Announcer: 00:00:00

This episode of Transmission Interrupted was recorded May 26th, 2026

Jill Morgan: 00:00:28

Hello, and welcome to Transmission Interrupted.

Jill Morgan: 00:00:30

My name is Jill Morgan.

Jill Morgan: 00:00:32

I'm a nurse here at Emory University Hospital in Atlanta, Georgia.

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For those of you not yet familiar with NETEC, our mission is to set the gold

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standard for special pathogen preparedness and response across health systems in

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the U.S. with the goals of driving best practices and closing knowledge gaps

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and developing innovative resources.

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NETEC works alongside and in cooperation with the CDC and is

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funded by ASPR, the Administration for Strategic Preparedness and Response.

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I am thrilled today to get to talk to two friends of mine, who just happen to

Jill Morgan: 00:01:02

be brilliant women in their own right.

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Today we're gonna talk to, Vicki Herrera.

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Vicki is the Biocontainment Laboratory Training and Education

Jill Morgan: 00:01:11

leader for UNMC in Omaha, Nebraska.

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She's been in clinical labs for more than 20 years.

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Colleen Kraft is the medical and laboratory director of Emory's

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Biocontainment Unit here in Atlanta.

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She's a professor of pathology and laboratory medicine and a professor

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of medicine and infectious diseases.

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These two brilliant women co-lead NETEC's laboratory workgroup.

Jill Morgan: 00:01:35

I am thrilled to have you guys here, and we're going to try to demystify

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what we mean by basic labs and how we can help healthcare facilities at the

Jill Morgan: 00:01:46

front lines get prepared to actually deliver clinical care for a suspect or

Jill Morgan: 00:01:52

confirmed special pathogens patient.

Jill Morgan: 00:01:54

So welcome, and thanks for joining me today, ladies

Vicki Herrera: 00:01:57

Thanks for having us

Colleen Kraft: 00:01:58

Thank you

Jill Morgan: 00:02:00

Absolutely.

Jill Morgan: 00:02:01

Okay.

Jill Morgan: 00:02:02

So, when I think of a patient presenting to an emergency room or, you know,

Jill Morgan: 00:02:09

wherever, even an urgent care, I think about what immediately happens.

Jill Morgan: 00:02:14

And I know that, you know, like in a really efficient, busy emergency

Jill Morgan: 00:02:18

department, many times somebody's like drawing a rainbow and shipping it off

Jill Morgan: 00:02:21

to the lab, and we'll talk why we don't want that to happen in just a minute.

Jill Morgan: 00:02:25

But I think about what clinical care we want to be able to deliver to

Jill Morgan: 00:02:30

somebody who might have the vague symptoms of these presentations.

Jill Morgan: 00:02:35

So, fever and vomiting, fever and cough, fever and nausea, malaise, body

Jill Morgan: 00:02:41

aches, headache, all those things.

Jill Morgan: 00:02:43

And I think, typically we would want to order a CBC and a seven.

Jill Morgan: 00:02:48

That might be the most basic thing we wanna do.

Jill Morgan: 00:02:50

But how do we do that safely for a patient like this?

Jill Morgan: 00:02:56

So, can we start with how you guys define basic labs and maybe a

Jill Morgan: 00:03:00

little bit about how we get there?

Colleen Kraft: 00:03:03

Yeah.

Colleen Kraft: 00:03:03

I think, we may have to clarify a few terms such as a rainbow for this audience,

Colleen Kraft: 00:03:08

but that just means that they draw all the tubes that they usually draw for any

Colleen Kraft: 00:03:12

type of lab, so that when the laboratory needs something or when the provider

Colleen Kraft: 00:03:16

wants to add something on, then they have it already in the clinical laboratory.

Colleen Kraft: 00:03:21

So I think the reason that we can't and we don't necessarily, think about that,

Colleen Kraft: 00:03:26

is that we want to make sure that we can, do all of those laboratories safely.

Colleen Kraft: 00:03:30

I think I want to answer your question in two different ways,

Colleen Kraft: 00:03:34

if that makes sense, Jill.

Colleen Kraft: 00:03:35

One of them is if you are knowingly testing somebody that you have very

Colleen Kraft: 00:03:41

high suspicion that may have Ebola virus disease or something else like

Colleen Kraft: 00:03:45

Lassa fever, you want to make sure you're doing the testing in a very

Colleen Kraft: 00:03:49

controlled environment, and that's what both, Vicki and I, get the

Colleen Kraft: 00:03:53

privilege to do at our institutions.

Colleen Kraft: 00:03:55

And so in that case, you really can only order what we can do in

Colleen Kraft: 00:03:59

the biocontainment environment.

Colleen Kraft: 00:04:01

That might seem a little austere if you think about, all the things that

Colleen Kraft: 00:04:05

the clinical laboratory can actually order and do on a regular basis.

Colleen Kraft: 00:04:09

But in this case, it's really to make sure that we're not missing anything

Colleen Kraft: 00:04:13

that's life-threatening, while at the same time, making sure that we have

Colleen Kraft: 00:04:17

a baseline, or a standard for what's going on with that patient on that day.

Colleen Kraft: 00:04:21

So for instance, I would consider a Complete Blood Count, or a CBC.

Colleen Kraft: 00:04:25

A Basic Metabolic Panel, so that was the Chem-7 that Jill was referring to.

