We are planning on running the Roche LIAT at POCT by the team of staff processing COVID Ag on DNA Nudge and SAMBA II within our ED areas (lab managed staff so not truly POCT but are providing a Near patient Testing Service). The issue is the LIAT as there is no deactivation step. We have purchased safety hoods for the LIAT process. An alternative approach is you run the rapid COVID test and only test COVID Negative patients on the LIAT and send the COVID positive swabs to the lab.
Helen Peat
Head BMS Biochemistry, Immunology, Toxicology and POCT
Tel: 07826875875
Internal: 0121 371 5963 0121 4241187
Mobile: 07826875875
Email: [log in to unmask]
Web: http://www.uhb.nhs.uk
Clinical Laboratory Services, Level -1, Office 8
Pathology - University Hospitals Birmingham NHS Foundation Trust
Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston
Birmingham, B15 2GW
-----Original Message-----
From: ACB Point-of-Care Testing [mailto:[log in to unmask]] On Behalf Of HEANEY, Katy (FRIMLEY HEALTH NHS FOUNDATION TRUST)
Sent: 09 October 2020 12:34
To: [log in to unmask]
Subject: Re: POCT RSV and flu season - risk of Covid exposure when testing
Dear all,
Mansour - good food for thought indeed.
Victoria - agree risk assessment needed.
Additional food for thought:
What is the difference in risk between taking a throat and nose swab, and pipetting? If PPE worn for taking the swab is adequate, then is it also adequate for a 1 step downward motion pipette step between 1 vial to the next. ?
My personal opinion is yes. But the parts in between - the movement while wearing that PPE from the patient to the room, or do they strip off that PPE and put on a full new set etc need to be practically considered.
Alternative:
Deactivate the virus.
There are published methods for doing so.
https://www.gov.uk/government/publications/covid-19-phe-laboratory-assessments-of-inactivation-methods
We have now verified the use of the SAMBA swab buffer on our roche liat, so we will be using the roche liat at POCT this season. Albeit run by the staff running my SAMBAs.. (argue if you fancy over whether that’s POCT or not - views on both sides, ultimately need of the patient has overridden my need to stick with a definition!).
With Kind regards
Katy
Katy Heaney
POCT Specialty Lead, Consultant Biochemist Berkshire & Surrey Pathology Services Qpoint EQA Scheme Director Frimley Health NHS Foundation Trust
Tel: 07557 865 201
Email: [log in to unmask]
-----Original Message-----
From: ACB Point-of-Care Testing <[log in to unmask]> On Behalf Of SARGAZI, Mansour (WIRRAL UNIVERSITY TEACHING HOSPITAL NHS FOUNDATION TRUST)
Sent: 08 October 2020 14:52
To: [log in to unmask]
Subject: Re: POCT RSV and flu season - risk of Covid exposure when testing
Hi Victoria,
There is no doubt that analysis by main laboratory should be always considered as the main option if meets the clinicians' accepted turnaround time compared to POCT which is performed by wards. However, all risks for entire process of a test should be reviewed in balance not looking only on one (here pipetting) alone.
1. Risk of staff working on hospital wards looking after suspected patients: This is a fact that staff who choose to work for a healthcare environment may be at higher risk. This is why staff should be risk assessed.
2. Risk of taking swab from suspected patients; this step is the most dangerous and risky step of all but often not seen correctly by analytical colleagues who works in main laboratories. I assume proper training, competency assessment and wearing proper PPE address this step.
3. Risk of pipetting steps from UTM/VTM into the PCR reagent tube; This is a fact that staff who perform the test is also may use a POCT assay which generates some aerosols (possibly) and therefore risks to working environment compared to main laboratories who may do this step under a safety cabinet. However, initial assessment of the associated risks and assumption that the test is usually carried out in a location with minimal risk, providing full training for best practice hence the staff competency assessments and full protection by wearing proper recommended PPE (FFP3,....) when analysing suspected patients' specimens should address all above. Also one should realise that the risk is always higher when taking swab directly from a patient throat/noise compared to smaller risk of aerosols production during pipetting process.
