The safe handling of suspect EVD specimens requires strict adherence to laboratory safety guidelines. Key points for laboratory professionals to remember include:
- Following all laboratory safety procedures: This is crucial to preventing the transmission of EVD. This includes ongoing training and adherence to all precautions and practices specified in the OSHA BBP Standard.
- Keeping laboratory testing to a minimum: Include only tests critical to patient care that cannot be obtained using point-of-care (POC) instruments.
- Wearing appropriate PPE: Training and practice is critical. PPE must be put on (donned) and removed (doffed) correctly. Doffing must occur in the proper order.
- Preventing the creation of aerosols: Never use a pneumatic tube system to transport suspect EVD specimens. Actions such as centrifugation, vortexing, cap removal, and cap piercing are all examples of procedures that can create aerosols. If these types of procedures are necessary, perform them in a manner that prevents aerosols (eg, using rotator covers for centrifugation or covering specimens while uncapping).
- Performing all specimen manipulations in a class II biological safety cabinet (BSC): Procedures such as preparing a blood smear should be performed in a class II BSC, fixed in methanol, and air dried before removing from the BSC and staining.
- Packing and transporting suspect EVD specimens appropriately: The packing and transporting of suspect EVD specimens can only be performed by personnel trained to handle category A substances.
In a gap analysis reported in 202116, some of the most significant safety risks involving the potential for aerosols were reported to be during the analytic phase - the use of laboratory instrumentation that:
- had decappers (uncapped tubes),
- moved tubes along open (exposed) areas of conveyor belts,
- lacked sealed centrifuge rotors or safety cups,
- had open decapper discharge chutes, and/or
- contained nonenclosed disposal containers for liquid waste.
16. Cornish NE, Anderson NL, Arambula DG, et al. Clinical laboratory biosafety gaps: Lessons learned from past outbreaks reveal a path to a safer future. Clin Microbiol Rev. 2021;34(3):e0012618. doi:10.1128/CMR.00126-18