Colleen Kraft: 00:04:30

We can add on a few other things besides that.

Colleen Kraft: 00:04:33

In our laboratory we can do a urinalysis, pregnancy testing, which you know can

Colleen Kraft: 00:04:38

be done on more of a point-of-care, which we're gonna get to what

Colleen Kraft: 00:04:41

that's called, or what that's about.

Colleen Kraft: 00:04:44

And then, I think especially in our patients that are returning from travel,

Colleen Kraft: 00:04:48

we always test for malaria, which we can do by either a molecular test that

Colleen Kraft: 00:04:54

we have in our laboratory, or we can do more of like a lateral flow assay,

Colleen Kraft: 00:05:00

if you want to think about it that way.

Colleen Kraft: 00:05:02

Where we can do like almost a malaria test just by lateral flow.

Colleen Kraft: 00:05:07

So I think those are what I consider our very basic tests.

Colleen Kraft: 00:05:10

Now again, if you have somebody that's now approaching the emergency department

Colleen Kraft: 00:05:16

and you're not quite sure what to do in that setting, and you're worried that

Colleen Kraft: 00:05:20

they may have something like Ebola Virus Disease, like sincerely worried, not just

Colleen Kraft: 00:05:25

superficially worried, the things that we want to think about are probably the same.

Colleen Kraft: 00:05:30

We want to make sure that they don't have something else that's life-threatening.

Colleen Kraft: 00:05:33

So that's usually gonna involve again, CBC to look for severe anemia.

Colleen Kraft: 00:05:38

I think the electrolytes are absolutely critical in these people that have

Colleen Kraft: 00:05:41

vomiting and diarrheal illnesses.

Colleen Kraft: 00:05:43

We think that a lot of deaths that happen in Ebola treatment units

Colleen Kraft: 00:05:46

across the world happen because of electrolyte imbalance, not necessarily

Colleen Kraft: 00:05:50

because of the virus itself.

Colleen Kraft: 00:05:52

And we may wanna do, depending on how sick the individual is, you may have

Colleen Kraft: 00:05:56

the opportunity to also do a blood gas analysis for like a venous blood gas.

Colleen Kraft: 00:06:00

But remember, where you're sending those labs, also makes a big difference.

Colleen Kraft: 00:06:04

If you're not gonna be able to do those labs in your regular laboratory,

Colleen Kraft: 00:06:08

or if you have to do something special around them, I think really

Colleen Kraft: 00:06:11

trying to work with the laboratory leadership to understand what you can.

Colleen Kraft: 00:06:15

And remember, these things should be available twenty-four seven with

Colleen Kraft: 00:06:18

rapid turnaround times in order to help patients not die from things

Colleen Kraft: 00:06:22

that they may be coming here with

Jill Morgan: 00:06:25

It's a great point, and I'm glad you separated what happens in a

Jill Morgan: 00:06:28

biocontainment lab, like you and Vicki are used to, on the regular, but also in an

Jill Morgan: 00:06:33

emergency department or in an urgent care.

Jill Morgan: 00:06:35

And thinking, really making sure that we bring the laboratorians in because

Jill Morgan: 00:06:40

I think this is where, to me, we have a lot of ED providers who are used

Jill Morgan: 00:06:45

to being able to get lots and lots and lots of results very quickly for

Jill Morgan: 00:06:48

a patient, which is great, right?

Jill Morgan: 00:06:50

Helps patient care.

Jill Morgan: 00:06:52

But then we have laboratorians who are like, "Wait a minute, this is not just a

Jill Morgan: 00:06:56

normal specimen you're asking me about. This might be a special pathogens kind

Jill Morgan: 00:07:00

of event. I don't wanna run this on this, or I, we're not prepared to do

Jill Morgan: 00:07:04

this." And so the, disconnect between what providers might think they need or

Jill Morgan: 00:07:09

think they want and what labs can provide is this ongoing sort of gap or tension.

Jill Morgan: 00:07:16

And maybe thinking about, okay, so I can't get everything I want.

Jill Morgan: 00:07:21

It's like Christmas.

Jill Morgan: 00:07:22

I can't get everything I want, but what is the one thing that

Jill Morgan: 00:07:24

would make me really happy?

Jill Morgan: 00:07:26

Well, a CBC and Basic Metabolic Profile, as you said, or basic,

Jill Morgan: 00:07:30

basic metabolic panel profile.

Jill Morgan: 00:07:33

Which one is it?

Colleen Kraft: 00:07:34

It's probably been all of those throughout the time of our lives.

Colleen Kraft: 00:07:37

But

Colleen Kraft: 00:07:37

yes, I think it's a panel,

Jill Morgan: 00:07:40

I think it's, good to make sure you're

Jill Morgan: 00:07:42

opening up those conversations.

Jill Morgan: 00:07:44

So if you're a laboratorian, you need to go talk to ED providers,

Jill Morgan: 00:07:49

and if you're an ED provider, you need to talk to a laboratorian.

Jill Morgan: 00:07:52

If you're in an urgent care, you might need to talk to your techs,

Jill Morgan: 00:07:56

whoever's over your laboratory, to make sure that you have the devices that

Jill Morgan: 00:08:00

would let you look at these things, because we don't want people to suffer

Jill Morgan: 00:08:05

bad consequences from lack of care.

Jill Morgan: 00:08:09

And so I want to pivot that to something I admit complete

Jill Morgan: 00:08:14

ignorance on until recently.

