Credit CDC PHIL
One of the oft asked questions during the CDC’s COCA call on Ebola earlier this week involved the safe collection, handling, transporting, and testing of patient specimens. At the time, the presenters were unable to offer specifics, stating that interim guidance for these issues would soon be announced.
I’m pleased to note we didn’t have to wait long. Follow the link below to read, in its entirety:
CDC is working with the World Health Organization (WHO), the ministries of health of Guinea, Liberia, and Sierra Leone, and other international organizations in response to an outbreak of EVD in West Africa, which was first reported in late March 2014. As of August 4, 2014, according to WHO, a total of 1,711 cases and 932 deaths (case fatality 55-60%) had been reported across the three affected countries. This is the largest outbreak of Ebola virus disease (EVD) ever documented and the first recorded in West Africa.
EVD is one of numerous viral hemorrhagic fevers (VHF). It is a severe, often fatal disease in human and nonhuman primates. EVD is spread by direct contact with the blood or secretions (urine, feces, semen, breast milk, and possibly others) of an infected person or exposure to objects that have been contaminated with infected secretions. The incubation period is usually 8–10 days (rarely ranging from 2 to 21 days). Patients can transmit the virus while febrile and through later stages of disease, as well as postmortem.
U.S. hospitals can safely manage a patient with EVD by following recommended isolation and infection control procedures. Standard, contact, and droplet precautions are recommended for management of hospitalized patients with known or suspected EVD.
Potentially infectious diagnostic specimens are routinely handled and tested in U.S. laboratories in a safe manner, through adherence to standard safety precautions as outlined below.
This document provides interim guidance for laboratorians and other healthcare personnel collecting or handling specimens in the United States on appropriate specimen collection, transport and testing of specimens from patients who are suspected to be infected with Ebola virus.
Infection Control for Collecting and Handling Specimens
It is expected that all laboratorians and other healthcare personnel collecting or handling specimens follow established standards compliant with the OSHA bloodborne pathogens standard, which encompasses blood and other potentially infectious materials. This includes wearing appropriate personal protective equipment (PPE) and adhering to engineered safeguards, for all specimens regardless of whether they are identified as being infectious.
Recommendations for specimen collection: full face shield or goggles, masks to cover all of nose and mouth, gloves, fluid resistant or impermeable gowns. Additional PPE may be required in certain situations.
Recommendations for laboratory testing: full face shield or goggles, masks to cover all of nose and mouth, gloves, fluid resistant or impermeable gowns AND use of a certified class II Biosafety cabinet or plexiglass splash guard, as well as manufacturer-installed safety features for instruments.
Specimen Handling for Routine Laboratory Testing (not for Ebola Diagnosis)
Routine laboratory testing includes traditional chemistry, hematology, and other laboratory testing used to support and treat patients. Precautions as described above offer appropriate protection for healthcare personnel performing laboratory testing on specimens from patients with suspected infection with Ebola virus. These precautions include both manufacturer installed safety features for instruments and the environment as well as PPE specified in the box above.
When used according to the manufacturer’s instructions, Environmental Protection Agency (EPA)-registered disinfectants routinely used to decontaminate the laboratory environment (benchtops and surfaces) and the laboratory instrumentation are sufficient to inactivate enveloped viruses, such as influenza, hepatitis C, and Ebola viruses.
When Specimens Should Be Collected for Ebola Testing
Ebola virus is detected in blood only after onset of symptoms, most notably fever. It may take up to 3 days post-onset of symptoms for the virus to reach detectable levels. Virus is generally detectable by real-time RT-PCR from 3-10 days post-onset of symptoms, but has been detected for several months in certain secretions. Specimens ideally should be taken when a symptomatic patient reports to a healthcare facility and is suspected of having an EVD exposure; however, if the onset of symptoms is <3 days post-onset of symptoms, a subsequent specimen will be required to completely rule-out EVD.