I work in a NHS lab

[nc3457]

Nc for this. I recently went back to work after mat leave. I work in an NHS hospital lab (pathology).
So things are a bit different, they have asked staff to try to keep to the 2 meter rule and put in some procedures so that staff don't move into sections unnecessary. However the space isn't massive so it's difficult, I still need to work with coworkers, we are quite often within 2 meters and it's unavoidable. Lots of hand washing and clean your workstation.

I'm not working on the CV testing section but I am running routine testing on samples from pos CV patients, and obviously anyone can be carrying it so all samples are treated the same.

What I'm pretty shocked about though is we don't have masks or visors. Ive been told I still need to do manual work (requires opening blood sample) but to do it carefully so not to create an aerosol. No hand gel at all provided (I take my own now). We do have gloves. My colleagues laugh when I questioned this, they have got used to it.

My manager says that there's very small viral load in the blood that's why we don't need mask but I suspect there's also no ppe anyway. Is there anyone in a similar position to me? Any lab workers?

Oddly they say no staff have been off sick in our department. But most of us are under 40 and healthy. A couple of my coworkers are pregnant (1st trimester) and they don't seem to mind. Am I out of line being shocked?

Sorry don't work in a lab but I think that is bloody shocking.
Surely in normal circumstances you should be wearing masks and ppe anyway handling samples.

If you are not performing aerosol generating procedures then you do not need a face mask.

Guidance here www.gov.uk/government/publications/wuhan-novel-coronavirus-guidance-for-clinical-diagnostic-laboratories/wuhan-novel-coronavirus-handling-and-processing-of-laboratory-specimens#personal-protective-equipment

What does your infection control policy say? I find it really hard to believe that eye protection is not available in a path lab, it should have been standard way before COVID. Are you handling samples within a cabinet?

@Chinnychinnychinnychib thanks for the info I've had a quick read. Masks aren't require for urine etc but I'm talking about blood samples (sorry to drip feed). It talks about automated machines which is fine. Although we aren't cleaning ours as it says to and never have, mainly due to time it would take I think and machine downtime.

The manual procedures I'm taking about would create an aerosol, it involves opening blood samples and doing various tests.

Love the doc "To date, laboratory-acquired infection has not been reported for SARS-CoV-2." It's not classed as a laboratory acquired infection so gov can say that no lab staff have got it. To anyone who knows lab speak this is shit of the gov. I know lab staff in other hospitals that have caught it.

Do you not have class 2 / downflow cabinets for biological work? That's standard procedure in pharma so I don't see why nhs labs would have bloodwork on an open bench? If you're working in a cabinet then a mask is unnecessary.

@Chinnychinnychinnychib
I haven't read the policy's for the lab recently. We have 1 pair of goggles between 10 plus people over all shifts. We don't have a cabinet but in the new risk assessments released by management they mention one is coming but I don't believe one will appear anytime soon. For starters there isn't anywhere to put it and so many people need it for there test across the whole lab, if it was implemented to use it everyone would need to.
I think infection control for lab staff has been blasé for awhile before CV. We are in the background and forgotten about.

@LilithTheKitty I've worked at a few NHS labs and never used a cabinet for blood. I think the NHS don't have the money for them. I know microbiology departments have them.

I think working in a cabinet would be impossible for my job. The lab is not set up for it. It would be a major reshuffle with significant investment. The amount of samples and tests to preform even just for manual samples would be too difficult.

Aren't safety cabinets required for anything from Class II on?
We (private company) have more hoods than people at the moment.

I had a quick talk to a friend who works in the NHS (I work in a private research lab but, fortunately, we're both starting early today). They said that it's best to refer to your trust SoP which should have citations for the rationale behind the guidance.

Regarding the above link to the government guidance and your working with blood, the word you're looking for is viraemia, specifically that viruses have only been identified in 5% of blood samples from infected patients. When handling the samples, popping the top off isn't classed as an aerosol generating procedure in my lab unless the tube has been agitated but yours may vary.

Regarding laboratory acquired infections, this refers to the method of infection, not the specific disease; namely, acquisition of a disease through laboratory work. The statistic doesn't surprise me because, from what I've read, it seems like standard laboratory precautions should be quite effective when handling blood samples; other than possible contamination from the exterior of the transport packaging.

They also asked me to wag a finger at you for not staying up to date on reading the latest lab policies.

@nc3457 I had no idea that it wasn't standard practice across all laboratories. I've just seen your eye protection comment too. One pair of safety specs for 10 people?! That is awful. There should be enough for everyone, plus spares for visitors. Noone should be in a lab without basic PPE of lab coat and gloves.

Can you wear your own face masks? Is it allowed? Would it raise eyebrows if you supplied your own?

No scientist here, but I would be worried.

Can you go to supplies yourself. are you in a hospital lab? I dont believe there is a ppe shortage. do you wear goggles at least?
or ask higher up than your manager?
Occ health
union?