Jill Morgan: 00:08:16

We've been using this term point-of-care.

Jill Morgan: 00:08:19

I know people here that are friends of mine, have been friends of mine

Jill Morgan: 00:08:22

for years, and they're like, " We work in point-of-care lab." But the

Jill Morgan: 00:08:26

only time I saw them as a bedside nurse was when they came up to do

Jill Morgan: 00:08:30

like an update on a glucometer or one of those other things that we

Jill Morgan: 00:08:36

would keep at the patient's bedside.

Jill Morgan: 00:08:37

So that's what I thought point-of-care was, an iStat, a

Jill Morgan: 00:08:42

glucometer, something like that.

Jill Morgan: 00:08:45

But I understand that actually point-of-care means a whole another

Jill Morgan: 00:08:50

thing to those of you in the lab role, which is a much wider and broader group

Jill Morgan: 00:08:56

of devices than I would've expected . So can we talk a little bit about what you

Jill Morgan: 00:09:01

guys mean by point-of-care and what's the difference between a point-of-care

Jill Morgan: 00:09:04

device and what happens in that mystical, magical place we call a core lab?

Vicki Herrera: 00:09:10

Well, you're not wrong, Jill.

Vicki Herrera: 00:09:12

Like point-of-care, it does include iStats and glucometers and things like that.

Vicki Herrera: 00:09:17

Generally, the point-of-care instrumentation is portable, it's smaller,

Vicki Herrera: 00:09:21

it can be done at the bedside or at the point where somebody is getting cared for.

Vicki Herrera: 00:09:26

So that's general terms for point-of-care.

Vicki Herrera: 00:09:29

There are some larger instruments that are still considered point-of-care.

Vicki Herrera: 00:09:34

They're generally easier to use, less requirements with them.

Vicki Herrera: 00:09:38

But, we still utilize those pieces of equipment, but we use them

Vicki Herrera: 00:09:42

in our biocontainment units so that we can really use them away

Vicki Herrera: 00:09:46

from our main core laboratory.

Vicki Herrera: 00:09:48

The core laboratory has some bigger pieces of equipment.

Vicki Herrera: 00:09:51

Depending on the facility that you're at, they can be really quite large.

Vicki Herrera: 00:09:57

And a lot of times the labs are open concept, so you have multiple people

Vicki Herrera: 00:10:01

walking in and out of areas, doing lots of different things in there.

Vicki Herrera: 00:10:05

So we utilize the point-of-care so that we can really put those in

Vicki Herrera: 00:10:09

our biosafety cabinets, keep them more contained, and use them in a

Vicki Herrera: 00:10:12

smaller, more controlled environment.

Jill Morgan: 00:10:17

So if you're in a doctor's office or a urgent care, and they can

Jill Morgan: 00:10:21

turn around like a CBC and a chemistry of some kind, those are probably being done

Jill Morgan: 00:10:25

on some sort of point-of-care device?

Vicki Herrera: 00:10:28

Some of them, yes.

Vicki Herrera: 00:10:29

They're just a smaller device that you can have close to the bedside.

Jill Morgan: 00:10:35

So the two of you, when you're thinking about education that

Jill Morgan: 00:10:39

your workgroup is working on and the things that you prioritize for Level

Jill Morgan: 00:10:44

two, three, four, facilities, can we talk for a minute about like lab safety

Jill Morgan: 00:10:49

and how you go about thinking about a risk analysis or, how labs should think

Jill Morgan: 00:10:54

about whether they can do this or not?

Colleen Kraft: 00:10:58

I would say that we have to be able to do laboratory testing, and

Colleen Kraft: 00:11:02

so it shouldn't be whether or not we can.

Colleen Kraft: 00:11:05

That's not really the answer.

Colleen Kraft: 00:11:06

And I'm only saying that because we've had that scenario happen to us a few

Colleen Kraft: 00:11:10

times, and I'm sure in Vicki's region as well, where the answer is we're not

Colleen Kraft: 00:11:14

gonna test the patient because we're worried about this, rather than we need

Colleen Kraft: 00:11:17

to figure out a way to avoid, or make ourselv as risk-free as we can while

Colleen Kraft: 00:11:23

testing in order to help the patient.

Jill Morgan: 00:11:26

Vicki, so tell us more about what a lab risk assessment looks like.

Vicki Herrera: 00:11:30

Yeah.

Vicki Herrera: 00:11:30

So really what we're looking for, when you're talking special pathogens, is

Vicki Herrera: 00:11:35

looking at things that would expose the personnel to some of these pathogens.

Vicki Herrera: 00:11:41

So you want to look at every aspect of the test that you're doing.

Vicki Herrera: 00:11:46

Are there sharps involved?

Vicki Herrera: 00:11:47

Are there possibly aerosols that are produced?

Vicki Herrera: 00:11:50

Are you centrifuging?

Vicki Herrera: 00:11:52

Those are all, you know, laboratory terms if you're not familiar.

Vicki Herrera: 00:11:55

But just things that may expose the laboratorian to the pathogen and looking

Vicki Herrera: 00:12:02

at these, with a much deeper dive than your normal clinical laboratory testing.

Vicki Herrera: 00:12:08

The special pathogens have a lower infectious dose, and so we really want

Vicki Herrera: 00:12:12

to scrutinize a lot more of things that could possibly expose the laboratorian.

