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SINGAPORE – A total of 233 Covid-19 swab samples were accidentally removed before being tested, following failures at a private medical laboratory.
The lot was collected from clinics under the Swab-and-Send-Home (Sash) program. The test samples were “inadvertently discarded (from) prior to testing” at the lab, a Quest Laboratories spokesperson told The Straits Times on Monday (October 12).
Under the Sash program, patients who meet certain criteria are swabbed and then sent home to await test results. The swab samples are sent to a laboratory, where testing can take up to three business days.
The incident at Quest Laboratories occurred last Wednesday and was discovered two days later, when clinics began contacting the laboratory to inquire about the test results of these patients.
The laboratory spokesperson noted that no other batch of samples was affected.
One of the errors involved an internal courier failing to follow standard operating procedure (SOP) in delivering the untested samples to the lab and this resulted in the batch being discarded along with the old samples, the lab spokesperson said.
The spokesperson added that all samples were removed in accordance with Covid-19 safety requirements.
As of Sunday, all 87 affected clinics have been informed of the incident and 102 patients have been re-examined. Their results have come back negative, the lab said.
The Health Ministry, which was notified of the incident last Friday, said it is working with the laboratory and clinics to contact affected patients and arrange for samples to be re-collected as soon as possible.
The lab said reevaluated samples will be prioritized to ensure affected patients receive test results without further delay.
The ministry said it takes the incident seriously and is investigating the matter. He added that he will work with the laboratory to implement the “necessary corrective and preventive measures” to ensure that such lapses do not reoccur.
“We will take appropriate action against the laboratory if the investigations reveal any non-compliance with the regulations. We will also remind the other authorized laboratories of the need to ensure adequate training of personnel and compliance with their standard operating procedures,” the ministry added.
Quest Laboratories investigations found two compliance lapses in their SOPs related to sample handling and disposal.
“The first lapse refers to the delivery of samples from the courier to the sample receiving personnel. This occurred at the same time that the laboratory personnel were discarding the old samples.
“As a second SOP lapse, laboratory personnel were discarding samples in the sample receiving area, leading to the erroneous disposal of the unanalyzed lot,” the spokesperson said.
The spokesperson added that all relevant employees have been notified of the specific issues that led to the incident and the repercussions.
The internal courier will also receive disciplinary action, the spokesman said, adding that the laboratory has conducted a review of the incident and implemented corrective and preventive measures.
Quest Laboratories CEO Ginny Foo said that adherence to chain of custody procedures is taken very seriously and that this is the first time such an incident has occurred in the lab.
“However, any such lapse is unacceptable. We have made reviews to strengthen our chain of custody and staff training on the new SOP has already begun,” he said, noting that the laboratory processes more than 6.5 million samples per day. year in Singapore.
New measures implemented by the laboratory include color-coded containers intended for sample delivery to ensure they are easily distinguished from containers intended for disposal.
This will eliminate the possibility of confusion between incoming sample batches not tested and batches that have already been tested and should be discarded.
The lab has also added a second verification step that requires all samples for disposal to be verified and signed by two separate people.
Ms Foo said: “We deeply regret this failure of our systems and the inconvenience this has caused to the patients, physicians and clinic staff involved. Our highest priority, as always, is the safety of our patients, healthcare providers we serve. and the communities we live in. “
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