Table 2.
Application of high-reliability organization principles to laboratories handling coronavirus disease 2019-related materials
| High-reliability organization principles | Considerations for COVID-19 laboratories |
|---|---|
| Preoccupation with failure | Conduct daily or weekly huddles with stakeholders to report on how things are going, deviation from procedures, etc. |
| Nonpunitive reporting | |
| Accident/incident reporting | |
| Encourage near-miss reporting | |
| Encourage laboratorians to identify early signs of failure or near misses, e.g., using tubes with slight cracks not enough to cause a spill, gloves that rip easily when doffing, fogging of eye protection due to using a surgical mask | |
| Reluctance to simplify | Clarify SOPs |
| Clarify and specify details related to cleaning and disinfection procedures | |
| Ask the five “W's” (who, why, when, what, and where) when doing accident investigation to find the root cause | |
| Challenge long-held beliefs | |
| Sensitivity to operations | Understand all processes and potential risks associated with the handling of samples (i.e., example, mixing with vortex, sonication, centrifugation, cell culture, cytometry, and concentration) |
| Encourage laboratorians to visualize or enact their actions and decisions during an emergency, for example, during a biological spill | |
| Pay attention to PPE availability, different sizes needed for personnel, correct type of PPE (fluid-resistant gown, nitrile gloves, medical-grade surgical mask) | |
| Accommodate different schedules so that physical distancing is maintained as well as density of population in facility | |
| Use the virtual buddy system for individuals working alone by using technology such as text message notification when going into high containment | |
| Be mindful of personnel turnover or understaffing | |
| Resilience | Work together as a team |
| Communicate problems to supervisor | |
| Review emergency procedures and feasibility for a new facility when personnel are transferred to a surge laboratory | |
| Avoid unnecessary stress and physical fatigue | |
| Encourage time off, breaks, and mental and physical health support | |
| Review lessons learned from previous episodes or events | |
| Deference to expertise | Promote basic knowledge and understanding about novel pathogens |
| Include all stakeholders when completing risk assessments | |
| Involve other specialties (HVAC, infection control, and occupational health) | |
| Seek expert guidance and current information available, always verify the source of your information |