Vicki Herrera: 00:12:20

So, taking a deep dive into that is going to be helpful in determining not

Vicki Herrera: 00:12:26

whether you can do it, but what safe mitigations you can add to doing that

Vicki Herrera: 00:12:31

test in order to be able to do it.

Vicki Herrera: 00:12:33

We don't want you to be scared of doing the labs, but we do want you to make sure

Vicki Herrera: 00:12:37

that you're taking appropriate cautions.

Vicki Herrera: 00:12:40

So that may be doing something in your biosafety cabinet.

Vicki Herrera: 00:12:43

That may be adding extra PPE.

Vicki Herrera: 00:12:46

Adding some engineering controls that can help you safely mitigate doing the test

Vicki Herrera: 00:12:51

on the pieces of equipment that you have.

Vicki Herrera: 00:12:54

And that can look a variety of different ways in a variety of labs.

Vicki Herrera: 00:12:57

We like to say if you've seen one lab, you've seen one lab.

Vicki Herrera: 00:13:00

So every different laboratory can look completely different, and you

Vicki Herrera: 00:13:04

may need to adjust based on what your workflow is, your airflow, and what

Vicki Herrera: 00:13:10

pieces of equipment you're using.

Jill Morgan: 00:13:12

Yeah.

Jill Morgan: 00:13:12

So this is not something that a laboratory needs to do by themselves.

Jill Morgan: 00:13:16

Like, you probably have infection prevention if you're at a hospital,

Jill Morgan: 00:13:19

and you might have somebody else who comes in and I know in many places

Jill Morgan: 00:13:23

there are actually lab safety people.

Jill Morgan: 00:13:26

And, so thinking about walking through those.

Jill Morgan: 00:13:29

Okay.

Jill Morgan: 00:13:29

So what would I do in this circumstance?

Jill Morgan: 00:13:32

I love, Vicki, you mentioning this risk assessment, because I think

Jill Morgan: 00:13:37

both as a clinician, if you're an ED nurse or provider versus a

Jill Morgan: 00:13:43

laboratorian, we both should be using the standard precautions that keep us

Jill Morgan: 00:13:49

safe most of the time we do our jobs.

Jill Morgan: 00:13:52

B ut when we know that there's this heightened risk, right?

Jill Morgan: 00:13:55

Like you said, there's a lower infectious dose, they're scarier, they're whatever,

Jill Morgan: 00:13:59

we really need to think about what steps we can take to ensure our own safety

Jill Morgan: 00:14:06

above and beyond the standard precautions.

Jill Morgan: 00:14:09

At the bedside we might call those transmission-based precautions, and

Jill Morgan: 00:14:12

in the lab you're really talking about what transmission risks do

Jill Morgan: 00:14:16

these devices add to my workflow.

Jill Morgan: 00:14:20

Either way, we want to react with, "This is what I can do to mitigate those

Jill Morgan: 00:14:27

risks," versus, "I'm scared, I don't want to do this." And I'm certainly

Jill Morgan: 00:14:32

not saying that healthcare providers or laboratorians are consciously doing

Jill Morgan: 00:14:37

that, but things do scare us and we hear about these pathogens we do not

Jill Morgan: 00:14:41

know much about them, and suddenly here somebody wants us to handle that blood.

Jill Morgan: 00:14:46

Well, that is kind of intimidating . I mean, I understand people being sort of

Jill Morgan: 00:14:51

anxious about it, but if we do it right, and please tell me I'm right about this.

Jill Morgan: 00:14:58

If we do it right, then we can really minimize any risk that is

Jill Morgan: 00:15:03

presented to a laboratorian or a healthcare provider of any kind.

Vicki Herrera: 00:15:07

Absolutly I agree.

Vicki Herrera: 00:15:10

These sometimes sound really scary, right?

Vicki Herrera: 00:15:12

There's a reason, and we know that laboratory infections

Vicki Herrera: 00:15:15

have occurred before.

Vicki Herrera: 00:15:17

So it is a little bit scary, especially when you hear something

Vicki Herrera: 00:15:20

that may not have a current treatment.

Vicki Herrera: 00:15:23

But yeah, I agree that I cannot state this enough, but communication

Vicki Herrera: 00:15:28

is really key in this situation.

Vicki Herrera: 00:15:31

Notifying your laboratory as soon as you possibly can that this may

Vicki Herrera: 00:15:35

be a possibility, that way they can implement some of their mitigation

Vicki Herrera: 00:15:40

strategies, whether that's PPE, whether that's designating one or

Vicki Herrera: 00:15:44

two people to be in the area at the time, or whatever that mitigation is.

Vicki Herrera: 00:15:49

By communicating early, the laboratory is aware, and they can take extra

Vicki Herrera: 00:15:53

precautions in these situations.

Jill Morgan: 00:15:57

Yeah.

Jill Morgan: 00:15:57

And I think that's one of the things that we try to emphasize to those people who

Jill Morgan: 00:16:00

might be getting these specimens, right?

Jill Morgan: 00:16:02

So, typically in many of these situations we're not calling

Jill Morgan: 00:16:05

phlebotomy in to draw these.

Jill Morgan: 00:16:07

If we have a suspicion, probably the one person we can put in the room who can

Jill Morgan: 00:16:11

get a good history and do a good exam and put in an IV may be the one drawing your

Jill Morgan: 00:16:16

lab specimens or getting that nasal swab.

