News from the laboratory in the middle of corona, Part 1
Piia Lainio, laboratory nurse, Turku university hospital emergency & automation laboratory
”My work mainly involves analytics and at times sampling as well. The coronavirus pandemic took me by surprise, as I could never have imagined that such an issue could cause so much confusion. Luckily, I’m used to constant changes, which helped me to adapt to the crisis situation.
At first, nobody seemed to have a clear idea how to deal with the situation. When I arrived at work, I always checked the latest guidance first, as it changed from one day to another. We had to make extra effort to stay focused and alert at all times, and it was often difficult to put it behind me at the end of the workday. However, the tension started to ease gradually. As we received clearly fewer samples other than samples for COVID-19 testing, we were able to cope with the situation pretty well.
There are over 70 of us in the emergency laboratory, which means that the infection could easily spread here. Since the frequency of cleaning and disinfection has been significantly increased, we are probably better protected at work than when in our local grocery store. At the beginning of the summer, the situation in Southwest Finland has clearly taken a turn for the better. We now have established guidance and routines. I have noticed that together we can overcome anything!”
Satu Kurkela, Chief Medical Officer, HUS Diagnostic Centre, virology and immunology laboratory
”My work involves managerial tasks and coordinating service production. Our academic team includes doctors, hospital microbiologists and other experts. I also try to take an active part in the whole range of tasks within our unit.
At the beginning of January, the WHO reported that unusual cases of pneumonia had occurred in the county of Wuhan in China. The Chinese were publishing information on the SARS-CoV-2 virus, which had been indicated as the cause of pneumonia, at a rapid pace. We were working in extensive cooperation with our European partners. At the end of the month, we finished the first version of our PCR test. The samples of the first suspected and identified case were examined at our unit and at the Finnish institute for health and welfare.
In mid-March, the situation escalated. The number of samples taken per day initially grew tenfold and then a hundredfold, which meant that we had to react very quickly. A significant part of our laboratory processes were converted according to the LEAN principle to focus solely on coronavirus diagnostics, and we started working in three shifts. We are currently running the production cycle with five different methods in use. If there’s a problem with one production line, we can put more emphasis on another. Any problems that we have encountered have mostly been due to the fact that the methods were put into operation at a speedy pace, and there’s been a lack of supplies and reagents from time to time.
Regardless of the developments concerning the pandemic over the coming months, there will continue to be a significant need for laboratory diagnostics. The crisis operations have included elements which we will permanently adopt in our work. We have become more agile and we have improved our ability to focus on the most relevant issues.
It has been rewarding to see that there really is strength in team work and that nobody is left alone when the going gets tough.”
Hilkka Tukkiniemi, team leader, HUSLAB laboratories sampling (Aurora hospital, Laakso hospital, Skin and allergy hospital and Tullinpuomi laboratory)
”We have streamlined the Aurora and Laakso hospital laboratory processes with the LEAN approach. There was a need for this at the Tullinpuomi laboratory as well, however the work was interrupted when the Laakso health station was converted into a corona health station. At that point we had no idea what was yet to come.
Then the phones started ringing and I set out to organise a laboratory at the Laakso health station.
For two and a half weeks, we took blood samples and throat swabs in a team of two, and were later provided with more staff to help us. We worked quite a few overtime hours and as the number of daily samples kept growing, we set up another sampling room.
When you’re wearing full protective equipment you get very sweaty and you can’t eat or drink. I have tried to make sure that my team gets enough breaks and recovery time and also to ensure their safety as effectively as I can. The fuss over getting enough protective equipment has been going on for 11 weeks now. At times I have had to return equipment when there have been quality issues.
Long experience, extensive education and professional routines have helped us to manage the situation. It is difficult to avoid pressure though as the corona virus was constantly covered by the media and was a constant talking point at work. We talk and we try to help each other in our working community. A good team spirit and mutual support among colleagues is very important.”
