Renewed Focus on the Threat of Cross-Contamination in Molecular Laboratories: Notes from the COVID-19 Testing Experience in Bangladesh

Abstract

Rapid and accurate laboratory diagnosis of SARS-CoV-2 infection is crucial for the management of COVID-19 patients and control of the spread of the virus. At the start of the COVID-19 pandemic, Bangladesh had only one government molecular laboratory where real-time RT-PCR would be performed to diagnose SARS-CoV-2 infection. With the increasing number of suspected cases requiring confirmation diagnostic testing, there is a requirement to expand capacity for large-scale testing quickly. The government of Bangladesh established over 100 molecular laboratories within one year to test COVID-19. To expand the testing capacity, the government was compelled to recruit laboratory staff with limited experience and technical expertise, especially in molecular assays, to process specimens, interpret results, troubleshoot. As a result, the risk of diagnostic errors, such as cross-contamination, increased, potentially undermining the efficacy of public health policies, public health response, surveillance programs, and restrictive measures aimed toward containing the outbreak. In this piece, we discuss the different sources of cross-contamination in the COVID-19 RT-PCR laboratories and proffer practical preventive measures to avoid them.