Jill Morgan: 00:16:19

So I think it's important to say we want everybody to use caution.

Jill Morgan: 00:16:25

We want people to not pass risk downstream, and that means that

Jill Morgan: 00:16:30

a specimen needs to be clean.

Jill Morgan: 00:16:32

Don't send those nasty, covered in blood, specimens to your lab.

Jill Morgan: 00:16:38

That's just not fair.

Jill Morgan: 00:16:40

Especially when you're talking about something that is as

Jill Morgan: 00:16:43

fear-provoking as a special pathogen.

Jill Morgan: 00:16:47

So you mentioned PPE, Vicki, and I want to get back to that because of course it's my

Jill Morgan: 00:16:51

favorite topic . But also, are there some everybody should do this with PPE rules

Jill Morgan: 00:16:57

in the lab and then you just add layers on top depending on what you're working with?

Jill Morgan: 00:17:03

Or are there special things that you think laboratorians should all have in order to

Jill Morgan: 00:17:09

handle specimens from patients like this?

Vicki Herrera: 00:17:12

Well, you probably know better than I do on the PPE.

Vicki Herrera: 00:17:15

You do such a great job with PPE.

Vicki Herrera: 00:17:17

But, definitely with your PPE, you need to practice, right?

Vicki Herrera: 00:17:21

It's not all the same.

Vicki Herrera: 00:17:22

Not everybody has the same PPE, so there's different things you can do.

Vicki Herrera: 00:17:27

We talk a lot about, working in a BSL-2, which most core laboratories

Vicki Herrera: 00:17:31

are a BSL-2, but we talk about using BSL-3 precautions, right?

Vicki Herrera: 00:17:36

So that would be a fluid-impermeable gown, adding that to your list.

Vicki Herrera: 00:17:41

An N95, maybe a face shield, doing something to cover all those mucous

Vicki Herrera: 00:17:46

membranes, maybe double gloves.

Vicki Herrera: 00:17:48

It really kind of depends on your facility.

Vicki Herrera: 00:17:50

That may or may not… actually, BSL-3, you would usually use double gloves.

Vicki Herrera: 00:17:55

Some people use triple gloves.

Vicki Herrera: 00:17:56

That's a whole different story.

Vicki Herrera: 00:17:58

Adding those things, but you need to practice, right?

Vicki Herrera: 00:18:01

You need to be able to get those gloves off safely.

Vicki Herrera: 00:18:05

You need to have a procedure for doffing all of that stuff and

Vicki Herrera: 00:18:09

where you're gonna put it as well.

Vicki Herrera: 00:18:11

So again, practicing all of that.

Vicki Herrera: 00:18:13

But, again, every lab is a little different, and what they have on

Vicki Herrera: 00:18:16

hand may be a little bit different.

Vicki Herrera: 00:18:18

But in general, covering all of your mucous membranes are gonna

Vicki Herrera: 00:18:20

be an important thing here.

Jill Morgan: 00:18:23

And it would seem like a lot of that would depend on whether I

Jill Morgan: 00:18:26

can do what I'm doing with a specimen, like inside a glove box or under a hood.

Jill Morgan: 00:18:31

And PPE etiquette, like just like we know it at the bedside, is super

Jill Morgan: 00:18:36

important . You can't have your hands up under that hood and be dealing with the

Jill Morgan: 00:18:40

specimen and then reach out to get your pen or reach out to get something else.

Jill Morgan: 00:18:44

Like obeying sort of the rules of, once your hands are under there,

Jill Morgan: 00:18:49

we're gonna consider them dirty and we're not gonna touch other

Jill Morgan: 00:18:51

stuff in the lab with those hands

Vicki Herrera: 00:18:53

Yes, if you're gonna use your BSL3 precautions, once

Vicki Herrera: 00:18:57

you're in a biosafety cabinet, everything stays in there, including

Vicki Herrera: 00:19:01

that outer layer of gloves.

Vicki Herrera: 00:19:03

You don't want to bring that out.

Vicki Herrera: 00:19:04

You don't want to touch other things, especially if you opened

Vicki Herrera: 00:19:07

a tube, because that could potentially aerosolize some things.

Vicki Herrera: 00:19:10

You also want to just change your gloves a lot in general.

Vicki Herrera: 00:19:13

If you're touching that specimen, you're moving it, you don't want

Vicki Herrera: 00:19:15

to touch other pieces of equipment.

Vicki Herrera: 00:19:17

So just being very mindful of what you are touching and how often you

Vicki Herrera: 00:19:21

should be changing those gloves.

Vicki Herrera: 00:19:23

Not touching your face.

Vicki Herrera: 00:19:24

Um, you know, everybody wants to adjust their glasses, or they have

Vicki Herrera: 00:19:29

an itch that they need to scratch.

Vicki Herrera: 00:19:30

Being very mindful of that when you have your PPE on and

Vicki Herrera: 00:19:34

not touching anything really.

Vicki Herrera: 00:19:36

Um, which is, you know, easier said than done because people touch their

Vicki Herrera: 00:19:39

face more often than they realize.

Vicki Herrera: 00:19:42

And so really practicing with your PPE and having somebody observe you and

Vicki Herrera: 00:19:46

noticing and, having maybe that partner that's helping you just to say, "Hey,

Vicki Herrera: 00:19:51

wait, don't touch anything." Or maybe, you know, they notice a little splash

Vicki Herrera: 00:19:56

that needs to be cleaned up right away.

