Laboratory Strategy for Supporting Patients with Ebola Virus Infections
Hospital laboratories are preparing strategies to support the medical care of patients with Ebola virus infections. A major question facing laboratory directors is whether they should allow blood and body fluids to be sent to the clinical laboratory for testing. Specimen transport, processing and testing substantially increases the risk of viral transmission to laboratory staff.
A recent article in Lab Medicine (Summer 2014, 46: number 3, e109-110) described the establishment of self-contained point of care laboratory within a specialized isolation unit at Emory University. This laboratory included an Abaxis Piccolo Xpress chemistry analyzer, GEM Premier 4000 arterial blood gas analyzer, Clinitek Status urinalysis analyzer, CoaguChek coagulation analyzer, Sysmex pocH 100i hematology analyzer, Alere BinaxNow for malaria testing and BioFire Filmarray for bacterial, viral and fungal pathogens. Most of these instruments were housed within a laminar flow biosafety containment hood located in the isolation facility. Nurses collected the specimens, sealed them in plastic bags, placed them in a transport box and delivered them to the point of care lab. A team of 10 specially trained clinical pathologists and clinical laboratory technologists performed all testing.
To minimize the risk of aerosols, centrifugation was not performed. Plasma was allowed to separate by gravity. No serological testing was performed in the blood bank. If blood transfusions had been required, the laboratory would have issued uncrossmatched O negative packed red blood cells and AB plasma.
This plan minimized the risk of transmission to laboratory staff while providing adequate support for patient care. However, in these days of limited financial resources, many hospitals cannot afford to equip and staff a separate dedicated STAT laboratory in an isolation unit.
An alternative strategy is to place smaller point of care instruments in the isolation unit and train clinical staff to perform all testing. This could be achieved using an Abbott ISTAT for chemistry, blood gas and coagulation testing along with urine dipsticks. This strategy is much less expensive and further reduces the number of medical personnel at risk of exposure.
