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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.
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
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