Precautionary measures on laboratory steps that may generate aerosols or droplets:

1. Frozen section (refrain from performing frozen sections on possible cases of CoVID19 unless the
laboratory is confident in containing aerosols in the cryostat)
2. Expelling aspirates from the needle or syringe, smearing the aspirated material and airdrying or heat
drying the smears wherein pathologists and/or residents may be involved during the rapid on-
site evaluation (ROSE) of the sample for adequacy. Air-drying or heat drying of smears is best
performed under Class II Biosafety Cabinets. If ROSE is performed, it should be performed with
appropriate personal protective equipment (PPE) including gloves, laboratory coat/gown and
goggles or face shields for eye protection and respiratory protection using a properly fit-tested
filter respirator (N95 or higher level) or a powered air-purifying respirator (PAPR).
3. Opening of containers and removing tube caps
4. Blending, vigorous shaking or mixing, vortexing
5. Pipetting, aliquoting, diluting
6. Centrifugation of fluids and discarding the supernatant

Guidelines for handling surgical specimens and bodily fluids of probable/suspect/confirmed COVID-19
patients.

Person responsible: 1. Pathology Resident

Only one resident will process all histopathology specimens from
probable/suspect/confirmed COVID-19 patients.
2. Medical Technologist
Only one histotech will process the histo-cytopathology specimens.

Take the necessary precautions:

1. Wearing personal protective equipment (PPE) as recommended by the WHO (long sleeves lab
gown/coverall suit, double gloves, goggles/face shield, masks).
2. Check for the details of specimens with precautionary label probable/suspect/confirmed COVID-19
patients.
3. Ensuring that the containers are sealed upon receiving.
4. Disinfecting the outer surface of the container upon receipt and prior to processing using bleach
solution.
5. Processing the specimen in a negative pressure room.
6. Prolonged fixation time (24-72 hours depending on the penetration of the fixative agent).
Cytology samples (non-gyne, FNAB): must be fixed first prior analysis.
7. Placing specimens in separate sealed containers for storage with precautionary label.
8. Properly clean the grossing/cutting area after cutting the specimens.
9. Proper disposal of used PPEs (yellow bin).
10. Handwashing using soap and water for at least 20 seconds. Alternatively, an alcohol-based hand
sanitizer containing at least 62% alcohol can be used, if soap and water are not available.

Handling glass slides for microscopic studies:

1. The Pathologist must wear a mask and may prefer using gloves for all the slides since glass slides are
touched by multiple hands until it reached his desk while dipping the slides in 95% alcohol (or similar)
for a couple of minutes would inactivate the virus, it would also erase the marks on the slides.
2. Decontamination of computer keyboards, phones and frequently touched areas of microscopes.
3. Dispose of used PPEs properly (yellow bin).
4. Handwashing using soap and water for at least 20 seconds. Alternatively, an alcohol-based hand
sanitizer containing at least 62% alcohol can be used, if soap and water are not available.

Guidelines for handling postmortem cases of COVID-19 patients

1. Wearing personal protective equipment as recommended by the WHO (long sleeve lab
gown/coverall suits, double gloves, goggles/face shield, masks).
2. Avoiding aerosol generating procedures like the use of oscillating saw.
3. Avoid touching a surface or object that has the virus on it and then touching their own mouth, nose,
or possibly their eyes.

Recommendations about the type of postmortem specimens to collect vary based on whether the case
of COVID-19 is suspected or confirmed, as well as whether an autopsy is performed.

The following factors should be considered when determining if an autopsy will be performed for a
deceased known or suspected COVID-19 case: medicolegal jurisdiction, facility environmental controls,
availability of recommended personal protective equipment (PPE), and family and cultural wishes.

If an autopsy is performed for a suspected COVID-19 case, collection of the following postmortem

specimens is recommended:
 Postmortem swab specimens for COVID-19 testing:
o Upper respiratory tract swab: Nasopharyngeal Swab (NP swab)
o Lower respiratory tract swab: Lung swab from each lung
 Separate swab specimens for testing of other respiratory pathogens and other postmortem
testing, as indicated
 Formalin-fixed autopsy tissues from lung, upper airway, and other major organs

If an autopsy is NOT performed for a suspected COVID-19 case, collection of the following postmortem
specimens is recommended:
 Postmortem Nasopharyngeal Swab (NP swab) specimen for COVID-19 testing
 Separate NP swab for testing of other respiratory pathogens

If an autopsy is performed for a confirmed COVID-19 case, collection of the following postmortem

specimens should be considered:
 Postmortem swab specimens for testing of other respiratory pathogens,
 Other postmortem microbiologic and infectious disease testing, as indicated
 Formalin-fixed autopsy tissues from lung, upper airway, and other major organs

In addition to postmortem specimens, any remaining specimens (e.g., NP swab, sputum, serum, stool)
that may have been collected prior to death should be retained.

References:
Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from Persons for Coronavirus
Disease 2019 (COVID-19)

Public Health England. 2020. COVID-19: safe handling and processing for samples in laboratories.
Available
at https://www.gov.uk/government/publications/wuhan -novel-coronavirusguidance-for-clinical-
diagnostic-laboratories/wuhan-novel-coronavirushandling-and-processing-of-laboratory-specimens.

World Health Organization. Guidance on COVID-19: Safe handling and processing for samples in
laboratories. Public Health England. Updated 28th March 2020

World Health Organization. Guidance on regulations for the transport of infectious substances 2019-
2020. (online) 2019. (cited: January 28, 2020) https://www.who.int/ihr/publications/WHO-WHE-CPI-
2019.20