Commercial Labs React To Ontario SARS Outbreak

Canada’s largest laboratory company swiftly responds to fast-moving disease

CEO SUMMARY: Ontario’s SARS outbreak has affected commercial laboratory companies in the province. Because so many healthcare workers were contracting SARS, laboratory directors at MDS Diagnostic Services took swift action to protect both patients and laboratory staff—to prevent exposure and transmission of SARS as well as to insure that no labs would be lost because of quarantines.

COMMERCIAL LABORATORY FIRMS in the Canadian province of Ontario found themselves on the front lines of the effort to control the province’s outbreak of SARS (severe acute respiratory syndrome).

“The SARS challenge facing us has been immense,” said Chuck Frosst, Vice President of Operations and General Manager of MDS Diagnostic Services’ laboratory operations in Ontario and Quebec. “First, we are dealing with a disease about which little is known. Second, the laboratory operations of MDS in Ontario are extensive, so we needed to work quickly to insure that our healthcare team and the patients we serve were protected.”

Infecting Healthcare Staff

“Another dimension of the SARS out- break gave us added concern,” declared Frank Thompson, M.D., Medical Director for MDS Diagnostic Services in Ontario. “Unlike the early outbreaks of Legionnaire’s disease, which involved only individuals from the community, the Toronto SARS outbreak was infecting healthcare workers first.

“Because our laboratory actively serves healthcare providers throughout the province,” he continued, “we needed to protect our staff and patients from the disease. We also needed confidence that our laboratory activities did not, unintentionally, expose anyone to SARS.”

Frosst and Thompson do not understate the challenge of meeting these objectives. About one-third of the population of Ontario is served by some part of MDS Diagnostic Services’ laboratory infrastructure.

Within the province, MDS provides direct testing services to physicians’ offices, manages a number of hospital laboratories, performs send-out testing for many hospital laboratories, and has hospitals perform tests for it. MDS maintains an extensive network of patient service centers (PSC), and provides phlebotomy services for home healthcare.

“Province-wide, we collect, transport, test, and transfer laboratory data to all segments of the healthcare system,” noted Frosst. “Because we go everywhere and interact regularly with hospitals, physicians, and patients, it is imperative that our response to SARS be effective. Any lapse or flaw in our performance might expose someone to SARS.”

Threat To Public Health

“SARS is a public health threat,” said Thompson. “When the outbreak in Toronto was first recognized last month, we immediately organized what we called the ‘business continuity team.’ Meeting daily, it has representatives from each area of laboratory operations.

“This team recognized the need to take three distinct actions. Each was effected in rapid-fire sequence,” noted Frosst. “Remember, our management strategy was protection—protect patients and protect our staff.”

“Our first priority was to communicate to physicians. It was critical that any patient showing symptoms common with SARS not come to our patient service centers,” explained Thompson. “We used our electronic links, courier system, and direct phone calls to educate physicians about SARS and notify them that, if they had a patient fitting this definition, to contact us by telephone. We respond to that patient’s needs in a setting that protects both the patient and the phlebotomist.

Prevent Exposure

“Effectively, we were going upstream to turn off the tap to prevent possible SARS patients from going into our PSCS, sitting in a waiting room, and exposing other patients and lab staff,” noted Frosst. “We took these steps even before the public health sector had turned their attention away from hospitals and toward physicians’ offices.

“Our next priority was to ensure that patients were handled in a manner that protected them from exposure and protected our laboratory staff from exposure,” said Frosst. “This was essential, because it preserved our ability to respond to the community’s needs. If any lab worker is exposed, we lose their services for the ten days of their quarantine. We did this in several phases.

“In the first phase, we made sure they had the right protection,” he explained. “Anyone seeing a patient suspected of having SARS, at a minimum, wears gloves and an N-95 mask.

“Our next phase was to secure adequate supplies to maintain protection for our staff,” noted Frosst. “We contacted suppliers in Canada, the United States, and Europe. We secured enough supplies to guarantee that all our PSCs would be fully protected through the course of this outbreak.”

Reassure Laboratory Staff

The third phase of this project was to educate and reassure the laboratory staff. “With a disease like SARS around, laboratory staff has valid questions. ‘Do I come to work?’ ‘Am I safe at work?’ ‘Can I be exposed to SARS at work?’ Remember, newspapers and TV news were full of stories about healthcare workers contracting SARS,” Frosst observed.

“We conducted employee education and meetings,” he said. “We did a video, established a telephone hotline, provided Web-access to information, and gave updates at the same time every day.

“We also helped our staff understand how to conduct business while minimizing the risk of exposure,” stated Thompson. “These were little things, like having smaller meetings, meeting off site, restricting access to facilities, and increased use of teleconferencing. Because many people chose to work in the laboratory to provide healthcare services to others, our laboratory staff was very responsive to these efforts. They understood the importance of maintaining work flow, while reducing the chance that disease might be transmitted.”

“There is also the need to test specimens from diagnosed SARS patients,” stated Thompson. “Although SARS testing is done by public health laboratories, routine testing work on these patients must continue. We reinforced the need to follow existing protocols, which should already be in place in a well-run laboratory.”

Restricted Access To Lab

“We also instituted restricted access into the laboratory, similar to what hospitals are doing at entry,” added Frosst. “Our staff signs in daily, has their temperature taken, and, if they have traveled to areas of known SARS outbreaks, they don’t come into the laboratory for ten days.

“Our couriers have the same protection as is required in hospitals, including gloves and N-95 masks,” continued Frosst. “They go through each hospital’s screening process and are screened again at our lab. They may be screened as often as 12 times each day.”

Effective Response

To date, MDS’s management response to the SARS outbreak has been effective. “We know several instances where our staff have been in contact with SARS patients,” stated Thompson. “In each case, these were protected sessions and infection did not result. In fact, public health authorities state that no healthcare worker who was properly protected has contracted SARS. That gives us and our laboratory a high degree of confidence as we go about our work.”

Lab directors and pathologists at MDS plan a post-outbreak review to identify changes that would improve their laboratories’ protection. “One insight is that the design of our laboratories may need changing,” stated Frosst. “We intend to rethink high ceilings, open lab spaces, and other aspects of our facilities’ designs.”

Overall, Frosst and Thompson give their laboratory staff high marks for an effective response to SARS. “Neither we nor our healthcare system can afford to lose any of our laboratories to quarantine,” noted Thompson. “It’s why we describe our protection process as ‘shrink wrapping’ our labs. Laboratories are a frontline defense and must always be ready to continuously provide diagnostic services.”

Update to Ontario’s SARS Outbreak

PUBLIC HEALTH AUTHORITIES in Ontario are watching closely to see if they have the SARS outbreak under control.

As of as last Friday, the Ministry of Health reported the total number of suspected or probable cases of SARS in the province was 217. This was an increase of 11 over the previous day. Ten deaths have been attributed to SARS in Ontario. For all of Canada, suspected and probable cases total 266.

Public health officials were closely watching the number of new cases daily. They are hoping to contain the outbreak in its “third ring.” The main containment strategy emphasizes control of potential exposure of staff and patients in hospitals, believed to be the primary source of “second ring” infections.

News reports in Toronto indicate that health officials believe that SARS is likely to permanently change how hospitals in the province treat certain types of patients.

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