Assessment of Training Needs on Biorisk Management for Medical and Veterinary Laboratory Staff in Vietnam: A Survey in 13 Provinces

Abstract

The study team conducted a cross-sectional study among medical laboratory staff (MLS) and veterinary laboratory staff (VLS) employed in laboratories affiliated in Vietnam to assess the current biorisk management (BRM) training situation and to identify MLS and VLS training needs. A total of 283 laboratory staff members, comprising 168 MLS and 115 VLS, completed the questionnaire. Over two-thirds (68.7%) of the respondents possessed more than 5 years of laboratory experience, with 71.4% operating within high levels of laboratory biosafety. Results showed that more MLS had undergone BRM training, but higher scores were observed for VLS in terms of addressing their organizational reputation and other types of biorisk within their biorisk system. Training needs on BRM among both MLS and VLS were confirmed to be high across all BRM areas measured, with most respondents expressing the need for training or retraining. The study underscores the necessity to enhance both the quantity and quality of BRM training in Vietnam. Consequently, it strongly advocates for the development of a standardized national training program on BRM, aimed at ensuring the effectiveness of training activities.

Introduction

The escalating threats posed by microbiological agents, including SARS-CoV-2, MERS-CoV, Ebola, Zika, Marburg, and avian influenza viruses, alongside the growing fear of bioterrorism, have become global concerns. Enhancing biosecurity and biosafety practices has become an urgent global objective and a crucial component of laboratory operations.^1,2

Laboratories engaged in activities involving human and/or animal pathogens should have necessary biosafety and biosecurity capabilities.³ Biorisk management (BRM) is the effective management of risks associated with pathogens in laboratories and includes various practices and procedures ensuring biosecurity, biosafety, and biocontainment.^2,4,5 The recent introduction of ISO 35001:2019: Biorisk Management for Laboratories and Other Related Organisations,² a standard for BRM, offers a framework for managing biological agents effectively.

Many countries have implemented BRM in laboratories, but the optimal approach varies depending on their available resources and specific needs.⁶ Human factors play integral roles in BRM, emphasizing the importance of training for laboratory staff on biosecurity and biosafety.⁷ The protective measures required for individual and network laboratories can vary, depending on their biosafety levels (BSLs), which range from BSL-1 (basic risk) to BSL-4 (highest risk).⁸

In Vietnam, biosafety and biosecurity have become paramount in health regulations, and have led to mandatory biosafety training for medical laboratory staff.⁹ However, evaluations of biosafety and biosecurity in veterinary laboratory facilities are lacking across Vietnam, highlighting a need to explore the training status and requirements for BRM among staff in medical and veterinary laboratories. This study assessed the existing state of BRM training in 2020 and identified training needs for laboratory staff across Vietnam.

Methods

Study Design

We conducted a cross-sectional study from October to November 2020 of medical and veterinary laboratory staff working in laboratories affiliated with the Vietnamese Centers for Disease Control, hospitals, subdepartments of animal health, and universities in Vietnam. These institutions maintain a strong collaboration with the Vietnam One Health University Network (VOHUN), which is part of the regional Southeast Asia One Health University Network. VOHUN has developed a field-based joint training course for health and veterinary professionals focused on infectious disease prevention and control at the provincial and district levels. Leaders from these laboratories, hospitals, and institutions provided a list of eligible staff members along with their contact information. The details of the study were communicated to the identified staff members, who were then selected for the study based on specific inclusion criteria: (1) being at least 18 years old; (2) being employed in a laboratory as a technician, researcher, or manager under a full-time labor contract; and (3) expressing consent to participate in the study by providing informed consent online.

Instruments and Data Collection

A self-administered questionnaire was developed by the research team with input from experts at VOHUN, referencing ISO 35001:2019: Biorisk Management for Laboratories and Other Related Organisations² and the World Health Organization’s Biorisk Management: Laboratory Biosecurity Guidance.⁵ The questionnaire was created using Kobo Toolbox and consisted of 3 main sections.

The first part gathered sociodemographic information, including age, gender, highest educational qualification, years of laboratory work experience, and the perceived level of biosafety in the workplace.

The second part assessed biorisk at working facilities, comprising 2 main components: biorisk system and biorisk measurement. The first component included an assessment of the biorisk system (9 items measured on a 5-point Likert scale), the types of biorisks addressed (5 items), and performance of the biorisk system (10 items). The second component included an assessment of the biorisk measurement method (6 items), accidents and incidents related to biosecurity occurring in the last 5 years (yes/no), identification and recording of accidents and incidents (5 items), and awareness of biosecurity hazards (8 items).

