Laboratory Basics For High-Consequence Infectious Diseases: Safe Testing Starts With Preparation

When caring for patients with suspected high-consequence infectious diseases (HCIDs) such as Ebola, Lassa fever, Marburg virus disease, or Middle East respiratory syndrome (MERS), timely laboratory testing is essential—but it must also be performed safely.

In a recent episode of Transmission Interrupted, host Jill Morgan, RN, of Emory University Hospital speaks with Vicki Herrera, MS, Training & Education Coordinator at the Nebraska Biocontainment Unit and the University of Nebraska Medical Center, and Colleen Kraft, MD, Medical and Laboratory Director of the Emory University Hospital Biocontainment Unit and Professor of Pathology and Laboratory Medicine and Medicine at Emory University. As co-chairs of the NETEC Laboratory Workgroup, Herrera and Kraft share practical guidance on how healthcare facilities can safely perform essential laboratory testing while protecting laboratory personnel, supporting clinicians, and ensuring patients receive timely care.

Key Takeaways
Start with the Essential Laboratory Tests

When evaluating a patient with suspected HCID, laboratory testing should focus on the diagnostics needed to guide immediate clinical care—not routine “draw everything” approaches.

Essential laboratory testing often includes:

• Complete blood count (CBC)
• Basic metabolic panel (BMP/Chem 7)
• Malaria testing for patients with a relevant travel history
• Urinalysis and pregnancy testing, when appropriate
• Blood gas analysis for critically ill patients

Limiting testing to clinically necessary diagnostics reduces unnecessary specimen handling while still providing the information needed to make timely treatment decisions.

Why More Testing Isn’t Better
Many clinicians are accustomed to “drawing a rainbow”—collecting multiple tubes for potential future testing. While this is common practice in many emergency situations, it is not appropriate for suspected HCID cases.

Every additional specimen increases handling and potential exposure risk, and not every test can be safely performed. Instead, facilities should prioritize the tests that are essential for immediate patient management.

Safe Testing Supports Better Patient Care
Patients with suspected HCIDs often experience complications such as electrolyte abnormalities, dehydration, kidney injury, or bleeding that may require urgent intervention.

Delaying or withholding necessary laboratory testing may prevent clinicians from identifying and treating these life-threatening complications. Healthcare facilities should plan ahead so essential testing can be performed safely whenever needed.

Every Laboratory Should Start with a Risk Assessment

Before testing specimens from patients with suspected HCIDs, laboratories should conduct a facility-specific risk assessment that considers:

• Potential exposure risks
• Laboratory workflow and environment
• Equipment used for testing
• Staffing and operational considerations

The question isn’t whether testing can be performed—it’s how testing can be performed safely within the capabilities of the facility.

Risk Mitigation Looks Different at Every Facility

Once risks have been identified, laboratories can implement mitigation strategies such as:

• Using biosafety cabinets
• Adding engineering controls
• Modifying workflows
• Limiting the number of personnel handling specimens

There is no one-size-fits-all approach. Every laboratory must develop processes that align with its own environment, equipment, and staffing.

Point-of-Care Testing Can Improve Safety

Point-of-care (POC) testing can be an effective strategy for reducing specimen handling while providing rapid results.

Compared with testing in a core laboratory, some portable point-of-care analyzers can be used at the bedside and, depending on the device, certain analyzers may also be operated inside a biosafety cabinet, reducing specimen handling and opportunities for exposure.

However, point-of-care testing must still meet all regulatory and quality standards for validation, training, and competency assessment.

Specimen Handling Begins at the Bedside

Safe laboratory testing starts before a specimen reaches the laboratory.

Healthcare personnel collecting specimens should:

• Clean specimen tubes and containers before transport
• Use appropriate labeling – remember Date/Time/Initial
• Perform hand hygiene
• Ensure containers are free of external contamination

These simple steps help protect laboratory personnel by reducing unnecessary exposure and preventing avoidable risks from being passed downstream during specimen handling.

PPE and Safe Laboratory Practices Matter

Appropriate PPE may include:

• Fluid-impermeable gowns
• N95 respirators
• Face shields or eye protection
• Double gloves

Equally important are safe work practices, including:

• Working within biosafety cabinets whenever appropriate
• Keeping contaminated materials inside containment areas
• Changing gloves frequently
• Avoiding unnecessary contact with your face or the environment

Regular training, drills, and the use of trained observers help staff maintain these skills before an actual event occurs.

Communication Is Essential
Safe laboratory testing depends on early, ongoing communication between emergency and clinical providers, laboratory leadership, infection prevention, emergency management, and safety teams.

When these groups work together before a patient arrives, they can:

• Align expectations for laboratory testing
• Establish safe specimen workflows
• Ensure appropriate staffing, equipment, and PPE are available
• Reduce delays in patient care

Strong communication helps laboratories prepare in advance so they can safely support clinical decision-making during an event.

Healthcare organizations should establish multidisciplinary plans before an HCID event occurs. Planning should address:

• Which laboratory tests are considered essential
• Validated equipment and testing methods
• Staff training and competency verification
• Safe specimen workflows
• Partnerships with reference or larger laboratories when additional testing is needed

Because laboratory testing is highly regulated, facilities should avoid introducing unfamiliar equipment or unvalidated tests during an event. Instead, procedures, training, and competency assessments should be established well in advance.

Bottom Line
Safe laboratory testing is a critical component of caring for patients with suspected high-consequence infectious diseases. By focusing on essential diagnostics, conducting facility-specific risk assessments, strengthening communication between clinical and laboratory teams, and preparing workflows in advance, healthcare facilities can protect staff while ensuring patients receive the timely, life-saving care they need.