Feasibility for SARS-CoV-2 tests in the hospital: an Exposure Analysis and Critical Control Points approach
CUI Zelin1, Sebastian Leptihn2, LI Mingyue3, GUO Mingquan4, GAO Jing5, LI Qingtian6, ZENG Lingbing7, ZHOU Yuhua8, WEI Yanxia9, GUO Xiaokui10, Nigel Temperton11, FENG Tingting12
1. Department of Laboratory Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China; 2. Zhejiang University-University of Edinburgh Institute (ZJU-UoE), Zhejiang University, Haining, 314400, Zhejiang Province, China; 3. Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104, USA; 4. Shanghai Institute of Phage, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China; 5. Department of Clinical Laboratory, Obstetrics and Gynecology Hospital, Fudan University. Shanghai, 200011, China; 6. Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China; 7. Department of Clinical Laboratory, the First Affiliated Hospital, Nanchang University, Nanchang, 330006, Jiangxi Province, China; 8. Department of Emergency Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; 9. Department of Pathogenic Biology and Immunology, Xuzhou Medical University, Xuzhou, 221004, Jiangsu Province, China; 10. Key Laboratory of Parasite and Vector Biology, Ministry of Health, China; School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China; 11. Viral Pseudotype Unit, Medway School of Pharmacy, University of Kent, Chatham, Kent, ME4 4TB, United Kingdom; 12. Department of Clinical Pharmacy, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201620, China
Abstract：This work aims to assess the feasibility of performing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA tests in hospitals and communities experiencing coronavirus disease 19 (COVID-19) outbreaks, to ultimately provide recommendations for hospitals with so-called fever clinics. In China, these specialized clinics within a hospital specifically receive outpatients with fever symptoms. A team with expertise in the Exposure Analysis and Critical Control Points (EACCP) framework identified potential infection routes during the testing for SARS-CoV-2, then constructed and tested flow diagrams, which were confirmed under actual conditions, demonstrating the feasibility to carry out in hospitals with fever clinics. The team determined critical control points to mitigate the exposure risks at each control point. The sampling and inactivation steps of clinical samples in fever clinics appeared to be associated with particularly high-risk levels of exposure to SARS-CoV-2. Moderate exposure levels were associated with storage and transportation of samples for inactivation. Low-risk levels associated with the transportation, storage, and detection steps after inactivation. To minimize infection risks for personnel, we proposed optimized processes to carry out SARS-CoV-2 RNA tests in hospitals with fever clinics in China. The high risk of SARS-CoV-2 exposure during procedures preceding testing is the sampling and biological inactivation. Simultaneously, full personal protective equipment and biosafety level-2 (BSL-2) laboratories in fever clinics or mobile BSL-2 laboratories could reduce the risk. Implementing the EACCP framework could facilitate rapid responses to outbreaks of emerging infectious diseases.
崔泽林，Sebastian Leptihn，李明月，郭明权，高晶，李擎天，曾令兵，. 基于暴露分析与关键控制点方法对医院开展严重急性呼吸综合征冠状病毒 2 型检测的可行性研究[J]. 微生物与感染, 2021, 16(1): 26-36.
CUI Zelin, Sebastian Leptihn, LI Mingyue, GUO Mingquan, GAO Jing，LI Qingtian, ZENG Lingbing, ZHOU Yuhua, WEI Yanxia，GUO Xiaokui, Nigel Temperton, FENG Tingting. Feasibility for SARS-CoV-2 tests in the hospital: an Exposure Analysis and Critical Control Points approach. JOURNAL OF MICROBES AND INFECTIONS, 2021, 16(1): 26-36.
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2021, Vol. 16 
