key: cord-0853081-kvy3fatn authors: Dubey, A.; Bansal, A.; Sonkar, S. C.; Goswami, B.; Makwane, N.; Manchanda, V.; Koner, B. C. title: In-house assembled protective devices in laboratory safety against SARS-nCoV-2 in clinical biochemistry laboratory of a COVID dedicated hospital date: 2020-08-26 journal: nan DOI: 10.1101/2020.08.24.20155713 sha: 57d2ef3ca6620a88724846298d15e6cbb5f8f76f doc_id: 853081 cord_uid: kvy3fatn Background: Health Care Workers (HCWs) of diagnostic laboratory handling COVID positive samples are at risk and need to take protective measures. Many protective materials were not available when the pandemic reached India forcing laboratory managers to take innovative measures to protect the laboratory staffs. Methods: We made face shields from OHP sheets and substitute of biosafety cabinets from cardboard boxes fitted with hypochlorite spraying devices. Here we present if these two in-house developed safety devices when incorporated in standard operating procedure (SOP) of laboratory safety were effective in clinical biochemistry laboratory of dedicated COVID hospitals. Results: We assessed contamination of laboratory surfaces (n=6) and rate of SARS-nCov-2 positivity from their nasal and throat swab by RT-PCR among laboratory personnel (n=18) after 14 days of their use along with other routine safety devices like use of gloves, surgical masks, OT gowns etc. These HCWs were checked regularly for signs and symptoms of COVID-19 and none had any signs and symptoms during these 14days. The SARS-nCov-2 test report was negative for the staff members and no surface contamination was detected. We conclude that innovative and cost effective protective devices can be built in-house with locally available resources and are effective in preventing the spread of COVID 19 among the staff working in clinical biochemistry laboratories. Conclusions: Laboratory managers in resource scarce areas need to be innovative to face such sudden safety challenges like COVID-19 pandemic. Strengthening the Basics Approaches to protect the lab personnel in dedicated COVID hospital of Low-Resource Settings. Designed and developed in-house standard operating procedure (SOP) to fill the gap and evaluate the effect in dedicated COVID-19 hospitals. Innovative protective devices made from OHP sheets and cardboard boxes fitted with hypochlorite spraying devices as alternatives to biosafety cabinets on contamination of laboratory surfaces. Performance of the devices were clinically validated and it can be used as alternative in low resources settings. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 26, 2020. . https://doi.org/10.1101/2020.08.24.20155713 doi: medRxiv preprint Health Care Workers (HCWs) of diagnostic laboratory handling COVID positive samples are at risk and need to take protective measures. Many protective materials were not available when the pandemic reached India forcing laboratory managers to take innovative measures to protect the laboratory staffs. We made face shields from OHP sheets and substitute of biosafety cabinets from cardboard boxes fitted with hypochlorite spraying devices. Here we present if these two in-house developed safety devices when incorporated in standard operating procedure (SOP) of laboratory safety were effective in clinical biochemistry laboratory of dedicated COVID hospitals. We assessed contamination of laboratory surfaces (n=6) and rate of SARS-nCov-2 positivity from their nasal and throat swab by RT-PCR among laboratory personnel (n=18) after 14 days of their use along with other routine safety devices like use of gloves, surgical masks, OT gowns etc. These HCWs were checked regularly for signs and symptoms of COVID-19 and none had any signs and symptoms during these 14days. The SARS-nCov-2 test report was negative for the staff members and no surface contamination was detected. We conclude that innovative and cost effective protective devices can be built in-house with locally available resources and are effective in preventing the spread of COVID 19 among the staff working in clinical biochemistry laboratories. Laboratory managers in resource scarce areas need to be innovative to face such sudden safety challenges like COVID-19 pandemic. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 26, 2020. . (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 26, 2020. . https://doi.org/10.1101/2020.08.24.20155713 doi: medRxiv preprint The experience is shared from the clinical Biochemistry laboratory of LN Hospital, New Delhi, India that has been ear-marked as an exclusive facility catering only to COVID-19 patients. The SOP developed was a part of the managerial and operational effort when lab personnel suddenly reported of arrival of blood samples in the lab for investigations from patients suffering from COVID-19 and the results presented in this article are by product of the activities done during this process on subsequent days till the lab could ensure standard safety measures recommended for such labs 11-16 . A three member team was formed immediately to make a SOP for Biochemistry lab processing COVID samples based on WHO/CDC guideline, to find out the gaps/deficits in lab for implementing those standard biosafety recommendations and to recommend the best possible measures to tackle the gaps 8 . PPEs were made available. During this period the staff members were instructed to report any symptoms such as sore throat, cough, fever, diarrhea, loss of taste or smell or any other symptoms during their posting in the lab. COVID-19 screening facility by RT-PCR as recommended by ICMR could not be arranged for lab staff on 6 th day as COVID-19 diagnostic facility had limited capacity and was overloaded with a number of samples from suspected cases. The staff members underwent COVID-19 testing on 14 th day. Both nasal and throat swabs were sent to the virology laboratory in the Microbiology department for RT-PCR detection of the virus causing COVID-19. One technician refused to provide a sample because he was fasting during Ramdan and as per his faith the introduction of a swab to the nose or throat is equivalent to breaking his fasting. His faith was respected. Swabs from lab surfaces from sample collection and processing area, centrifuge machine, cardboard box used for decapping and sample loading area of clinical chemistry analyzer were sent for viral detection by RT-PCR to assess surface contamination. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 26, 2020. . https://doi.org/10.1101/2020.08.24.20155713 doi: medRxiv preprint Total RNA was isolated from fresh Throat & Nasal swab (TS/NS-200 ul/ Specimens) collected from laboratory staff and followed by MagGenome Xpress RNA Isolation Kit as per instruction manuals 18 . The surface swabs were also processed in a similar way. The residents (n=5) and lab technicians (n=10) did 4 to 5 days lab duty of 12 hour duration during this 14days period. Each nursing orderlies did duty for 8 to 10 days in 8-12 hr shifts during this period. None of the staff members reported sick during this period. The nasal and throat swab test for virus causing COVID-19 of all technical staff (n=10), residents (n=5) and nursing orderlies (n=3) also came out to be negative. No surface contamination with the virus of the work area and instruments was detected. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 26, 2020. . https://doi.org/10.1101/2020.08.24.20155713 doi: medRxiv preprint This article presents the data that evaluated the effectiveness of a SOP that used a face shield made in-house from OHP sheets and innovative device made from card board fitted with hypochlorite spraying device as alternative to biosafety cabinet along with other standard biosafety measures in preventing spread of COVID-19 virus among laboratory personnel working in biochemistry laboratory in a dedicated COVID-19 hospital. The data shows that at the end of 14days of following the SOP, none of the lab personnel including those who did high risk jobs that produce aerosols developed signs and symptoms of COVID-19 infection and RT-PCR based COVID-19 testing was negative for all lab staff. This indicates that these low cost, innovative devices built in-house were effective in preventing COVID-19 spread through aerosol among lab staff. We attribute this prevention to use of these innovative devices along with other protective gears like face mask, gloves etc. However, we do not claim that it is solely due to our innovative devices but is contributed by these devices also. However, we could not keep a control arm in our study to prove our claim. Another limitation is that most of the COVID-19 cases are asymptomatic and hence, clinical monitoring by self-reporting of symptoms is bound to miss the diagnosis in most of the cases. Even We conclude that in resource scarce health set up where standard CDC or WHO recommended biosafety measures cannot be totally followed, such simple, low cost and innovative devices made in-house or locally from locally available materials can be effectively used in such sudden outbreak of contagious viral infections. With All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 26, 2020. . https://doi.org/10.1101/2020.08.24.20155713 doi: medRxiv preprint understanding of the basic principle of barrier method, innovations are possible and are key to success in such critical periods. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 26, 2020. . https://doi.org/10.1101/2020.08.24.20155713 doi: medRxiv preprint the COVID-19 pandemic: major risks to healthcare and other workers on the front line Preventing infection of patients and healthcare workers should be the new normal in the era of novel coronavirus epidemics Detection of SARS-CoV-2 in Different Types of Clinical Specimens Significance of Fomites in the Spread of Respiratory and Enteric Viral Disease Does COVID-19 Spread through Droplets Alone? 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No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted doi: medRxiv preprint receptor binding A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR Evaluation of reverse transcription-PCR assays for rapid diagnosis of severe acute respiratory syndrome associated with a novel coronavirus All rights reserved. No reuse allowed without permission.(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.The copyright holder for this preprint this version posted August 26, 2020. . https://doi.org/10.1101/2020.08.24.20155713 doi: medRxiv preprint All rights reserved. No reuse allowed without permission.(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.