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COVID testing on wheels

Chief Biomedical Scientist Bamidele Farinre outlines a Mobile Processing Unit project to take COIVD testing out into the community.

Due to the impact of the COVID-19 pandemic, the Department of Health and Social Care expanded the nation’s testing capacity by doubling the capacity of the NHS and Public Health England laboratories, as well as setting up an entirely new nationwide network of testing sites, Lighthouse Laboratories and partner laboratories to process COVID-19 swab samples for the public. The importance of testing, isolation and contact tracing for control of SARS-CoV-2 transmission has been highlighted by the World Health Organization (WHO) as a critical intervention to prevent the spread of infection and ensuing morbidity and mortality from COVID-19. International efforts have largely focused on the detection of infection in symptomatic individuals as well as evolving clinical testing systems to detect those with asymptomatic infection that may still be infectious to others.

Mobile Processing Units (MPUs) are mobile laboratories that were designed to deploy to COVID outbreaks. The rationale is to reduce mobility or eliminate the transit time for samples to travel to the traditional static lab location and, therefore, reduce test turnaround time. MPU vans (MPUVs) are designed and purpose built for flexibility – they are small laboratories, housed vans and can support a diagnostic workflow, with all required equipment on site. Loop-mediated isothermal amplification (LAMP) is a single-tube technique for the amplification of DNA and a low-cost, rapid alternative to RT-qPCR. Reverse transcription loop-mediated isothermal amplification (RT-LAMP) combines LAMP with a reverse transcription step to allow the detection of RNA. Target sequence is amplified at a constant temperature. Typically requiring four different primers to amplify six distinct regions on the target gene, which increases specificity. The amount of amplified product produced in LAMP is considerably higher than PCR-based amplification.

LAMP MPUVs are equipped with an OptiGene Genie HT machine and are capable of processing ~400 samples a day. MPUVs have been designed to potentially support other diagnostic capabilities. Their mobile nature makes them ideally suited to support outbreak response, agilely responding to the location of most need through Test and Trace. The primary target for this service is to deploy MPUs to COVID outbreak regions to conduct testing of COVID swab samples via RNA RT-LAMP. OptiGene’s COVID-19 RT-LAMP assay is a test for the detection of SARS-CoV-2 in clinical specimens (nasopharyngeal swabs/oropharyngeal swabs and saliva). The RT-LAMP assay targets the positive-sense viral genomic RNA within the ORF1ab region. The assay has two formats – an RNA version for use on extracted RNA and its primary use case is in symptomatic testing, and a direct version for use on crude clinical samples, such as saliva, and its primary use case is in asymptomatic testing.

 

My role

I was employed by the Acacium Group as the Chief Biomedical Scientist on the delivery of the MPUVs for the Department of Health and Social Care. This is a project that has been running for nine months with me leading the team for the last seven months. I started in the project as a Senior Biomedical Scientist (Training and Developmental Lead). During the initial project set-up and establishment of requirements for the validation and verification of the assay and the vans, I was able to demonstrate my leadership skills and my ability to solve problems, as well as support other members of the team. I was then promoted to Chief Biomedical Scientist (Scientific Lead) for the project with responsibility for the validation and verification, as well as operation of 14 validated vans. To achieve this, I set up detailed standard operating procedures and processes for the performance of the test. I trained my own biomedical science team and develop a comprehensive “train the trainer” programme, with all staff members receiving  the full three weeks of comprehensive molecular training. I established the competency assessment framework for signing off staff, led the implementation of the IT laboratory information management system and established a key performance indicator monitoring programme. These were all key requirements for the achievement of accreditation and validation from the Department of Health and Social Care.

I demonstrated diligence and the ability to engage with senior clinicians and executives at the Department of Health and Social Care to submit the required accreditation audit checklist and achieve the verification of all the vans on target and according to schedule.