Susanna Matilainen, laboratory nurse and infection prevention nurse, ISLAB – the Eastern Finland Laboratory Centre Joint Authority Enterprise, Kuopio university hospital emergency laboratory
”I work at the emergency laboratory and I’m also responsible for infection prevention and hygiene issues within our unit. Along with a colleague, I train the laboratory infection team and update guidance for isolation in cases of serious infection. When the first news started to come in from Wuhan, I felt a little confused. What was it all about and could it spread to Finland? We immediately set about updating our guidance with specialist doctors and other experts. We assumed that the virus would reach Finland as well but had no idea how soon that would be.
By March we had held several training sessions for our infection team. We used empty rooms to practise putting on protective gear and operating in the patient room and exit ways. We produced a 20-page guidance document, in which sampling alone takes up three pages. Everyone involved in taking coronavirus samples must know exactly what they are doing.
The crisis has improved our multidisciplinary collaboration. We all worked together; domestic staff, laboratory nurses, assistant head nurses, head nurses, doctors, microbiologists and so on. We have received a lot of thanks for our work.
Although laboratory staff are seldom mentioned in media coverage, we play a very important role in patient care. Many people don’t realise that laboratory nurses are also an integral part of the patient care team in emergency situations.
I believe that autumn will prove to be very busy even without a second wave as there is likely to be a backlog of missed tests to clear. Now we are better equipped to face what’s to come.”
Ulla Immonen, laboratory nurse, Fimlab, Tampere central laboratory, clinical microbiology
”I relocated from Lahti to Tampere in January and I work at different locations of the Fimlab microbiology laboratory. In March we were told at our department meeting that we would start taking and testing coronavirus samples. My supervisor called and asked if I would like to switch to a testing site which would be set up at the Tampere university hospital. The induction was provided on the same day and I was one of the first nurses to start taking samples for the virus. I had to practice taking throat swab samples though as I had very little experience of those.
Once the pandemic broke out, we were only allowed to take the elevator one at a time, so I got a lot of exercise taking the stairs up to the fourth floor. At first we had to work overtime, however now it’s been enough working normal hours according to the rota. The number of samples taken has varied a great deal, but the sampling itself has become much faster.
Some of our clients have been very supportive and thankful that we have taken their samples. This has helped us to cope with the situation. It has also been fun getting to know new people! The corona pandemic may cause people to switch more between job sites and tasks in the future as well. I may now be better equipped to face changes which will inevitably occur from time to time.”
Päivi Anttonen, assistant head nurse, clinical chemistry Laboratory, SataDiag, Satasairaala hospital
”When the government announced the recommendations to slow down the spread of coronavirus, it didn’t take long before we received recommendations regarding hospital operations from the hospital management. It felt unbelievable that this was really happening. Some of our staff had been abroad for training and they now had to self-isolate for two weeks. We tried to arrange substitutes for them and made sure that patient and employee safety would not be compromised. Retired colleagues were not an option however as they were at increased risk from coronavirus, so we tried to do our best with the staff at hand.
Sampling has been slower than normal because of the protective equipment and packaging procedures, and face shields and masks also affect visibility and hearing. Identifying suitable veins for blood samples has been more difficult, for example.
We have rearranged our sampling logistics so as to get test results as quickly as possible. We are currently analysing samples here at Satasairaala hospital ourselves. The Laboratory has cooperated with the new pandemic outpatient clinic and ward and the intensive care unit and has also acquired new point of care equipment for monitoring possible COVID-19 patients. Regular sampling operations quietened down at first, non-urgent operations were reduced, wards were combined and a pandemic unit and outpatient clinic were established. Little by little, we have now started to call low-risk patients in for their operations and encouraged people with a heart condition to attend their regular check-ups, for example.
Our families and even others have given their support and asked how we are doing here on the front line. We have supported each other at work. We have also made an effort to protect more vulnerable colleagues from unnecessary risks. The corona pandemic has lasted so long now that people may get tired of self-isolation and regulations and may want to take a little break from it all. It remains to be seen what will happen as a result of this and also as a result of easing restrictions.”