Laboratory toolkit for preparing for viral hemorrhagic fever

With viral hemorrhagic fevers such as Ebola and Marburg posing a major threat, a new laboratory toolkit promises to improve early detection and containment, enabling frontline healthcare workers to save lives and curb the spread of these deadly diseases.

Study: Enabling laboratory readiness and preparation for the assessment of suspected viral hemorrhagic fever: development of a laboratory toolkit. Image source: PreciousJ / Shutterstock.com

In a recent study published in Infection control and hospital epidemiologyResearchers are developing a laboratory toolkit to help frontline healthcare facilities provide essential laboratory tests needed to care for patients with suspected viral hemorrhagic fever (VHF).

What are VHF radios?

AFs such as Ebola virus disease, Marburg virus disease, and Lassa fever are highly contagious infectious diseases that are associated with significant morbidity and mortality. Therefore, rapid identification and isolation of people suspected of having VHF is essential to prevent further transmission.

In the United States, frontline healthcare facilities often face the challenge of identifying and isolating patients suspected of having AF because of the low prevalence of these diseases and the presentation of nonspecific symptoms. These factors also contribute to the lack of established laboratory protocols to routinely test patients for these diseases and minimize the risk of workplace exposure in the event of a positive sample.

As a result, most suspected patients examined in American healthcare facilities receive an alternative diagnosis. Failure to accurately diagnose AF increases the risk of exposure of the surrounding population to these pathogens, as well as patient morbidity and mortality. For example, delayed malaria diagnosis and treatment has been found to significantly increase the risk of death in the United States

Development of laboratory toolkits

In the current study, researchers at Massachusetts General Hospital developed a laboratory testing toolkit for suspected AF patients to support regional preparedness through evidence-based approaches, innovative tools, and education.

The toolkit was developed using Clinical Laboratory Improvement Amendments (CLIA) quality standards for laboratory testing, U.S. Centers for Disease Control and Prevention (CDC) public health guidelines, internal standard operating procedures, and established resources. In addition, the toolkit consists of two main components, including a baseline plan that outlines the facility-level planning of a suspected AF patient's initial laboratory testing and an appendix with customizable resources such as checklists, templates, and other resources to facilitate local implementation.

The development took into account all components of the laboratory testing process, from sample collection and laboratory testing to reporting test results. The toolkit also includes infection prevention and control measures such as: B. personal protective equipment, cleaning, disinfection and waste management.

The toolkit has been repeatedly reviewed by subject matter experts using a Plan-Do-Study-Act framework. The usefulness and completeness of the toolkit were evaluated by collecting feedback from various end users. Researchers then distributed the toolkit to acute care facilities within the Mass General Brigham (MGB) Health System during the winter of 2023-2024.

What is included in the toolkit?

The toolkit summarizes best laboratory practices at all stages of the testing process to reduce the burden on frontline healthcare facilities through independent development of processes and procedures.

Pre-built checklists and other documents provided by the toolkit can be adopted and modified for local settings. This ensures that safe practices are maintained in clinical laboratories while facilitating the timely communication of important test results to clinicians.

The toolkit provides detailed information on the minimal laboratory tests required to provide safe and supportive care to suspected AF patients before an AF diagnosis can be ruled out or patients can be referred to a higher level of care.

The US CDC currently recommends various clinical laboratory tests for the evaluation of a suspected AF patient, including immediate blood smears with same-day results for malaria testing, complete blood count (CBC) with differential, liver function tests, coagulation tests, urinalysis, etc. Blood cultures. However, most frontline clinical laboratories do not have the infrastructure or resources to perform these tests on-site.

Of the CDC-recommended tests, the toolkit includes only basic chemistry, electrolyte, and rapid malaria tests as essential procedures for frontline laboratories because severe electrolyte imbalances and untreated falciparum malaria can be life-threatening.

Limitations of the toolkit

Although the toolkit was designed to facilitate initial laboratory testing of suspected AF patients, the researchers note certain limitations that frontline clinical laboratories must consider.

Although rapid testing for malaria can be performed using the commercially available BinaxNOW malaria test, most clinical laboratories do not routinely perform this test due to the low prevalence of malaria in the United States. This may impact the test verification process, which is typically performed by testing well-characterized clinical samples.

The toolkit does not provide information about verification protocols, laboratory testing training, proficiency testing, or competency assessments. Therefore, individual clinical laboratories should establish the required procedures for these items prior to patient examination and reporting.

Overall, the toolkit is expected to improve laboratory preparation and readiness in the initial care of suspected AF patients who may present to acute care hospitals.