Handling and Operation Regulations of Suspected COVID-19 Specimens in District and Regional Hospitals in Taiwan

By Yao-Lung Tsai, PhD - May 19, 2021

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In Taiwan, the alert to the COVID-19 threat began in January 2020. At that moment, the knowledge and information about SARS-CoV-2 were very limited. Thanks to the experience of dealing with SARS 17 years ago, technicians who received and processed suspected COVID-19 specimens followed the most stringent regulations, including complete personal protective equipment (PPE: protective caps, N-95 masks, face shields, waterproof isolation clothing, double gloves and shoe covers, etc.), opening specimen test tube lids in biological safety cabinet (BSC), setting the un-opening lid mode of automatic analyses, waste liquid recovery and disinfection, and two-person specimen operating squad, to name a few. As virus information became clear, our government health authorities formulated relevant standard operating protocols and protective methods for COVID-19 specimens in Taiwan.

For medical laboratories in medium-sized district/regional hospitals that are not well-equipped and thus qualified to perform SARS-CoV-2 molecular testing, they need to outsource the tests for SARS-CoV-2-suspected specimens to medical centers. However, routine tests for patients suspected to have COVD-19 (such as rapid flu screening, hematological/biochemical examinations) can still be conducted in these hospitals. Members of the sampling unit were required to inform laboratory staff by phone after they finished collecting specimens from subjects suspected to have COVID-19 infection. The operators in the laboratory must immediately put on PPE, and conform to the following regulations while performing COVID-19 tests:

1.     For routine hematological, biochemical and other tests, use un-opening lid mode (puncture) of automatic analysis equipment to directly analyze the specimens.

2.     For the items in which tube lids needed to be removed for analysis (such as routine urine tests, serum immunoassays, etc.), staff must open the lid in the BSC and then carefully take the test tubes out for automatic analyses in order to prevent aerosol generating and spreading.

3.     For tests that needed to be carried out manually (such as influenza rapid screening, blood, microscopic smears, etc.), samples should be processed and the results interpreted in BSC. Once microscopic observations are needed, operators should be well-protected by PPE.

4.     For specimens needed to be preserved after analysis, they should be placed in isolated boxes and stored in refrigerators. To discard specimens, test tubes should be disposed in a double-layer zipper bag containing 1% bleach before being disinfected and discarded.

Testing for suspected/confirmed cases of COVID-19 can be stressful on laboratory professionals, even with full PPE protection. Education and training courses about SARS-CoV-2 transmission, risk of being infected while operating specimens, appropriately using personal protective equipment, etc., should be provided to medical staff to ensure their safety. Since current data reveals the risk of being infected while operating specimens is quite low, the chance of getting infected in the laboratory should be effectively minimized as long as laboratory personnel can prevent aerosol production and spread while working with specimens. This is why regulations regarding specimen test tube lid-opening must be strictly enforced and performed by qualified personal with fully protected equipment.

We hereby express our most sincere gratitude to all the medical staffs and inspectors who devote their time and effort for coping with the COVID-19 pandemic on the front line, and look forward to getting back to the normal life track soon!


Yao-Lung Tsai, PhD