Showcasing Science: NI team adapts to the challenge

As demand for COVID-19 testing soared at the height of the outbreak, Northern Ireland’s H&I laboratory adapted remarkably to the challenge.

The Northern Ireland (NI) Regional Histocompatibility & Immunogenetics (H&I) Laboratory ‘answered the call’ to help with COVID-19 testing – completing 19,752 COVID19 tests, while also supporting a massive 84 kidney transplants since the start of April 2020.

The laboratory, part of Belfast Health & Social Care Trust (BHSCT), usually supports renal transplantation in NI – undertaking human leukocyte antigen (HLA) typing of deceased donors and their recipients to determine kidney suitability.

A testing task

During the pandemic, the laboratory was asked to assist in testing patients for the virus. This meant the team having to rapidly retrain, as, despite their expertise in molecular techniques essential for the test, they lacked any prior Virology or Microbiology training. The call for testing also led to a revamp in lab set-up, procedures and shift patterns.

Gerry Lennon, a senior Biomedical Scientist and Health & Safety lead at the laboratory said:

“At the start, when our routine work reduced and we were working remotely or as a skeleton crew at the lab, it was stressful. You need to have a goal to focus on and that was taken away from us by COVID-19.

Once we knew we were to re-train and help with the testing, I felt glad to be of help in the fight against this pandemic, but also worried about becoming infected, and anxious about what the new technique would involve, since I don’t have any previous virology training.”

The Regional Virology Laboratory (RVL) were testing for SARS CoV 2 on different platforms but needed to increase capacity for testing.

The Northern Ireland Blood Transfusion Service (N.I.B.T.S) then offered the use of their Cobas 6800 for SARS CoV 2 testing to BHSCT. The RVL collaborated with NIBTS and H&I to validate the SARS CoV 2 test on the Cobas 6800. The NIBTS Microbiology staff trained H&I staff in the use of their Cobas 6800.

Gerry added: “Training can be stressful, especially in a different discipline to your own, but H&I used this as a way to keep active, stay productive and positively contribute to the pandemic.

Once we started training, I realised that the technique was straight forward, and all of the validation and SOPs were in place. This boosted my confidence. The training only took a few days to complete, and the online videos helped to prep us while remote working before the hands-on training begun.“

Rota revamp

Dr Jennifer McCaughan (H&I Laboratory Director) and Elaine Boyle (H&I Laboratory Manager) rolled out a new way of working for H&I, splitting the staff into teams of 2, covering day and night shifts, including weekends and the Easter and May bank holidays.

Each team worked sequential days, followed by a recovery period and remote working – This protected all staff. The theory was that if any staff members became infected, they would only have been in contact with a limited number of other staff, who would have all had to self-isolate. Thankfully, this contingency was not required. The new shifts allowed H&I to continue any routine work, and emergency on-call transplantation service, while also providing 24/7 availability for SARS CoV 2 testing.

Staff created training videos, to help those working from home, to get up to speed with techniques before returning to work for their official face to face training. Some staff had to adapt to working at night while prioritising their childcare duties during the day.

Elaine commented: “Jennifer and I are immensely proud of the H&I team. Every one of the team was committed to supporting their colleagues and patients in any way they could. They were professional and adapted different work patterns to undertake Covid-19 testing while supporting the busiest time of kidney transplantation in NI.

They did this willingly in a time of uncertainty, whilst supporting their families, friends and each other. They embraced the spirit of teamwork and the essence of being a healthcare worker and scientist. This has been the greatest achievement of the H&I team to date. We are delighted to be part of this excellent team.”

Record transplantations

Once all staff were trained and the SARS CoV 2 testing on the C6800 went ‘live’, the Renal Unit consultants and surgeons, committed to meeting clinical needs and doing the best for all patients during this pandemic, decided to start accepting kidney offers for transplantation again, after reviewing the risks on a case by case basis.

As most of the transplant centres in the UK were not accepting kidney transplant offers at this stage, Belfast received a massive increase in offers. This led to the busiest time in Northern Irish transplant history, with the UK record of 5 transplants in one day being repeated.

84 patients have now been successfully transplanted from deceased donor offers, since the start of this pandemic, thanks to H&I support. To put this in context, there were 49 deceased donor transplants in Northern Ireland in the entirety of 2019.

As the transplant recipients required a SARS CoV 2 test before surgery, H&I staff ensured those samples were on the next available run of SARS CoV 2 tests allowing the renal surgeons to commence surgery as soon as possible. A reduced cold ischemia time is vital in successful transplantation.

H&I staff all gave 100% commitment, covering the 24/7 shifts, with some staff working beyond their shift for a number of additional hours, to ensure all testing were complete.

The RVL has since implemented testing on a new Cobas 8800 and now can complete all SARS CoV 2 tests. H&I have stepped down from COVID-19 testing and are now focusing on routine H&I and transplantation work.

This collaboration and flexibility of working have brought H&I staff closer together and created new links within BHSCT labs and N.I.B.T.S. Hopefully, this pandemic peak is over but with the new skills and camaraderie acquired, H&I stand ready to “answer the call” again if needed.

Gerry added: “When our routine transplant work increased, this was stressful again, but Elaine and Jennifer protected us by adjusting our out of hours shifts. It was good to know other colleagues were there to help with transplant work when it occurred at night.

Morale was high, as we were helping in the COVID fight, and now contributing to the transplantation of many of our renal patients. In H&I we get to know the patients’ antibody profile, molecular and serological HLA Type and CDC and Flow cytometry cross-match results, so it’s nice to hear when they get a transplant, even if you didn’t do the cross-matching on the night yourself. You’ll always find that you have contributed towards their transplantation work up.”

This blog was published as part of our Showcasing Science: Behind the scenes of COVID19 series. Read the rest of the blogs here.