1. DEPARTMENT OF HEALTH RESEARCH INSTITUTE FOR TROPICAL MEDICINE ROLES OF THE LABORATORIES IN EVD PREPAREDNESS Amado O. Tandoc III, MD, DPSP Department of Virology

2. 2 RESEARCH INSTITUTE FOR TROPICAL MEDICINE OBJECTIVES Discuss the roles of the laboratories in EVD preparedness o RITM NRL o SNL o Laboratories in the Regional Hospitals and Referral Centers for EVD o Laboratories in the Private Hospitals Provide points for consideration to the regional hospitals and hospitals hosting SNLs for EVD preparedness 2

3. 3 RESEARCH INSTITUTE FOR TROPICAL MEDICINE LEVELS OF LABORATORY CAPACITY National Reference Laboratory Subnational Laboratory Regional Laboratory Provincial/City Laboratory Other Laboratories 3

4. 4 RESEARCH INSTITUTE FOR TROPICAL MEDICINE LEVELS OF LABORATORY CAPACITY Regional Reference Laboratory Global Specialized /Referral Laboratory

5. 5 RESEARCH INSTITUTE FOR TROPICAL MEDICINE LABORATORY LINKAGES 5 Specimen Collection Referral of specimens Augment testing capacity Information sharing Regional Reference Laboratory Global Specialized /Referral Laboratory Cascade Standards Guidelines Expertise Training Logistics Information sharing

7. 7 RESEARCH INSTITUTE FOR TROPICAL MEDICINE LIMITATION OF CENTRALIZED TESTING Centralized testing Only 1 testing facility Not easily accessible to all referring centers Logistic concerns Limited surge capacity

9. BAGUIO GENERAL HOSPITAL SAN LAZARO HOSPITAL LUNG CENTER OF THE PHILIPPINES VICENTE SOTTO MEMORIAL MEDICAL CENTER SOUTHERN PHILIPPINES MEDICAL CENTER

10. 10 RESEARCH INSTITUTE FOR TROPICAL MEDICINE THE BIGGER PICTURE 10

11. 11 RESEARCH INSTITUTE FOR TROPICAL MEDICINE NATIONAL REFERENCE LABORATORY Provides specialized testing services and quality assurance Provides standards, guidelines and recommendations Provides training and technical expertise Provides logistics Planning Oversight 11

12. 12 RESEARCH INSTITUTE FOR TROPICAL MEDICINE SUBNATIONAL LABORATORIES 12 Equipment Training -Confirmatory testing -IPC, Biosafety, PPE -Specimen inactivation -Packaging and shipment Augment national testing capacity Provide specialized testing services Participate in QA of NRL

13. 13 RESEARCH INSTITUTE FOR TROPICAL MEDICINE REGIONAL HOSPITAL LABS Provide laboratory services for regional hospital patients/referrals to guide management Collect specimens safely Package and ship specimens to next level laboratory with capacity (NRL or SNL) 13 Training -IPC, Biosafety, PPE -Specimen collection -Packaging and shipment

14. 14 RESEARCH INSTITUTE FOR TROPICAL MEDICINE PRIVATE HOSPITAL LABS Probably more sophisticated and capable than other labs at city, provincial and regional level. Provide laboratory services for hospital patients/referrals to guide management. Collect specimens safely Package and ship specimens to next level laboratory with capacity (NRL or SNL) 14

15. 15 RESEARCH INSTITUTE FOR TROPICAL MEDICINE PROVINCIAL HOSPITAL LABS Collect specimens safely Package and ship specimens to next level laboratory with capacity (NRL or SNL) 15 Training -IPC, Biosafety, PPE -Specimen collection -Packaging and shipment

16. 16 RESEARCH INSTITUTE FOR TROPICAL MEDICINE REFERRAL SYSTEM Will link the laboratories at various levels Integrated with DOH National Epidemiology Center Disease Surveillance System (PIDSR) –Case Investigation Form –Laboratory Request Form RITM Guidelines for referral of outbreak specimens RITM Interim Guidelines for novel, emerging-reemerging, high consequence pathogens (e.g., NRP, MERS, EVD) 16

17. 17 RESEARCH INSTITUTE FOR TROPICAL MEDICINE 17

18. 18 RESEARCH INSTITUTE FOR TROPICAL MEDICINE POINTS FOR CONSIDERATION Threat of EVD Hospital care for EVD IPC Safety of HCW Prevent transmission 18 SAFETY

