New Minnesota Ebola fear: Labs may balk at testing blood

Twin Cities doctors and nurses say they can safely handle an Ebola patient, but state health officials are hearing a different story from hospital labs.

Many local hospitals are telling the state Health Department their in-house clinical laboratories do not want to perform some routine blood tests on patients identified as possible Ebola cases.

Hospital leaders say they're looking for ways to ease lab workers' worries while ensuring potential Ebola patients get needed care and blood analysis. Health authorities, however, worry the labs could be a weak link in the public health chain and may compromise timely care for patients.

Concerns about the safe handling of patient blood specimens have intensified in Minnesota in recent weeks as the prospect for treating possible Ebola patients looms large for local hospitals. While the virus is not easily spread person-to-person, exposure to an infected person's body fluids, including blood, is risky. Health care workers minimize the risk by wearing protective equipment and following best practices.

Previous coverage:
• How contagious is Ebola?
• How prepared is Minnesota for Ebola?
• Photos: The Ebola response in Liberia, and beyond
• Liberian Americans warned to stay away from homeland

Most of the major metro area hospitals, though, have told the Health Department their clinical laboratories are uncomfortable receiving Ebola-infected blood specimens in their microbiology labs, Deputy State Epidemiologist Richard Danila said.

"The laboratories have sort of been on the outside...they are reluctant to manage and/or provide routine non-Ebola testing," said Danila, adding the state lab will conduct Ebola tests.

The safety of labs and lab technicians is a big part of the concern at the hospitals. Can blood samples be transported safely from bedside to lab? What happens if there's a spill?

Safety rules can go a long way to easing concerns, said Sara Vetter, manager of the state's public health laboratory. If blood potentially contaminated with Ebola virus spills in a containment area in the state's lab, "they would use bleach to clean it up. If there's a spill outside of containment area in some other part of the lab, the normal procedure is to leave the room for a moment and let everything settle," she said.

"You put a sign outside the door that tells people not to go in. Sometimes the person is a little shaken up, so that gives the person time to just calm down, relax, tell somebody what's going on," she added. "And then after a certain time is passed, you know, you gear up, you put on personal protective equipment, go in the room, deactivate the area with bleach and with our normal chemicals and clean up the spill."

There's also an emotional fear that can't be ignored, Vetter acknowledged.

"We've all seen the movie 'Outbreak,'" she said, referring to the 1990s film about a fictional, deadly Ebola-like virus that mutates and spreads wildly.

Vetter said she understands lab workers' concerns. "Even though we all are educated and we know the facts," she added, "it's really hard to not get your brain wrapped up in the sensation of it and this other side, the scary cinematized, Hollywood-side version of it."

Hospitals are reluctant to talk about the fear. MPR News contacted several metro area hospitals to comment for this story. The University of Minnesota Medical Center was the only hospital that agreed to an interview.

The university's clinical laboratories are telling doctors to expect only limited blood testing during the initial evaluation of a potential Ebola patient, and that hasn't gone over well with some physicians, said infectious disease specialist Dr. Susan Kline.

"They (physicians) feel that there's certain things that they need to have to provide good care for the patient," said Kline, who's been involved in the testing discussion between fellow doctors and clinical lab staff. The doctors are concerned they might not get the blood chemistry testing that would normally be routine, she said.

The U of M's lab has agreed to add malaria testing to its screening because the risk of malaria among West African travelers is very high, she said, adding the lab said it could arrange more extensive blood cultures, under certain circumstances.

For now, doctors will start with bedside testing to monitor possible Ebola patients. These point-of-care tests provide physicians with basic blood chemistry readings, blood counts and a measure of the blood's clotting ability.

But those tests fall short, Danila said, because they don't give a complete picture of a patient's health and don't rule out a patient's possible other conditions.

"You can't tie the doctor's hand behind their back and say, 'Now manage this patient.' Which is basically what would be done," Danila said.

The idea that performing blood cultures is even a question concerns Dr. Gary Procop, chairman of the Department of Clinical Pathology at Cleveland Clinic.

Doctors have a responsibility to be judicious about the tests that they order, but if a test is clearly needed for patient care it must be performed, even if the patient has a high likelihood of having Ebola, Procop said.

"The patient's more likely to have a blood stream infection and need a blood culture than have Ebola," Procop added. "So it would be a travesty to not perform a blood culture and have a patient die of bacteremia because a laboratory was unprepared to handle a specimen from a person under investigation."