RESEARCHERS from the University of Santo Tomas published a review article recently that may address the problem of cross-contamination of Covid19 testing facilities in the country.

In the article posted on the Philippine Journal of Pathology, UST’s Professor Pia Marie Albano, Faculty of Medicine and Surgery’s Kin Israel Notarte and Imee Macaranas and Philippine Genome Center’s Benedict Maralit said that the rapid growth of testing centers in the country and the shortage of a trained clinical laboratory workforce resulted in the hiring of personnel with limited training in handling and processing samples.

“Remarkably, within 200 days from announcement of the first confirmed Covid-19 case in the Philippines in January 30, 2020, the country has been able to expand its testing capacity from one national reference laboratory, the Research Institute for Tropical Medicine, to more than 100 licensed reverse transcription-polymerase chain reaction and cartridge-based PCR laboratories across the country,” the researchers said.

They warned that the explosion of testing centers poses a threat.

“Due to the shortage of trained clinical laboratory workforce, diagnostic centers are forced to hire additional personnel who have limited experience and technical knowledge and skills of molecular assays, especially in processing specimens, interpreting the results, identifying errors, and troubleshooting, in order to meet the demand of increased testing,” the authors said.

Because of this, they said, “vulnerability to diagnostic errors, including cross-contamination, is increased.” The researchers added that these errors, like false positive or false negative results, could disrupt public health policies and programs aimed at curbing the virus. These errors could also compromise the health of the patients.

To address these problems, the authors grouped their suggestions into two major categories — specimen handling and analytical issues.

“When collecting specimens, it is important to properly identify the sample, collect adequate amount or volume as well as practice standard protocols in the transport and proper storage of biological materials to be tested,” the researchers said.

They said that medical frontliners must strictly adhere to the recommended testing protocols.

“For healthcare providers…proper infection control must be observed. Prior to specimen collection, all PPEs must be sanitized and worn following the proper sequence. When wearing gloves, it is important to cover part of the forearm while assuring that they remain under the sleeves to minimize skin exposure. Using a  second pair of gloves may also be done to cover part of the sleeves. PPEs, including the gown, FFP2 (N95), goggles or face shield, and gloves must be worn all the time. Male health workers are also advised to shave in order to obtain an adequate mask’s adherence to the face,” they said.

The researchers acknowledged that the increasing number of Covid19 cases and high demand in confirmatory diagnostic testing puts “severe pressure” and high workload on healthcare providers. However, the researchers said that healthcare providers must always follow the guidelines of the World Health Organization and the Department of Health on how to operate local Covid19 testing centers.

“This sets the standard to make sure that tests are reliable, and to promote the safety of those operating the laboratory,” they said.

“It is also worth noting that cross-contamination in the laboratory may not be the only cause of unreliable results. In the early stage of the Covid19 pandemic, a delay in testing in Europe was caused by contamination in the test kits. This problem was  also experienced by the Philippines when locally made test kits were found to have contaminated reagents,” the researchers said.

“The Covid19 pandemic has caused a global public health emergency. Although  efforts have been made to prevent the spread of the disease, there is still an  increasing number of cases each day. Reliable diagnosis through RT-PCR testing  plays an important role in the management of the disease. Thus, it is essential to  avoid any cross-contamination when handling biological specimens from patients.” the researchers concluded.

The full article can be accessed through the link: https://philippinejournalofpathology.org/index.php/PJP/article/view/191/291.