Andrew Bryan (Presenter)
University of Washington
Bio: Andrew Bryan pursued his a undergraduate studies at the University of Wisconsin, he majored in Medical Microbiology and Immunology and investigated uropathogenic E. coli. He also worked on a project at the University of Minnesota on tetracycline resistance. From Wisconsin, he went to the University of Michigan to pursue an M.D. and Ph.D., in the later in Microbiology and Immunology and worked on Legionella pneumophila pathogenesis and genetics. In 2013, he moved to the University of Washington Department of Laboratory Medicine as a clinical pathology resident and has enjoyed the integration of and applications of clinical chemistry and microbiology to problems that cross divisions.
Authorship: Andrew Bryan, Linda Cook, Ederlyn E. Atienza, Jane Kuypers, Anne Cent, Geoffrey S. Baird, Robert W. Coombs, Keith R. Jerome, Mark H. Wener, and Susan M. Butler-Wu
University of Washington Department of Laboratory Medicine
| Short Abstract The Centers for Disease Control (CDC) states that laboratory testing for persons under investigation for Ebola virus disease can be safely performed using automated laboratory instruments by adhering to bloodborne pathogen practices. We assessed contamination of a clinical chemistry total laboratory automation system by Hepatitis B and C viruses occurring through routine clinical use and after processing high-titer Hepatitis C-positive specimens. Contamination was detected primarily in association with a decapper instrument, but was also found in other locations including exposed surfaces. These data suggest a need for more detailed guidance regarding the handling of specimens potentially positive for Ebola virus. |
Long Abstract
Background:
Guidance from the Centers for Disease Control (CDC) on laboratory testing for persons under investigation for Ebola virus disease has stated that routine laboratory testing can be safely performed using automated laboratory instruments by adhering to bloodborne pathogen practices. Many laboratories use total laboratory automation (TLA) systems to perform routine clinical testing wherein specimens are centrifuged, decapped, and transported uncapped on a conveyor belt to downstream test analyzers. TLA systems come with a range of safety features standardly available; furthermore, decontamination procedure recommendations from manufacturers has been variable during the 2014-2015 Ebola outbreak. To develop evidence-based protocols for handling high risk pathogens in the clinical laboratory, we sought to investigate the levels of contamination by common bloodborne pathogens Hepatitis B (HBV) and Hepatitis C viruses (HCV), of a TLA system occurring through routine clinical use as well as immediately after processing high-titer samples.
Methods:
In order to ensure that our clinical HBV and HCV assays, a laboratory-developed test (HBV) and Abbott RealTime HCV, were capable of nucleic acid detection from environmental specimens, we assessed the recovery of viral nucleic acid from swabs of non-porous surfaces (glass slides). We observed linear recovery of viral nucleic acid over a range of concentrations with a recovery of 75% and 46% for HBV and HCV, respectively. Following a risk assessment, environmental swabs were then performed at key locations along a representative TLA system, taken during routine clinical use. Contamination was further assessed immediately after running a small number of high-titer HCV specimens (mean 5.8 x 107 IU/mL); to distinguish this contamination from baseline contamination present prior to the experiment, clean glass slides were placed at key locations and swabbed for the presence of HCV, as above.
Results:
Of 79 baseline swabs performed on the TLA system, 10 were positive for HBV and 8 for HCV. Viral nucleic acid was consistently detected from swabs taken from the distal inside surface of the decapper discharge chute, with areas adjacent to the decapper instrument and the centrifuge rotor also positive for HBV or HCV nucleic acid. Of note, contamination was occasionally detected on exposed surfaces in areas without protective barriers between samples and personnel. After running known HCV-positive samples, at least one additional site of contamination was detected on an exposed area of the line after the decapper and next to a barcode reader.
Conclusions:
Together, these data indicate that a low level of viral contamination of automated clinical laboratory equipment occurs during clinical use and suggests a need for better risk-mitigation procedures when handling highly infectious agents such as Ebola virus. At our institution, we have coupled engineering controls and modified procedures with increased communication between laboratories and clinicians via on call Laboratory Medicine residents to increase safety of lab personnel while maximizing the test menu offered for patients with high risk pathogens.
References & Acknowledgements:
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IP Royalty: no
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