Apologies, I forgot to add, if you're still concerned, it's probably worth looking for the author of the guidance for your lab and having a talk to them. In my experience, they're usually very enthusiastic about their work, almost to the point of being unsettling and will discuss infection control with the same vigour as a railway enthusiast who's just seen a rare shunting engine.

You appear to be suggesting that your working conditions have always been unsafe. You'll be in a union then? Speak to them.

I had no idea that it wasn't standard practice across all laboratories. I've just seen your eye protection comment too. One pair of safety specs for 10 people?!

I work with similar samples in the private sector, it's not all that unusual. Because we're adults, we're generally allowed to make our own decisions and identify risks as they arise. The last time I wore goggles was when using a particularly nasty cleaning mixture.

This doesn't surprise me. In my experience many behind the scenes NHS workspaces are very crowded and poorly laid out. A lot of hospitals are old buildings that have expanded rather than purpose designed workspaces. You can come up with new policies but can't easily change the workspace.

Lab coat and gloves have always been standard in blood labs.
Back in the day, when HIV was newly discovered and being routinely tested for, I worked in a blood transfusion centre and the lab for testing bloods for HIV and Hep B was not only accessed via a double door lock decontamination foyer but also had negative pressure to avoid accidental release. We had a cabinet, but it was only used for applying positive controls and for further testing on any positive samples that came in.
Disposable gowns and eye protection were standard.

I think you should all have safety specs available, definitely, in case of accidents. You should all be wearing gloves anyway. The rest should be standard procedures and the machines should be cleaned, regardless of downtime.
I know how hard it is to FIND that down time but that's not really an excuse not to do it.

I'm in a similar position, I'm NHS microbiology, so test positive samples, but I don't personally test for covid, but share a tea room, corridors, lab reception etc with those that do.

We have no masks or goggles either but we don't need it. If we are doing anything that may generate aerosols we have category 3 cabinets to do it in, all respiratory samples are done in there too as standard, there is a TB risk too.

Surely washing your hands at work is enough and you don't need sanitiser gel? We don't use any at my work in the lab as we're trained not to touch our faces anyway and I always consider my hands dirty while at work. In the NHS you are always recommended to wash your hands with soap and water over hand sanitiser as its a much better option. Sanitiser is for situations when you can't, so like district nurses.

Remember too, if you are using vaccutainers of blood, they are under pressure so that when you open them air rushes in not out, that's how they fill themselves up!!

I don't know about the testing you do, but anyone preparing samples for PCR definitely needs a hairnet and facemask. The risk of contamination is high as it is such a sensitive procedure and the PPE helps mitigate it.

I should point out that HIV was "downgraded" in terms of risk after a few years, so that the "air lock" system and the rest of the extra precautions were no longer considered necessary. But of course everyone still wore gloves and labcoats, and eye protection was still standard for applying positive controls.

I think if you KNOW there is an infection risk, even if it's tiny, in a sample then you probably should have the ability to wear eye protection if you want to. To not have the resources available for that is very poor practice.

ThumbWitchesAbroad it's also worth differentiating that HBV/HIV are blood borne diseases, while C-19 is not.

My lab considers decapping blood samples to be an aerosol-generating procedure, albeit with minimal risk. Advice is to wear standard PPE of gloves and lab coat plus plastic apron and visor for decapping which I do. Hardly anyone else does though. To say people are complacent is an understatement.

Social distancing is very difficult and there are quite a few, including seniors, who think they are immune from catching anything and behave accordingly. We have visors, just taken a delivery of some made in the community. Could you see if anything like this is available? If you can get one grab it, put your name on it and hid it for when you want to use it. Clean it yourself after use and you know it's ok for when you want to use it. Ignore any rolling of eyes by others.

The reality is that I'm more likely to catch Covid19 from my co-workers than the positive blood samples that I'm handling.

If you have always handled blood samples you have always had a risk of BBV from the blood samples so your COSHH assessments should have always had procedures in place that protected you. Covid-19 is not uniquely dangerous in this respect.

I assume you are wearing Howie lab coats, LEP and disposable gloves while working in the lab as standard? You don't need hand sanitiser in the lab, soap and water is much more effective at cleaning your hands (there should be a handwashing sink at the entrance to the lab and you should wash your hands as you enter and leave even when there isn't a pandemic). I agree with your boss that there won't be many aerosols from opening and correctly pipetting from small volumes (assuming

I guess some of this depends on what bit of pathology you’re in and what work you’re doing. But with blood samples I’m not sure why Covid would be any more of a risk than other diseases that have been around forever (& I’m sure less than some). I was always taught to treat every sample like it could be infectious. It’s why you leave containers closed for a while after centrifuging.

The frequent hand washing and cleaning of work stations is likely to try to prevent staff transmitting covid to each other rather than due to a danger from the samples themselves.

I’m more concerned about what kind of equipment isn’t being cleaned tbh, because I’ve never worked in any lab where cleanliness wasn’t essential to prevent contamination of samples and the risk of false results. And it’s more time-consuming & inefficient having to fully strip, clean, change reagents, and redo a run if you get a suspicious results set than it is to just clean the equipment routinely.