The third part assessed training needs on BRM across 4 key competencies: general understanding of concepts (4 items), capacity for biorisk assessment (6 items), capacity for biorisk mitigation (5 items), and performance capacity (5 items). Additionally, these competencies were examined through 5 subcategories: training status, practice, confidence, need for training or retraining, and type of training.

Data Analysis

Descriptive statistics, such as frequency, percentage, and mean with standard deviation, were calculated for the characteristics of the study respondents. To examine differences in the characteristics, we conducted an assessment of biorisk at working facilities and an assessment of BRM training needs among study respondents by working sector—medical laboratory and veterinary laboratory. The t test was used for continuous variables and chi-square tests and Fisher exact tests were used for categorical variables. A P value of <.05 was considered statistically significant. The collected data were transferred from Kobo Toolbox (Cambridge, Massachusetts, USA) to Microsoft Excel and subsequently imported into Stata version 16 (Stata Corp LLC, College Station, Texas, USA) for analysis.

Ethical Clearance

The study received approval in accordance with Decision No. 407/2020/YTCC-HD3 by the Institutional Review Board of the Hanoi University of Public Health. All methods were conducted in compliance with the committee’s relevant guidelines and regulations. Written informed consent was obtained from all study respondents.

Results

Characteristics of Study Respondents

A total of 327 staff members from 13 provinces in 3 regions in Vietnam were selected, and self-administered questionnaires were distributed to each respondent via email. Of the questionnaires sent, 283 were completed and returned, resulting in a response rate of 86.5%, which indicates strong participation. The final study population was comprised of 168 (59.4%) medical laboratory staff (MLS) and 115 (40.6%) veterinary laboratory staff (VLS). The general characteristics of all respondents are summarized in Table 1.

Table 1.

Demographic Characteristics of Respondents by Working Sector

Demographic Characteristics	Veterinary Laboratory Staff (n=115) n (%)	Medical Laboratory Staff (n=168) n (%)	P Value
Gender
Female	77 (67.0)	121 (72.0)	.44
Male	38 (33.0)	47 (28.0)
Age, years
Mean (SD)	34.9 (5.9)	36.4 (7.8)	.07
29 and under	31 (27.0)	43 (25.6)	.07
30 to 39	62 (53.9)	73 (43.5)
40 and above	22 (19.1)	52 (31.0)
Living region
North region	51 (44.3)	99 (58.9)	<.001
Center region	22 (19.1)	45 (26.8)
South region	42 (36.5)	24 (14.3)
Level of education
Undergraduate	38 (33.0)	66 (39.3)	.35
University and higher	77 (67.0)	102 (60.7)
Current working position
Leader/manager/administrator	13 (11.3)	27 (16.1)	.34
Staff/officer/technician	102 (88.7)	141 (83.9)
Working experience, years
4 or less	44 (38.3)	47 (28.0)	.009
5 to 9	41 (35.7)	47 (28.0)
10 or more	30 (26.1)	74 (44.0)
Direct contact with biological agents
Yes	107 (93.0)	146 (86.9)	.15
No/do not know	8 (7.0)	22 (13.1)
Current position is biosafety officer
Yes	37 (32.2)	35 (20.8)	.044
No/do not know	78 (67.8)	133 (79.2)
Number of staff members at laboratory department
5 and below	43 (37.4)	48 (28.6)	.29
6 to 10	26 (22.6)	41 (24.4)
11 and above	46 (40.0)	79 (47.0)
Biosafety committee at working facility
Yes	17 (14.8)	18 (10.7)	.40
No/do not know	98 (85.2)	150 (89.3)
Biosafety level of laboratory department
Level 1	45 (39.1)	36 (21.4)	<.001
Level 2	47 (40.9)	123 (73.2)
Levels 3 and 4	23 (20.0)	9 (5.4)

A greater percentage of VLS and MLS live in the North region (44.3% and 58.9%, respectively) than in the Central or South regions (Table 1). The number of laboratory staff with 10 years or more of working experience was higher in MLS (n=74, 44.0%) than VLS (n=30, 26.1%). Both groups reported that a majority of their laboratory departments had 10 or more laboratory staff at their facilities, MLS (n=79, 47.0%) than VLS (n=46, 40.0%); however, more VLS biosafety officers (n=37, 32.2%) participated in our study than MLS biosafety officers (n=35, 20.8%). More VLS worked in BSL-3 and BSL-4 laboratories (n=23, 20.0%) than MLS (n=9, 5.4%); however, substantially more MLS worked at BSL-2 laboratories (n=123, 73.2%) than VLS (n=47, 40.9%).”

