Question from S 15 Flashcards
Actual verbal
You have 1 major supplier for serology/ molecular testing e.g Architect, which has an interruption in supply chain which will last 1 month
How would you manage this situation?
Gathering information stage
Repeat question back -
We have identified a major problem in our supply chain, which will affect our ability to maintain our results output and/or turnaround time
Gather information
- what is the problem exactly
- how long is this expected to last
- how many tests we perform/ how much stock we have/ and how will this impact us
Actual verbal
You have 1 major supplier for serology/ molecular testing e.g Architect, which has an interruption in supply chain which will last 1 month
How would you manage this situation?
Alternative solutions
Activate local contingency plan - each lab has contingency plan as part of UKAS accreditation
- alternative local assay/ method testing e.g VIDAS serology
- neighbouring network support - outsource routine testing to nearby lab networks.
- send away tests - to private/ reference lab
- pause/ defer testing - stop testing altogether
Actual verbal
You have 1 major supplier for serology/ molecular testing e.g Architect, which has an interruption in supply chain which will last 1 month
How would you manage this situation?
Methods to decrease requesting of tests
- Communicate to end users about the problem. Include details of clinical indicator conditions we will test for. Inform that routine tests may be rejected, or have increased TAT
- scrutinse request forms - lab staff/ doctors
- warnings on electronic requesting pathway
- batch testing e.g viral loads once a week to save resources. Inform end users e.g haematology that this will occur
- stop testing - inform users that testing will not be performed for certain conditions
Actual verbal
You have 1 major supplier for serology/ molecular testing e.g Architect, which has an interruption in supply chain which will last 1 month
How would you manage this situation?
Communication
Convene meeting with senior laboratory staff and Trust management
Notify internal/ external end users explaining current situation, the cause, and the ongoing solution.
External end users include GPs - notify the Chief Clinical Commissioner for the area, to disseminate information
Communicate to UKAS to you are working outside the accrediation as a temporary basis e.g change of assay/ protocol
Regular weekly update emails to key stakeholders to advise about progress
Identify one person to be senior point of contact for the management issue - e.g laboratory director
Actual verbal
You have 1 major supplier for serology/ molecular testing e.g Architect, which has an interruption in supply chain which will last 1 month
How would you manage this situation?
What are the challenges with communication?
Complex situation with multiple challenges
Requires co-ordination between the lab, Trust management and end-users
Have one person (lab director) as single point of enquiry for all issues
Need to set up regular meetings/ emails to ensure that all updates are communicated to appropriate stakeholders
All meetings should have documented records/ minutes, so they can be referred to in the future
If of public interest, may have the media involved
Actual verbal
You have 1 major supplier for serology/ molecular testing e.g Architect, which has an interruption in supply chain which will last 1 month
How would you manage this situation?
How to prioritise workload?
Workload can be broken down in to:
Urgent - e.g respiratory/ BBV
Routine
GP
We absolutely want to maintain urgent tests
We want to try and maintain routine, or delay/ increase TAT
We may delay/ cancel GP requests
We need to convene meeting to discuss what to prioritise from each area. Maintain testing for these areas:
IP&C/ Outbreaks
Emergency Department
Elective
ITU
Immunosuppressed
Consider alternative solution for routine/ GP testing - e.g outsource to other lab in network, increase TAT, cancel testing
Rank these viruses by their infectiousness
HBV
Enterovirus
VZV
Parvo B19
Measles
SARS-CoV-2
Measles
VZV
SARS-CoV-2
Parvo B19
Enterovirus
HBV
HBV only has high infectivity if blood exposure
What is risk of BBV infection following exposure to these viruses?
HBV
HCV
HIV
HBV 30%
HCV 3%
HIV 0.3%
what are names of monoclonal antibodies used for RSV?
Palivizumab
Nirsevimab
What is mechanism of action of palivizumab?
Antigenic site II of RSV
Binds to both:
Pre-F protein and
Post-F protein
As these are both present before and after fusion
What is mechanism of action of nirsevimab?
Antigenic site Ø of the RSV pre-F protein
Antigenic site Ø disappears following viral fusion
Authorised for use by JCVI in 2022
What is Inmazeb used for?
Ebola virus infection - only licensed for Zaire Ebola strain
Palm trial
What does Inmazeb contain?
3x monoclonal antibody cocktail
Atoltivimab
Maftivimab
Odesivimab
What does Inmazeb target?
All 3 monoclonal antibodies bind to:
-Ebola surface GP1/2 (glycoprotein)
prevents virus from entering cells
Which drug is usually preferred?
Inmazeb
Zmapp
Inmazeb
Palm trial showed superiority over Zmapp
