Professionals in laboratories across the UNMC campus are on the front line in helping physicians get the information they need to treat Ebola patients.
Pete Iwen, Ph.D., director of the Nebraska Public Health Laboratory (NPHL) and professor of pathology and microbiology at UNMC, and UNMC colleagues recently published an editorial in a top journal, the American Journal of Clinical Pathology. The paper provides guidance on the essential list of laboratory tests needed to support a patient infected with Ebola virus – and how to perform the tests safely.
This required professionals to think outside the box.
“We had to brainstorm to come up with alternatives,” said Dr. Iwen, first author of the editorial. “Some tests were requested that couldn’t be done safely with equipment available, so alternatives were developed. We had two goals in mind throughout to provide optimal testing and keep laboratory employees safe.”
He said their template of tests helps health professionals define what may be needed and how they can be run safely.
They turned to the journal so they could share the information with laboratories across the country seeking guidance.
“Normally it takes months to get a paper approved through the peer review process, additional months to get the galley proofs back with editing changes and potentially more months before it’s published,” Dr. Iwen said. “But in this case, it was fast-tracked.
“It took the editor of the journal about 18 hours to get the paper approved, which in my experience is unheard of. It was available electronically in about 10 days.”
Dr. Iwen said dealing with the Ebola virus in recent months has been like a whirlwind.
“We were prepared for the possibility that something like this could happen, but we were thinking more along the lines of pandemic flu,” Dr. Iwen said. “The technologists who work in the clinical laboratories on campus are a great group of professionals. They play a key role in providing safe testing and this leads to great care for patients every day.”
The NPHL biosafety level 3 (BSL-3) became the first state public health laboratory in the U.S. to test specimens that were positive for the Ebola virus. It also was the first lab to commercially ship these specimens within the U.S.
“To me that’s a pretty big deal,” Dr. Iwen said. “When we called couriers, the phone went silent, followed by, ‘You want to do what?’ We had to educate the shippers on how they could handle our specimens while meeting federal guidelines. We even had the airlines calling us asking, ‘What’s in the box?’ “
He and UNMC colleagues published another article, “An Integrated Approach to Laboratory Testing for Patients with Ebola Virus Disease,” in the fall edition of Laboratory Medicine.
The clinical team was closely monitoring cardiopulmonary function and electrolyte balance – key to stabilizing Ebola patients. But, the NPHL was not a hospital lab. It wasn’t prepared to do those types of hourly clinical tests and, because of the infectious nature of Ebola those tests couldn’t be done in the hospital lab. Only tests that could be performed on instruments with closed-tube sampling capability were done in the hospital laboratory. No opening of tubes was allowed outside the BSL-3 laboratory.
“Special risks had to be considered,” Dr. Iwen said. “We were primarily concerned about microdroplets generated by centrifuges and automated instruments, breakage of tubes and bottles during processing and laboratory accidents.
We performed a risk assessment on our instruments to determine if specimens became airborne during processing. A tiny amount of tainted blood can deliver an infectious dose to mucous membranes and the eyes.”
Another risk was the transportation of the specimens. The NPHL is located across campus, resulting in a one-hour delay of testing due to decontamination and transportation of the specimen.
Between the discharge of the first patient and the arrival of the second, a new BSL-3 laboratory was set up in the biocontainment unit with an expanded menu of tests available.
“As always, advanced preparation establishes a firm foundation on which we could make changes as the situation evolved. An essential part of the training exercises was learning how to adjust to changing conditions,” Dr. Iwen said.
“The procedures that we developed resulted in a process adaptable to many clinical laboratories that may need to test specimens that could contain the Ebola virus.”