ANNEX F

MANILA DOCTORS HOSPITAL LABORATORY DEPARTMENT PROCEDURE ON SARS

Laboratory Biosafety Procedures for Specimens from Patients with Severe Acute Respiratory syndrome (SARS)

A. Objective

1. To provide a set of infection control or biological safety procedure for laboratory workers to prevent transmission of SARS to themselves, their co-workers, and other patients and clients of the hospital.

B. Scope

1. This procedure covers the collection, handling, processing and transport of specimens obtained from patients who are under surveillance for SARS, suspect for SARS or probable SARS patient.

C. Case Definitions

1. Patient under Surveillance for SARS- patients with history of travel to high –risk places and/or exposure to persons with possible SARS but with out symptoms.

2. SARS Suspect Patient- patients with history of travel to high – risk places and/ or exposure to persons with possible SARS but with symptoms of high fever, respiratory syndrome, dry cough.

3. Probable SARS Patient- patients described under SARS suspect patients with laboratory findings and radiolographic evidence of infiltrates consistent with pneumonia or respiratory distress syndrome on chest X-ray that increase the suspicion of SARS.

4. Confirmed SARS Patient- patients with a positive confirmatory test for the SARS virus.

D. Procedure

1. Collection of Specimen (Blood for Hematology Examination)

1.1. All laboratory personnel are required to observe standard precautions in collection and handling of potentially infectious laboratory specimens.

1.2. Phlebotomist and other laboratory workers should wear personal protective equipment (PPE) including disposable gloves, long laboratory coats, eye protection and surgical mask or face shield to provide a barrier to mucosal surface exposure. The PPE can be obtained from the Nursing Service Supervisors in the Wards/ Floors and the Ward Clerk at the ER.

1.3. A single Med. Tech. wearing PPE should handle the request from collection to processing and disposal of the specimen.

1.4. Careful attention should be given to hand hygiene after removal of gloves and specially before touching the eyes or mucosal surfaces.

1.5. After collection, all specimens are properly labeled and should be placed in a plastic box or receptacle which is further enclosed in a clear plastic resealable bag with a biohazard sticker. The box and bag serves to prevent leakage of contents in case there is breakage of glass tubes or spoilage.

1.6. The specimens with accompanying requests forms are to be brought immediately to the laboratory after collection.

2. Specimen Reception, Handling and Processing

2.1. Minimize the number of personnel in the Hematology Section. If possible, only the Med. Tech who collected the specimen is the only person within the room.

2.2. The same Med. Tech. verifies the identification on the request form and logs it in a separate logbook for SARS/other Hazardous specimens.

2.3. Procedure for Hematology Examination

2.3.1. Remove the EDTA tube from the specimen bag.

2.3.2. Run the specimen on the 3500 in closed tube mode

3. Post Analytical Handling and Waste Disposal

3.1. Decontaminate analyzer at the end of the test. Run 5% Na Hypochlorite in rinse mode.

3.2. De-gown and decontaminate accordingly

3.3. Autoclave all complements and specimen and place in yellow bag.

3.4. Decontaminate all working surfaces

4. Transport of Specimen to Referral Laboratory

4.1. Coordinate by phone with referral laboratory (San Lazaro or RITM)

4.2. Specimen is packaged as described after collection (refer to 1.4.)

4.3. Specimen is brought as soon as possible to referral laboratory.