Preventing laboratory-associated infections in the COVID-19 era: experience from a tertiary care infectious disease hospital in Southern Vietnam

Abstract Background: Laboratory staff is at higher risk of infection owing to the handling and testing of coronavirus disease 2019 (COVID-19) patient samples. Reviewing the existing risk assessment and improving risk management are essential for preventing laboratory acquired infections (LAIs) related to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) testing during the COVID-19 epidemic. We present herein the steps taken to prevent LAIs related to SARS-CoV-2 testing in a tertiary care hospital in Vietnam. Methods: A SARS-CoV-2-focused risk assessment exercise was conducted for laboratory processes and workflow. Risk management strategies, including engineering, administrative and operations control procedures, were established. Standard operating procedure (SOP), staff training, COVID-19 symptom reporting, enhanced cleaning and decontamination, and inventory monitoring protocols were implemented. Sample reception and results reported from February 1, 2020 to September 17, 2020 were documented. Results: Based on risk assessment, a risk management strategy for SARS-CoV-2 testing was developed. This strategy includes the use of dedicated facility, instrument, and cold chain units for testing; SOPs; training (testing, decontamination and cleaning staff); the introduction of biosafety level (BSL)2+ laboratory practices; enhanced cleaning protocols for testing; and the assigning of additional staff for testing and safety system implementation. In total, 38,377 (daily mean and range: 166; 3 – 2,377) samples were received, including 301 (0.8%) samples that were rejected. The turnaround time (median ± standard deviation (SD)) was 3.54 ± 2.97 days. Altogether, 32 staff members were involved with SARS-CoV-2 testing and biosafety management, and there were no reports of COVID-19 symptoms among them. Conclusion: For epidemics and outbreak diagnostics, risk assessment and risk management strategies are important for the prevention of LAIs. Clear instruction on revised risk management protocols, necessary training, and leadership in risk management strategy implementation are essential.