Assessment of Biorisk at Working Facilities

Biorisk System

In the assessment of biorisk systems at working facilities, VLS scored higher than MLS overall (see means, standard deviations, and P values in Table 2). Specifically, VLS scored higher in the maintenance and periodic review of the biorisk assessment system in their facilities and in the clarity of defined roles and involvement of employees in their laboratory department. They also scored higher in the number of staff in their laboratory department who have been trained and understand biorisk assessment and who clearly understand biorisk assessment methods. VLS also reported higher scores for the inclusion of risk assessment methods in their department’s training process.

Table 2.

Assessment of Biorisk Systems at Working Facilities by Sector

Assessment of Biorisk System	Veterinary Laboratory Staff (n=115)Mean (SD)	Medical Laboratory Staff (n=168)Mean (SD)	P Value
Assessment system
Formal biorisk assessment process has been established	3.7 (0.98)	3.7 (0.89)	.82
Biorisk assessment system is maintained and reviewed periodically	3.8 (1.00)	3.6 (0.95)	.032
Staff have been trained and understand biorisk assessment	3.8 (0.89)	3.5 (1.01)	.001
Leadership supports a biorisk assessment and problem response system	4.0 (0.85)	3.9 (0.68)	.24
Staff clearly understand biorisk assessment methods	3.8 (0.92)	3.4 (1.04)	.001
Risk assessment methods have been included in the training process	3.7 (1.05)	3.4 (1.01)	.022
Risk assessment is supported by tools and documentation	3.5 (1.07)	3.4 (0.91)	.46
Roles and involvement of employees are clearly defined	3.6 (1.09)	3.3 (0.97)	.044
Biorisk assessment method complies with accreditation standards	3.6 (1.00)	3.5 (0.91)	.18
Total scores	33.5 (7.73)	31.5 (7.02)	.033
Types of biorisk addressed
Biological safety	4.0 (0.89)	4.0 (0.68)	.64
Environmental pollution	4.0 (0.93)	3.9 (0.78)	.39
Biosecurity	3.7 (1.01)	3.6 (0.84)	.74
Organizational reputation	3.7 (0.92)	3.5 (0.79)	.049
Other	3.5 (0.80)	3.3 (0.82)	.016
Total scores	18.8 (3.51)	18.3 (2.70)	.18
Performance of the biorisk system
Classification and control of pathogens	4.0 (0.80)	4.0 (0.55)	.89
Installation and use of new equipment/tools	3.8 (0.94)	3.7 (0.77)	.16
Application of new or modification of existing methods	3.8 (0.93)	3.7 (0.70)	.24
Reception of new professional scientific staff	3.7 (1.06)	3.5 (0.85)	.16
Welcoming scientists to visit	3.8 (1.01)	3.5 (0.81)	.038
Contractor/maintenance personnel have access to work area	3.7 (1.02)	3.9 (0.51)	.10
Planning of construction or facility repairs	3.8 (1.01)	3.8 (0.76)	.75
Planning and establishment of contingency measures for emergencies	3.9 (0.98)	3.7 (0.79)	.06
Receiving or shipping of new biological material	3.6 (1.12)	3.7 (0.86)	.48
Evaluation of testing department external relationships	3.7 (0.96)	3.5 (0.86)	.05
Total scores	37.9 (7.94)	37.1 (4.96)	.30

Although the scores for the types of biorisk addressed and the performance of the biorisk system were close, VLS scored slightly higher in both areas. VLS also scored higher on the biorisk system addressing organizational reputation and other types of biorisk and in welcoming scientists to visit their laboratory department.

Biorisk Measurement

In the assessment of biorisk measurement, VLS again reported higher total scores than MLS (see means, standard deviations, and P values in Table 3). Specifically, VLS scored higher in terms of describing failure likelihood/frequency, the consequences of the incident (scale and severity), acceptable and unacceptable average levels of risk using consistent measures in working facilities. VLS also reported higher scores in the evaluation of capabilities and results of information collected from the unit using qualitative data in their working department and in referring to external information and data to evaluate capabilities in working facilities.

Table 3.

