Changes in clinical laboratory operations and biosafety measures to mitigate biohazard risks during the COVID-19 pandemic
Authors: Kay Weng Choy
Journal: The Lancet Microbe (2020)

Many global health bodies have highlighted that the COVID-19 outbreak could be especially hazardous to health-care professionals, including laboratory workers.1Lim CY Bohn MK Lippi G et al.Staff rostering, split team arrangement, social distancing (physical distancing) and use of personal protective equipment to minimize risk of workplace transmission during the COVID-19 pandemic: a simulation study.Clin Biochem. 2020; (published online Sept 12.)https://doi.org/10.1016/j.clinbiochem.2020.09.003Crossref PubMed Scopus (23) Google Scholar Various health agencies—international and national—have provided interim recommendations on biosafety measures for routine laboratories that operate at biosafety levels 1 and 2, to help minimise the risk of COVID-19 while working in clinical laboratories.1Lim CY Bohn MK Lippi G et al.Staff rostering, split team arrangement, social distancing (physical distancing) and use of personal protective equipment to minimize risk of workplace transmission during the COVID-19 pandemic: a simulation study.Clin Biochem. 2020; (published online Sept 12.)https://doi.org/10.1016/j.clinbiochem.2020.09.003Crossref PubMed Scopus (23) Google Scholar Whether additional laboratory biosafety measures and changes in laboratory operations will substantially mitigate biohazard risks during the COVID-19 pandemic is unclear. To date, clinical laboratory-acquired severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has not been reported. In 2003, laboratory-acquired severe acute respiratory syndrome coronavirus (SARS-CoV) infections were recorded in research laboratory settings in Singapore2Lim PL Kurup A Gopalakrishna G et al.Laboratory-acquired severe acute respiratory syndrome.N Engl J Med. 2004; 350: 1740-1745Crossref PubMed Scopus (127) Google Scholar and Taiwan,3Orellana C Laboratory-acquired SARS raises worries on biosafety.Lancet Infect Dis. 2004; 4: 64Summary Full Text Full Text PDF PubMed Scopus (42) Google Scholar but no cases were reported in routine clinical laboratories. The case from Singapore was a 27-year-old microbiologist who was working with a non-attenuated strain of West Nile virus in a biosafety level 3 laboratory at a university in which research on SARS-CoV was also done.2Lim PL Kurup A Gopalakrishna G et al.Laboratory-acquired severe acute respiratory syndrome.N Engl J Med. 2004; 350: 1740-1745Crossref PubMed Scopus (127) Google Scholar No history of SARS-CoV exposure was reported and there was no relevant travel history. The case in Taiwan was a 44-year-old researcher who had been testing herbal remedies against SARS-CoV at a research laboratory.3Orellana C Laboratory-acquired SARS raises worries on biosafety.Lancet Infect Dis. 2004; 4: 64Summary Full Text Full Text PDF PubMed Scopus (42) Google Scholar Although the individual was not in the contagious phase when they travelled, 90 contacts in Singapore and Taiwan were quarantined, none of whom was eventually found to be infected. With the case from Taiwan, SARS-CoV was most probably contracted while cleaning spilled waste liquid in the biosafety level 4 laboratory. The International Federation of Clinical Chemistry and Laboratory Medicine Taskforce on COVID-19 did a global survey between April 16 and May 1, 2020, to better understand how biochemistry laboratories have mitigated biohazard risks during the COVID-19 pandemic.4Loh TP Horvath AR Wang CB et al.Laboratory practices to mitigate biohazard risks during the COVID-19 outbreak: an IFCC global survey.Clin Chem Lab Med. 2020; 58: 1433-1440Crossref PubMed Scopus (19) Google Scholar, 5Loh TP Horvath AR Wang CB et al.Operational considerations and challenges of biochemistry laboratories during the COVID-19 outbreak: an IFCC global survey.Clin Chem Lab Med. 2020; 58: 1441-1449Crossref PubMed Scopus (20) Google Scholar 1210 responses were analysed, 1067 of which were from hospital laboratories that handle moderate volumes of samples daily.4Loh TP Horvath AR Wang CB et al.Laboratory practices to mitigate biohazard risks during the COVID-19 outbreak: an IFCC global survey.Clin Chem Lab Med. 2020; 58: 1433-1440Crossref PubMed Scopus (19) Google Scholar During the survey period, 186 laboratories restricted tests on patients with clinically suspected COVID-19 and 171 laboratories restricted tests on patients with confirmed COVID-19.5Loh TP Horvath AR Wang CB et al.Operational considerations and challenges of biochemistry laboratories during the COVID-19 outbreak: an IFCC global survey.Clin Chem Lab Med. 2020; 58: 1441-1449Crossref PubMed Scopus (20) Google Scholar The most common restrictions were on tests of pleural fluid and respiratory samples followed by faecal tests, urine tests, and direct microscopy.5Loh TP Horvath AR Wang CB et al.Operational considerations and challenges of biochemistry laboratories during the COVID-19 outbreak: an IFCC global survey.Clin Chem Lab Med. 2020; 58: 1441-1449Crossref PubMed Scopus (20) Google Scholar 819 laboratories had increased the frequency of disinfection, most usually from once a day to four times a day.5Loh TP Horvath AR Wang CB et al.Operational considerations and challenges