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.
•
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.
Special engineering and design requirements.
Ducted exhaust air ventilation system draws air from clean to
contaminated area.
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.
HematologySysmex XS-1000i
and POUCHi
• CBC w/Electronic Diff
• Platelet estimate
• Slide for DIC
Chemistry
GEM 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
TestingHemochron
Signature Elite
• Protime
• Aptt
• Blood film screen for
DIC
Urinalysis
• Urine Dip Stick
• Specific Gravity
Microbiology
• Malaria Thin
Smear
Chemistry Analyzer
for
Liver EnzymesPiccolo
• 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.
• 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