Eighteen months ago, if anyone had predicted the state of affairs in laboratories across the country today, you likely would not have believed it. You may have even tried to come up with ways to avoid such a fate, ways to skip the year 2020 altogether. However, the year of the COVID-19 pandemic did indeed occur, and it did alter the way we practice laboratory medicine. It’s not all bad, though. There were some good lessons learned which we can take forward in order to continue our research safely and, for testing labs, safely produce test results for the patients they serve.
Some of the most important lessons learned by many organizations revolved around the purchase and use of personal protective equipment (PPE). Shortages of PPE began to abound as the pandemic tightened its grip around the world, and many US supplies originated from countries that were also struggling with COVID-19—many manufacturers simply halted production of the PPE labs use every day.
Lesson I: PPE
Some organizations began to stockpile PPE, to purchase it from wherever they could. While that may seem like a smarter strategy at first, this practice had some unexpected repercussions. In some cases, organizations ran out of space to store the PPE. Other facilities purchased PPE that did not meet OSHA standards, so it could not be used. A few hospitals stockpiled reusable lab coats, but they did not have a laundry service in place to wash them.
Some of the same PPE problems occurred when organizations could not obtain their normal supply from the usual vendors. That led purchasers to search the internet for alternative products, and many times this new PPE was not appropriate for lab use, it did not provide adequate protection for the staff. In some instances, for example, replacement gloves did not protect against chemicals, or replacement gowns were received which did not cover the user’s arms or shoulders. Respirators were purchased which did not correctly fit users and proper fit-testing could not be performed. When stockpiling or looking for alternate lab products, the lesson learned remains the same: make sure a representative from laboratory safety is involved in these purchasing decisions. Doing that ahead of time can save a great deal of time and prevent much waste.
Because of PPE shortages in 2020, the US Centers for Disease Control and Prevention (CDC) created new guidance for both the extended use and re-use of certain protective equipment. These references are still available, and offer a lasting resource if and when future PPE shortages are faced. Make sure the laboratory has a back-up plan for these critical supplies, and use proven strategies such as proper product replacement, PPE sterilization, and approved extended use practices. Being prepared for the next PPE shortage is a sure sign the lab has learned that unpleasant lesson in the last year.
Lesson II: Standard precautions
After a year of working with the coronavirus and learning how to add testing and handle samples in the lab, the threat of the Ebola virus has raised its head once again. A recent outbreak in Africa has led the CDC to begin screening travelers into the United States in order to help contain the spread of the dreaded disease. The war human beings wage against the pathogens of the world is not new, and it will not be over anytime soon. In fact, there are specialists who are closely watching a short list of other zoonotic pathogens to see if they will cause the next infectious disease pandemic.
Laboratorians are required to have training and education about bloodborne and airborne pathogens, but another lesson learned in 2020 was that this education must become ongoing. The COVID-19 pandemic taught the general public that their safety can be affected by the actions of others around them, and many lab employees began to understand that more clearly as well. Some laboratorians became afraid to work with others, to work with patients, and to work with specimens, and it created issues for lab leaders in multiple locations.
Ongoing training focused on pathogen safety helps lab staff remember that they work with dangerous substances on a daily basis. Because of pathogens and hazardous chemicals, the laboratory is not an inherently safe environment, but employees can and must work there safely. That is accomplished via engineering controls, PPE, and the use of Standard Precautions. Using Standard Precautions means that all laboratory specimens are treated as if infectious. If these practices are followed, staff will remain safe from the pathogens they are aware if, but also from those about which little is known. At the start of that pandemic, reminding staff about those practices became vital in order to overcome the fear many expressed. The lesson learned going forward is the importance of that continual education about pathogens and safe lab practices which protect laboratorians from them.
Lesson III: Move quickly ahead—but safely
One final lesson that many laboratories learned in 2020 was that they may need to move ahead swiftly to implement new testing and new practices, and those things need to be done safely! After years of being hidden in the basement, labs across the world suddenly became headliners on the news and in the hospitals they serve. Because of a new COVID-19 testing demand, facility administrators had to provide the means to add equipment, space, and other infrastructure necessary to support this extra lab workload. Many now recognized the value of the laboratory, which was exciting, but the new processes had to be implemented at a breakneck pace, and that created some unforeseen issues.
In some labs, instruments and test procedures were set up in areas that were not adequate. Test steps that should be performed inside of a biological safety cabinet (BSC) were not, makeshift lab spaces with inadequate environments (temperature, humidity, ventilation, etc.) were erected, and some testing was implemented so quickly that adequate staff safety training did not occur. These unfortunate consequences lead to the conclusion that while labs may be called to move quickly on a new process, they need plans in place ahead of time to be able to do so safely.
That planning could include a new test or new instrument set-up checklist. A stepwise generic process should exist so that vendors, facility staff, IT folks and anyone else necessary can work together to bring the new testing into existence. One important part of that process should be the use of a comprehensive risk assessment that examines each step of the new testing procedures as well as the environment in which the testing will occur. Having this plan in place at all times will enable laboratories to implement new testing rapidly and safely so that both the staff and the environment are protected.
While these three safety lessons may stand out as those which will be remembered best from the year of the pandemic, there certainly were more. We learned from the CDC that N95 respirators function well long past their given expiration dates. We learned that some disposable lab coats can be laundered and re-used if necessary. We learned that not all face masks are created equal. If you look back at your experiences from the last year, you can no doubt make your own list of lessons learned. Some were not important, but others were.
Carry those big lessons with you as you move forward into the next year. Keep a list, and be ready to use those lessons when the next crisis arises—as it likely will. Learning from the past and using those lessons to plan ahead is a way to be proactive with laboratory safety. That’s the best way to protect your staff and the laboratories where they will work today and into t