Laboratory Processing of Specimens

Although not always the first topic discussed when preparing for a bioemergency, the availability of a competent clinical laboratory is vital for the optimal care of a patient with a risk group 4 (RG-4) high-consequence pathogen. The recent development of highly specialized facilities in the United States to assess and treat patients with highly hazardous communicable diseases has led to the design of dedicated laboratories or the redesign of laboratory space to safely process and test specimens that might contain one of these pathogens. For frontline and other acute care facilities to be prepared, safety practices need to be assessed and reviewed as necessary as pertaining to all laboratory activities, to include the pre-analytical (specimen collection and processing), analytical (specimen testing), and post-analytical (specimen disposal/waste management and reporting) processes. Laboratorians and administrative personnel need to consider the risks in handling specimens containing these pathogens and subsequently develop or revise processes to mitigate risks. In addition, issues such as scalability to handle large volume testing, the availability of trained staff, and long-term sustainability to meet the requirements of regulatory agencies need to be adopted within a fiscally responsible budget setting. This chapter provides generalized information on how clinical laboratories, from those supporting small frontline medical facilities to highly specialized laboratories supporting acute care treatment centers, can safely manage specimens from a patient known or potentially infected with a high-consequence pathogen.