directly from the unit.
Clinical Experience to Date
The Johns Hopkins BCU has activated on three occasions: once for a person under investigation, and twice to run laboratory tests on persons under investigation in emergency departments in the Johns Hopkins Health System. Following these activations, a number of modifications were made to existing protocols to enhance preparedness and safety.
A number of processes were also successfully tested. During the first activation, the on-call physician was onsite within 1 hour of notification, and the nurse team arrived within 4 hours. The scheduling system populated a 2-week schedule for clinicians within 30 minutes of activation. The Johns Hopkins Hospital did not have to close beds or divert patients during activation. The transport team safely transported the person under investigation from the emergency department to the BCU via the designated route. The communication system facilitated staff communication and enabled the patient to speak with an offsite social worker. The laboratory was ready to receive specimens within 2 hours of notification, the process for transporting specimens from the emergency department to the BCU functioned appropriately, and the laboratory successfully reported values for all point-of-care devices.
A Call for Research in Biocontainment and Infection Control for High-Consequence Pathogens
The design of the Johns Hopkins BCU highlighted the lack of evidence surrounding the management of highly infectious diseases in a biocontainment environment. Several key areas would benefit from further research to enhance patient and provider safety: the role of technology and environmental control in treating highly infectious diseases; personal protective equipment design; and the application of human factors engineering to improve the safety and efficiency of care processes. Innovations in these areas could have broader implications for infection control and patient care in other areas of the hospital.
In collaboration with Johns Hopkins Hospital Facilities Engineering, the BCU team is examining the effectiveness of the air-handling system in containing airborne pathogens to help inform the design of other BCUs. Along with the Johns Hopkins Applied Physics Laboratory, the BCU is working to expand the capability of a teleoperated digital robotics platform to perform high-risk procedures such as a phlebotomy and intravenous catheter placement. The group is also examining the use of no-touch technologies to minimize the contact of care providers with contaminated surfaces. For example, sensors that respond to hand gestures could be used to operate doors in high-risk areas.
There is little evidence concerning the effectiveness of the personal protective equipment used in the EVD outbreak (28, 29). The BCU has partnered with the Johns Hopkins Center for Bioengineering Innovation and Design and Jhpiego to test the comfort, visibility, and ease of doffing of new personal protective equipment prototypes. This will inform design modifications before testing in simulated Ebola treatment units in West Africa.
There are few data guiding personal protective equipment training and the validation of donning and doffing practices. In partnership with the CDC and the Johns Hopkins Armstrong Institute for Patient Safety and Quality, the Johns Hopkins Prevention Epicenter will undertake research to optimize the use of personal protective equipment for infection prevention. For example, it is unclear whether a 3-month recertification process is ideal for maintaining competency in the use of this equipment. In addition to examining training methodology and skills decay, the team will evaluate donning and doffing practices using Glo Germ fluorescent synthetic beads (Glo Germ Co., Moab, UT) as well as a nonenveloped, nonpathogenic RNA virus (29, 30). This approach will also be used to examine the effectiveness of unidirectional flow on cross contamination.1 . Risi GF, Bloom ME, Hoe NP, Arminio T, Carlson P, Powers T, Feldmann H, Wilson D. Preparing a community hospital to manage work-related exposures to infectious agents in BioSafety Level 3 and 4 laboratories. Emerg Infect Dis 2010;16:373–378. 2 . Smith PW, Anderson AO, Christopher GW, Cieslak TJ, Devreede GJ, Fosdick GA, Greiner CB, Hauser JM, Hinrichs SH, Huebner KD, et al. Designing a biocontainment unit to care for patients with serious communicable diseases: a consensus statement. Biosecur Bioterror 2006;4:351–365. 3 . Johnson DW, Sullivan JN, Piquette CA, Hewlett AL, Bailey KL, Smith PW, Kalil AC, Lisco SJ. Lessons learned: critical care management of patients with Ebola in the United States. Crit Care Med 2015;43:1157–1164. 4 . Garibaldi B, Ernst N, Reimers M, Langlotz R, Gimburg A, Iati M, Bova G, Trexler P, Clarke W, Daugherty E, et al. Establishing a new biocontainment and treatment unit [abstract]. Chest 2015;148:248A. 5 . Beam EL, Boulter KC, Freihaut F, Schwedhelm S, Smith PW. The Nebraska experience in biocontainment patient care. Public Health Nurs 2010;27:140–147. 6 . Siegel J, Rhinehart E, Jackson M, Chiarello L; Healthcare Infection Control Practices Advisory Committee. 