Dear collegae,
A few years ago, we had the privilege of taking care for a patient infected with Marburg-virus.
http://www.who.int/csr/don/2008_07_10/en/
http://wwwnc.cdc.gov/eid/article/15/8/09-0015_article
The patient stayed in our hospital for several days before the final diagnosis was made. Many tropical disease were tested, and only because all were negative and the patient's condition deteriorated (with start of classical symptoms) tests for hemorrhagic fever were ordered. By that time, a large number of employees had been in unprotected contact with the patient or possibly infectious material. For the lab, 13 technician performed venipuncture and/or had worked with open-tube material/samples. As you probably have seen in the presentation, most of our automated analyzers have closed-tube samplers. We traced all actions with all samples of the patient. I often questioned the burden of our iso-accredited quality system, but at that time it was absolutely helpful ;-) ! So, in our case we were unable to plan the use of instruments and workflow.
At the moment the diagnosis was made, we collected all remaining patient material and stored it in a special container for high-risk infectious materials. It was collected later by the Dutch environmental control authorities and was send to CDC afterwards. We ran extra cleaning cycles on all instruments involved (e.g. yearly extended maintenance) and we contacted all manufacturers for maximum decontamination levels. We were lucky that no samples were send to other labs.
The 21 days surveillance period after last contact was very stressful for the technicians involved, their families and colleagues. I contacted all of them every single day. They all decided to come to work as scheduled. They appreciated the support from their colleagues. For some of the contacts, relatives and also some of the colleagues it was hard to accept that the contacts were not infectious unless they developed fever. We talked a lot about this, and no one stayed home.
It was decided that in case of other infected individuals, they would be transferred to a specialized university hospital (extensive ICU isolation facilities). My lab-colleague there told me that their ICU personnel were very unhappy with this decision, and many considered to refuse to go to work.
We made a SOP after this incident, obviously in Dutch.
In short:
- Immediate contact clinical chemist (on call)
- Only venipuncture if essential (specific order from doctor, after consultation of clinical chemist)
- Do not use tube-system for transport of the samples
- Gloves during all sample handling
- Disposable labcoat, face mask and mouth-nose mask (all in a special box in our lab)
- Disinfect hands/gloves before touching systems, keyboards, telephone etc.
- Maximum disinfection of all material/systems involved immediately after use
- Only closed-tube testing. Open tube only after consultation of clinical chemist.
- Limitation of number of persons "exposed".
- No samples send to other labs
Please find enclosed a presentation I prepared for a course for epidemiologists.
Kind regards,
Hans
dr. J.L.P. van Duijnhoven, laboratoriumspecialist klinische chemie
Elkerliek ziekenhuis
Algemeen Klinisch Laboratorium
Wesselmanlaan 25
5707 HA Helmond
The Netherlands
0492-595051 (direct)
0492-595050 (secretariaat)
0492-595555 (centrale)
-----Oorspronkelijk bericht-----
Van: Clinical biochemistry discussion list [mailto:[log in to unmask]] Namens Elizabeth MacNamara, Dr.
Verzonden: vrijdag 1 augustus 2014 04:37
Aan: [log in to unmask]
Onderwerp: Ebola suspect patient samples.
Due to the likelihood of patients coming from African regions which have an Ebola outbreak with temperature and flu like symptoms we are likely to have to analyse these very high risk samples. Does anyone who is part of this list serve have any practical experience of this. If so could you please contact me.
I am worried that the Microbiologists and Infectious Disease specialists are making decisions and do not understand modern chemistry or haematology laboratory equipment. But I could be completely wrong. Before I allow my staff to comply with this government directive that the only protection they need us double gloves, eye shields, mask and a gown I want to know the practical issues such as instrument contamination, maintenance, trouble shooting, disposables disposal, disinfection etc. I am worried that I will have staff not turning up due to perceived or real risks due to these issues not being dealt with by people who understand them. But again I may be completely wrong and worrying unnecessarily.
I would have liked to use small instruments such as iSTAT and a small CBC analyser and kept the samples out of the central lab
Thank you
Elizabeth Mac Namara
Jewish General Hospital
Montreal
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