Things have changed drastically over the past several months as the COVID-19 pandemic continues. Many adjustments to how we work and live have been made and it has become difficult to separate fact from fiction.

Should masks and goggles be worn at work? What type? Can we eat together on breaks? Information about the pandemic is abundant on news outlets and social media. Not all this information is correct, there are many coronavirus myths and misconceptions that are promoted online. However, many people treat all this information as gospel—a dangerous practice for those working in the laboratory.

How can laboratorians discern fact from fiction or opinion? There are at least two basic truths of safety we should never forget. These foundational facts can help us to navigate as we continue to work to keep our staff safe—during and after the COVID-19 pandemic.

Fact 1: The Hierarchy of Controls always works.

The Hierarchy of Controls has been used to keep workers in all fields safe for over 50 years. It is an orderly set of protections that can be used when making decisions today about practices during the pandemic.

The hierarchy starts at the top with the best protection from hazards, and it moves down to the least protective option. It moves from:

  1. Elimination
  2. Substitution
  3. Engineering Controls
  4. Administrative Controls
  5. Personal Protective Equipment (PPE)

Elimination and substitution in the workplace are typically not feasible options during the pandemic. In a laboratory or clinic there are hazardous samples and asymptomatic coronavirus-carrying colleagues may be present.

When making decisions about how employees can safely perform duties and work with each other, begin by thinking about engineering controls. These controls use physical barriers to protect employees from hazards. Biological Safety Cabinets (BSC) and counter-mounted shields are good examples. Adding a shield where there may be multiple employee interactions can be very helpful.

Administrative controls use safety policies and practices (like social distancing) to ensure employee safety. Making sure staff deliver specimens properly to the department (in transport bags, not wearing gloves) can ensure surfaces like lab doors do not become contaminated unnecessarily. Placing hand sanitizer in convenient locations and ensuring compliance with proper hand washing are important and effective protective measures.

PPE is the last and least effective control in the hierarchy. Of course, things like lab coats, gowns, gloves, and masks are important and required. That said, these protections should not have a primary focus until the more effective aforementioned controls are considered. When making PPE decisions for staff, consider how long they will be in close contact with others. There is very little science behind the many varieties of cloth masks in use, but more is known about the surgical styles. Deciding between goggles or face shields is a matter of reviewing tasks and time together in the department. Use CDC guidelines if you need direction for PPE decisions.

Fact 2: Standard Precautions protects in all situations.

The World Health Organization (WHO) is currently reviewing its stance on the modes of transmission for the SARS-CoV-2 virus. It has been known that the virus is spread through direct, indirect, or close contact with infected people via infected secretions (saliva, respiratory secretions, or respiratory droplets) that are expelled when an infected person coughs, sneezes, talks, or sings.

For infection prevention purposes, the WHO is looking to see if the virus can also spread through aerosols (in the absence of aerosol generating procedures), particularly in indoor settings with poor ventilation.

Regardless of the scientific findings, employees should continue to use standard precautions when handling samples from potentially infected patients. That means staff treat all specimens as if they were infectious by using proper engineering, administrative, and PPE controls.

If an aerosol can be generated when handling or testing a COVID-19 sample, utilize the BSC or face shield and PPE combinations recommended by the CDC. Even if the virus remains classified under droplet transmission proper precautions still need to be followed whenever aerosols may be generated—that is true under any laboratory condition. Standard precautions remain the same, even as we learn new things about a virus or admit what we don’t know about it. They help us to maintain those safe practices that are important at all times in the lab or clinic setting.

 

The COVID-19 pandemic has brought many changes to our world, and many questions have come with those changes. It can be a confusing time, but we need to make sure we stay focused on what we do know. The Hierarchy of Controls and the use of tandard precautions are two well-tested and time-honored methods that can always be trusted to keep employees safe from hazards. Focus on those first, and you can continue to make smart safe decisions for your workplace.