2007 Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings [2007; accessed 2016 Feb 18]. Available from: www.ashrae.org 7 . Schoen LJ, Hodgson MJ, McCoy WF, Miller SL, Li Y, Olmsted RN, Sekhar C; ASHRAE Airborne Infectious Diseases Position Document Committee. ASHRAE position document on airborne infectious diseases [2014; accessed 2016 Feb 17]. Available from: https://www.ashrae.org/File%20Library/docLib/About%20Us/PositionDocuments/Airborne-Infectious-Diseases.pdf 8 . Katz LM, Tobian AA. Ebola virus disease, transmission risk to laboratory personnel, and pretransfusion testing. Transfusion 2014;54:3247–3251. 9 . Centers for Disease Control and Prevention. Ebola (Ebola virus disease): Guidance for U.S. laboratories for managing and testing routine clinical specimens when there is a concern about Ebola virus disease [updated 2015 Oct 8; accessed 2016 Feb 17]. Available from: http://www.cdc.gov/vhf/ebola/healthcare-us/laboratories/safe-specimen-management.html 10 . Iwen PC, Garrett JL, Gibbs SG, Lowe JJ, Herrera VL, Sambol AR, Stiles K, Wisecarver JL, Salerno KJ, Pirruccello SJ, et al. An integrated approach to laboratory testing for patients with Ebola virus disease. Lab Med 2014;45:e146–e151. 11 . Lippi G, Mattiuzzi C, Plebani M. Laboratory preparedness to face infectious outbreaks: Ebola and beyond. Clin Chem Lab Med 2014;52:1681–1684.other 12 . Hill CE, Burd EM, Kraft CS, Ryan EL, Duncan A, Winkler AM, Cardella JC, Ritchie JC, Parslow TG. Laboratory test support for Ebola patients within a high-containment facility. Lab Med 2014;45:e109–e111. 13 . Centers for Disease Control and Prevention. Ebola (Ebola virus disease): Ebola-associated waste management [updated 2015 Feb12; accessed 2016 Feb 17]. Available from: http://www.cdc.gov/vhf/ebola/healthcare-us/cleaning/waste-management.html 14 . Occupational Safety and Health Administration. Safe handling, treatment, transport and disposal of Ebola-contaminated waste [updated 2014; accessed 2016 Feb 17]. Available from: https://www.osha.gov/Publications/OSHA_FS-3766.pdf 15 . Lowe JJ, Olinger PL, Gibbs SG, Rengarajan K, Beam EL, Boulter KC, Schwedhelm MM, Hayes AK, Kratochvil CJ, Vanairsdale S, et al. Environmental infection control considerations for Ebola. Am J Infect Control 2015;43:747–749. 16 . Lowe JJ, Gibbs SG, Schwedhelm SS, Nguyen J, Smith PW. Nebraska Biocontainment Unit perspective on disposal of Ebola medical waste. Am J Infect Control 2014;42:1256–1257. 17 . Hewlett AL, Varkey JB, Smith PW, Ribner BS. Ebola virus disease: preparedness and infection control lessons learned from two biocontainment units. Curr Opin Infect Dis 2015;28:343–348. 18 . U.S. Department of Transportation, Pipeline and Hazardous Materials Safety Administration. Transporting infectious substances safely [2006; accessed 2016 Feb 17]. Available from: http://www.phmsa.dot.gov/pv_obj_cache/pv_obj_id_54AC1BCBF0DFBE298024C4C700569893C2582700/filename/Transporting_Infectious_Substances_brochure.pdf 19 . Chosewood LC, Wilson DE; U.S. Department of Health and Human Services. Biosafety in microbiological and biomedical laboratories, 5th ed. [2009; accessed 2016 Feb 17]. HHS Publication No. (CDC) 21-1112. Available from: http://www.cdc.gov/biosafety/publications/bmbl5/bmbl5_introduction.pdf 20 . Goyal SM, Chander Y, Yezli S, Otter JA. Evaluating the virucidal efficacy of hydrogen peroxide vapour. J Hosp Infect 2014;86:255–259. 21 . Galvin S, Boyle M, Russell RJ, Coleman DC, Creamer E, O’Gara JP, Fitzgerald-Hughes D, Humphreys H. Evaluation of vaporized hydrogen peroxide, Citrox and pH neutral Ecasol for decontamination of an enclosed area: a pilot study. J Hosp Infect 2012;80:67–70. 22 . Ray A, Perez F, Beltramini AM, Jakubowycz M, Dimick P, Jacobs MR, Roman K, Bonomo RA, Salata RA. Use of vaporized hydrogen peroxide decontamination during an outbreak of multidrug-resistant Acinetobacter baumannii infection at a long-term acute care hospital. Infect Control Hosp Epidemiol 2010;31:1236–1241. 23 . Mollura DJ, Palmore TN, Folio LR, Bluemke DA. Radiology preparedness in Ebola virus disease: guidelines and challenges for disinfection of medical imaging equipment for the protection of staff and patients. Radiology 2015;275:538–544. 24 . U.S. Department of Health and Human Services. HHS launches National Ebola Training and Education Center [2015 July 1; accessed 2016 Feb 17]. Available from: http://www.hhs.gov/about/news/2015/07/01/hhs-launches-national-ebola-training-and-education-center.html 25 . Connor MJ Jr, Kraft C, Mehta AK, Varkey JB, Lyon GM, Crozier I, Ströher U, Ribner BS, Franch HA. Successful delivery of RRT in Ebola virus disease. J Am Soc Nephrol 2015;26:31–37. 26 . Faubel S, Franch H, Vijayan A, Barron MA, Heung M, Liu KD, Koyner JL, Conner MJ Jr. Preparing for renal replacement therapy in patients with the Ebola virus disease. Blood Purif 2014;38:276–285. 27 . Sugarman J, Kass N, Rushton CH, Hughes MT, Kirsch TD. Translating professional obligations to care for patients with Ebola virus disease into practice in nonepidemic settings. Disaster Med Public Health Prep 2015;9:527–530. 28 . Sprecher AG, Caluwaerts A, Draper M, Feldmann H, Frey CP, Funk RH, Kobinger G, Le Duc JW, Spiropoulou C, Williams WJ. Personal protective equipment for filovirus epidemics: a call for better evidence. J Infect Dis 2015;212:S98–S100. 29 . Fischer WA II, Weber DJ, Wohl DA. Personal protective equipment: protecting health care providers in an Ebola outbreak. Clin Ther 2015;37:2402–2410. 30 . Casanova L, Alfano-Sobsey E, Rutala WA, Weber DJ, Sobsey M. Virus transfer from personal protective equipment to healthcare employees’ skin and clothing. Emerg Infect Dis 2008;14:1291–1293.
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