Vicki Herrera: 00:19:57

That extra person to observe you can be very helpful as well.

Jill Morgan: 00:20:03

Yeah.

Jill Morgan: 00:20:03

you know, we tell people all the time, like, "Don't touch your face," and, use

Jill Morgan: 00:20:06

a trained observer or someone similar, like you said, a helper or observer

Jill Morgan: 00:20:11

that can hand you something if you need it, rather than having you move

Jill Morgan: 00:20:14

your dirty hands out from under a hood.

Jill Morgan: 00:20:16

And I think about that whole idea of leaving the dirty gloves where they

Jill Morgan: 00:20:21

are because, you don't want to just turn around and here you've been so

Jill Morgan: 00:20:25

worried about these things inside the hood, and then you're just gonna

Jill Morgan: 00:20:28

contaminate the rest of the lab.

Jill Morgan: 00:20:29

That defeats the whole purpose

Jill Morgan: 00:20:32

. Vicki Herrera: Well, just the way the clinical lab is laid out as well.

Jill Morgan: 00:20:34

You know, their processes and their workflow tend to be a little

Jill Morgan: 00:20:38

bit different than when you're dealing with a special pathogen.

Jill Morgan: 00:20:40

So like you may have a biosafety cabinet that already has some of their supplies

Jill Morgan: 00:20:45

in it, and really when you're working with your special pathogen or, the

Jill Morgan: 00:20:49

potential to have that, you want to clean all those supplies out and only

Jill Morgan: 00:20:53

bring in the stuff that is necessary.

Jill Morgan: 00:20:54

So you might need to clear off both your biosafety cabinet and the work area

Jill Morgan: 00:20:59

or, space around the instrument, just to ensure that if there were a splash,

Jill Morgan: 00:21:03

that you're not contaminating extra pieces of material that you don't need.

Jill Morgan: 00:21:09

Yeah.

Jill Morgan: 00:21:10

And if I were manipulating like all the tubes and toppers and things like

Jill Morgan: 00:21:13

that, that you guys have to do, I would think that practicing with two

Jill Morgan: 00:21:17

pair of gloves on is really important.

Jill Morgan: 00:21:20

Because I know how hard it was for me, I mean it sounds dumb, but one

Jill Morgan: 00:21:24

of the most frustrating parts of dealing with Ebola patients was the

Jill Morgan: 00:21:29

very simple act of having two pair of gloves on and not being able to open

Jill Morgan: 00:21:35

a Band-Aid, because you just couldn't feel that tiny little fine wax paper.

Jill Morgan: 00:21:41

Or finding the end of a roll of tape and you think, "Oh my gosh,

Jill Morgan: 00:21:45

this is just gonna drive me crazy."

Jill Morgan: 00:21:47

But I imagine in lab you guys also have all these little tiny fidgety

Jill Morgan: 00:21:50

things you have to pick up that might be hard if you're not used

Jill Morgan: 00:21:53

to doing it in two pair of gloves.

Vicki Herrera: 00:21:55

Yeah, absolutely.

Vicki Herrera: 00:21:56

It's worth practicing in two pairs of gloves just to feel how different

Vicki Herrera: 00:22:00

it is to pipette open tubes, some of those things that you do take for

Vicki Herrera: 00:22:04

granted with the textile sensation.

Jill Morgan: 00:22:08

I know we need to wrap up, and I wanted to just

Jill Morgan: 00:22:10

sort of go through a few points, that you and, Colleen have made.

Jill Morgan: 00:22:13

And I think it's, worth reiterating something you said early on, Vicky,

Jill Morgan: 00:22:19

which was communication is so important . So the only way we're

Jill Morgan: 00:22:25

going to close the gap between what bedside clinicians, care providers want

Jill Morgan: 00:22:32

to deliver, and what laboratorians can and will deliver, is to talk about it.

Jill Morgan: 00:22:38

Gotta talk about what the expectations are.

Jill Morgan: 00:22:41

What the needs are.

Jill Morgan: 00:22:42

How these things will happen.

Jill Morgan: 00:22:44

How can we do it safely?

Jill Morgan: 00:22:46

What's the turnaround time?

Jill Morgan: 00:22:48

Are there other ways to do it, like maybe utilizing an iStat or a VBG machine

Jill Morgan: 00:22:53

that isn't used very often to at least get me a little bit of basic chemistry?

Jill Morgan: 00:22:58

How can you bridge that gap, so that we can deliver good care and not

Jill Morgan: 00:23:03

put anybody unnecessarily at risk?

Jill Morgan: 00:23:06

And then, I think this whole idea of what a point-of-care device is, again, like I

Jill Morgan: 00:23:11

had no idea that a Pochi, or a Piccolo, or a GEM, was a point-of-care device.

Jill Morgan: 00:23:17

I didn't think about them as being point-of-care, and I know

Jill Morgan: 00:23:20

you call them portable, but to me, they're just sitting there.

Jill Morgan: 00:23:24

They're not like an Accu-Chek machine or a glucometer or whatever that

Jill Morgan: 00:23:27

I'm taking in and, probably putting on my patient's bedside table.

Jill Morgan: 00:23:31

So I'm glad to know that all those devices, that could be really

Jill Morgan: 00:23:36

helpful for people, are also just considered point-of-care.

