COVID-19 and the changes in respiratory laboratory management

This email is a follow up from the ANZSRS email about COVID-19 and it being managed from a state/territory level. As the WA chairs, we would like to reach out to those hospitals from regional and private laboratories who have limited guidance to changes in management. Here is our 2 cents: 

First thing to re-iterate is from the previous ANZSRS email:

"It is important that respiratory laboratories across Australia and New Zealand adhere to their local infection control procedures, the direction of their hospital’s executive along with state/territory and federal government recommendations. Events are unfolding daily and we all must keep aware of and follow the direction of recommendations from experts in the field of disease control and containment".

As we, the WA chairs, are not qualified to give out direct advice, it was thought best to present what other hospitals in WA, Eastern States, Singapore and the UK are doing as examples rather than gospel. They do not represent the exact situation of management in each state or country and are purely examples from different hospital(s)' approaches that may guide other laboratories. Please note that this was as of 18/03/2020. Massive thanks to the heads of lab in WA for sharing their plans and especially Sharon Lagan for extending email contact to over east and Singapore and Sina Panic for extending email contact to the UK. Here are the responses:

A hospital in Singapore:

• we suspended all routine/scheduled cases except for pre-operative/chemotherapy/radiotherapy lung function studies

• we stopped all tests that are aerosol generating or associated with risks, e.g. Methacholine challenge test and CPET. This is for staff safety and to reduce need for medical supervision
• we denied all external including private clinic referrals to reduce patient movement
• urgent/essential order remains available for Consultant physicians only and we encourage tests to be done on the same day as the Clinic consult to avoid multiple hospital travels
• for those who visits our lab, in addition to screening at hospital entrance, we do additional screening at the respiratory lab including travel history, contact history, new respiratory symptoms and also temperature check. Suspect case will be sent to the Screening Centre and the test postponed to a later date.
• during the test, all staff wear surgical masks and observe strict hand hygiene
• staff perform twice daily temperature check, anyone with fever/unwell will go to the Screening Centre (this is a national/hospital guideline)
• recently we have implemented social distancing too, whereby the patients are seated 1m apart when waiting for tests. Staff are seated 1 m apart too, and we stagger meal breaks. 

A hospital in Victoria: 

• continuing routine testing for most of this week
• next week- non urgent patients to be cancelled. Only pre-op/lung cancer
• apparently some labs in Victoria have “stopped all testing for the foreseeable future” and others have continued “business as usual”

A hospital in South Australia:

• same as the hospital in Victoria
• proposal given to management for reduction in non-urgent testing

A hospital in NSW:

• this was one of few labs still operational as others have closed
• as of 17/3, limiting lab staff exposure to <15 min. This means only doing shorter testing eg only spiro pre/post or spiro/DLCO.
• will not test acutely unwell patients
• staff stay home if on non-clinical duties
• mandatory staff temperature screening before starting shift (starts 18/3). Staff get sticker saying they are fit for that day.
• using gloves and wiping all surfaces before and after testing. 
• one staff / one pt per room (no visitors/family allowed unless interpreting).

A hospital in WA: 

• currently we have ceased all challenge testing and non-urgent exercise tests
• we have ceased all nasal measurements so no nasal NO or SNIP testing to reduce possible contact with mucous membranes
• as per HOD we are asking all patients about recent travel and symptoms and recommending isolation and COVID clinic as appropriate
• we will be moving to a 1 scientist operation in the coming weeks with reduction of OPD visits. We will offer a full service. Any suspect cases will only be tested in the isolation room and we will continue our general infection control guidelines. We use Oxiver TB wipes which is effective against this emerging pathogen.
• any staff with comorbidities will be reducing patient contact, and all other staff will be working from home.

Another hospital in WA: