Date of session: 3/31/2022

CHELSEA PARSONS: Welcome, everyone. Good morning, afternoon, evening, wherever you’re joining us from, thank you for joining. We’re going to go ahead and get started. My name is Chelsea Parsons and I’m a consultant with Guidehouse supporting the CDC OneLab Initiative. Just a couple of notes about the webinar before we get started. If you’re having any technical issues throughout, feel free to email the OneLab Inbox, and that’s onelab@cdc.gov, and that’s onelab@cdc.gov.

If you have questions throughout the session, please insert them into the Q&A function below. You’ll see it in the little panel bar at the bottom of your screen. It says Q&A. We’ll be taking in all the questions through that Zoom Q&A function. And we’ll have some dedicated time at the end of the training where you can input additional questions and we’ll try to get to a Q&A today, we’ve got a lot of content for you to get through.  

If you’re in need of some closed captions for today’s event, we’re going to post them in the chat right now. The one thing to note that is if you are going to use those closed captions, please make sure you open them in a separate browser and you also have Zoom pulled up, too. So let’s go ahead and open up our agenda.  

So today we’re going to start by introducing our guest speakers. We’ll go through some OneLab resources related to this topic, and then we’ll begin the main training. And we’ll have a little bit of Q&A at the end if there’s time, and our sessions today will end with the discussion of our upcoming OneLab events.  

So additionally today, we’re going to be using a tool called Mentimeter to do some knowledge checks throughout. And Mentimeter is an external browser app. So you’ll need to open up a new browser on your computer or you can scan this QR code right now with your phone. You can use Mentimeter in your computer browser or on your mobile device.  

So if everyone wants to go ahead and practice Mentimeter right now, if you follow the instructions on the screen, go ahead and open it up, enter that code. If you use the QR code, it’s already going to be pulled up into our Mentimeter session. And I’m going to go ahead and pull up Mentimeter and we’ll just do a practice question all together. So let’s get this on the screen here.  

So go ahead and answer this question. The instructions are still at the top of the screen here, so you’ll go to Menti.com and use the code 39822502. And it would help if I open up the voting. So go ahead and insert your answers now, you should be able to answer. And we’re getting some answers in. Vanilla, chocolate, strawberry. Now I’m getting hungry.  

All right, great. So it looks like we’ve got a lot of users entering these answers. So please keep that Mentimeter tab open through the rest of the presentation, there’s going to be a couple of knowledge checks where we’ll use it again. So let’s get back into our introductions here. All right. So I’d like to begin by introducing our guest presenters.  

Before I do so, I want to let everyone know that we are offering one P.A.C.E. Credit for this webinar. We’ll give you some more information about that at the end of the session. We’ll drop a link in the chat, and then you’ll need to complete the evaluation that’s within the link within two weeks of today. So we’ll drop that information again. You’ll also be receiving this information in an email after this session.  

So let me go ahead and introduce our presenters today. So as always, we have Triona Henderson-Samuel on the line. She’s a board-certified and clinical laboratory subspecialty trained physician and pathologist. She’s directed hospital-based clinical laboratories and has a passion for patient safety and laboratory quality improvement. And she’s currently a public health physician in the CDC, and she represents our OneLab Network.  

And then our guest speakers today are Sabrina DeBose. She is the safety team lead in the Division of Laboratory Systems, Quality and Safety Systems Branch at the Center for Disease Control and Prevention. She proudly serves in the United States Public Health Service Commission Corps as a commander. She has over 18 years of combined experience in bio risk management, regulatory compliance, emergency preparedness, and program management.  

She’s been a valuable member of the Quality and Safety Systems Branch Safety Corps Team where she serves as biosafety subject matter expert. She’s a registered biosafety professional with the American Biosafety Association.  

And second, we have Alicia Branch. She’s a health scientist safety specialist in the Division of Laboratory Systems, Quality and Safety Systems Branch at the CDC as well. Dr. Branch has more than 20 years of professional experience as an academic researcher and she served in various roles in clinical laboratory.  

She supported three pandemics, including serving twice during the current pandemic as the External Biosafety SME, and as the Laboratory of CDC’s Infection Prevention and Control Team. She’s been performing waived point of care antigen testing in three nursing home facilities. So I’ll now pass it over to Dr. Henderson-Samuel from CDC’s Division of Laboratory Systems.  

TRIONA HENDERSON-SAMUEL: Thank you so much, Chelsea, for the introduction, and good afternoon to everyone. So before we get into the main presentation, I’d like to take a moment to orient you to some of our relevant resources. So firstly, the Laboratory Outreach Communication System, LOCS, is managed by the Division of Laboratory Systems in the Center for Surveillance Epidemiology and Laboratory Services or CSELS.  

So currently, the LOCS is a functional CDC mailbox which you can email at locs@cdc.gov. That’s L-O-C-S-@-C-D-C-dot-G-O-V. Designed to provide updates and answer questions from clinical laboratories through coordination with professional organizations, CDC programs, and state public health laboratories.  

The mailbox is managed and monitored by DLS staff and is active during regular business hours. Information and updates are sent to clinical laboratories through professional organizations. This system is available to other CDC programs and may also be used during emergency responses to disseminate information in collaboration with CDC Joint information Center and the Emergency Operations Center. The link is now going to be dropped in the chat for you to access. Next slide, please.  

The Ready? Set? Test! is a training that will help to assure the testing personnel have the basic training necessary to safely and accurately perform patient testing waived under the Clinical Laboratory Improvement Amendments of 1988 or CLIA. After viewing this training module, participants will understand that waived testing can produce inaccurate results and that these results could adversely impact patients.  

There are many things that they can do, however, to minimize the risk of inaccurate testing. The learning objectives itemized several specific things that a participant will be able to do as a result of this training, and we’re now also dropping the link to register for this training. Next slide, please. The Center for Disease Control and Prevention, Division of Laboratory Systems is approved as a provider of continuing education programs in the clinical laboratory sciences by the ACLS P.A.C.E. program.  

Today’s webinar is approved for 1.0 contact hours of P.A.C.E. credit. Instructions for obtaining P.A.C.E. credit through CDC Train will be provided at the end of this webinar before we get to the Q&A section if we have time for the Q&A, but we will give you the details at the end. As a reminder, today’s audio, transcript, and slides will be posted online afterwards. You will also have access to the hyperlinks of the existing resources.  

Additionally, my team and I will be monitoring the Q&A section in case you have any questions throughout the presentation. Now I’m going to hand it over to Dr. DeBose and Dr. Branch to take us through this training session.  

SABRINA DEBOSE: Hi, everyone. Thank you, Triona, much appreciated. I want to say welcome to the Waived Point of Care Testing Basic Virtual Training webinar. That’s a mouthful, but I want to say welcome. Next slide, please. So our objective for this training, we aim to share the basic safety procedures and quality management practices to assist non-traditional testing personnel with ensuring testing is performed safely and results are accurate at point-of-care testing sites that conduct respiratory tests.  

After completion of this training, participants will be able to describe the basic safety procedures and the importance of quality control and point-of-care testing. You’ll also be able to identify major considerations that impact workplace set up, testing workflow, and hazardous waste management at point-of-care testing sites.  

There will be another opportunity for us to go into more detail on other aspects of point-of-care testing in a trainer of trainers that we will host later this year. So please keep a look out for an update on this training. Next slide, please. All right. So let’s get into it. What is point-of-care testing?  

Point-of-care tests are designed to detect disease or infection at or near the place of where specimen is collected. Point-of-care testing involves performing a diagnostic tests outside of a laboratory area, but this test produces rapid and reliable results helping to manage or identify chronic disease and acute infections. Next slide, please.  

When you think about waived point-of-care tests, some of the locations that you may consider, it can be performed in a physician’s office, at an urgent care facility, you might want to think about a pharmacy, the pharmacist conducting them, even long-term care facilities in nursing homes. Some of the more recent sites that where we’ve seen these tests being performed are drive-thru sites as well as even in parking decks. Next slide, please.  

So who performs waived point-of-care tests? Well, the test can be performed by nurses, a physician, students, technical assistants, and even store clerks. But it’s important to remember that individuals who perform waived point-of-care testing, they may not be trained laboratorians and may not be familiar with the processes involved in testing.  

So it’s absolutely important that testers must understand general safety and quality procedures to ensure accurate test results and also to avoid any possible safety issues. Next slide, please.  

So today for this training, we’re going to focus on four major areas when performing point-of-care tests. So those areas that we’ll look at today are safety and risk management, we’ll also take a look at the importance of implementing quality control at you’re testing site, we’ll also take a look at the general workflow setup and your testing workflow, and also, how to manage that waste at the point-of-care testing site. Next slide, please.  

Now we’ll take a look at how to conduct waived point-of-care tests in a safe manner and also examine the importance of implementing risk management. So here, we would like to direct you to– let’s address, what is safety? When you think about safety, it can be defined as practices used to protect the worker from harm. You want to always follow basic safety practices, which can help eliminate or reduce risk to the individual and the surrounding environment.  

If you take a look at the screen, what you’ll see is the pyramid, and we actually refer to that as the hierarchy of control. These are strategies that we use to help prioritize the types of controls that are most effective in eliminating or reducing the risk of your exposure to a hazard. So if you look at the pyramid, the first– at the very top, you will see where they addressed elimination.  

So elimination, if you think about it, is where the potentially hazardous substance or material is removed from the environment, and substitution is when the hazard is replaced. If you take a look at the center of the pyramid, which is identifying as engineering controls, it provides a barrier between you and the hazard, such as if you have a separate specimen collection area and testing processing area, or if you have a testing location that’s away from a high-traffic area.  

When we look at administrative controls, they are procedures that are put in place to minimize the impact of a hazard. So if you think about your standard operating procedures that may be at your facility that you’ve implemented for collecting specimen, another example is where procedures are in place when you have to clean your workspace. Those are administrative controls.  

Personal Protective Equipment or PPE are items that you put on to place a barrier between you and the hazard, such as when you put on that face mask. But it’s important to remember that PPE is identified as our last line of defense, and we’ll go into a little bit more detail about that in the presentation. Next slide, please.  

So why is safety important? You want to follow basic safety practices to help reduce risks to you, your coworker, participants, any customers that you may encounter, your family, and the community. You want to keep everyone safe while you’re performing point-of-care tests. So it’s always important to identify the safety concerns that’s associated with any testing and implement all safety precautions to minimize what could go wrong to yourself and also to others.  

This is done by just assessing what could go wrong in your testing workspace, which is going to help to ensure that the staff and the participants are safe. And you want to keep this in mind while you’re testing, during testing, and after testing. I should have said before you start testing, while you’re testing, and also after your testing.  

For the purpose of this webinar, we’re going to be calling those that are receiving tests participants. Now keep in mind at your site, you may refer to them as patients or clients. At the point-of-care testing, as we mentioned earlier, it can occur in many different settings. So it’s important how you identify risk. However you identify your risk will depend partly on where you work.  

So all staff that work at the point-of-care testing sites should have adequate training on safety precautions, standard operating procedures, and testing processes, along with training on any safety information that’s available, standard operating procedures to put on a face mask correctly, and also procedures that if there is an incident, how to report it and where to report it. These items should be easily accessible and posted in highly visible areas for anyone that’s working at the point-of-care testing site.  

It’s always important to check with your site supervisor for more information on any site-specific training around any safety issues or concerns and any standard operating procedures. Next slide, please. So when you’re thinking about conducting waived point-of-care testing, there are actually many things that could go wrong with performing tests that can harm the tester or those around them. And this potential danger or harm is what we consider a risk.  

So you may not consider testing risky, because this is something that you do on a daily basis. However, we want you to keep in mind that when you’re collecting specimen from individuals, that means that you’re handling something that may contain a virus or a bacteria, and this is the risk that can make you sick.  

So the viruses or bacteria that you come in contact with, they can enter your body through things that we don’t even think about on a daily basis. Your nose, your mouth, or breaks in your skin. And they can be dangerous to you and those around you. Even thinking about the chemicals and the equipment that you use at the testing sites, these can also be harmful.  

So there are risks involved from the time you start each test until the time you finish, and that’s what we want you to consider the risk in how to evaluate the risk in your area. Now here’s an opportunity to answer a question using the Mentimeter app that was announced in the beginning of the presentation.  

This is an open-ended question, so it will allow you to provide a response, and this response is based on your experience that you observed at your facility. So the question that’s on your screen is, how do you identify what could go wrong when conducting point-of-care testing? So you have about 30 to 40 seconds, and we will get you to go ahead and provide a response, and we’ll see the different responses that we get from the participants.  

And there’s our timer. And I’m just guessing that we should have different responses, because a different– I mean, you may do the same job at all the locations, however, your risk, what you identify will actually be different. Let’s see, and I think we’re going now. Let’s see. We’ll give them one or two more seconds to see if we can get those responses in.  

So maybe we can come back to that question if the Mentimeter app is not– all right, we can always go on. So then our next slide– correct. So we’ll come back to that. Technology is going to catch up with us. All right, so let’s take a look at how this is done. When you’re performing point-of-care testing, it’s important to assess what could go wrong as we discussed a little earlier. This can be done by assessing the testing workspace and identifying anything that can harm the staff or participants.  

We refer to this as conducting a risk assessment. So risk assessments are performed to evaluate what could go wrong. Never want to think about that, but it’s something that should always be in the forefront of our brain, such as if there’s an injury or an exposure. And you also want to– it helps us to identify the worst that could happen if something does go wrong.  

So this helps to identify ways that we can reduce the possibility of something going wrong and how to manage the impact if it does go wrong. Important questions to ask yourself on a daily basis when you’re performing point-of-care testing should be, what can go wrong? We identified that as our risk. We always want to know, what’s the risk? If something does go wrong, what’s the worst thing that could happen?  

We also want to identify, if it does go wrong, how can it be prevented? And if it can’t be prevented, how can the impact be reduced? So an example I’ll share with you, let’s see, if you’re at a testing site– let’s see, if you’re at your point-of-care testing site and your workspace is in a high-traffic area, that could actually increase the possibility of a virus spreading more easily.  

So some of the ways to reduce this risk would be to make sure the workspace is located in an area with minimum traffic, you may implement the use of personal protective equipment, you may also find a way to place a barrier between the participant– between the participants that are there and also the testers, and this can be done by maybe taping off the surrounding areas to make sure you have proper social distance.  

So those are all the factors that go into that risk assessment process, and that’s something that should be done on a daily basis. You want to always follow your site standard operating procedures any time you’re performing tests, and also check with your supervisor about where to find SOPs and other important risk assessment information.  

For a step-by-step guide on how to perform a site-specific risk assessment, a link to the point-of-care testing website has been placed in the chat for your reference. Next slide, please.  

So I believe– I’m looking at the screen, I believe these are the responses from the question that we asked earlier. How do you identify what could go wrong when you’re doing waived point-of-care testing? So as you can see, we have different answers, because, of course, we have different scenarios and each location is different.  

I like the one it’s Murphy’s law. Anything that can go wrong will go wrong, and that’s the whole point of learning and understanding how to do a risk assessment. Thank you for those responses. Now we’ll take a look at ways to stay safe when you’re at the facility. There’s a lot of things that you should do and don’t do, and some of the things that we want to point out that you should definitely– do not eat, drink, chew gum, apply makeup in areas where specimens are collected and testing is being performed.  

You never want to store food and refrigerators where testing supplies or specimens are stored. Never handle personal items, cosmetics, cell phones in an area where specimens are collected and tested. Some of the things you definitely want to do on a daily basis when you’re at your point-of-care testing site, you always want to know where the handwashing sinks and soap is located. You want to always review the safety information to ensure that you’re following all requirements and guidelines before, during, and after testing is completed.  

You want to always wear appropriate PPE for the procedures that you’re performing. And always clean the work areas with the approved disinfectants that’s known to kill the organisms that you’re handling. You want to be sure to use disinfectant according to the manufacturer’s instructions. Next slide, please.  

So here, we’ll take a look at the use of personal protective equipment. You may also hear it referred to it as just PPE. So PPE refers to the specific clothing, such as gloves, face shields, goggles, face mask, respirators, or other equipment designed to protect the wearer from injury or the spread of infection or illness.  

The PPE you wear should be based on a site-specific risk assessment and standard operating procedures. Now this may vary based on how and where the test or the type of test that’s being performed. And the type of PPE that you use can also help protect your body from hazards encountered in the workplace.  

Still keeping in mind with PPE, always remember that appropriate PPE should be put on– you may also hear that referred to as donned– before handling potential biological material, or doffed, which is immediately remove– I’m sorry, which is removed, which you may have referred or heard of as doffed. You want to make sure that you immediately remove your PPE after handling any biological material or specimens and replace that PPE if it becomes damaged or dirty.  

You should have appropriate training on site-specific safety precautions, including how to manage the PPE used at your testing site. Always contact your site supervisor for information on safety and PPE training. Next slide, please.  

So in this section, we will take a look at the most commonly type use of PPE at point of care testing sites. When used properly, as we mentioned earlier, PPE acts as a barrier between you and the infectious material. So there are various types of PPE that have been used to protect different areas of the body. And on the screen, you’ll see we have safety glasses, goggles, disposable masks and face shields used to protect the eyes, we identified the PPE that’s used to protect the respiratory system.  

There’s also PPE that’s designed for the body, which is a gown. We have PPE that’s designed to protect your hand, which is most commonly used, nitrile or latex gloves. And also, PPE that’s designed to protect your feet. So the PPE may vary based on your role and your responsibility. So for example, your role may be to collect the specimen, and so in that case, you may wear an N95, a face shield, gloves, and gown.  

Someone else’s role could be to test the specimen. So they may wear disposable masks, gloves, and gown, or just a disposable mask and gloves that’s based on the facility’s recommendation. PPE may also vary based on your location. If you’re collecting and testing in the same area and that’s done by the same person, then you may actually use the same N95 face shield, gloves, and gown.  

If PPE and testing are done in different locations within the facility and the specimen must be transported, then you may require a disposable face mask, gloves, and a gown. So it does vary, it does vary based on your location and the type of work that you’re doing.  

In this slide right here, we’ll talk about PPE and how it is designed to protect the various areas of the body that we touched on just a little bit in the slide before. So we’ll show you the face and eye protection. It does help to protect your face and eyes from any flying objects, droplets, and splashes.  

When you have on a face shield, it does protect the nose and the mouth from most exposures, except for if you’re working with aerosols. And we would recommend, respiratory protection is a better PPE option if that’s the case. We’ll take a look at respiratory protection as well. It protects you from exposures to droplets generated during routine procedures.  

Examples of a standard operating procedure that generate aerosols are if someone is sneezing and coughing. Let’s examine hand protection. And we identified hand protection is as latex or nitrile gloves. Those are the ones that are most commonly used at the point-of-care testing sites, and they protect your hands from exposures to hazardous material and reduce the risks associated with skin contact. So it’s important to verify that gloves are correct– that the gloves that you’re wearing or the correct size and type for the work that you’re performing.  

Now let’s take a look at our body protection. When you think about your body protection, it helps to shield the body from hazards in the workplace, such as if there are splashes, chemicals, infectious body fluids, or any other hazardous material. And we will examine foot protection. It helps protect your feet from splashes and chemicals.  

It’s important that you wear– your entire foot is enclosed and protected. So it’s important to also understand how to use PPE, how to recognize its limitation, how to put it on, which is donning, take it off, doffing, and how to maintain it properly. Always refer to your site-specific SOP and supervisor for more information about what PPE is available for use and instructions on how to put it on and remove it correctly. For more information on putting on and taking off PPE, a link to a video has been provided in the chat. Next slide, please.  

Now here’s an opportunity for us just to go through, summarize what we’ve learned in the safety section of this presentation. It’s important to understand how to use PPE, how to recognize its limitations, put it on, take it off, and always remember to check with your supervisor and review any SOPs for any additional details on PPE usage.  

You want to identify any safety concerns associated with testing, and make sure you implement safety precautions to minimize the risk to yourself and to others. Now we will open up the Mentimeter browser for a couple of safety checks. So you have a few seconds to provide your response as the Mentimeter that we used earlier.  

So I have a couple of questions for you. Some are multiple-choice, some may be true-false. The first question. What is the first question you should ask when assessing risks at your point-of-care site? And if I had some Jeopardy music, I would play it for you. But we’ll give you 30 seconds to provide a response.  

All right. I see those answers coming in. All right, and they’re coming. Maybe three or four more seconds. All right, well, it looks like majority of you said the right answer. So that first question we should always ask is, what can go wrong? It’s very important. And thank you for providing your response.  

Now we’ll move on to the second question. So this is a true-false question. And the question is, you should handle personal items, such as cell phone in the areas where specimens are collected and tested. The question is, you should handle personal items, such as cell phones, in the area where specimens are collected and tested. True or false?  

So it may not be on the screen, but I could feel you all answering it in your head, and what we’ll do, we’ll go ahead and move on. And I majority– or if– everyone on the call answered false, You. Should not handle personal items such as cell phones in the area where specimens are collected and tested. You should always avoid personal items when wearing gloves, especially if your hands can be contaminated. I know everyone got that question right, good job.  

All right, let’s go on to the next section, please. So here, we’ll take this opportunity to submit your question in the question-and-answer function. We will address questions later in the presentation. Next slide– well, we’re here. So now I’ll pass it on to Alicia who will provide details related to the importance of quality control.  

ALICIA BRANCH: Thanks, Sabrina.  

SABRINA DEBOSE: You’re welcome.  

ALICIA BRANCH: Good laboratory practice recommends performing quality testing to ensure that the test performs as expected and alerts the user when problems occur, such as issues with the kit or an operator error. However, note, it does not detect incorrect specimen identification or specimen that’s tested at the wrong time.  

The manufacturer’s instructions explain the controls included in the kit and the steps to perform in the QC and when to perform QC testing. Now keep in mind, not all waived tests require QC testing. Some have internal QC checks, some contain positive control and may have a built-in procedural controls. Next slide, please.  

Now if your kit has a positive control provided, it is usually performed once with each new kit. However, each test operator performs a negative control daily. You will record the positive and the negative control results using a QC log for good document control. On that log you record the initials of the person performing the test, the test date, test name, the kit lot number, and expiration date. For an example of a QC log, you can check the link in the chat.  

Now if the QC results are questionable, do not– and I’ll say it again, do not test an individual’s specimen until the QC results are corrected, and you also need to inform your supervisor. Next slide, please. Now let’s just do a quick summary of the quality control. Now to achieve the highest accuracy and reliability, always follow the manufacturer’s instructions to know if your kit requires QC testing and when to perform QC tests.  

Remember, not all waived tests require QC. You should always use a QC log for good document control. Now again, I’ll stress this again, if the QC results are questionable, do not test an individual specimen until the QC results are correct. Next slide, please. Now let’s use a Mentimeter to answer a quality control question.  

What are ways to implement quality control measures for your waived point-of-care testing? We’ll give you a few minutes. We’ve had a few issues with the Mentimeter. OK. Yes, all of those are great ways to implement QC.  

And what are examples of ways to implement quality control? Yes, those are some of the possible answers, of which we also– I saw that a lot of operators actually chose those answers. Remember, if you have any additional QC questions, to place them in the Q&A form in the Zoom. Now let’s talk about testing workflow. Next slide, please.  

Now here are some safety considerations when setting up the testing site. You want to ensure that the physical environment provides adequate storage space as well as has space for the test that you’re performing. You want to make sure that there’s a clear and safe workflow from the specimen collection area to the testing area while maintaining proper social distance during the testing process.  

You also want to make sure that the access to the area is limited to essential staff and those being tested. Your testing supplies, including your PPE, should be stored in a secure location, and all hazardous material properly disposed to minimize the risk of exposure and cross-contamination. Next slide, please.  

Now when setting up your workspace, you want to inspect all your test material, and this includes your PPE for damage, discoloration, expiration dates, and you want to let your site’s coordinator or your supervisor know if you have any damaged items. You want to lay out your supplies, it includes your manufacturing kit, manufacturer’s instructions, the kit, the test kit, you won’t have a timer if you require a timer, a tube rack is always a good idea, and if you have positive-negative controls along with the QC log.  

You want to ensure that you have enough appropriate PPE supplies as well as test kits. Now there may be additional site considerations, so you should always check with your supervisor or your site coordinator to review– and review your site-specific SOP for additional workspace setup details.  

As you can see from the picture, the specimen collection was performed in residents’ rooms. For convenience, the specimen collection items were placed on a rolling cart. Next slide, please. As you prepare for testing, you want to review and follow the manufacturer’s instructions for performing that test. Now if that test kit should– also, if that test kit should be stored at room temperature, you want to make sure that it’s stored at room temperature prior to performing the test.  

You want to disinfect the surface area where you’re going to perform the test, and you want to make sure that everyone who performs testing completes a quality control test before testing a specimen from an individual. And you also want to make sure that it’s been documented on the quality control log. Next slide, please.  

Now let’s look at some considerations for specimen collection. The first thing you want to always do is to put on the correct PPE based on your facility’s SOPs. You want to follow the manufacturer’s directions to identify the type of specimen needed, how to collect that specimen, and collect and test assessment within the approved time frame for accurate results.  

Now specimens not collected and tested within the manufacturer’s stated time frame could cause an accurate result. At a minimum, change your gloves between collecting individual specimens to avoid cross-contamination. But always check with your supervisor and review your SOP for additional PPE requirements.  

If the collection area is in the same room, you should transport that specimen into a primary steel closed tube. For example, place a swap into a clean compo tube with the individual’s identification on the tube. If the collection and the testing area are in different rooms or floors, consider placing the primary container or tube into a secondary container, such as a cooler, and then tape a biohazard label so that cooler. Additional resources for collecting specimens have been posted in the chat. Next slide, please.  

During the testing process, do not open your test content such as your cassettes, your test cards until you’re ready to start the testing process. Again, you always want to follow the manufacturer’s instructions for performing the test, including reading the results at the correct time. Remember to perform quality control testing, and if the QC fails, again, correct the issue and perform the QC again before testing a specimen.  

To avoid cross-contamination, change your glove between testing each participant’s specimen. And be sure to properly remove your gloves and discard them into the designated waste container. You then want to decontaminate the testing area after every positive test result. Next slide, please.  

After testing, you want to discard your used test content materials and do not reuse them. This also include a test card that you may have opened which you didn’t use it in the test process. You want to go ahead and discard that as well. You want to read your and record your results within the time specified in the manufacturer’s instructions, and if the results are not read within that time frame, disregard those results, you want to dispose of that specimen and collect the new specimen.  

Remember, you want to decontaminate the testing area after every positive test result and after completing testing for the day. Follow the manufacturer’s recommendations for the approved– the approved disinfectant and the proper dilution, contact time, and safe handling of that disinfectant. Next slide, please.  

So let’s just summarize the testing workflow. Always you want to follow the manufacturer’s instructions for collecting and handling a specimen, performing the test, and decontaminate the work surface. You want to limit access to the testing area, so essential staff and individuals receiving tests to minimize the risk of exposure and cross-contamination.  

You always want to use the appropriate PPE based on your facility’s SOP. And again, read and record your results within the time specified in the manufacturer’s instructions. And if the results are not read within the time frame, you want to just disregard that result, you want to dispose of that specimen and collect a new specimens. Next slide, please.  

Now we’ll answer a couple of questions for testing a workflow. What are some things you should consider when setting up a workspace for waived point-of-care testing? OK, we have a few answers coming in. OK. All of these are great answers. I did see on there, you want to find make sure that there’s– that it’s isolated with minimal traffic, you want to inspect your kits, you want to lay your testing supplies out, for example, you want to ensure the availability of your PPE.  

You also want to inspect your kits– I mean your PPE when you’re inspecting your kits. And you want to make sure that– another thing I didn’t stress, you want to make sure that you actually have enough PPE supplies for that entire day. And if you don’t, you want to make sure that if you’re going to test again the following day, that you do pre-order or replenish your supplies. Again, if you have any additional questions, you can place them in the Zoom Q&A.  

Now let’s transition into managing waste. Next slide, please. Now testing sites generate tons of waste data, therefore, it’s important to identify what is considered regular waste and what is considered hazardous waste, and how to dispose of it correctly. Hazardous waste, also commonly known as medical waste, is any item that has the risk of having infectious substances that can be transmitted. It includes, but not limited to body fluids that could be potentially infected, harmful chemicals, or any item that could damage the skin.  

Some waste generated during specimen collection and testing could be considered hazardous waste, such as a specimen that may contain a human infectious material such as a tube which saliva, your nasal swabs. Absorbent material that’s soiled with potentially infectious body fluids or soiled PPE. For example, an individual sneezes on you while you’re collecting the specimen. And yes, this has happened to me several times. Next slide, please.  

Since waste regulations vary from state to state, disposal must comply with the applicable local, regional, and national regulations. Therefore, your waste disposal guideline should follow your federal, state, local, tribal, and territorial regulation requirements. Review your site-specific SOPs and speak with your supervisor to learn more about how to handle the waste at your testing sites. Next slide, please.  

So the take-home message really for waste management is to review site-specific SOPs and speak with your supervisor. In addition, your supervisor should speak with the facility waste management contractor, your state public health– public health lab, the testing manufacturer’s technical support team to learn more about handling waste at your testing site. Links have been provided in the chat for additional waste management resources.  

Before we summarize the webinar, let’s answer a waste management question using the Mentimeter. What are items of hazardous waste– what examples of hazardous waste generated during point-of-care testing? And all of these are great. Some test device depending on what type of test you– kind of waived point-of-care test you’re using. All of these are great answers.  

Remember, if you have any additional questions, you can place them in the Zoom Q&A, and we will try to take a look at those and the end of the presentation. Now Sabrina will provide a summary of the virtual training.  

SABRINA DEBOSE: Thank you, Alicia. So yeah, we’ll go ahead and we– we know that we provided a lot of information during this training. We touched on how to work safely in point-of-care testing sites. We also discussed the importance of conducting site-specific and activities-specific risk assessment for the work that you are conducting, and the location where the work is being conducted.  

We also provided an overview of implementing quality control at your site in order to achieve the highest accuracy and reliability of testing results. We do want to take this opportunity to thank you for attending the training. But before moving to the next slide, Chelsea will provide information on how to obtain P.A.C.E. credits.  

CHELSEA PARSONS: Thank you, Sabrina, and thank you everyone for attending. So I want to give you all instructions for receiving P.A.C.E. credits for this webinar. So if you would like to receive P.A.C.E. credits, we’re dropping the link in the chat right now for you to complete the webinar evaluation to receive the P.A.C.E. credits.  

The password is P-O-C, as in point of care, T-B-1, and that password will be pasted in the chat, too. We’ll be contacting you after this event as well to send you some more information about those P.A.C.E. credits. You must complete the webinar evaluation within two weeks to receive credit and download your certificate. After two weeks you will not be able to receive credit.  

If you have any trouble receiving credit for the webinar, please contact us at onelab@cdc.gov. And I think we have time for one Q&A question, so I’m going to ask JZ to come on. JZ representing the Training Workforce Development Branch at CDC, and she’s going to ask one question we got from the audience. I’m sorry if we didn’t get to your questions, but please submit any to that email address, too, and let’s go ahead and do one Q&A question. Thanks, JZ.  

SPEAKER: Thanks, Chelsea. And great presentation, Dr. DeBose and Dr. Branch, that was really great. So I guess we only have time for one question. So looking at the Q&A, I have one here for you. Most tennis shoes have a mesh covering which really isn’t considered closed. What are your thoughts on that in terms of in the lab?  

SABRINA DEBOSE: So I don’t mind taking this one. It’s very important, like we pointed out earlier, that you definitely want to place a barrier. Protecting your feet is very important, so you want to place a barrier between yourself and any hazard. It’s highly recommended closed-toe shoes.  

SPEAKER: Great. Thank you, Dr. DeBose. I’m going to turn this now back over to you, Dr. Henderson-Samuel for closing. Triona.  

TRIONA HENDERSON-SAMUEL: Thank you, Johanson, and thank you to Dr. DeBose and Dr. Branch for the presentation. Again, we know there was a lot of content, and so we didn’t have time to get to your questions. If you’d really like them answered, please send them to onelab@cdc.gov to get a response.  

Finally, I’m sure most of these– not all of you– have received our invitation to our inaugural OneLab Summit Event. So this is a free opportunity for the OneLab Network members and laboratory professionals with education and training responsibilities in the clinical public health and academic laboratories.  

We have quite a few topics. It’s going to be three days of topics. We have tips for accessible and inclusive training, we have strengthening connections within the changing laboratory community, we have an amazing discussion, panel discussion on the future of laboratory workforce also bolstering collaboration.  

But also, we have planned two separate sessions for networking where you as a network member will be able to meet one-on-one with your colleagues and have time of discussion and sharing resources and information. This year’s summit includes presentations, facilitated discussions, and keynote speeches every single day across a variety of topics. We have representation from, of course, the CDC, the American Society for Clinical Pathology, the American Society for Clinical Laboratory Science, and a lot of your colleagues across the clinical and public health laboratories.  

So this is going to be a chance to network, to learn more about best practices, challenges, and new opportunities from your peers. We are– we have a cap– or a limit, not a cap. We have a limit of registrants. So please, please, please, if you’re at all interested or you have colleagues who are interested who are involved in education and training, please share that information with them and have them register. Thank you for joining us today and have a great day.