Jill Morgan: 00:23:40

That still means they have rules to follow, right?

Jill Morgan: 00:23:42

I mean, lab is an extremely well-regulated industry.

Jill Morgan: 00:23:47

But it might mean that a point-of-care device is much easier

Jill Morgan: 00:23:50

for somebody to think about using than it is to think about sending

Jill Morgan: 00:23:54

a specimen to their core lab.

Vicki Herrera: 00:23:56

Yeah, absolutely.

Vicki Herrera: 00:23:56

So, I think the important thing to do really is to create a team, some

Vicki Herrera: 00:24:03

leadership in your laboratory, that can discuss things with the providers,

Vicki Herrera: 00:24:09

anybody else that needs to be involved.

Vicki Herrera: 00:24:11

That could be a variety of people, right?

Vicki Herrera: 00:24:13

So creating some sort of a team where you can discuss those things and really

Vicki Herrera: 00:24:17

discussing with the providers, what are the tests that you really, really need?

Vicki Herrera: 00:24:22

Not what you want, but what do you really, really need?

Vicki Herrera: 00:24:25

And then the lab doing a risk assessment on that side, to figure

Vicki Herrera: 00:24:31

out how they can provide that for you.

Vicki Herrera: 00:24:33

And a point-of-care device may or may not be the answer.

Vicki Herrera: 00:24:37

I mean, there's a lot of things that come into play with that, right?

Vicki Herrera: 00:24:40

There's regulatory issues.

Vicki Herrera: 00:24:41

You still have to follow all the regulatory standards.

Vicki Herrera: 00:24:44

There may be a cost issue.

Vicki Herrera: 00:24:46

There may be only one in your ED that you may not be able to

Vicki Herrera: 00:24:50

dedicate to a particular patient that you're investigating.

Vicki Herrera: 00:24:55

There's a variety of reasons.

Vicki Herrera: 00:24:56

So really walking through those, doing the risk assessments, determining is

Vicki Herrera: 00:25:01

this really the safest way we can do it?

Vicki Herrera: 00:25:04

Is this a possibility or do we need to relook at something and do it differently?

Vicki Herrera: 00:25:09

And then communicating that back to your providers, so that they have a clear

Vicki Herrera: 00:25:14

understanding as to why or why not you are able to provide those particular tests.

Vicki Herrera: 00:25:22

Again, you may have to go back to the drawing board, but as long as you can have

Vicki Herrera: 00:25:26

that communication back and forth with your providers as to why it's feasible

Vicki Herrera: 00:25:31

or not feasible for that particular instrumentation and those particular tests

Vicki Herrera: 00:25:35

are going to move the needle a lot faster than just saying yes or no to things.

Jill Morgan: 00:25:41

Yeah.

Jill Morgan: 00:25:42

I thought you were going to break into the Spice Girls song, "Tell me what you

Jill Morgan: 00:25:45

want, what you really, really want." So I think that the other piece that I just

Jill Morgan: 00:25:49

want to get in here, because I have been threatened every time I come up with

Jill Morgan: 00:25:53

what I think is a brilliant idea about lab, I get told I might go to lab jail

Jill Morgan: 00:25:56

because it is such a regulated industry.

Jill Morgan: 00:25:58

But that's of course for the protection of our data, right?

Jill Morgan: 00:26:01

We want to be able to trust lab results and therefore we have to be really

Jill Morgan: 00:26:06

persnickety about who does what and on what devices and how those devices

Jill Morgan: 00:26:10

are validated and all that stuff.

Jill Morgan: 00:26:11

So I don't mean any disrespect to that.

Jill Morgan: 00:26:14

But for somebody who says like, "Oh, our ED doesn't currently use an iStat, but if

Jill Morgan: 00:26:19

we had a potential Ebola patient, we could just use one like from another unit."

Jill Morgan: 00:26:24

Well, no, because those nurses aren't checked off on that device.

Jill Morgan: 00:26:28

We have to make sure all those pieces are in place.

Jill Morgan: 00:26:31

Like it might sound easy to do, but there are some rules about why that can't

Jill Morgan: 00:26:36

just be thrown in at the last minute.

Jill Morgan: 00:26:38

And so your advice to like really talk about this and have a meeting

Jill Morgan: 00:26:42

and have the right people at the table ahead of time is, I think, critical.

Jill Morgan: 00:26:46

Not just for avoiding lab jail, but for making sure we're getting

Jill Morgan: 00:26:49

the results that can be trusted.

Vicki Herrera: 00:26:51

Yeah, a-agree.

Vicki Herrera: 00:26:52

There's a lot of regulatory, things that do go into bringing up a test, and you

Vicki Herrera: 00:26:57

do still have to follow all of that.

Vicki Herrera: 00:27:00

And sometimes it takes a little bit of time to get that, especially if you're

Vicki Herrera: 00:27:04

bringing a new piece of equipment, it does take a little bit of time to bring

Vicki Herrera: 00:27:07

that up and have that test available.

Vicki Herrera: 00:27:09

So those early conversations are really crucial in making sure that

Vicki Herrera: 00:27:13

the providers have the tests that they need to provide adequate care.

Jill Morgan: 00:27:18

All right.

