COVID-19 - recommendations for laboratory work

The guidance has been approved by NHS England and NHSI  as a guide to prioritisation of resources during this time of unprecedented emergency. The clinical input has been collated and coordinated by Jo Martin, President of the Royal College of Pathologists (RCPath) with input from the IBMS,  Association of Clinical Biochemistry and Laboratory Medicine (ACB) and the Association of Clinical Pathologists (ACP).

Aims and objectives

Pathology services must be in a position to continue to support clinical services over the coming difficult period. Many laboratories have already reviewed their work in order to safeguard core services whilst moving to minimal staffing levels to promote resilience and social distancing. This document outlines a range of measures that laboratories can use to prioritise work, to release staff, facilities, equipment and reagents to cope with the viral outbreak and maximise SARS-CoV-2-19 testing capacity.

1. There is significant unwarranted variation in laboratory testing, identified by the Getting it Right First Time Programme. A reduction in non-essential testing, and unnecessary testing, is a pre-requisite to release staff, and should be implemented without delay.
    
2. In general, tests which are not essential to managing a patient’s condition safely should be stopped. For example, mild infections can often be treated empirically without the need for confirmatory microbiology. Many other laboratory tests can be deferred. This document provides a guide for local tests that could be high priority for review, and laboratories can use this document to provide the necessary permission to accelerate these decisions.
    
3. Plans should be made to explore the potential for multi- disciplinary working within pathology and utilising staff from other areas (in a support role) to ensure service continuity.
    
4. All laboratories should review the measures outlined in this document and undertake a local review of activities. Where appropriate, but within a competency framework, flexibility of staff between the different disciplines should be reviewed locally.

Recommendations

The guidance sets out 20 recommendations that should be considered urgently, by all Pathology Laboratory and Clinical Pathology providers, working with primary care, community and acute care providers, including NHS and Public Health England. 

They include:

Respiratory Virus Testing
Stop routine testing for influenza viruses and other respiratory viruses.  

Reduce and refine drug resistant organism screening 
Reduce and refine MRSA screening, especially if multiple body sites are being screened, to save capacity.

Swab specimens
Genital and wound swabs should be reconsidered for reduction and refining.

Faecal specimens
In some instances, reduce faecal microscopy and stop the routine culture of non-bloody faecal samples from primary care.

Urine specimens
Clear urine samples should not undergo laboratory testing. 

Sputum specimens
Sputum samples that are non-purulent should not undergo routine culture.

Routine mycology testing
In most cases, this can be stopped.

Environmental microbiology 
If engineering control deemed satisfactory, temporary cessation of microbiological assessment may be considered.

H pylori antigen and antibody testing
In most cases, this can be stopped.

Reducing blood science testing
There is currently a reduced GP and outpatient testing volume, as reduced face to face visits are taking place.

Allergy testing
Not a priority at this time unless there are overriding clinical indications.

Newborn and Antenatal Screening Programmes
Newborn and antenatal Screening Programmes must continue.

Cancer Screening Programmes
Symptomatic cases to be prioritised as usual, whilst all Cancer screening programmes for breast, bowel and cervical cancer to be deferred and HPV screening capacity to be diverted to a smaller number of centres.

Genomics testing
The genomics implementation unit has issued guidance for the prioritisation of testing

Routine andrology testing
Routine infertility testing of semen should be deferred for 3-6 months in the first instance whilst post vasectomy testing of semen should be continued.

Turnaround times for batch testing
Certain specialist tests and batch tests which could, with minimal risk, move to less frequent testing. Laboratories should review the possibility of consolidating more complex tests on fewer sites.

Lab to Lab electronic connectivity 
Connecting labs to avoid repeated data entry and data transcription and allowing end to end transmission of results to patient records is a priority. 

Minimum retest intervals
All organisations should follow the guidelines related to RCPath minimum retest intervals to avoid over testing.

The guidance also contains an assessment that each of the recommendations is likely to have on the laboratory workforce and patients. 

Allan Wilson, IBMS President, said: 

"It is vital to provide our members with the guidance they need to continue to support clinical services during the COVID-19 pandemic. I am grateful to Jo Martin, President of the Royal College of Pathologists, for leading on this guidance document and proud of the contribution the Institute has made.

Producing this information in a short period of time, is testament to the close working relationship we have with other laboratory professional bodies. I hope that you find this guidance helpful and please do share with laboratory colleagues everywhere"

Whilst these recommendations have been agreed by the Pathology and Laboratory Medicine professional bodies, local Pathology Laboratories are asked to review their current local practices and if other local services can be reduced and refined then a local assessment should take place.

Read the guidance document in full

Joint guidance for pathology testing prioritisation