Preparing for Highly Infectious Disease Testing Before the Patient Arrives
If Part 1 of this blog post answered why every laboratory should think about highly infectious disease preparedness, the next question is obvious: What does preparation actually look like?
The good news is that it probably doesn't involve purchasing expensive new equipment or building a high-containment laboratory. The better news is that much of the preparation revolves around something laboratory safety professionals already understand well—performing a thorough risk assessment. The CDC intentionally avoids prescribing one universal procedure because every laboratory is different. Instead, laboratory leaders are expected to evaluate their own environment, equipment, staff competencies, and workflows before a patient ever arrives.
Start by tracing the journey of a specimen. Where is it collected? How does it enter the laboratory? Who handles it? Which analyzers are used? Does any step have the potential to create splashes or aerosols? Where could contamination occur? Walking through those questions often identifies weaknesses that aren't obvious on paper.
Many laboratories also discover that specimen transportation deserves closer attention. Does the specimen travel through a pneumatic tube system? Is that appropriate? Are there hand-delivery procedures available? Is there a designated receiving location? The goal isn't simply moving the specimen quickly; it's moving it safely.
Instrument selection is another frequently overlooked issue. Many laboratories assume their chemistry or hematology analyzers can simply process any specimen that arrives. Unfortunately, that's not always true. Some instrument manufacturers have specific recommendations—or restrictions—for testing specimens from patients with highly infectious diseases. Others provide detailed decontamination procedures that should be reviewed long before they're needed. Imagine calling your analyzer vendor after testing a suspected Ebola specimen only to learn they will not service the instrument until extensive decontamination has been completed. Those are conversations worth having today—not during an emergency.
Waste management presents another challenge that receives far less attention than PPE. Testing even a single suspected VHF specimen may generate regulated waste requiring Category A infectious substance handling. Many hospitals discover too late that their routine medical waste contractor cannot accept Category A waste. Establishing disposal contracts beforehand can prevent enormous delays, regulatory issues, and expensive emergency disposal fees.
Training is something else that deserves attention. Policies stored in binders won't protect anyone. Staff members should know exactly what to do when a specimen arrives unexpectedly. They should understand notification procedures, PPE selection, packaging requirements, testing limitations, spill response, and waste handling. Tabletop exercises often reveal communication gaps before they become real problems.
One reassuring point from the CDC guidance is that laboratories are not expected to perform every possible test. If your laboratory cannot safely perform certain testing, referral is an acceptable—and often preferable—option. That may be the most important message for smaller laboratories. Being prepared doesn't mean trying to do everything. It means knowing your capabilities, recognizing your limitations, and having a plan.
Sometimes the safest decision is transferring the patient. Sometimes it's referring specialized testing. Sometimes it's limiting testing to only what is immediately necessary for patient care. Those decisions should be made during planning sessions—not while a physician is waiting for critical results.
The underlying principle extends far beyond viral hemorrhagic fevers. Whether the next emerging pathogen is Ebola, Marburg, Nipah virus, an unknown influenza strain, or something we've never encountered before, the laboratories that respond most effectively won't necessarily be the largest or best funded. They'll be the laboratories that already asked the difficult questions. They'll know where specimens travel, how risks are controlled, who to call, where waste goes, what their instruments can safely do, and when to say, "This testing belongs somewhere else."
That's what preparedness really looks like. It isn't about expecting an Ebola patient tomorrow. It's about building a laboratory safety program capable of handling uncertainty with confidence. History has taught us one lesson repeatedly: The next emerging pathogen isn't a matter of if, it's a matter of when.