Assessment of Biorisk Measurement at Working Facilities by Sector

Assessment of Biorisk Measurement	Veterinary Laboratory Staff (n=115)Mean (SD)	Medical Laboratory Staff (n=168)Mean (SD)	P Value
Risk measurement method
Describe failure likelihood/frequency using consistent measures	3.9 (0.86)	3.7 (0.77)	.049
Describe the consequences of the incident (scale and severity) using consistent measures	3.9 (0.85)	3.7 (0.7)	.035
Describe acceptable and unacceptable average levels of risk using consistent measures	3.9 (0.88)	3.7 (0.72)	.006
Evaluate the capabilities and results of information collected from the unit using qualitative data	3.8 (0.88)	3.5 (0.81)	.015
Refer to external information and data to evaluate the capabilities and results of information collected from the unit	3.8 (0.93)	3.7 (0.77)	.09
Refer to external information and data to evaluate capabilities and results of information gathered from other industries	3.8 (0.86)	3.5 (0.88)	.005
Total scores	23.1 (4.70)	21.7 (4.00)	.009
Accidents related to biosecurity have occurred in the last 5 years, n (%)	15 (13.0)	47 (28.0)	<.001
Incidents related to biosecurity have occurred in the last 5 years, n (%)	5 (4.3)	7 (4.2)	.99^a
Identification and recording of accidents and incidents
Use clear and consistent definitions of accidents and incidents	4.0 (0.73)	3.9 (0.60)	.18
Fully report and record all accidents and incidents	4.0 (0.86)	3.7 (0.76)	.020
Use accident research data to identify trends and lessons learned	3.9 (0.81)	3.5 (0.88)	<.001
Use a predetermined, structured approach to accident and incident investigation	3.8 (0.88)	3.5 (0.85)	.001
Use lessons learned from accident and incident investigations to implement changes by classifying and improving incident recovery activities	3.9 (0.83)	3.7 (0.74)	.035
Total scores	19.6 (3.70)	18.3 (3.19)	.002
Awareness of biosecurity hazards
Use clear and consistent definitions of accidents and incidents	3.2 (1.10)	3.08 (1.07)	.38
Bioterrorism is the greatest threat to safety in laboratories	3.9 (0.93)	3.83 (0.90)	.36
The higher the biological risk of a laboratory, the more stringent the level of control	4.3 (0.65)	4.29 (0.51)	.67
Regulations are necessary and effective to reduce risks from laboratories	4.4 (0.67)	4.37 (0.51)	.96
Security at current laboratories is better than it was 5 years ago	4.2 (0.60)	4.07 (0.48)	.034
Today, government research initiatives and funding effectively support the response to the threat from biological agents	4.03 (0.76)	3.85 (0.65)	.030
The biological industry poses less risk to the public than the nuclear industry	3.71 (1.04)	3.22 (1.03)	<.001
The biological industry understands and controls risks as well as the nuclear industry	3.83 (0.81)	3.63 (0.74)	.040
Total scores	31.5 (4.21)	30.3 (3.60)	.013

Fisher exact test.

Although more MLS respondents reported accidents related to biosecurity occurring in their working facilities in the last 5 years, VLS respondents rated higher total scores in terms of identifying and recording accidents and incidents in their departments. Specifically, VLS scored higher in terms of fully reporting and recording all accidents and incidents and in using accident research data to identify trends and lessons learned in their departments. They also had higher scores in using a predetermined, structured approach to accident and incident investigation and in using lessons learned from accident and incident investigations to implement changes by classifying and improving incident recovery activities.

VLS reported higher total scores in the awareness of biosecurity hazards. Specifically, VLS scored higher on improvements in laboratory security compared to 5 years ago. Additionally, VLS assigned higher scores to the effectiveness of government research initiatives and funding in supporting responses to biological threats. Furthermore, VLS rated the biological industry as posing less risk to the public than the nuclear industry, and scored higher in their perception that the biological industry understands and controls risks as effectively as the nuclear industry.

Assessment of Biorisk Management Training Needs

Training Status

When assessing the training status of BRM, MLS reported a higher level of training in basic concepts (86.3%) compared to VLS (71.3%) (Table 4). Additionally, MLS reported being more extensively involved in training classes focusing on the classification of biological agents and biosafety levels (89.9%) and having higher participation in training related to hazards, risks, and biological risk assessment (79.8%) than VLS (73.9% and 67.0%, respectively). Notably, more MLS participants (92.3%) reported training in the use of personal protective equipment (PPE) than VLS participants (73.9%). Furthermore, MLS reported higher rates of training in disinfection (88.7%); packaging, storing, and shipping of specimens (85.1%), and waste treatment (87.5%) compared to VLS.

Table 4.

