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By now Critical Values readers are well aware of SARS-CoV-2, the novel coronavirus that causes COVID-19. When the virus became more widespread, and laboratories started doing more testing for it, there was a lot of uncertainty, from which test to use, how best to test patients, and importantly, how to keep medical laboratory professionals safe while running the tests. For the wider medical laboratory community, the safety questions asked mirrored the ones asked in 2014 when the Ebola virus hit the United States. Do we need extra PPE when handling these specimens? If we’re a BSL-2 laboratory, can we handle these samples at all? Can samples be sent through the pneumatic tube system? Can autopsies be safely performed? And what do we do if we suspect we’ve contracted the virus through work in the laboratory?

These sorts of questions weren’t entirely unexpected, says laboratory safety officer and consultant ­Daniel J. Scungio, MT(ASCP), SLS, CQA (ASQ). “So much was unknown about the virus when it first emerged,” he says. “So it’s unsurprising laboratory personnel had questions about specimen handling.” What did surprise him, however, were the basic laboratory safety questions he fielded. “Questions such as ‘can I move paper reports or slides from the laboratory area to clean areas’ and ‘should specimens from patients with COVID-19 be quarantined once they reach the lab’ are infectious control issues that should always be considered in the laboratory setting.”

If anyone can be deemed experts in laboratory safety, it’s the laboratory professionals who run the Nebraska Biocontainment Unit at Nebraska Medicine in Omaha, Nebraska. The unit was commissioned by the Centers for Disease Control and Prevention (CDC) in 2005 to provide first-line treatment for people affected by bioterrorism or highly hazardous communicable diseases.¹ The team in charge of the biocontainment unit includes Peter Iwen, MS, PhD,D(ABMM) with the Department of Pathology and Microbiology at the University of Nebraska Medical Center. Dr. Iwen has written papers regarding laboratory safety considerations for patients infected with Ebola virus² as well as SARS-CoV-2³, so the concerns laboratory personnel have are familiar for him.

According to Dr. Iwen, while it’s hard to define an “official” determination of which risk bucket SARS-CoV-2 should be sorted into, according to the National Institutes of Health’s Office of Science and Policy, the current risk group classification is 3.⁴ While that classification may change in the future, what does it mean for laboratories now? “For procedures most laboratories would perform, such as processing samples, using automated analyzers, examination of microbiology cultures, examining pathology slides, and performing molecular diagnostic tests, a BSL-2 laboratory is sufficient,” he says. According to the CDC’s interim biosafety guidelines,⁵ standard precautions (gloves, lab coats, and eye protection) should be followed when handling specimens from patients suspected to be infected with SARS-CoV-2.

While following these guidelines means any procedure that could generate aerosols or droplets—such as specimen preparation—should be performed in a biological safety cabinet, some platforms such as the Abbott ID NOW system contains an open well. Since this analyzer (and others like it) were developed as a way to get point-of-care diagnostics broadly available, they do present challenges for healthcare professionals performing these tests. According to the APHL fact sheet,⁶ testing should be performed in a biosafety cabinet if available. If a cabinet is not available, PPE including face shields should be used when performing tests on this analyzer. If that isn’t feasible, “it may be more prudent to offer testing through a reference lab than to risk exposure for staff in smaller labs and clinics,” says Mr. Scungio.

But what if, even after medical laboratory professionals have been vigilant about PPE, have performed everything in a biological safety cabinet, and have hand washing down to a science, someone in the lab still develops symptoms of COVID-19? Your very first step is notifying your supervisor, says Dr. Iwen. “They subsequently contact laboratory leadership and the institutional occupational health program officer.” In addition, “The laboratory should have an employee infection plan in place,” says Mr. Scungio. “This may include testing, self-isolation, or even a designated quarantine time.” The most important thing is to speak up—it’s important for medical laboratory professionals to take care of themselves, as well as anyone they may have come in contact with.

As the COVID-19 pandemic progresses and more is learned about the virus, laboratory safety guidance may change. It’s incredibly important to keep a close eye on recommendations from the CDC as well as safety regulatory agencies in order to implement the latest regulations. Perhaps most importantly, stay calm while remaining cautious and vigilant. The laboratory community is providing a vital resource during the COVID-19 pandemic, and the training and knowledge possessed by this community will serve us all well in the coming months.

References

1. https://www.nebraskamed.com/biocontainment. Accessed June 5, 2020.
2. https://doi.org/10.1309/AJCP26MIFUIETBPL
3. https://doi.org/10.1093/ajcp/aqaa047
4. https://osp.od.nih.gov/biotechnology/interim-lab-biosafety-guidance-for-research-with-sars-cov-2/
5. https://www.cdc.gov/coronavirus/2019-ncov/lab/lab-biosafety-guidelines.html
6. https://www.aphl.org/programs/preparedness/Crisis-Management/Documents/COVID%20Abbott%20ID%20Now%20Fact%20Sheet.pdf