19. 19 RESEARCH INSTITUTE FOR TROPICAL MEDICINE POINTS FOR CONSIDERATION 19

20. 20 RESEARCH INSTITUTE FOR TROPICAL MEDICINE POINTS FOR CONSIDERATION 20

21. 21 RESEARCH INSTITUTE FOR TROPICAL MEDICINE 21

22. 22 RESEARCH INSTITUTE FOR TROPICAL MEDICINE 22

23. 23 RESEARCH INSTITUTE FOR TROPICAL MEDICINE 23 SAFETY

24. 24 RESEARCH INSTITUTE FOR TROPICAL MEDICINE 24

25. 25 RESEARCH INSTITUTE FOR TROPICAL MEDICINE 25

26. 26 RESEARCH INSTITUTE FOR TROPICAL MEDICINE 26 SAFETY

27. 27 RESEARCH INSTITUTE FOR TROPICAL MEDICINE 27 SAFETY

28. 28 RESEARCH INSTITUTE FOR TROPICAL MEDICINE 28 SAFETY

29. 29 RESEARCH INSTITUTE FOR TROPICAL MEDICINE 29 SAFETY

30. 30 RESEARCH INSTITUTE FOR TROPICAL MEDICINE 30 SAFETY

31. 31 RESEARCH INSTITUTE FOR TROPICAL MEDICINE 31 SAFETY

32. 32 RESEARCH INSTITUTE FOR TROPICAL MEDICINE 32 SAFETY

33. 33 RESEARCH INSTITUTE FOR TROPICAL MEDICINE POINTS FOR CONSIDERATION 23 private institutions – 23 different scenarios, situations, challenges –No work flow yet from specimen collection to disposal –No dedicated POC testing equipment –Facility layouts, POC lab not yet established –No dedicated BSC –No dedicated supplies, PPEs –Et cetera 33

34. 34 RESEARCH INSTITUTE FOR TROPICAL MEDICINE IDEALNO DEDICATED BSCNO BSC/POC ROOM Established “POC” lab adjacent to isolation rooms. Do all procedures in the dedicated BSC (POC testing, specimen handling, processing, packaging) wearing full PPE Dedicated supplies and materials Work flow considerations Buddy system Waste management/lab decontamination procedures Do all procedures in the BSC (POC testing, specimen handling, processing, packaging) wearing full PPE Dedicated supplies and materials Consider general lab work flow Full decontamination before using for other procedures Buddy system Waste management/ lab decontamination procedures Minimize lab testing If lab will perform POC testing, staff should wear full PPE and there should be adequate and dedicated space in the isolation room Only perform testing if you have the supplies, training and staff can do so safely (confidently) Minimize/NO aerosol generating procedures Buddy system Waste management/ decontamination procedures 34 If we cannot assure safety of the medical technologists, do not do the procedure.

35. 35 RESEARCH INSTITUTE FOR TROPICAL MEDICINE POINTS FOR CONSIDERATION Hospitals encouraged to do a risk assessment and come up with hospital preparedness plan Do include the laboratory staff in your discussions –Needs (equipment, training, supplies, number of staff) –Concerns (ensuring IPC, integration to work flow, roles and responsibilities, fears) –Capabilities and Limitations 35

36. 36 RESEARCH INSTITUTE FOR TROPICAL MEDICINE 36

37. 37 RESEARCH INSTITUTE FOR TROPICAL MEDICINE 37

38. 38 RESEARCH INSTITUTE FOR TROPICAL MEDICINE 38

39. 39 RESEARCH INSTITUTE FOR TROPICAL MEDICINE 39

40. 40 RESEARCH INSTITUTE FOR TROPICAL MEDICINE 40

41. 41 RESEARCH INSTITUTE FOR TROPICAL MEDICINE 41

42. 42 RESEARCH INSTITUTE FOR TROPICAL MEDICINE 42

43. 43 RESEARCH INSTITUTE FOR TROPICAL MEDICINE 43

44. 44 RESEARCH INSTITUTE FOR TROPICAL MEDICINE 44

45. 45 RESEARCH INSTITUTE FOR TROPICAL MEDICINE 45

46. 46 RESEARCH INSTITUTE FOR TROPICAL MEDICINE 46

47. 47 RESEARCH INSTITUTE FOR TROPICAL MEDICINE NEXT STEPS FOR REGIONAL LABS Follow through with the hospital laboratories –Workflow assessment –Laboratory assessment Refresher training Training of trainors 47

48. 48 RESEARCH INSTITUTE FOR TROPICAL MEDICINE NEXT STEPS FOR SNLs Legal mandate and operational support mechanisms Training of SNL laboratory staff on PPE and laboratory biosafety Training on inactivation procedures Training on realtime PCR Build capacity for serologic testing 48

49. 49 RESEARCH INSTITUTE FOR TROPICAL MEDICINE 49