Training Needs on Biorisk Management According to Training Status

Biorisk Management	Veterinary Laboratory Staff (n=115) n (%)	Medical Laboratory Staff (n=168) n (%)	P Value
General understanding of biorisk management
Basic concepts	82 (71.3)	145 (86.3)	.003
Classification of biological agents and biosafety level	85 (73.9)	151 (89.9)	<.001
Regulations/standards	69 (60.0)	105 (62.5)	.76
Assessment, mitigation, and performance model	66 (57.4)	85 (50.6)	.32
Risk assessment capacity
Hazard, risks, and biological risk assessment	77 (67.0)	134 (79.8)	.022
Risk assessment methods and data collection	71 (61.7)	96 (57.1)	.52
Risk assessment strategy	66 (57.4)	99 (58.9)	.89
Risk classification	71 (61.7)	122 (72.6)	.07
Risk analysis	74 (64.3)	122 (72.6)	.18
Risk measurement	61 (53.0)	100 (59.5)	.34
Risk mitigation capacity
Using personal protective equipment	85 (73.9)	155 (92.3)	<.001
Practices and procedures	77 (67.0)	123 (73.2)	.32
Administrative management principles	67 (58.3)	86 (51.2)	.29
Engineering controls to minimize biological risks	76 (66.1)	123 (73.2)	.25
Elimination or substitution of biological risks	71 (61.7)	88 (52.4)	.15
Biorisk management performance capacity
Emergency handling and response plan for biological incidents and occupational accidents	76 (66.1)	119 (70.8)	.47
Operation and maintenance of laboratory equipment	73 (63.5)	125 (74.4)	.07
Disinfection (cleaning, disinfection, sterilization)	86 (74.8)	149 (88.7)	.004
Packaging, storage, and shipping of specimens	79 (68.7)	143 (85.1)	.002
Waste treatment (laboratories, medical waste, animal carcasses)	77 (67.0)	147 (87.5)	<.001

Practice

In terms of practicing BRM, a higher percentage of VLS reported engaging in certain aspects of BRM compared to MLS (Table 5). Particularly, VLS reported a greater adoption of the assessment, mitigation, and performance (AMP) model (59.1%) compared with MLS (43.5%). VLS also reported a higher practice rate in terms of risk assessment methods and data collection (67.8%) than MLS (53.6%), and the proportion of VLS who reported practicing risk assessment strategies (65.2%) surpassed that of MLS (49.4%). Additionally, VLS showed a higher reported practice rate in terms of administrative management principles in BRM (67.0%) compared to MLS (45.8%). The practice of eliminating or substituting biological risks reported by VLS (72.2%) exceeded that of MLS (49.4%). However, more MLS (89.9%) reported practicing waste treatment than VLS (78.3%).

Table 5.

Training Needs on Biorisk Management According to Practice

Biorisk Management	Veterinary Laboratory Staff (n=115) n (%)	Medical Laboratory Staff (n=168) n (%)	P Value
General understanding of biorisk management
Basic concepts	99 (86.1)	137 (81.5)	.40
Classification of biological agents and biosafety level	94 (81.7)	139 (82.7)	.95
Regulations/standards	77 (67.0)	98 (58.3)	.18
Assessment, mitigation, and performance model	68 (59.1)	73 (43.5)	.014
Risk assessment capacity
Hazard, risks, and biological risk assessment	87 (75.7)	121 (72.0)	.59
Risk assessment methods and data collection	78 (67.8)	90 (53.6)	.023
Risk assessment strategy	75 (65.2)	83 (49.4)	.012
Risk classification	82 (71.3)	110 (65.5)	.37
Risk analysis	86 (74.8)	113 (67.3)	.22
Risk measurement	74 (64.3)	95 (56.5)	.23
Risk mitigation capacity
Using personal protective equipment	96 (83.5)	140 (83.3)	.99
Practices and procedures	91 (79.1)	117 (69.6)	.10
Administrative management principles	77 (67.0)	77 (45.8)	<.001
Engineering controls to minimize biological risks	90 (78.3)	123 (73.2)	.41
Elimination or substitution of biological risks	83 (72.2)	83 (49.4)	<.001
Biorisk management performance capacity
Emergency handling and response plan for biological incidents and occupational accidents	88 (76.5)	113 (67.3)	.12
Operation and maintenance of laboratory equipment	91 (79.1)	138 (82.1)	.63
Disinfection (cleaning, disinfection, sterilization)	96 (83.5)	149 (88.7)	.28
Packaging, storage, and shipping of specimens	92 (80.0)	145 (86.3)	.21
Waste treatment (laboratories, medical waste, animal carcasses)	90 (78.3)	151 (89.9)	.011

Confidence

Regarding confidence in BRM, VLS demonstrated a higher level of confidence than MLS in certain aspects (Table 6). A greater percentage of VLS (47.8%) expressed confidence in terms of risk assessment strategies compared to MLS (33.3%). Additionally, more (48.7%) VLS reported confidence in administrative management principles in BRM than MLS (32.7%). The percentage of VLS expressing confidence in terms of eliminating or substituting biological risks (55.7%) exceeded that of MLS (38.1%). However, more MLS (81.0%) reported confidence in waste treatment than VLS (67.0%).

Table 6.