Jill Morgan: 00:27:19

So when we say every healthcare facility should be able to offer a patient

Jill Morgan: 00:27:24

who presents with a suspected or confirmed special pathogens patients,

Jill Morgan: 00:27:29

so we're talking about Ebola, Lassa, Marburg, MERS, all those things.

Jill Morgan: 00:27:35

Basic labs would include, a basic chemistry, so whether you

Jill Morgan: 00:27:38

call it a BMP or a Chem-7, we're talking about some electrolytes.

Jill Morgan: 00:27:44

We wanna know a little bit about their CBC, and maybe we won't

Jill Morgan: 00:27:47

get the whole thing, because I know some of those are available.

Jill Morgan: 00:27:49

Maybe you get a hemoglobin, a hematocrit on an iStat, or you might get a white

Jill Morgan: 00:27:53

count on something, you get the idea.

Jill Morgan: 00:27:56

Parts of a CBC chemistry, maybe a urine pregnancy , if that's

Jill Morgan: 00:28:01

the patient population that you might be taking care of.

Jill Morgan: 00:28:05

A malaria test would be a really value add because so many of these

Jill Morgan: 00:28:11

suspect patients end up with malaria.

Jill Morgan: 00:28:14

And then everything else is really gravy after that point it sounds like.

Jill Morgan: 00:28:19

That if we can get those down, the rest are just like bonus prizes.

Jill Morgan: 00:28:24

Does that sound right?

Vicki Herrera: 00:28:26

Yes, but keep in mind that not every single facility

Vicki Herrera: 00:28:32

may have all those tests available or be able to provide them, right?

Vicki Herrera: 00:28:35

We want them to be able to provide basic stuff, right?

Vicki Herrera: 00:28:38

But that's also where those conversations come into play.

Vicki Herrera: 00:28:43

And if they aren't in a position that they can offer some of those or offer

Vicki Herrera: 00:28:48

what the physicians really need to assess, that is where you phone a friend, right?

Vicki Herrera: 00:28:54

So maybe you have a facility nearby that could offer those tests.

Vicki Herrera: 00:29:00

So that might be a conversation with your partner lab.

Vicki Herrera: 00:29:04

I don't want to say reference lab because we don't want to send stuff to a reference

Vicki Herrera: 00:29:07

lab, but a reference lab could mean different things to different facilities.

Vicki Herrera: 00:29:11

It could just mean their larger laboratory that's associated

Vicki Herrera: 00:29:14

with their facility, right?

Vicki Herrera: 00:29:16

So making sure that you're having those conversations, and if you can

Vicki Herrera: 00:29:19

get something maybe that the larger laboratory is able to provide.

Vicki Herrera: 00:29:24

Again, making sure that you keep all of those safe practices and again,

Vicki Herrera: 00:29:28

having those conversations about what makes sense and what you can

Vicki Herrera: 00:29:31

and cannot do in your laboratory, but still being able to provide the

Vicki Herrera: 00:29:35

testing that they need in some way

Jill Morgan: 00:29:37

Yeah.

Jill Morgan: 00:29:38

And then before you think about what you need to wear or how you need to

Jill Morgan: 00:29:43

do it, you need to think about a risk assessment for what handling these

Jill Morgan: 00:29:48

specimens and doing those tests, that we just mentioned, might entail.

Jill Morgan: 00:29:52

Which equipment you're gonna be using, what risks specifically might

Jill Morgan: 00:29:55

you have, so that you can make sure you're addressing those risks with

Jill Morgan: 00:30:00

your choices of protection mechanisms

Jill Morgan: 00:30:03

. Parts of that are PPE, but parts of that, like Vicki said, would be things

Jill Morgan: 00:30:07

like knowing where your airflow is.

Jill Morgan: 00:30:09

Are you using a hood?

Jill Morgan: 00:30:10

Do you have negative pressure somewhere?

Jill Morgan: 00:30:12

Are you using a glove box?

Jill Morgan: 00:30:14

Because those change what PPE we might really say is super

Jill Morgan: 00:30:19

important to that situation.

Jill Morgan: 00:30:21

So basic labs, risk assessment, and then thinking about the importance of

Jill Morgan: 00:30:28

this communication so you understand everybody's on their same playing field

Jill Morgan: 00:30:33

for how we can advance the medical care these folks desperately need.

Vicki Herrera: 00:30:39

You hit the nail on the head.

Jill Morgan: 00:30:42

Well, thank you guys so much.

Jill Morgan: 00:30:44

to Vicki and Colleen, I know that the NETEC Laboratory Working Group is

Jill Morgan: 00:30:49

in great hands with the two of you.

Jill Morgan: 00:30:50

So thank you.

Jill Morgan: 00:30:52

For those of you listening at home, thank you for tuning in

Jill Morgan: 00:30:54

to this episode on Lab Basics.

Jill Morgan: 00:30:56

We hope you'll join us for future episodes on a wide range of topics.

Jill Morgan: 00:30:59

We've talked about everything from trash to treasure and healthcare worker safety

Jill Morgan: 00:31:04

and personal protective equipment.

Jill Morgan: 00:31:06

So please, think about subscribing to future episodes, which you can do at

Jill Morgan: 00:31:13

If you have questions for NETEC or ideas for future shows, please feel

Jill Morgan: 00:31:17

free to contact us at info@netec.org.

Jill Morgan: 00:31:22

And we appreciate you being here, and we hope we'll see you next

Jill Morgan: 00:31:25

time on Transmission Interrupted.