The COVID-19 pandemic has affected healthcare operations profoundly, and clinical labs are no exception. Fortunately, lab directors have been sharing their experiences and insights to support others dealing with the same issues. Three sets of authors writing in The Journal of Applied Laboratory Medicine elaborate on assessing lab safety risks, making contingency plans, and selecting a SARS-CoV-2 molecular testing method.
Labs should conduct a biologic risk assessment to protect laboratory workers from occupationally acquired infections, advise James H. Nichols, PhD, DABCC, FADLM, and Carol A. Rauch, MD, PhD, of Vanderbilt University School of Medicine in Nashville. The authors recommend individualizing risk and biosafety measures to a lab’s workflow and specimen management.
Labs can minimize aerosol-generating procedures by centrifuging specimens in closed centrifuges, utilizing caps on centrifuge carriers to prevent release of fluid if a specimen breaks, avoiding pipetting, diluting and vortexing in an open laboratory (using biologic safety cabinets for higher risk procedures), and avoiding use of pneumatic tubes to transport respiratory samples.
Laboratory staff members should frequently wash their hands and disinfect laboratory, analyzer, and high-contact surfaces, such as door handles, phones, and computer keyboards. Staff should wear standard PPE recommended by the U.S. Centers for Disease Control and Prevention for biosafety level 2 practices.
Labs should also be prepared to operate with less and prioritize needs during the pandemic. This calls for contingency planning, according to Allison B. Chambliss, PhD, DABCC, an assistant professor of clinical pathology at the Keck School of Medicine of the University of Southern California, Los Angeles, and Nicole Tolan, PhD, DABCC, associate medical director of clinical chemistry and medical director of point-of-care testing at Brigham and Women’s Hospital in Boston.
“It’s vital for laboratories to have access to not only their laboratory-specific data but also to hospital census and prediction models in order to inform how to respond to various factors affecting clinical testing workflows,” Tolan told CLN Stat.
Labs should determine which tests can support emergent care and inpatient testing. They should also evaluate their reagent and supply inventory, increasing supplies to prepare for higher test volumes and possible disruptions to deliveries or vendor supplies.
From a personnel standpoint, labs could protect the safety of workers by altering shift hours or alternating staffing groups. Tolan and Chambliss also recommended electronic daily huddles to assess daily staff needs and improve communication among lab and healthcare providers at institutions.
Dina Greene, PhD, DABCC, outlines eight questions for labs to consider in selecting a molecular testing method for SARS-CoV-2. Many different assay kits are available with emergency use authorization for detecting SARS-CoV-2 RNA in upper and lower respiratory specimens. Labs should consider whether their instrumentation would support these tests. Assessing reagent availability and intended uses for collection devices also are important factors. “In addition to reagent allocation, collection devices and media are limited,” she noted. Greene advised reaching out to colleagues, asking them questions about their experiences with reagent production and distribution.
Above all, labs should be cognizant of illicit tests. “Ensure that your purchases are coming from known manufacturers or distributors. Complete a verification process with the original reagent shipment and lot-to-lot or shipment-to-shipment comparisons with additional reagent deliveries,” advised Greene, technical director of Kaiser Permanente Washington Laboratories in Renton, Washington.