Core Lab Response to

Ebola

Laboratory and JHH Response to Ebola is an Ever Evolving Process

• Please note changes are constantly taking place as discussions occur within

the entire health care environment.

Communication

• Low Risk and High Risk Patient in the Hospital.

• Communications will come through Customer Service.

Obtaining a Sample for Laboratory Testing

• ER will contact HEIC before collecting samples.

• All testing must be approved by faculty and HEIC.

• Only essential approved tests will be performed.

• Specimens clearly labelled and sent to BSL-3 Lab

• Wipe samples down with 10% bleach, double bag, ,wipe bags down with 10% bleach and place in special transport container.

• Specimens delivered directly to Micro BSL-3 Lab.

No Ebola Samples in Core Lab

• Do not accept Ebola samples at window.

• Phlebotomy will not collect samples

• Samples are never to be sent through the pneumatic tube system.

• Samples go to Micro BSL-3 Lab for testing.

• We will escort person carrying samples to the Micro BSL-3 lab.

Where do samples go? BSL-3 Biosafety Micro Lab-Meyer-B-171

• Special Lab for dealing with dangerous pathogens.

• Special engineering and design requirements.

• Ducted exhaust air ventilation system draws air from clean to contaminated area.

• Air discharged outside after going through high efficiency air filter (99.97% of all 0.3 micron particles removed).

• All activities performed under hood and all personnel covered with PPE and air ventilation devices. Scientists work in teams to reduce chances of self contamination.

• Decontamination of PPE with 10% bleach, double red bag of waste materials and autoclave discarded materials.

Tests performed in BSL-3

lab.

• Test menu options based on recommendations by New York State, CDC, Emory University and JHH.

• Training of micro personnel by Core chemistry, hematology, coagulation and point of care staff and leadership.

• SOFT training and support by Jayesh

• All testing currently performed by micro personnel.

Test Menu

• Only tests on

menu will be performed.

• Paper requisitions will be used for ordering tests.

Hematology-Sysmex XS-1000i and POUCHi

• CBC w/Electronic Diff

• Platelet estimate

• Slide for DIC

ChemistryGEM 4000

• Blood gas (arterial and venous)

• Sodium

• Potassium

• Chloride

• Ionized calcium

• Glucose

• Bilirubin, Total

• Lactate

• Hemoglobin

• Oxyhemoglobin

• Carboxhemoglobin

• Methemoglobin

• Oxygen Saturation

• Base Excess of Blood

Coagulation Testing-

Hemochron Signature

Elite

• Protime

• Aptt

• Blood film screen for DIC

Urinalysis

• Urine Dip Stick

• Specific Gravity

Microbiology

• Malaria Thin Smear

Chemistry Analyzer for

Liver Enzymes-Piccolo

• Alkaline Phosphatase

• Alanine Aminotransferase

• Aspartate Aminotransferase

• Creatinine

• Magnesium

• Phosphorus

Transfusion Medicine

• No pretransfusion testing

• Type O negative red cells

• Group AB plasma products

General Lab Comments

• Specimens should be labelled to indicate they came from Ebola patient.

• Lab testing should be limited to the lab menu.

• Log should be kept of lab personnel exposed to Ebola cases.

• Specimens transported within the hospital should be transported in a biohazard approved transportation container.

• Never send these samples through the pneumatic tubes

• Bacterial cultures should not be performed. If blood culture is needed use plastic bottles.

Ebola waste must be

autoclaved

• Retention of specimens is discouraged. It is

recommended that Ebola samples be isolated and

disposed of as soon as possible.

• Any waste material that has come from an Ebola patient or

come in contact with Ebola body fluids must be double red bagged, wiped with 10% bleach and autoclaved before disposal.

Core Lab Support through

education

* JHH updates and town meetings.

• Mandatory PPE lab in-services by HEIC

• Centralized Lab bulletin board.

• HEIC link on Core Lab website.

• HEIC assessment of lab safety

• Continuous updates and recommendations from established Ebola centers.

What is our big worry?

“The elephant in the room”

• An Ebola sample comes to our lab.

• What if I didn't know it was an Ebola sample?

• What do I do?

Sample of low or high risk comes to lab

without our knowledge.

• Samples run on TLA, Sysmex, BCS and Access.

• BMP, Heme-8 and diff, PT, APTT and troponin.

• HEIC has confirmed that your BSL2 safety lab coat, gloves and face

shield worn properly at all times is sufficient.

• Note: The Dallas lab which had no infected lab scientists, ran the

Ebola samples in their Core Lab using BSL-2 safety precautions.

Customer Service gets call from HEIC that a high/low risk

patient sent to lab in error.

What do we do:• Customer service notifies CLS supervisor on

sight.

• Supervisor talks with HEIC and contacts a Core Lab director.

• Customer Service activates phone tree and supervisor begins to collect the following information: sample received time, instrumentation utilized, personnel handling samples.

• In the event of an employee exposure, call 5-STIX and HEIC and report the route of exposure.

• Each area where sample was run is temporarily shut down until decontamination cleaning can take place.

What to do.

• Staff at affected analyzers and work areas take off current lab coats, gloves, face shields and place them in red bags. Wipe shoes with 10% bleach. Wipe outside of bags with 10% bleach and double bag in red bags. Wipe 2nd red bag with 10% bleach.

• Place red bags in holding area.

• Wash hands.

• Put on disposable tear away fluid resistant yellow gowns, double glove (one under and one over coat cuff), clean face shields, face mask and disposable boots.

What to do.

* Follow sample path by wiping all counters and instruments with 10% bleach or bleach dispatch wipes. Any heavily used or blood soiled areas soak with bleach wipes for 10 minutes.

* Suspect patient samples and aliquots should be isolated into small red biohazard bag or small biohazard containers. Wipe each with 10% bleach. Set aside in holding area.

• Shut down or mask analyzers used by suspect samples, as time permits, take instrument through decontamination procedures after consulting with supervisor or director.

• Mop floors with 10% bleach. Rinse mop and let it soak for 10 minutes in new 10% bleach before rinsing it again and allowing it to dry.

What to do.Click icon to add picture

• Once cleaning is complete, discard yellow gown, gloves, face shields, face masks, boots and cleaning waste into red bag. Wipe shoes with 10% bleach. Wipe outside of red bag with 10% bleach wipes and place another red bag over this red bag. Again wipe with 10% bleach. Red bag will be isolated by setting aside. May or may not need to be autoclaved.

• Wait for supervisor to re-instate testing, on any analyzers requiring decontamination.

• Change into clean lab coat, gloves, face shield where applicable and return to work as usual.

• If highly suspect case, place clothes in double red bag, shower and wear disposable gowns.

Work in Progress

• HEIC PPE for all staff

• HEIC lab risk assessment

• Lab procedures

• Training of BSL-3 staff

• Development of Osler -8 Ebola unit