4. Also we should appreciate that the beauty of POCT is that POCT services when available on wards, they are accessible on demand with no extra hassles, provides accurate results by the patient's bed in less than 20 min in most cases (for Flu, RSV & Covid-19, & 90 min in case of using Samba II) compared to long turnaround time of the main laboratories (registering a specimen on HIS, transferring specimen to main lab, pre-analytical, analytical and post-analytical processes). This is why the demands for POCT has increased markedly in the last decades hence the change in format of delivering future healthcare services to patients at home should be considered. POCT is already well-established fact of life in our society.
5. And finally, what about the risks to patients quality of life if delayed treatment, poor quality of clinical services and so on alters patients safety due to delays by the main laboratories to provide results in shortest time they agreed, hence on top of all above, benefits of POCT to patient's flow and releasing hospitals' beds which is currently in crisis.
Hope the above point is real food for thought.
Kind regards
Mansour
Mansour Sargazi
Clinical Scientist & Point of Care Testing Service Lead Laboratory Medicine Wirral University Teaching Hospital NFT Wirral CH49 5PE
Tel: 0151 678 5111 (2830)
-----Original Message-----
From: ACB Point-of-Care Testing [mailto:[log in to unmask]] On Behalf Of CLOUGH, Victoria (BARKING, HAVERING AND REDBRIDGE UNIVERSITY HOSPITALS NHS TRUST)
Sent: 08 October 2020 11:44
To: [log in to unmask]
Subject: Re: POCT RSV and flu season - risk of Covid exposure when testing
Hi all
We've been advising against POCT RSV testing since March but Paeds are keen to start testing again - there are concerns that if not available at POCT this will have a severe impact on patient flow over the Winter. I'm still worried about the pipetting step. Following on from the discussions below in August I was wondering whether any other Trusts have completed risk assessments. What measures have you put in place to mitigate risk?
Many thanks
Victoria
Victoria Clough | Consultant Clinical Biochemist & Clinical Lead for POCT Barking, Havering and Redbridge University Hospitals NHS Trust
-----Original Message-----
From: ACB Point-of-Care Testing [mailto:[log in to unmask]] On Behalf Of HODGES, Nicola (ROYAL UNITED HOSPITALS BATH NHS FOUNDATION TRUST)
Sent: 05 August 2020 09:03
To: [log in to unmask]
Subject: Re: POCT RSV and flu season - risk of Covid exposure when testing
Hi All,
To be fair this is going to be taken out of our control by allocations this winter, definitely a risk. My experience is a lot of users cut corners wherever possible even if they start with good intensions. Having a pipetting step spells disaster for me, this will not be done consistently or accurately and I imagine that all flu like symptoms will again have to be classed as potential COVID so any additional controls will need applying to all of these samples.
Nicola
-----Original Message-----
From: ACB Point-of-Care Testing <[log in to unmask]> On Behalf Of HEANEY, Katy (FRIMLEY HEALTH NHS FOUNDATION TRUST)
Sent: 04 August 2020 16:55
To: [log in to unmask]
Subject: POCT RSV and flu season - risk of Covid exposure when testing
Dear all,
Collective POCT brain...
POCT RSV and flu season.
- Has anyone done a risk assessment yet for potential presence of covid and a pipetting step?
- and then decided not to do this test at POCT?
- or decided the risk can be mitigated and doing it?
I am concerned about the number of RSV tests there are out there - lateral flows etc - that can lurk around even them most established of POCT Trusts.... that could pose a risk.
Thoughts?
Many thanks
Katy
Katy Heaney
POCT Specialty Lead, Consultant Biochemist Berkshire & Surrey Pathology Services Qpoint EQA Scheme Director Frimley Health NHS Foundation Trust
Tel: 07557 865 201
Email: [log in to unmask]
Notice of A/L; 24th – 28th August .
-----Original Message-----
From: ACB Point-of-Care Testing <[log in to unmask]> On Behalf Of Theresa Hornsby
Sent: 31 July 2020 15:33
To: [log in to unmask]
Subject: Re: Coaguchek Pro II QC lockout
Hi,
I would still go with the Pro II. Annoying though these issues have been, and it would have been nice for Roche to tell me about them sooner, I am still happy with the device.
My staff like them too.
Theresa
NNUH
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