The evolving COVID-19 pandemic has changed the world – the way we educate, the way we conduct business, and the way we socialize (or don’t). In the lab and clinic settings, there are many practices and procedures that have changed or are now being questioned. Sometimes the answer evolves quickly, sometimes there is national guidance to assist with a particular issue, and sometimes your own facility or organization makes the decisions for you. As we begin a return to “normal” practices, as the pandemic starts to wind down, it’s time to address some issues that arose often in recent months but that should always be considered for employee safety.
Q: Should nurses or other staff come into the lab department wearing gloves?
A: No, it is generally not acceptable for others to enter (or exit) the lab wearing gloves. Door handles should be considered clean. If specimens are being delivered, the outside of the bag/container being carried is considered clean (even if a COVID-19 specimen is inside). Post signage to remind non-lab staff to remove gloves, and notify people immediately if you see them using gloves to enter or exit the lab.
Q: How does staff maintain an appropriate social distance from each other while working?
A: The answer to this really depends on your set-up and processes. Is it possible for staff in smaller areas to change work patterns in order to better maintain a distance from co-workers? Try a different receiving location so that those from outside the department can drop off specimens from a distance, like placing a cart near the lab door. Some facilities require masking of all staff, and if that is the case, then social distancing while at work may not be as necessary. Be sure to limit staff in break rooms as well, and make sure areas are disinfected regularly.
Q: Can PPE be disinfected and re-used safely?
A: Some locations have moved to disinfecting and reprocessing N95 respirators, surgical masks and isolation gowns. Make sure there are appropriate quality and safety checks being performed on this equipment before it is re-used. While some methods can disinfect items used for COVID-19 patients (i.e. UV light treatment, hydrogen peroxide mist, etc.), they have not been approved for the disinfection of tuberculosis. Therefore, if PPE has been used to protect staff from TB, it should not be reprocessed with the other PPE used for COVID-19 patients. As PPE becomes more readily available, this will hopefully be less of an issue.
Q: Histology and cytology slides from fresh (unfixed) samples are made in the lab space and moved to offices for reading, and so are hematology slides for pathology review. Can these slides from potential COVID-19 patients be safely read in clean office areas?
A: This is a valid question at all times, not just during this pandemic. We should think about infectious pathogens and making slides from any patient specimen. The answer depends on the process used for making the slides. It is known that xylenes or solutions containing 60% ethanol or more easily inactivate COVID-19 and other pathogens. Slides made with these chemicals can safely be transferred to office areas for reading. Fresh tissue/sample slides using other methods (i.e. methanol fixation) should be read in the lab space only. Check your reagents in your slide stains to see if they eradicate pathogens. If not, check to see if it is possible to fix the slides in stronger ethanol solutions before staining.
These are just some of the many questions people have been asking in the past months. There are references which can help to provide some of the answers (CDC.gov, WHO.int, OSHA.gov, etc.), but if you need more lab safety information, please feel free to send me questions at firstname.lastname@example.org. I will provide the most current safety guidance for your issue. Make sure you do your best to validate what you hear, and continue to use Standard Precautions and good behaviors to keep you and your laboratory staff safe from COVID-19 and other harmful pathogens. As we get back to “normal,” let’s do whatever we can to keep our staff safe all the time.