Training Needs on Biorisk Management According to Confidence

Biorisk Management	Veterinary Laboratory Staff (n=115) n (%)	Medical Laboratory Staff (n=168) n (%)	P Value
General understanding of biorisk management
Basic concepts	72 (62.6)	105 (62.5)	.99
Classification of biological agents and biosafety level	73 (63.5)	121 (72.0)	.16
Regulations/standards	61 (53.0)	76 (45.2)	.24
Assessment, mitigation, and performance model	56 (48.7)	64 (38.1)	.10
Risk assessment capacity
Hazard, risks, and biological risk assessment	70 (60.9)	95 (56.5)	.55
Risk assessment methods and data collection	60 (52.2)	73 (43.5)	.19
Risk assessment strategy	55 (47.8)	56 (33.3)	.020
Risk classification	61 (53.0)	76 (45.2)	.24
Risk analysis	68 (59.1)	80 (47.6)	.07
Risk measurement	57 (49.6)	72 (42.9)	.32
Risk mitigation capacity
Using personal protective equipment	84 (73.0)	131 (78.0)	.42
Practices and procedures	73 (63.5)	94 (56.0)	.25
Administrative management principles	56 (48.7)	55 (32.7)	.010
Engineering controls to minimize biological risks	69 (60.0)	90 (53.6)	.34
Elimination or substitution of biological risks	64 (55.7)	64 (38.1)	.005
Biorisk management performance capacity
Emergency handling and response plan for biological incidents and occupational accidents	71 (61.7)	91 (54.2)	.25
Operation and maintenance of laboratory equipment	72 (62.6)	113 (67.3)	.50
Disinfection (cleaning, disinfection, sterilization)	86 (74.8)	137 (81.5)	.22
Packaging, storage, and shipping of specimens	81 (70.4)	125 (74.4)	.55
Waste treatment (laboratories, medical waste, animal carcasses)	77 (67.0)	136 (81.0)	.011

Need for Training or Retraining

When discussing the need for training or retraining in BRM, VLS demonstrated a higher rate of need compared to MLS in certain aspects (Table 7). A greater percentage of VLS (92.2%) reported the need for training or retraining in the AMP model compared to MLS (81.5%), and a higher proportion of VLS (92.2%) demonstrated a need for training or retraining in risk assessment methods and data collection compared to MLS (82.7%). The percentage of VLS expressing the need for training or retraining in terms of using PPE (90.4%) exceeded that of MLS (76.2%). Additionally, more VLS (93.0%) reported a need for training or retraining in administrative management principles in BRM than MLS (83.3%).

Table 7.

Training Need on Biorisk Management According to Need for Training or Retraining

Biorisk Management	Veterinary Laboratory Staff (n=115) n (%)	Medical Laboratory Staff (n=168) n (%)	P Value
General understanding of biorisk management
Basic concepts	106 (92.2)	149 (88.7)	.45
Classification of biological agents and biosafety level	104 (90.4)	148 (88.1)	.67
Regulations/standards	103 (89.6)	145 (86.3)	.53
Assessment, mitigation, and performance model	106 (92.2)	137 (81.5)	.019
Risk assessment capacity
Hazard, risks, and biological risk assessment	108 (93.9)	153 (91.1)	.52
Risk assessment methods and data collection	106 (92.2)	139 (82.7)	.035
Risk assessment strategy	108 (93.9)	145 (86.3)	.07
Risk classification	106 (92.2)	152 (90.5)	.78
Risk analysis	105 (91.3)	148 (88.1)	.51
Risk measurement	106 (92.2)	148 (88.1)	.36
Risk mitigation capacity
Using personal protective equipment	104 (90.4)	128 (76.2)	.004
Practices and procedures	106 (92.2)	147 (87.5)	.29
Administrative management principles	107 (93.0)	140 (83.3)	.026
Engineering controls to minimize biological risks	104 (90.4)	148 (88.1)	.67
Elimination or substitution of biological risks	106 (92.2)	146 (86.9)	.23
Biorisk management performance capacity
Emergency handling and response plan for biological incidents and occupational accidents	105 (91.3)	150 (89.3)	.72
Operation and maintenance of laboratory equipment	105 (91.3)	152 (90.5)	.98
Disinfection (cleaning, disinfection, sterilization)	105 (91.3)	147 (87.5)	.42
Packaging, storage, and shipping of specimens	107 (93.0)	146 (86.9)	.15
Waste treatment (laboratories, medical waste, animal carcasses)	105 (91.3)	146 (86.9)	.34

Type of Training

Regarding formal or short-term training in BRM, VLS demonstrated a higher rate of participation compared to MLS in certain aspects (Table 8). A greater percentage of VLS (92.2%) preferred training in the AMP model compared to MLS (81.0%), and a higher proportion of VLS (93.0%) demonstrated a need for training in risk assessment methods and data collection compared to MLS (82.1%). The percentage of VLS expressing training needs in the use of PPE (90.4%) exceeded that of MLS (73.8%). Additionally, more VLS (93.9%) reported interest in training in the packaging, storage, and shipping of specimens compared to MLS (82.1%).