of biochemistry laboratories during the COVID-19 outbreak: an IFCC global survey.Clin Chem Lab Med. 2020; 58: 1441-1449Crossref PubMed Scopus (20) Google Scholar Use of pneumatic tube transport to deliver samples was reported to have diminished since the start of the COVID-19 pandemic, with hand deliveries increasing, and more layers of plastic bags were used to contain samples from patients with suspected or confirmed COVID-19.4Loh TP Horvath AR Wang CB et al.Laboratory practices to mitigate biohazard risks during the COVID-19 outbreak: an IFCC global survey.Clin Chem Lab Med. 2020; 58: 1433-1440Crossref PubMed Scopus (19) Google Scholar 992 laboratories denied requests for add-on testing for patients with clinically suspected COVID-19 and 814 laboratories denied requests for add-on testing for patients with confirmed COVID-19.4Loh TP Horvath AR Wang CB et al.Laboratory practices to mitigate biohazard risks during the COVID-19 outbreak: an IFCC global survey.Clin Chem Lab Med. 2020; 58: 1433-1440Crossref PubMed Scopus (19) Google Scholar 290 laboratories autoclaved blood samples of patients with clinically suspected COVID-19 and 276 laboratories autoclaved blood samples of patients with confirmed COVID-19.4Loh TP Horvath AR Wang CB et al.Laboratory practices to mitigate biohazard risks during the COVID-19 outbreak: an IFCC global survey.Clin Chem Lab Med. 2020; 58: 1433-1440Crossref PubMed Scopus (19) Google Scholar Using a discrete event simulation, Lim and colleagues1Lim CY Bohn MK Lippi G et al.Staff rostering, split team arrangement, social distancing (physical distancing) and use of personal protective equipment to minimize risk of workplace transmission during the COVID-19 pandemic: a simulation study.Clin Biochem. 2020; (published online Sept 12.)https://doi.org/10.1016/j.clinbiochem.2020.09.003Crossref PubMed Scopus (23) Google Scholar modelled the effect of different combinations of staff roster arrangements on workplace transmission of COVID-19 using a simulated index staff who had community-acquired infection over 3 weeks. The number of shifts per day, the number of staff per shift, total number of staff accessible to work in the laboratory, shift change frequency, team-splitting arrangements, and fixed work–rest days were all considered in the model. Lim and colleagues noted that a higher rate of SARS-CoV-2 transmission was associated with a smaller staff pool, a higher number of shifts per day, a larger staff number per shift, and longer consecutive days worked.1Lim CY Bohn MK Lippi G et al.Staff rostering, split team arrangement, social distancing (physical distancing) and use of personal protective equipment to minimize risk of workplace transmission during the COVID-19 pandemic: a simulation study.Clin Biochem. 2020; (published online Sept 12.)https://doi.org/10.1016/j.clinbiochem.2020.09.003Crossref PubMed Scopus (23) Google Scholar Of note, use of personal protective equipment and physical distancing significantly reduced the transmission rate.1Lim CY Bohn MK Lippi G et al.Staff rostering, split team arrangement, social distancing (physical distancing) and use of personal protective equipment to minimize risk of workplace transmission during the COVID-19 pandemic: a simulation study.Clin Biochem. 2020; (published online Sept 12.)https://doi.org/10.1016/j.clinbiochem.2020.09.003Crossref PubMed Scopus (23) Google Scholar Lim and colleagues proposed that laboratories should consider arranging staff into smaller teams and reducing the number of consecutive days worked.1Lim CY Bohn MK Lippi G et al.Staff rostering, split team arrangement, social distancing (physical distancing) and use of personal protective equipment to minimize risk of workplace transmission during the COVID-19 pandemic: a simulation study.Clin Biochem. 2020; (published online Sept 12.)https://doi.org/10.1016/j.clinbiochem.2020.09.003Crossref PubMed Scopus (23) Google Scholar Test and service restrictions could have adverse effects on health-care services—eg, by depriving clinicians of information important for patients' care.5Loh TP Horvath AR Wang CB et al.Operational considerations and challenges of biochemistry laboratories during the COVID-19 outbreak: an IFCC global survey.Clin Chem Lab Med. 2020; 58: 1441-1449Crossref PubMed Scopus (20) Google Scholar Large changes in laboratory operations can negatively affect staff morale, anxiety, and deployment.5Loh TP Horvath AR Wang CB et al.Operational considerations and challenges of biochemistry laboratories during the COVID-19 outbreak: an IFCC global survey.Clin Chem Lab Med. 2020; 58: 1441-1449Crossref PubMed Scopus (20) Google Scholar More data are needed to inform laboratory managers about whether these changes substantially mitigate biohazard risks in clinical laboratories during the COVID-19 outbreak, beyond the measures recommended in existing laboratory biosafety manuals, including those released by WHO.6World Health OrganizationLaboratory biosafety manual, third edition.https://www.who.int/csr/resources/publications/biosafety/en/Biosafety7.pdf#:~:text=WHO%20published%20the%20first%20edition%20of%20the%20Laboratory,pathogenic%20microorganisms%20in%20laboratories%20within%20their%20geographical%20bordersDate: 2004Date accessed: October 2, 2020Google Scholar I declare no competing interests.