Laboratory diagnostic pathway for viral haemorrhagic fevers in Ireland: a review of existing guidelines and gap analysis

Le résumé fourni par la source

Viral haemorrhagic fevers (VHF) are high consequence infectious diseases (HCID) with the potential for outbreaks and considerable mortality. Accessible, up-to-date national guidelines are essential to ensure adequate preparedness. This includes prompt confirmation/exclusion of a VHF diagnosis through sample procurement and processing. Here, we assess and recommend improvements for the VHF testing algorithm in Ireland, for the purpose of ensuring alignment with international best practice. Irish VHF laboratory guidelines were reviewed. Each step of the process was compared to relevant international guidance. Gaps in current practice were identified, root causes identified, and recommendations for improvements proposed. Eight process categories were identified during process mapping. Compared with international best practice, gaps were identified in Irish guidelines for each category. Notable examples include the lack of scheduled access to out of hours testing and uncertainty around testing procedures for non-virological tests (haematology, biochemistry, and microbiology). Although Irish guidelines largely align with international recommendations, important gaps were identified. These gaps risk a delayed diagnosis (of either VHF or alternative causes), sub-standard clinical care due to delayed baseline laboratory investigations, delayed patient transfer to the National Isolation Unit (NIU), and excessive resources maintaining patient isolation subsequently proven to be unnecessary. Refining the VHF diagnostic process would improve patient management and ensure a more efficient use of resources. Internationally, test repertoires for VHF and alternative diagnoses are mostly devised by dedicated specialist services with appropriate laboratory biosafety measures, and we recommend that Ireland moves towards this model.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.