Table 8.

Training Need on Biorisk Management According to Type of Training

Biorisk Management	Veterinary Laboratory Staff (n=115) n (%)	Medical Laboratory Staff (n=168) n (%)	P Value
General understanding of biorisk management
Basic concepts	104 (90.4)	142 (84.5)	.20
Classification of biological agents and biosafety level	105 (91.3)	147 (87.5)	.42
Regulations/standards	103 (89.6)	145 (86.3)	.53
Assessment, mitigation, and performance model	106 (92.2)	136 (81.0)	.014
Risk assessment capacity
Hazard, risks, and biological risk assessment	107 (93.0)	153 (91.1)	.71
Risk assessment methods and data collection	107 (93.0)	138 (82.1)	.014
Risk assessment strategy	107 (93.0)	144 (85.7)	.09
Risk classification	106 (92.2)	151 (89.9)	.66
Risk analysis	104 (90.4)	148 (88.1)	.67
Risk measurement	106 (92.2)	149 (88.7)	.45
Risk mitigation capacity
Using personal protective equipment	104 (90.4)	124 (73.8)	<.001
Practices and procedures	107 (93.0)	148 (88.1)	.24
Administrative management principles	106 (92.2)	142 (84.5)	.08
Engineering controls to minimize biological risks	106 (92.2)	149 (88.7)	.45
Elimination or substitution of biological risks	105 (91.3)	147 (87.5)	.42
Biorisk management performance capacity
Emergency handling and response plan for biological incidents and occupational accidents	106 (92.2)	150 (89.3)	.54
Operation and maintenance of laboratory equipment	102 (88.7)	149 (88.7)	.99
Disinfection (cleaning, disinfection, sterilization)	105 (91.3)	144 (85.7)	.22
Packaging, storage, and shipping of specimens	108 (93.9)	138 (82.1)	.007
Waste treatment (laboratories, medical waste, animal carcasses)	106 (92.2)	144 (85.7)	.14

Discussion

Global health crises such as COVID-19, SARS, Ebola, Zika, and avian influenza demonstrate the increasing risk posed by infectious agents at the human–animal–ecosystem interface. BRM is essential in mitigating these risks, comprising standardized microbiological techniques, containment measures, and safety training.¹⁰ Its goal is to reduce biological risks, safeguard public health, and enhance social security, including poverty reduction during epidemics. Ensuring every nation’s laboratories meet international biosafety and biosecurity standards is critical for global health resilience.³

Key Discrepancies in Biorisk Practices

The assessment of biorisk practices revealed significant disparities between MLS and VLS in Vietnam. MLS were more effective in BRM, but the findings also show that VLS excelled in specific aspects such as system maintenance, regular evaluations, and incident reporting. This indicates differences in institutional priorities between sectors, with VLS focusing more on risk management protocols and collaboration. For instance, VLS actively promoted scientific exchange by encouraging visits from scientists, fostering collaboration that strengthens risk resilience. This aligns with recommendations emphasizing knowledge-sharing to ensure rapid containment of emerging threats. A case study across 18 European countries demonstrated the importance of laboratory preparedness through high containment facilities to manage emerging public health risks.¹¹ This further highlights the need for cross-sector collaboration in Vietnam, especially given the gaps identified in the MLS approach to BRM.

Superior Incident Management

Interestingly, while MLS reported more accidents, VLS showed a better capacity to document, analyze, and act upon such incidents. VLS demonstrated proactive measures by maintaining comprehensive records, identifying trends through accident reports, and implementing recovery actions based on lessons learned. This contrasts with the findings of a 2021 survey across the United States, Canada, and New Zealand, which showed that only 63% of biosafety officers reported incidents outside their institution, reflecting inconsistencies in reporting standards.¹² These findings emphasize the importance of standardized incident management protocols. By adopting digital reporting tools and collaborative learning mechanisms, MLS could enhance their safety practices. Establishing joint accident investigation teams across sectors may also foster shared learning and improve incident recovery strategies.

Training Needs and Workforce Development

Our study highlights distinct gaps in training status between MLS and VLS in Vietnam, reflecting differences in workforce preparation. MLS staff typically receive formal training covering infectious diseases and biosafety, whereas VLS personnel, with diverse educational backgrounds, often lack structured laboratory diagnostics and safety education. Specialized training programs are essential to equip VLS for zoonotic disease management, given the complexity of veterinary work.¹³

An increasing focus on PPE training among VLS aligns with their need to manage occupational risks. Research from Western Canada reported that 38% of veterinarians developed allergies due to workplace hazards, leading to changes in their practices.¹⁴ This underlines the necessity for ongoing education and proactive safety measures to protect laboratory professionals from health risks.

