With the events occurring in our world regarding the Ebola outbreak and the related events in our own country, hospitals everywhere in the U.S. are preparing for the possibility of dealing with a suspected or confirmed Ebola patient. That affects laboratories as well. There is much information available, and some of it changes daily. The guidance listed in this column is meant to provide a basic structure for labs that are preparing for handling specimens from patients with Viral Hemorrhagic Fevers (VHF) such as Ebola. Always work with your hospital or system experts to develop processes that are specific to your site.
The information below details the appropriate safety guidelines for transport, handling, and testing of specimens from suspected VHF cases as issued by the Centers for Disease Control (CDC) and the American Society of Microbiology (ASM). These guidelines are designed to significantly reduce the chance of laboratory personnel from coming in direct contact with both suspected VHF patients and their specimens. Strict accordance with these guidelines is essential for reducing the chance of transmission of VHFs.
At Emory University Hospital in Atlanta and University of Nebraska Medical Center, no laboratory testing was sent to the laboratory, it was performed using point-of-care testing near the patient. The ASM recommends this course of action and states that no Ebola samples should be tested in the clinical laboratory proper. The CDC asserts that clinical laboratories can safely handle specimens from persons under investigation for EVD by following all required laboratory precautions and practices as specified in OSHA’s Bloodborne Pathogens Standard.
Should you be involved with VHF specimens, adhere to the following basic lab safety guidelines:
Specimen Transport:
- NEVER use a pneumatic tube system to transport suspected VHF specimens.
- Specimens should only be packed and transported by those trained to handle Category A substances.
Specimen Handling in the Laboratory:
- Keep lab testing to a minimum and include only those tests critical for patient care that cannot be obtained from Point-of-Care (POC) testing systems.
- Wear appropriate PPE and don it correctly (lab PPE will likely not be the same as PPE used for direct patient care).
- All lab procedures should be performed in such a way as to prevent the creation of aerosols. Centrifugation, cap removal, cap piercing, and vortexing are actions that create an aerosol.
- If centrifugation is necessary use rotor covers as for AFB processing.
- Carry out all specimen manipulations within a Biological Safety Cabinet in the laboratory.
- Cover specimen with gauze wipe or equivalent pad to uncap.
- Run a “clean cycle” and decontaminate racks as able when specimens are tested on analyzers.
- Make blood smears inside BSC, fix in methanol and air dry before removing slide for staining.
- Doff PPE in the correct order to prevent contamination.
Waste Handling:
- Segregate all waste from processing, handling, and testing specimens (including PPE) from other lab waste.
- Contact contracted Regulated Medical Waste handler for disposal instructions.
Utilize ALL resources before creating procedures or before handling specimens from suspected or confirmed VHF patients. For the latest resources, use the websites listed below. If you have other questions, send them to me at [email protected].
- http://www.cdc.gov/vhf/ebola/pdf/ebola-lab-guidance.pdf
- http://www.cdc.gov/vhf/ebola/hcp/guidance-safe-handling-human-remains-ebola-patients-us-hospitals-mortuaries.html
- http://www.cdc.gov/vhf/ebola/hcp/select-agent-regulations.html
- http://www.cdc.gov/vhf/ebola/hcp/interim-guidance-specimen-collection-submission-patients-suspected-infection-ebola.html
- http://www.cdc.gov/vhf/ebola/hcp/safe-specimen-management.html
Remember, keep yourself and your staff safe by using all of your resources before you act.
New events are still transpiring with this outbreak every day, and changes in these protocols may be necessary during this fluid situation. Check for updates regularly.