title: Biochemical testing in a laboratory tent and semi-intensive care of Ebola patients on-site in a remote part of Guinea: a paradigm shift based on a bleach-sensitive point-of-care device.
abstract: BACKGROUND
  During the West Africa Ebola virus disease (EVD) outbreak, a Belgian laboratory was deployed for supporting the Ebola treatment unit (ETU) of N'Zerekore, Guinea. Besides diagnosis of EVD and malaria, biochemical parameters were tested and used to guide supportive treatment of EVD.
  
  
  METHODS
  To preserve analytes stability, lithium-heparin blood samples were analyzed using the i-STAT® point-of-care testing (POCT) handheld device without the viral inactivation step. To mitigate the risk of Ebola virus transmission, assays were performed inside a portable glovebox with strict biosafety procedures.
  
  
  RESULTS
  Providing the medical staff with real-time biochemical data modified their therapeutic attitude, shifting from empiric to a semi-intensive laboratory-guided treatment of hydro-electrolytic disturbances, metabolic acidosis and/or impaired kidney function. As illustrated with representative EVD cases (n=8), optimized supportive treatment with intravenous fluid therapy and electrolyte replacement often helped correct these abnormalities. However, the harsh operating conditions, especially the use of bleach decontamination inside the glovebox, caused several technical failures and the final breakdown of the POCT device.
  
  
  CONCLUSIONS
  POCT availability resulted in a paradigm shift in laboratory practice and care delivery at the N'Zerekore ETU. We conclude that there is urgent need for novel well-designed and validated POCT devices usable by non-expert operators in high ambient temperature and limited space. These devices should withstand regular and thorough decontamination by the personnel working on-site with life-threatening pathogens and be compatible with high biosafety level procedures. Such specific users' requirements need a European validation and standardization process of proposed solutions led by the EU Standardization Committee (CEN).
authors.affiliation: .
authors.forename: Leonid M
authors.initials: LM
authors.lastname: Irenge
authors.affiliation: .
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Dindart
authors.affiliation: .
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Gala
mesh_terms: D000293:Adolescent; D000328:Adult; D019411:Clinical Laboratory Techniques; D003422:Critical Care; D029043:Ebolavirus / Q000187:drug effects / Q000378:metabolism; D005260:Female; D016701:Guinea; D019142:Hemorrhagic Fever, Ebola / Q000097:blood* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D055815:Young Adult
keywords: Ebola; biosafety; blood analytes; laboratory tent; point-of-care testing; technical failures