Practice of Biorisk Management and Risk Reduction Strategies

VLS demonstrated stronger engagement in BRM practices, including the use of the AMP model and a focus on eliminating biological risks. This proactive stance reflects their familiarity with complex animal diseases and the potential public health impact of zoonotic outbreaks.¹⁵ A recent study in Benin’s veterinary laboratories found critical gaps in biosafety measures, including the absence of structured accident prevention programs and outdated infrastructure.¹⁶

Addressing similar challenges in Vietnam will require systematic reforms, policy alignment, and continuous monitoring of BRM practices. The emphasis on hazard control strategies in VLS underscores their focus on preventing infections and environmental contamination. This supports previous research showing that integrating microbiological techniques and protective measures is essential to maintain safety standards and prevent laboratory-acquired infections.¹⁰

Confidence in Biorisk Management

The higher confidence levels expressed by VLS in BRM practices reflect their hands-on experience in managing biosecurity risks associated with animal diseases. VLS expertise allows them to implement targeted risk mitigation strategies and develop emergency response frameworks to address disease outbreaks. Research in China highlighted the importance of coordinated monitoring along animal value chains to manage emerging zoonotic threats effectively.¹⁷

Need for Training or Retraining

The demand for training or retraining among VLS demonstrates an awareness of the evolving nature of biosecurity risks and the importance of keeping up with emerging technologies and methodologies. As highlighted by research in Egypt, hands-on training programs enhance respondents’ abilities to guide their colleagues in sustainable BRM practices.¹⁸ Addressing the specific challenges identified in our study, such as deficiencies in risk assessment methods, biosafety procedures, and equipment calibration, will require targeted interventions and capacity-building efforts. Collaborative initiatives between the veterinary and medical sectors can ensure that personnel remain equipped to respond to evolving threats.

Recommendations for Cross-Sector Collaboration

Our findings emphasize the need for better collaboration between medical and veterinary laboratories in Vietnam. The gaps in BRM practices observed among MLS can be addressed through joint training programs, standardized protocols, and regular knowledge-sharing sessions. Structured collaboration can facilitate the adoption of best practices, ensuring that both sectors maintain high safety standards. Periodic evaluations and shared reporting mechanisms between sectors would enhance transparency and allow for continuous improvement. Furthermore, harmonizing BRM policies across sectors would ensure consistency and improve preparedness for emerging infectious threats.

Strengths and Limitations

This study is the first in Vietnam to assess BRM training needs among laboratory staff in both the medical and animal health sectors. It offers valuable insights into the current state of BRM practices and highlights gaps in training, providing a foundation for future interventions.

However, several limitations must be noted. First, the study relied on a self-administered questionnaire, which may introduce recall bias and social desirability bias, as respondents might have overreported or underreported their experiences or training needs. Additionally, the absence of independent verification of the responses raises concerns about the accuracy and reliability of the self-reported data.

The selection of respondents based on contact lists provided by laboratory leaders could result in selection bias, as those with more positive experiences or favorable attitudes toward BRM might have been more likely to participate. Furthermore, the cross-sectional design limits the ability to establish causal relationships or track changes in BRM training needs over time.

Another challenge was the lack of a standardized, validated tool to assess BRM training needs. Although the questionnaire was developed with input from experts and aligned with ISO 35001:2019 and the WHO biosafety manual, some nuances of BRM practices may not have been fully captured. Future studies should consider using mixed methods approaches, incorporating qualitative interviews or focus groups to gain deeper insights into respondents’ perspectives.

Lastly, the study was conducted during the COVID-19 pandemic, which may have affected respondents’ availability and the overall response rate. This context might also have influenced the perceived importance of BRM, potentially skewing the responses.

Conclusion

In conclusion, effective BRM training is essential to safeguarding public health and organizational wellbeing both nationally and globally. This study highlights significant gaps in the current BRM training for MLS and VLS in Vietnam, emphasizing an urgent need for enhanced training efforts. To address these gaps, the Vietnamese government and relevant organizations should develop comprehensive BRM curricula tailored to the specific needs of laboratory staff. Training programs should be implemented prior to employment in laboratories, along with structured retraining plans to ensure continuous professional development and alignment with evolving safety standards.

Footnotes

Acknowledgments

The authors gratefully thank the United States Agency for International Development and the Vietnam One Health University Network for financially supporting this study. We would like to thank all respondents who participated in this study. We would like express great appreciation to Iris Shurdhi for her technical advice on the assessment tool.

The data from this study are available upon request from the corresponding author. Public sharing of the data is not feasible due to ethical considerations and privacy constraints.

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