The challenges

The project was very challenging from the beginning with numerous changes in requirements that I managed to navigate and solve. Managing teams and projects across multi-sites is very challenging. One of the many challenges include coordinating site inductions that are relevant and cost-effective. This is often a huge strain on resources with added travel time and the time taken to conduct the actual induction on site. Some of the other hurdles I overcame included: effective engagement of the whole team, balancing consistency with local adaptation (working relationship between mobile processing units and mobile testing units), managing staff performance and maintaining open communication. Logistics planning for smooth-running management of resources had to be strategic. The success of this project was achieved thanks to my ability to utilise resources across different hub sites, ensuring the establishment of evidence-based technical standards and processes.

I exhibited a good grasp of the science but also of the management of a large cohort of scientists, advanced practitioners and laboratory assistants and helped them take ownership of their own development and performance, including creating a safe working environment and engaging a Health and Safety Officer to lead on this aspect of the project. I built a team of over 100 staff over the seven-month period.

The outcomes and results

Each MPUV requires formal audit accreditation through the verification and validation process. The project has been successful in its aim, which was to test the population by identifying symptomatic and asymptomatic individuals with SARS-CoV-2 that present to an MTU (or other relevant testing facility in combination with an MPU in the region of deployment) by ensuring that they self-isolate.

All 14 MPUVs were deployed to areas of outbreak, or where there was perceived to be a high risk, and they supported other additional testing capability in order to control infections.

This has led to the following milestones:

  • Improved outbreak response by deploying to outbreak areas to provide an onsite laboratory capability to deliver rapid processing of tests, able to deploy to the centre of outbreak areas and process samples within four hours of deployment.
  • Reduction in turnaround time. This capability enables reduced turnaround time for lab processing of tests, meaning the chain of transmission can be broken. Some of the vans deployed to add contingent capacity to meet demand in order to improve test turnaround time in areas where lab processing times need to improve.
  • Remote area testing. Mobile processing has been used to access geographically remote areas to provide test processing quickly, guaranteeing all members of the population to have quick ready access to Test and Trace services.
  • Improved capacity for symptomatic testing in an outbreak (300+ tests per day).

Partnership and collaboration

The Department of Health and Social Care is the ultimate customer and owner of the MPUVs and is responsible for governance of the unit. Remote Medical International is the lead contractor that owns the MPUV delivery process and is responsible for providing the oversight and governance of the MPUV delivery programme. Acacium Group provides the laboratory staff for the MPUVs and provides site and shift management to oversee the day-to-day running of the labs. Other collaborators include the key provider of vehicles for the MPUV programme; OptiGene, provider of the LAMP machines in the form of the Genie HT and also, a key consumables provider in terms of LAMP reagents; and Promega, provider of Maxwell RNA extraction machines, also, a key consumables provider in terms of RNA extraction reagents.  

The author would like to thank: the MPUV project team, RMI; Remote Medical, Acacium group (Espirita Workforce Solutions), LML (London Medical Laboratory) and HCA Labs.

 


Takeaways

  • Workforce planning for this project was a complex and time-consuming activity, involving a blend of various aspects of the talent acquisition and management processes. It involved recruiting, retention, leadership, and employee development and redeployment. Ensuring there was enough of the best-suited talent adequately trained for the project needs was at the core of workforce planning for the project. 
  • The nature of the project is such that we have a high turnover, as such, effective workforce planning resulted in massive savings for all parties involved in the project and helped to prevent negative impact on staff morale.

Tangible project impact for future

  • Reducing labour costs in favour of workforce deployment and flexibility.
  • Responding to the needs of our service users (Pillar II community testing).
  • Identifying skills gaps and areas of succession risk and formulating relevant strategies for talent management and people development with a great focus on targeting specific and identified inefficiencies in our processes.
  • Implemented employee retention in initiatives, which improved the quality of our outputs.
  • We have been able to improve work–life balance (with a four-days-on, four-days-off shift system in place).

Image Credit | Alamy

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